Jackson Thomas

Toenail onychomycosis: an important global disease burden

Onychomycosis is a fungal infection of the nail plate or nail bed. It does not usually cure itself and it can trigger more infectious lesions in other parts of the body. The reported prevalence of onychomycosis is increasing in Western countries, presumably due to lifestyle changes and the ageing of the population. Approximately 10% of the general population, 20% of the population aged >60 years, up to 50% of people aged >70 years and up to one‐third of diabetic individuals have onychomycosis. Care should be taken for the accurate diagnosis and timely treatment of toenail onychomycosis to prevent complications. Current treatment options have relatively limited therapeutic success, particularly long‐term. Oral medications are associated with high recurrence rates and treatment failure, and are not suitable for many cases due to potential adverse effects. Topical medications are recommended only for mild to moderate cases. The cost of therapies may also be prohibitive in some cases. In the light of these issues, more research is warranted for the investigation and development of more effective and economical options for the treatment and prophylaxis of toenail onychomycosis. In patient populations such as diabetic individuals, where onychomycosis can provoke lower extremity complications, professional podiatry care of toenails and feet should be encouraged.

Evaluation of Repellent Properties of Volatile Extracts from the Australian Native Plant Kunzea ambigua Against Aedes aegypti (Diptera: Culcidae)

ABSTRACT Kunzea ambigua (Smith) Druce (Myrtaceae) is an Australian native plant, commonly known as tick bush. The essential oil of the plant has been proposed as a potential mosquito repellent. Commercial K. ambigua oil was analyzed by gas chromatography-mass spectrometry (GC-MS) and its composition compared with that of oils from two individual K. ambigua plants and citronella oil. K. ambigua oils were studied for their repellency against Aedes aegypti L. Formulations of three different K. ambigua essential oils (30% vol:vol) were tested for repellency to mosquitoes using human volunteers. One oil was compared with citronella and N,N′-diethyl-3-methylbenzamide (deet) for repellency. Oil formulations were also tested for repellency with and without the addition of 5% vanillin. The formulation containing commercially produced K. ambigua oil had a mean complete protection time (CPT) of 49 ± 24 (SD) min. All the K. ambigua formulations had comparable repellency to 40% citronella. However, the 60% citronella formulation showed higher repellency than the 40% K. ambigua formulation. The addition of 5% vanillin did not increase the repellency of K. ambigua oil. Both K. ambigua oil and citronella were significantly less repellent than deet. The K. ambigua essential oil formulations should not be advocated for use as repellents in regions prone to mosquito-borne disease.

Therapeutic Potential of Tea Tree Oil for Scabies

Globally, scabies affects more than 130 million people at any time. In the developed world, outbreaks in health institutions and vulnerable communities result in a significant economic burden. A review of the literature demonstrates the emergence of resistance toward classical scabicidal treatments and the lack of effectiveness of currently available scabicides in reducing the inflammatory skin reactions and pyodermal progression that occurs in predisposed patient cohorts. Tea tree oil (TTO) has demonstrated promising acaricidal effects against scabies mites in vitro and has also been successfully used as an adjuvant topical medication for the treatment of crusted scabies, including cases that did not respond to standard treatments. Emerging acaricide resistance threatens the future usefulness of currently used gold standard treatments (oral ivermectin and topical permethrin) for scabies. The imminent development of new chemical entities is doubtful. The cumulative acaricidal, antibacterial, antipruritic, anti-inflammatory, and wound healing effects of TTO may have the potential to successfully reduce the burden of scabies infection and the associated bacterial complications. This review summarizes current knowledge on the use of TTO for the treatment of scabies. On the strength of existing data for TTO, larger scale, randomized controlled clinical trials are warranted.

The Effects of Resveratrol Supplementation in Overweight and Obese Humans: A Systematic Review of Randomized Trials

BACKGROUND Obesity and metabolic syndrome are significant global health issues, with current public health messages predominately focused on altering dietary and physical activity behaviors. Resveratrol is a polyphenol (stilbenoid) commonly found in grapes, and human trials to date have shown conflicting and limited beneficial effects with respect to health. The aim of this study was to determine the effect of resveratrol supplementation on reducing body weight and modifying associated inflammatory markers. METHODS A systematic review was undertaken following the PRISMA guidelines and using five indexed databases (OVID MEDLINE, Cochrane Library, Web of Science, SCOPUS, and CINAHL). A search strategy was formulated to select randomized, double-blind, placebo-controlled human trials investigating the effects of resveratrol supplementation on obesity or overweight, including body weight, metabolic and inflammatory markers. RESULTS Five thousand five hundred sixty-nine studies published from 1990 to November 2015 were identified, with only nine papers meeting the inclusion criteria. The studies involved 208 participants (aged 49.2 ± 8.3 years) and utilized a substantial range of resveratrol doses (75-3000 mg/day). Study durations were a minimum of 2 weeks (14-90 days). Seven studies indicated no significant change in body mass index or body weight (P > 0.05), and three studies showed no improvements in fat mass, fat volume, or abdominal fat distribution (P > 0.05). Four studies included measurements of inflammatory markers, with three of these finding resveratrol supplementation to have a significant positive effect (P > 0.05). CONCLUSION Based on the included studies, there is currently insufficient evidence to support the recommendation of resveratrol supplements in management of obesity. However, there were significant but not entirely consistent anti-inflammatory effects after resveratrol supplementation in overweight and obese individuals.

Scabies-An ancient itch that is still rampant today

Scabies is recognized as a neglected tropical disease responsible for a substantial health and economic burden, especially in resource‐poor communities around the world.

An Examination of the Essential Oils of Tasmanian Kunzea ambigua, Other Kunzea spp. and Commercial Kunzea Oil

Abstract Commercial kunzea oil (Ducane kunzea oil) was analyzed by gC/MS and gC-FID and its composition was compared with that of oils from four individual Kunzea ambigua plants and five other Kunzea spp. A total of 64 components were detected in the studied oils. Ducane kunzea oil contained monoterpenes (70%) including α-pinene (48.3%), 1,8-cineole (14.5%) and α-terpineol (1.9%). Oils from individual K. ambigua plants varied significantly in their content of α-pinene (0.6–62.5%), 1,8-cineole (0–11.2%), bicyclogermacrene (0.4–14%), spathulenol (0.5–12.2%), globulol (0.5–22.6%) and viridilflorol (0.3–38%). The oils from fve other Kunzea spp. had significant compositional differences from each K. ambigua oil. Kunzea sp. “Badja Carpet” had a high β-pinene content (56.1%), K. muelleri contained significant levels of allo-aromadendrene (8.0%), spathulenol (7.0%) and, among all the analyzed oils, it had the highest level of bicyclogermacrene (15.7%). Kunzea affinis contained significant levels of p-cymene (26.2%) and γ-terpinene (12.2%). Kunzea parvifolia gave an oil rich in γ-terpinene (36.5%) and p-cymene (5.0%).

Randomised controlled trial of the treatment of pastern dermatitis with a formulation containing kunzea oil

The efficacy of an ointment containing kunzea oil for the treatment of horses with localised acute or chronic pastern dermatitis was assessed. Thirty-seven horses were randomly allocated to treatment with an ointment containing either 20 per cent kunzea oil (test) or 2 per cent ketoconazole (control). Only 21 of the horses completed the study. The severity of the lesions was assessed before and after seven days of treatment. The kunzea oil formulation resulted in a significant decrease in the median total area of the lesions from 40 cm2 (range 3 to 252 cm2) to 0 cm2 (range 0 to 34 cm2), with complete resolution of the signs of pastern dermatitis in seven of 11 cases. The control formulation resulted in no significant change in the total area of the lesions, and the signs of pastern dermatitis resolved completely in only two of the 10 cases.

Impetigo: A need for new therapies in a world of increasing antimicrobial resistance

Impetigo is a highly contagious bacterial skin infection and is one of the most common skin infections in children. Antibiotics are the first‐line treatment when multiple lesions exist, but with an increasing prevalence of antibiotic‐resistant bacteria the successful management of impetigo in the future is an area of concern.

Effect of long-term nutraceutical and dietary supplement use on cognition in the elderly: a 10-year systematic review of randomised controlled trials

Nutraceuticals have generated interest as a way to mitigate the cognitive decline in older adults. The aim of this systematic review was to determine the evidence for these claims from the scientific literature in randomised, double-blinded, controlled trials (duration: ≥1 year; participants: n≥100; age(mean): ≥65 years). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched four electronic databases (PubMed, Scopus, CINAHL and Web of Science) and identified twenty-five studies published between the 15·June·2006 and 14·June·2016. Interventions included B-vitamins, n-3 fatty acids, antioxidant vitamins and herbs. Of the B-vitamin studies, four found benefits to cognition with supplementation. The first of these B-vitamin studies, in individuals with mild cognitive impairment (n 266; duration=2 years), included benefit to executive function (P=0·015) and improvements in the Mini-Mental State Examination (MMSE) among participants with baseline homocysteine above 11·3 µmol/l (P<0·001). In the same sample, the second study found cognitive benefits of B-vitamins dependent on the higher baseline plasma n-3 fatty acid status. The third B-vitamin study (n 900; duration=2 years) reported improved performance in immediate (P=0·046) and delayed recall (P=0·013), whereas the fourth study (n 856; duration=2 years) reported slower rate of cognitive decline in the MMSE (P=0·05). One study investigating DHA treatment (n 402; duration=1·5 years) revealed the slower rate of cognitive change in apoE e4 non-carriers (P=0·03). As only five included studies revealed notable benefits, presently based on the specific compounds explored here, there is not compelling evidence to support the use nutraceuticals to improve cognition in the elderly. Future long-term trials of nutraceuticals should investigate interactions with lifestyle, blood biomarkers and genetic risk factors.

An empirical review of antimalarial quality field surveys: the importance of characterising outcomes

HighlightsReview of 1499 articles with quantitative analysis of 61 full‐text articles.Of the 10,198 antimalarial samples analysed, 18% were found to be poor‐quality.Many reports do not characterise the results of medicine quality field surveys.Accurately characterised results can lead to effective countermeasures. ABSTRACT For decades, thousands of people have been dying from malaria infections because of poor‐quality medicines (PQMs). While numerous efforts have been initiated to reduce their presence, PQMs are still risking the lives of those seeking treatment. This review addresses the importance of characterising results of antimalarial medicine field surveys based upon the agreement of clearly defined definitions. Medicines found to be of poor quality can be falsified or counterfeit, substandard or degraded. The distinction between these categories is important as each category requires a different countermeasure. To observe the current trends in the reporting of field surveys, a systematic literature search of six academic databases resulted in the quantitative analysis of 61 full‐text journal articles. Information including sample size, sampling method, geographical regions, analytical techniques, and characterisation conclusions was observed for each. The lack of an accepted uniform reporting system has resulted in varying, incomplete reports, which may not include important information that helps form effective countermeasures. The programmes influencing medicine quality such as prequalification, procurement services, awareness and education can be supported with the information derived from characterised results. The implementation of checklists such as the Medicine Quality Assessment Reporting Guidelines will further strengthen the battle against poor‐quality antimalarials.