Medical Treatment of Mycotic (Fungal)

Fungal nail infections are ugly and embarrassing. They are common and easy to catch, but very hard to get rid of.

Unfortunately most people ignore them considering fungal nails a cosmetic nuisance. Fungus could be a minor bother for a while, but if left untreated, the infection will get worse: nails may grow so thick, you will feel discomfort wearing closed toe shoes, nails may separate from toes (onycholysis), the matrix can get permanently damaged (onychodystrophy)... Long story short, onychomycosis is a serious disease, which requires medical attention and a comprehensive treatment.

Nail fungus (Onychomycosis) is the most common nail disease, and over 30 million in the U.S. alone suffer from this condition. About 50% of the population over 45 years of age has nail infections. Some have battled fungi for decades. Treatment of Onychomycosis is challenging because the infection resides in the hard-to-reach area under the nail, called the nail bed.

Topical anti-fungal solutions cannot get there. Oral medications cannot target this specific area and may be toxic and hard on the liver. New laser-assisted therapies are being developed and a growing number of foot doctors in the U.S. report excellent clinical results. To maximize the efficacy, laser treatments should be combined with a complete and comprehensive program.

Typically at least two laser treatments of all toes with a focus on the badly infected ones are required. Patients need to use a UV shoe sanitizer (yes, we have to treat all shoes to kill fungus and bacteria), a strong topical medication as well as a care regimen for prevention of re-infection. This comprehensive course of treatment is safe, non-toxic, pain-free and highly effective.

Thanks to its ability to pass through the nail and kill fungi in the nail bed, laser light is the only modality available today, which allows practitioners to address the very cause of the disease. While the high intensity light and thermal damage delivered to the target by the laser is lethal for the fungi, it is safe for the surrounding skin. In fact, these same lasers are used for new collagen growth in anti-aging aesthetic procedures and may stimulate the growth of new, healthy and fungus free nails, which will gradually replace the old ones.

Patients with mycotic nails are very susceptible to re-infections. The fungus is everywhere in the environment of the people with Onychomycosis. Therefore, the complex decontamination and preventive care regimen are critical for the success of the treatment.

Hypertension - Medical Treatment

Possible Drug Combinations

The treatment is an initial immunotherapy with a drug in response is inadequate, as multiple combinations. Drug of first choice for drug therapy are ACE inhibitors, AT1 antagonists, beta blockers, diuretics and calcium antagonists. The choice depends on the age and comorbidities of the individual. ACE-inhibitors reduce the synthesis of pressor angiotensin II and thus the activity of the renin-angiotensin-aldosterone system. Angiotensin-1 receptor antagonists share the same system at another point on; they prevent the effects of angiotensin II at the angiotensin-1 receptor (AT1 receptor).

They are sometimes better tolerated than ACE inhibitors. In the case of beta-blockers agents from the group of β-1 are selective agents used. The β 1-receptors are localized at the heart of their resistance is lowered over the decrease in cardiac output of the heart, blood pressure. Diuretics, preferred by the thiazide-type, create an on increasing fluid secretion in the kidney, a reduction in volume in the vascular system and subsequently decrease in blood pressure. Calcium antagonists reduce the nifedipine-type vascular tone in the arteries.

These drug groups are considered with regard to mortality reduction as therapeutically equivalent.As regards the impact on the total number of organ complications (stroke, heart attack, heart failure), but there is a heterogeneous study situation. Means the second choice are alpha blockers, potassium, α2-agonists and NO donors.

Refractory Hypertension

Refractory hypertension is defined as hypertension, consists of three or more despite treatment with high-pressure medications, including at least one diuretic, is not in the target area. Approximately 20-30% of hypertensive therapy resistance is particularly in advanced age or obesity. Often, the resistance to therapy, a secondary high-pressure form is based. The most common cause is a hyperaldosteronism, other causes include obstructive sleep apnea syndrome, chronic renal disease, renal artery stenosis or pheochromocytoma. All patients with refractory hypertension should, therefore, the aldosterone /renin ratio are determined to avoid including hyperaldosteronism, even if the serum is-potassium normal. Addition of spironolactone in low doses (25 mg / day) or amiloride to standard therapy in most cases reach the therapy-resistant hypertension, hypotension, irrespective of the amount of the aldosterone / renin ratio. Common side effect of spironolactone is breast tenderness, which occurs in 10% of treated men. The risk of hyperkalemia is low because of the serious consequences but is potassium controls needed, especially in patients with chronic kidney disease, diabetes, elderly, or coadministration of an ACE inhibitor or AT1 antagonists.