ENDOTHELIAL DYSFUNCTION AND POLYHYPOVITAMINOSIS IN PATIENTS WITH COMPLICATED DESTRUCTIVE ONYCHOMYCOSIS AND THE COMORBID METABOLIC SYNDROME
Authors: Vergun Andrii , Chulovskyi Yaroslav , Parashchuk Bohdan , Vergun Oksana , Krasnyi Mykhailo , Kit Zoriana , Matsyakh Yurii , Moshchynska Oksana , Lytvynchuk Mykhailo , Marko Oksana , Makahonov Ihor 
Published: December 2023

In the pathogenesis of chronic infectious fungal processes, an important role is determined by the weakening of the body's protective factors. There are "endogenous and exogenous factors" that contribute to the transformation of fungi from vegetation to pathogenic. Endogenous factors (age, general infections, metabolic diseases, hypo- and avitaminosis, metabolic syndrome, gastrointestinal diseases, neuropathy) are define some clinical variants. Destructive fungal lesions predominate in middle-aged and elderly people, in elderly patients "surgical nail pathology" is half of all observations of purulent-necrotic chronic lesions of the distal parts of the hand and foot. The purpose of the work was to introduce minimally invasive nail removal or resection of nails by block-shaped eponychectomy access with the use of pedicure instruments, study of biochemical changes in the background of pathology, detection of correlations between hypo- and avitaminosis with the development of destructive onychomycosis. It has been established that conservative, podiatric and orthopedic treatment of mycotic surgical lesions and secondary nail incarnation are not very effective, while some classical methods are Dupuytren's nail removal, Emmert-Schmiden operation and others in 2-20% of cases (depending on the absence or presence of onychocryptosis and associated fungal lesions) determine recurrences. Instead, the proposed low-trauma removal or resection of nails by block-shaped eponychectomy access using pedicure instruments, excision of dermatophytoma with partial marginal matrixectomy, which significantly reduces the number of recurrences of ingrowth (respectively 1-3% in the early stages and, 3,25% та 6,42% periods of growth, χ2 = 28,17, p<0,01) and determines the improvement of quality of life. The study of endothelial function revealed the presence of endothelial dysfunction in most patients, which confirms our previous studies and literature data. Blood lipid spectrum  was significantly higher in both groups of patients (main and comparison group), compared with almost healthy individuals (p<0.01 for both groups, compared with controls), which is consistent with the literature. It was found that the supply of vitamins B1, B2, PP, B6 and C directly correlated with the severity of the underlying disease. In patients with polyonychomycosis with significant symptoms of background polyhypovitaminosis, some purulent complications of mycotic onychodestruction were detected – subungual abscess / panaritium, complicated nail incarnation  and mycotic-associated paronychia with purulent onychia / onycholysis of more than three nail plates. For comparison, in the other half of the sample of persons with less pronounced symptoms of polyhypovitaminosis, some purulent complications were found in only 37.5% of the subsample, which suggests that there is a relationship between the manifestations of multivitamin deficiency and the severity of necrotic complications. Low-traumatic mobilization of the nail through a block-like eponihectomy and nail plates removal or resection (some nail incarnation) of through areas of onycholysis/onychomadesis, or resection of nails through hyperkeratosis / onycholized structures using our methods, according to our complex analysis, due to reduction of intraoperative injury, determines increasing the rate of wound healing (χ2=32,14, p<0,01) and statistically significant minimization of the risk of mixed and reinfection of adjacent anatomical structures.