Clinico-Mycological Study of Onychomycosis and Pattern of Drug Resistance

Introduction: Onychomycosis is a fungal infection of thetoenails or fingernails that may involve any component of thenail unit, including the matrix, bed, or plate. Onychomycosisis caused by dermatophyte fungi, non dermatophyte mouldsand yeasts. Prevalence rates for OM varying from 3 to 5%have been found in most studies; however, a few reportssuggest a higher prevalence of even up to 26% in the generalpopulation. Hence through this study an attempt was made toidentify the various clinical patterns of onychomycosis and toidentify pattern of drug resistance in onychomycosis.Material and methods: The proposed study was carriedout in Outpatient Department of Dermatology Venereologyand Leprosy, Rohilkhand Medical College and Hospital,Bareilly, a tertiary care hospital in western Uttar Pradeshfor one year (November 2017- October 2018) on patientshowing nail changes suggestive of onychomycosis, usingdirect microscopy using potassium hydroxide. The culturemedium SDA with chloramphenicol was used. Sensitivity toTerbinafine, Fluconazole, Itraconazole and Griseofulvine wasstudied.Result: The most common pattern of onychomycosis seenwas distal lateral subungual onychomycosis. Pattern of drugresistance is maximum with Griseofulvin (49%) and least withTerbinafine (20%).Conclusion: A total of 104 patients were enrolled, withmean age 35.93 years. Males were more commonly involvedcompared to females. The culture results were positive among55 patients and negative in 49 patients. The most commoncausative agent isolated was dermatophyte moulds followedby non-dermatophytes and yeasts.

Visual Outcome among Patients Undergone Manual Small Incision Cataract Surgery Following their Identification in Screening Eye Camp in Jammu Province.

Introduction: One of the documented leading cause ofblindness in India is cataract as many patients with cataract donot have access to hospitals and surgery and to avoid blindnessdue to cataract, the only remedy is to perform hospital basedcataract surgery on a large scale. There is an increase in anumber of cataract patients due to improved quality of life,health indices and increased life expectancy. Study aimedto see the visual outcome and complications among patientsundergone manual SICS with PC-IOL implantation.Material and Methods: The present prospectiveobservational study was conducted on 72 patients who wereselected in various screening eye camps to undergo cataractextraction surgery by manual small incision cataract surgerytechnique with posterior chamber IOL implantation (MSICSwith PC-IOL).Results: Total of 72 eyes of patients who underwent manualsmall incision cataract surgery were studied. Best correctedpreoperative visual acuity of ≥ 6/60 was found in 13 patientswhile postoperatively on day1 total of 60 patients had visualacuity of ≥ 6/60. The final 6th week postoperative bestcorrected visual acuity of 6/12-6/9 was found in 65 patients.Iris prolapse was seen in 3 patients followed by posteriorcapsule rent which was seen in 2 patients. Mild postoperativeuveitis was seen in 20 followed by striate keratopathy in 8patients while hyphaema was seen in 2 patients.Conclusion: MSICS is a safe and effective procedure, due toits low rates of intraoperative and postoperative complicationswhich are easily treatable. Visual acuity is only one measureof the functional success of cataract surgery and the goodpostoperative visual outcomes achieved by our patientsfurther adds on to its benefits as a good surgical technique.MSICS can be performed as procedure of choice for largevolume cataract surgeries

The research on diagnostic value of fungal culture combined with galactomannan test for patients with invasive pulmonary aspergillosis / 中国中西医结合急救杂志

Objective To assess the clinical diagnostic value of sputum fungal culture combined with serum galactomannan (GM) antigen detection in patients with invasive pulmonary aspergillosis (IPA). Methods A total of 567 cases, because of respiratory symptoms and/or suspected aspergillosis infection, admitted into the Affiliated Hospital of Jining Medical University from January to December 2016 were enrolled, the positive rate of pulmonary aspergillosis infection was determined by sputum culture and serum GM test, the values of single sputum culture and the combination of the culture and GM test for diagnosis of IPA were analyzed, and the differences in the positive rates of pulmonary aspergillus determined by GM test and traditional methods [chest computed tomography (CT), sputum culture and blood culture] were compared. At the same time, when fever patients had treated for 3-4 days, the results were ineffective, antifungal therapy was applied according to the disease condition and the results of auxiliary examinations (chest CT, sputum culture and GM test), and the effect of antifungal therapy was observed. Results The serum GM test was positive in 85 cases, and sputum fungal culture was positive in 226 cases, there were 108 cases presenting positive and 148 cases negative in both culture and GM test; the diagnosis of IFD was confirmed in 186 cases (32.8%), clinical diagnosis was made in 107 (18.9%) cases, suspected in 131 (23.1%) cases and excluded in 143 cases (25.2%). Compared with single sputum fungal culture, the sensitivity [98.2% (108/110) vs. 20.4% (46/226)], specificity [85.1% (148/174) vs. 45.1% (148/328)], positive predictive value [80.6% (108/134) vs. 37.1% (46/124)] and negative predictive value [98.1% (148/151) vs. 63.0% (148/235)] of combination method of GM test and sputum fungal culture for diagnosis of IPA were obviously higher; the positive rate of GM test for the detection of pulmonary aspergillus infection was significantly higher than that of traditional methods of chest CT, sputum culture and blood culture [64.7% (55/85) vs. 35.7% (35/98), 20.4% (46/226), 4.8% (14/292)], and the GM value being 0.5 as the positive critical value for the diagnosis of IPA can provide desirable sensitivity and specificity. In this study, 186 patients with pulmonary aspergillus infection had completed the antifungal treatment. The effective rates of antifungal treatment 1, 2, 3 and 6 months after treatment were not significantly changed with the prolongation of the therapeutic time [75.4% (135/179), 77.1% (111/144), 77.2% (31/79), 82.6% (19/23)], but the contents of serum GM was significantly lowered compared with that before treatment [absorbance (A) value: 0.49±0.03, 0.46±0.03, 0.39±0.03, 0.23±0.03 vs. 0.56±0.03, all P < 0.05], the number of positive cases was also decreased (186, 179, 144, 79, 23 respectively), so dynamic GM tests can help observe the therapeutic effect. Conclusion The study results showed: serum GM antigen detection combined with sputum fungal culture can significantly improve the clinical diagnostic efficiency for patients with pulmonary aspergillus infection.

Comparative study of fungal culture and in vivo confocal microscopy in the diagnosis of non-primary fungal keratitis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare fungal culture and in vivo confocal microscopy ( IVCM ) in the diagnosis of non- primary fungal keratitis.?METHODS:The clinical data of 31 cases (31 eyes) with non- primary fungaI keratitis from September 2016 to February 2017 in our HospitaI were retrospectiveIy reviewed. The positive rate of the two methods was compared by chi-square test.?RESULTS: The positive rate by fungal culture was 58％(18/31 ) and IVCM was 19％ ( 6/31 ); the positive rate comparison difference was statistically significant between fungal culture and IVCM (x2=7. 56,P<0. 01). In the 13 eyes with positive culture results, 2 eyes were positive by IVCM;in the 25 positive IVCM eyes, 14 eyes were positive in culture.?CONCLUSION: The positive rate of fungal culture in non-primary fungal keratitis is higher than that of IVCM. Fungal culture is an essential auxiliary examination in the diagnosis of non - primary fungal keratitis. With the characteristics of fast, noninvasive and repeatable, IVCM also plays an important role in the diagnosis of non-primary fungal keratitis. The combination of the two methods can improve the positive rate of diagnosis.

Clinical value of serum (1-3 )-β-d-glucan detection on diagnosis of deep fungal infection / 国际检验医学杂志

Objective To investigate the clinical value of serum (1-3)-β-D-glucan(BG) detection (G test) in early diagnosis of deep fungal infection .Methods 132 patients with suspected deep fungal infection in the Chongqing Emergency Medical Center from October 2015 to April 2016 were selected as the research subjects .Among them ,38 cases definitely diagnosed and suspected diagnosed deep fungal infection served as the positive group and other 94 cases were taken as the negative group .Serum BG level was measured by Jinshanchuan MB-80 microbial dynamic detection system ,and the results were compared with the fungal culture results by the body fluid fungal culture .Results The serum BG level of the positive group was (150 .8 ± 133 .2)pg/mL ,and which of the negative group was (25 .7 ± 20 .1)pg/mL ,the difference was statistically significant (t=5 .76 ,P＜0 ,05) .The sensitivity ,specificity ,positive predictive value and negative predictive value of G test were 78 .9% ,85 .1% ,68 .1% and 91 .0% respectively ;the sensitivity ,specificity ,positive predictive value and negative predictive value of fungal culture were 57 .9% ,80 .9% ,52 .3% and 82 .6%respectively .Conclusion The serum BG detection is fast ,accurate ,simple and convenient ,and has clinical application value in the early diagnosis of deep fungal infection and clinical rational medication guidance .

Incidence of fungal etiology in patients with nasal polyps

Background: Sildenafil causes vasodilatation by relaxing the smooth muscles of blood vessels. This enhances endometrial development, the health of which is indispensable for implantation and embryonic and fetal development. Aim: To assess the role of Sildenafil when used in ovulation induction cycles with Clomiphene Citrate (CC) with reference to Endometrial Thickness (ET), follicular development, Pregnancy rates and Side Effects. Materials and methods: In this prospective comparative study on 80 infertile women, we randomly divided them into two groups. In group A with 40 patients, ovulation induction with CC was given and in group B with 40 patients oral Sildenafil Citrate 25mg – BD, was added from Day 8 up to hCG trigger, in the CC induced cycle. A transvaginal ultrasound was done on Day 13 to assess follicular growth and ET. A urine β-hCG on Day 30 was done to detect pregnancy. Patients were followed up for 8 weeks to monitor miscarriages, ectopics and multi foetal gestation. Results: Mean ET at the time of hCG trigger was 9.64 in the Sildenafil group compared to 8.47 in group A without Sildenafil (p value 0.01). 65% of the patients in group B conceived with 3 cycles of ovulation induction compared to 42.5% who conceived in group A (p value 0.04). The mean of total number of follicles greater than 18 mm at hCG trigger was 1.62 and 1.91 in group A and B respectively (p – 0.09). Side Effects were significantly higher in group B with sildenafil compared to group A with CC alone (p – 0.006). L. Pranathi Reddy, Y. Madhavi, Mohammed Ismail Khan. Role of Sildenafil in ovulation induction – A comparative study of outcomes with Sildenafil in ovulation induction cycles with Clomiphene Citrate. IAIM, 2016; 3(12): 26-32. Page 27 Conclusions: As our study shows that use of Sildenafil improves ET and rates of conception, we recommend the routine use of Sildenafil in ovulation induction protocols.

The Status and Tendency of Recent Five-year Fungal Cultures as a Diagnostic Measure in a Tertiary Hospital in the Southwestern Daegu Area / 대한의진균학회지

BACKGROUND: Fungal culture is a conventional method for diagnosing fungal infections and is important for determining etiologic agents of the fungal infections. OBJECTIVE: To study the prevalence and validity of fungus culture in various clinical departments. METHODS: A retrospective study of 4373 fungal culture cases at Daegu Catholic University Medical Center from January 2010 to December 2014 was made to investigate the prevalence of fungus culture depending on age, clinical departments, specimens and to evaluate the positive rate along with the distribution factor. RESULTS: The number of fungal culture increased with age. Fungal culture was more commonly performed in departments such as pulmonology (26.7%), ophthalmology (11.7%), dermatology (8.6%), emergency medicine (7.4%), neurology (7.3%). Among the cultured specimens, 43.6% were respiratory specimens, followed by CSF (17.2%), ophthalmic specimens (13.2%), skin (8.7%), and abscess (4.0%). Of the 4,373 specimens cultured, 222 (5.1%) were positive. The most commonly identified fungus was Trichophyton. Fungal culture was routinely performed with bronchoscopy and lumbar puncture. Prophylactic fungal evaluation was carried out for patients who had liver transplantation. CONCLUSION: Our study showed that fungal culture has been excessively conducted, even to a level where some departments take the test on their regular routine basis. The unfettered use of this low-yield diagnostic tool can give a false sense accomplishment and is often cost-ineffective and difficult in altering subsequent diagnostic or therapeutic plans. Clinicians should appropriately assess medical indications of fungal culture counting in the risk of infection, mortality, and cost as well.

Conservación de cultivos de hongos de importancia médica en agua destilada / Preservation of fungal cultures of medical importance in distilled water

Introducción: en la colección de cultivos de hongos patógenos del Instituto de Medicina Tropical Pedro Kourí, como centro de referencia nacional, se conservan los agentes causales de las principales micosis humanas, con fines de diagnóstico, investigaciones y enseñanza de la microbiología médica. La conservación de cultivos fúngicos en agua destilada estéril o método de Castellani ha sido avalada como un método que garantiza porcentajes elevados de viabilidad, pureza y estabilidad de las cepas; esto unido a su bajo costo y sencillez, la convierte en una alternativa ventajosa para el mantenimiento de los microorganismos en muchos laboratorios. Objetivo: mostrar los resultados en la preservación en agua destilada estéril de las principales especies fúngicas que integran esta colección. Métodos: se evaluó la viabilidad, pureza y estabilidad de las principales características morfológicas y fisiológicas de 240 cepas de diferentes especies fúngicas pertenecientes a la colección, conservadas en agua destilada estéril. Resultados: de los cultivos, 80 por ciento se conservó en estado viable y sin contaminaciones. Los mejores resultados se obtuvieron en la preservación de los hongos productores de abundantes conidios (97 por ciento de recuperación) y las levaduras (83 por ciento), mientras que con los dermatofitos y hongos dimórficos fue de 69 y 68 por ciento, respectivamente. En 17 géneros, la recuperación de cepas viables fue superior a 60 por ciento, mientras que en 8 resultó de 100 por ciento. El tiempo de conservación fue de 15 a 20 años. Se implementó una base de datos en formato digital de la colección sobre plataforma web. Conclusiones: el método de Castellani es un método de elección para la conservación de cultivos fúngicos en laboratorios de recursos limitados

Introduction: causal agents of the main human myicoses have been preserved in the culture collection of pathogenic fungi at Pedro Kourí Tropical Medicine Institute, a national reference center, with the purpose of using them for medical microbiology diagnoses, research and teaching. Preservation of fungal cultures in sterile distilled water, or Castellani's method, has been endorsed as a method ensuring high rates of strain viability, purity and stability, low costs and great simplicity. It is therefore an advantageous alternative for the maintenance of microorganisms in many laboratories. Objective: present the results obtained from the preservation in sterile distilled water of the main fungal species included in the collection. Methods: an evaluation was conducted of the viability, purity and stability of the main morphological and physiological characteristics of 240 strains of different fungal species from the collection, which had been preserved in sterile distilled water. Results: 80 percent of the cultures had retained their viable status without any contamination. The best results corresponded to the preservation of fungi producing abundant conidia (97 percent recovery) and yeasts (83 percent), followed by dermatophytes (69 percent) and dimorphic fungi (68 percent). In 8 genera, recovery of viable strains was 100 percent, and in 17 it was above 60 percent. Preservation time was 15-20 years. A web-based digital database was created for the collection. Conclusions: Castellani's is the method of choice for the preservation of fungal cultures in resource-limited laboratories

Clinical Application Value of Vaginitis Microbe Detection Kits / 昆明医科大学学报

Objective To assess the sensitivity and specificity of vaginitis pathogen detection reagent kit (Nucleic acid hybridization). Methods Four hundreds cases of vaginal secretion samples were detected with Amsel, vaginalis culture, fungal culture and Affirm VPIII detection method, respectively. Using the methods of Amsel, vaginalis culture and fungal culture as the gold standard, the clinical application value of Affirm VPIII detection method was evaluated. Results Compared with Amsel, the sensitivity and specificity of Affirm VPIII detection was 92.2%and 70.5%, respectively. Compared with fungal culture, the sensitivity and specificity was 88.3% and 92.9%, respectively. Compared with vaginalis culture, the sensitivity and specificity was 92.6% and 93.8%, respectively. There was a good consistency between the gold stardard and the Affirm VPIII detection. Conclusion Compared with the traditional detection methods,the Affirm VPIII detection has the advantages of fast detection speed,simple operation, and high sensitivity and specificity. In addition, it can identify three kinds of vaginitis pathogenic microorganisms at the same time,with a certain clinical value.

Predictive values of 10% potassium hydroxide examination for superficial fungal infection of the skin

Introduction Ten percent potassium hydroxide examination is one of the most frequently performed tests in dermatology. It is usually supplemented by fungal culture for detection of superficial fungal infection of the skin and its appendages. We aim to determine the predictive values of 10% potassium hydroxide examination in Sarawak General Hospital. Materials and Methods A retrospective review of 292 skin scraping results for 10% potassium hydroxide examination and culture was done between October 2003 and December 2004. Data for all the scrapings were analysed for predictive values, specificity, sensitivity and likelihood ratio with fungal culture as the gold standard investigation. Separate data analysis was done for those with onychomycosis. Results Positive cultures were noted in 80.8% of skin scrapping cases and 85.4% of onychomycosis cases. For the skin scrapping cases, the positive predictive value of 10% potassium hydroxide examination was 67.4%, negative predictive value of 16.9%, sensitivity of 12.3% and specificity of 75%. For those with onychomycosis, the positive predictive value was 75%, negative predictive value 13.6%, specificity 85.7% and sensitivity was 7.3%. The positive likelihood ratio for all cases and onychomycosis cases was 0.5 whereas the negative likelihood ratio was 0.9. Conclusion Ten percent potassium hydroxide examination has a very low negative predictive value and sensitivity, making it a poor investigative tool in Sarawak General Hospital. Thus, culture of the skin scraping for suspected superficial fungal infection of the skin and its appendages is of utmost importance. Steps to improve the quality of 10% potassium hydroxide examination are important as it is an easy and inexpensive test.