Assessment of factors related to treatment failure and recurrence of superficial dermatophytosis

Background: Superficial dermatophytosis, commonly known as ringworm, is a fungal infection of the skin, hair, or nails caused by dermatophytes, primarily belonging to the genera Trichophyton, Microsporum, and Epidermophyton. Despite being a superficial infection, the rising incidence of treatment failure and recurrence has become a matter of concern in recent years. Methods: This prospective observational study, conducted at the department of dermatology and venereology of Chittagong Medical College Hospital, aimed to investigate the epidemiological factors associated with treatment failure and recurrent cases of superficial dermatophytosis. The study spanned from March 2022 to February 2023, involving 249 participants diagnosed with Tinea corporis, Tinea cruris, Tinea facies, or Tinea pedis. Factors such as excessive sweating, use of warm water, clothing habits, sharing practices, and topical corticosteroid application were analyzed. Results: The most common age group affected was 21-30 years, with a male preponderance (1.6:1). Excessive sweating, wearing water-soaked garments, and sharing towels were prevalent among participants. After 4 weeks of treatment, 81.5% achieved complete cure, but 52.7% of these cases experienced a recurrence within the subsequent 4 weeks. Multivariate analysis identified sharing towels, family history of dermatophytosis, and past topical steroid use as significant risk factors for treatment failure/recurrence. Conclusions: The study emphasizes the importance of linen (sharing towels) in the transmission of dermatophytosis and highlights the increased risk associated with a family history of the condition. Additionally, the injudicious use of topical steroids emerged as a significant factor contributing to treatment failure and recurrence.

Relationship between inter-arm blood pressure differences and predicted future cardiovascular risk in hypertensive patients

Background: Hypertension stands as a widely recognized significant risk factor for cardiovascular disease. In clinical practice, it is advisable to measure blood pressure (BP) in both arms. The increasing attention on inter-arm blood pressure difference (IABPD) stems from its association with cardiovascular disease. This study aimed to assess the relationship between inter-arm blood pressure differences and predicted future cardiovascular risk in hypertensive patients. Methods: This cross-sectional study was conducted at the department of cardiology, Chittagong Medical College Hospital from July 2020 to June 2021. The study included 428 cases of previously or newly diagnosed hypertension, selected through convenient sampling. Data analysis was conducted using Microsoft Office tools and statistical package for the social sciences (SPSS) version 23.0. Results: In this study, 8.2% of patients exhibited noteworthy systolic IAD, and 2.3% demonstrated notable diastolic IAD. Median 10-year cardiovascular risk, assessed by Framingham and ASCVD calculators, was 21% and 11% respectively. A positive correlation was observed between sIAD and 10-year cardiovascular risk (p=0.003) and sIAD and 10-year ASCVD risk (p=0.041). Patients with significant sIAD had a higher incidence of ischemic heart disease compared to those without (p=0.041). Multiple regression analysis revealed a significant correlation between 10-year Framingham cardiovascular risk and sIAD (p=0.003). Conclusions: A significant difference in systolic blood pressure between arms is linked to a higher 10-year cardiovascular risk and the presence of cardiovascular disease in well-managed hypertensive patients. So, monitoring sIAD could be an additional factor in predicting future cardiovascular events in patients receiving hypertension treatment.

Bioavailability Study Of Ondansetron Gel In Rabbits And Human Volunteers Appling Uplc As Analytical Tool And Evaluation Of The Antiemetic Effect Of Ondansetron Gel In Cisplatin-Induced Emesis In Rats

Objective: This study was undertaken to determine the bioavailability of ondansetron gel in experimental animals and humans applying UPLC as an analytical tool and evaluation of the antiemetic effect of ondansetron gel in cisplatin-induced emesis in rats. Methods: Ondansetron gel (F13: sodium alginate 7% w/w) was used, marketed I. V. ondansetron (Zofran) ® was chosen as reference. The bioavailability study in rabbits was selected as a parallel design using nine healthy rabbits divided into three groups whereas, bioavailability study in humans was an open-label, wherein 6 healthy subjects administered ondansetron gel. The potential effect of ondansetron gel was evaluated for the prevention of different phases of emesis motivated by exposure to antineoplastic drugs (cisplatin) by determination of body weight loss, water and food intake applying kaolin-pica model in rats using seventy-two rats divided into six groups. Results: Ondansetron gel (0.5%) showed detectable plasma concentration 22.833±2.17 ng/m1 after ¼ h and 419.55±2.17 ng/ml after 1-h post-treatment in rabbits and human respectively and concentration was maintained above-reported minimum effective concentration for more than 2.5 h for rabbits and 7 h for humans compared to 1.75 h after I. V. administration. The ondansetron gel significantly reduces all phases of cisplatin-induced emesis and a decrease in body weight, water, and food consumption was significantly attenuated. Conclusion: Based on the high efficacy of gel on emesis induced by cisplatin, and its high bioavailability, transdermal ondansetron gel could be a promising convenient system to prevent nausea and vomiting following administration of antineoplastic drugs.

Prognostic Significance of Retroperitoneal Lymphadenectomy, Preoperative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Primary Fallopian Tube Carcinoma: A Multicenter Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to evaluate the prognostic role of preoperative neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) and the need for para-aortic lymphadectomy in patients with primary fallopian tube carcinoma (PFTC). MATERIALS AND METHODS: Ninety-one patients with a diagnosis of PFTC were identified through the gynecologic oncology service database of six academic centers. Clinicopathological, surgical, and complete blood count data were collected. RESULTS: In univariate analysis, advanced stage, suboptimal surgery, and NLR > 2.7 were significant prognostic factors for progression-free survival, whereas in multivariate analysis, only advanced stage and suboptimal surgery were significant. In addition, in univariate analysis, cancer antigen 125 > or = 35 U/mL, ascites, advanced stage, suboptimal surgery, NLR > 2.7, PLR > 233.3, platelet count > or =400,000 cells/mm3, staging type, and histological subtype were significant prognostic factors for overall survival (OS); however, in multivariate analysis, only advanced stage, suboptimal surgery, NLR > 2.7, and staging type were significant. Inclusion of pelvic and para-aortic lymphadenectomy in surgery showed significant association with longer OS, with a mean and median OS of 42.0 months and 35.5 months (range, 22 to 78 months), respectively, vs. 33.5 months and 27.5 months (range, 14 to 76 months), respectively, for patients who underwent surgery without para-aortic lymphadenectomy (hazard ratio, 3.1; 95% confidence interval, 1.4 to 5.7; p=0.002). CONCLUSION: NLR (in both univariate and multivariate analysis) and PLR (only in univariate analysis) were prognostic factors in PFTC. NLR and PLR are inexpensive and easy tests to perform. In addition, patients with PFTC who underwent bilateral pelvic and para-aortic lymphadenectomy had longer OS.

Adjuvant Treatment Modalities, Prognostic Predictors and Outcomes of Uterine Carcinosarcomas / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to evaluate the clinicopathological characteristics, treatment, and prognosis of uterine carcinosarcoma (UC). MATERIALS AND METHODS: A retrospective review of three cancer registry databases in Turkey was conducted for identification of patients diagnosed with UC between January 1, 1996, and December 31, 2012. We collected clinicopathological data in order to evaluate factors important in disease- free survival (DFS) and overall survival (OS). RESULTS: A total of 66 patients with UC with a median age of 65.0 years were included in the analysis. The median survival time of all patients was 37.5 months and the 5-year OS rate was 59.1%. In early stage patients (I-II) who received adjuvant chemotherapy (CT) with radiation therapy (RT), the median DFS and OS was 44 months and 55 months, respectively, compared to 34.5 months and 36 months, respectively, in patients who received adjuvant RT or CT alone (hazard ratio [HR], 1.4; 95% confidence interval [CI], 0.7 to 3.1 for DFS; p=0.23 and HR, 2.2; 95% CI, 0.9 to 5.3 for OS; p=0.03). In advanced stage patients (III-IV), the median DFS and OS of patients receiving adjuvant RT with CT was 25 months and 38 months, respectively, compared to 23.5 months and 24.5 months, respectively, in patients receiving adjuvant RT or CT alone (HR, 3.1; 95% CI, 0.6 to 16.0 for DFS; p=0.03); (HR, 3.3; 95% CI, 0.7 to 15.0 for OS; p=0.01). In multivariate analysis, advanced International Federation of Gynecology and Obstetrics (FIGO) stage and suboptimal surgery showed significant association with poor OS. CONCLUSION: In patients with early or advanced stage UC, adjuvant CT with RT is associated with improved DFS and OS, as compared to CT or RT alone.

fMRI resting state time series causality: comparison of Granger causality and phase slope index.

Granger causality and Phase Slope Index (PSI) are recent approaches to measure how one signal depends on another, which gives an indication of information flow in complex systems. We show that the Granger causality and PSI mapping, voxel-by-voxel, for functional magnetic resonance imaging (fMRI) resting state data set. Slow fluctuations (< 0.1 Hz) in fMRI signal have been used to map several consistent resting state networks in the brain. The results demonstrate that PSI influence directions among reference regions and gray matter voxels were more consistent with the relevant previous studies compared with Granger causality. The PSI approach proposed is effective, computationally efficient, and easy to interpret.

Oral Health Experience during Pregnancy and Dental Service Utilization in Bariadi District; Tanzania

Abstract:A substantial proportion of pregnant women reports experiencing oral health problems during pregnancy. However; most of them perceive that such problems are normal in pregnancy and hence do not seek dentist consultation. The objective of this study was to determine the prenatal oral health experience and the utilization of dental care services among pregnant women attending reproductive and child health clinics in Bariadi District in Tanzania. Data was collected using a questionnaire-guided interview. Key variables were socio-demographic characteristics of pregnant women; oral health experience; and dental visits during pregnancy with reasons and treatment received. A total of 305 pregnant women (mean age=25.7 years) were involved in the study. Most of the listed oral health problems during pregnancy were reported by women with 2+ children. The frequent oral health problems among the pregnant women were bleeding gums (22.6; N=69); pain in gums (21.6; N=66); swollen gums (21.3; N=65); dental pain (30.5; N=93); and tooth decay (25.6; n=78). However; only 31.8 (N=97) visited a dental clinic for consultation most whom; were those with three or more children (?2=4.682; P=002). The pregnant women who had visited a dentist in the past 12 months were 11.1 (N=34); mostly those aged 24 years and those with informal employment (P0.05). Curative and preventive treatments were received more significantly by the urban and with formal employment (P0.01). In conclusion; pregnant women in Bariadi; Tanzania experiences substantial oral health problems for which they do not often utilize dentists for consultation and management during pregnancy. Dentists and other health workers should therefore; intensify dental screening; emphasizing active family and community participation as part of regular prenatal care

study of Helicobacter pylori duodenal ulcer promoting gene [cfupA] polymorphisms in Iraq and Turkey and their role in IL-12 secretion

The duodenal ulcer promoting gene [dupA] has been identified recently and was found to associate with duodenal ulceration in some populations and gastric cancer in others. It was also found that this gene is polymorphic and dupAl [but not dupAZ] substantially increased H. pylori-induced IL-12 production from mononuclear cells. The aims of this paper were to determine the prevalence ofdupA polymorphisms in Iraq and Turkey and their effect on major cytokine secretion from peripheral blood mononuclear cells [PBMCs]. We studied a total of 85 H. pylon strains: 42 [non-ulcer disease [MUD]: 26; duodenal ulcer [DU]: 13; gastric ulcer [GU]: 3; gastric cancer [GC]: 0] which were isolated from Iraq and 43 [NUD: 28; DU: 12; GU: 2; GC: 1] from Turkey. dupA was PCR amplified then polymorphisms were studied by sequencing 10 and 9 dupA+ Iraqi and Turkish strains, respectively. It was found that none of the Iraqi strains and [22%] of Turkish strains typed as dupA1. Finally, 2 dupA1, 4 dupA2 and 2 dupA-negative strains were assessed for their ability to induce IL-12, IL-10 and IL-8 in PBMCs. The IL-12 response of PBMCs cultured for 48 hours with wild-type strains carrying the dupAl was significantly higher [strain: mean +/- sd pg/ml, WTD1A:416 +/- 22.8; WTD1B:405.9 +/- 22.4] than those induced by wild-type H. pylori carrying the dupA2 [WTD2A:290.7 +/- 16.3; WTD2B:252.5 +/- 5; WTD2C:262.1 +/- 14; WTD2D:279.5 +/- 17; p<0.02 for all] and than those typed dupA-negative [WTD-veA:258.5 +/- 12; WTD-veB:225.6 +/- 32; p<0.02 for all] . Regarding IL-8 and IL-10, we found no significant differences between dupAl and others. These data suggested that dupAl is rare in these two countries and dupAl plays an important role in IL-12 secretion from PBMCs. More research is needed to determine the functionality ofdupA and its relationship with disease

Identification and characterization of nuclear matrix protein[s] and assessment of its usefullness for early diagnosis of bladder cancer

The highest incidence rates of bladder cancer are generally found in industrially developed countries, particularly North America and Western Europe, and areas associated with endemic schistosomiasis, including parts of Africa and the Middle East. The appropriate treatment of patients with bladder cancer mandates early detection and regular follow up for recurrences. Currently, cystoscopy is the standard method for diagnosing and monitoring bladder cancer recurrence, but it is an invasive and relatively costly technique, and may sometimes be inconclusive, particularly in cases of cystitis. Western blot and specific immunoglobulin-G antibody were used to identify the urinary NMP marker. Urine samples from 123 patients with bladder cancer and 50 controls were evaluated using the developed SDS-PAGE, Western blot and ELISA. The NMP marker was identified in the urine of patients with bladder cancer at 52 kDa [NMP- 52] by SDS-PAGE, Western blot and ELISA. In addition, the NMP-52 tumor marker was not detected in the urine of patients. Detecting the urinary NMP-52 marker using SDS-PAGE, Western blot and ELISA, would be helpful in the rapid diagnosis of bladder cancer

Assessment of Mahmoudia canal and drinking water nitrogen forms following some corrective actions

The Nile is the main source of drinking water in Egypt. Alexandria water Company [AWCO] depends on the surface water only as canals fed by the Nile River. AWCO has 8 water treatment plants [WTP], 6 of which are located on Mahmoudia canal. AWCO has a monthly comprehensive program to survey canals supplying water to Alexandria water treatment plants [WTP], where all parameters of Mahmoudia canal and drain discharges are measured. This study was carried out during the period from March 2008 to Jan. 2010 and the program is still implemented until now. AWCO regularly monitors the water quality in the canals in the Rosetta branch of the Nile, all the way up to the Delta Barrage near Cairo. The water quality in Mahmoudia canal is stable at a manageable level. The raw water of WTPs has faced serious problems that are affected by the increasing free ammonia and nitrite in winter season. Many corrective steps [hourly free ammonia taken to overcome these problems. The main objective of this study was to identify long term feasible solutions for the drinking water quality problems on the basis of physical and chemical water parameters. The which are corrective actions had reduced the free ammonia values by more than 75% for WTPs distributed drinking water all over the years

Embedded esophageal foreign body. A diagnostic challenge

Esophageal foreign body [EFB] ingestion is of ubiquitous occurrence in pediatric population. Diagnosis and precise localization of non-radio opaque FB poses considerable challenge. Delayed presentation, poor history, and inconclusive esophagoscopic findings often lead to diagnostic delay. Multidetector computed tomography [MDCT] could be a great option in these situations. We present a case of EFB in a child who presented with failure to thrive, had negative fibreoptic endoscopy, ultimately diagnosed conclusively on MDCT examination

Mycobacterium tuberculosis infection of the lungs: CD[+4] T cells and CD[+8] T cells in peripheral blood and their relation to disease outcome

To determine the frequency of CD[+4] and CD[+8] T-cells in peripheral blood [Pb] in the patients with Mycobacterium tuberculosis infection of the lungs and to assess their roles in disease recovery. Flow cytometric analysis of the Pb from 41 patients with active pulmonary tuberculosis and 20 healthy individuals as controls for determination the frequency of CD[+4] and CD[+8] T-cells in Pb. the frequency of CD[+4] and CD[+8] T-cells in Pb from patients with pulmonary tuberculosis was higher than controls [p<0.001 and 0.05 respectively]. The frequency of CD[+4] T-cells was higher than CD[+8] T-cells in Pb of pulmonary tuberculosis patients. The rate of recovery from active pulmonary tuberculosis was inversely related to the frequency of CD[+4] and CD[+8] T-cells being higher in SR, but less in RR and IR. More CD[+8] T-cells producing IFN-y, while more CD[+4] T-cells producing IL-10. there was a higher frequency of CD[+4] T cells in Pb of active pulmonary tuberculosis. The recovery from this disease requires fine balance between CD[+4] c CD[+8] T cells in Pb

Timoma do mediastino médio: relato de caso / Middle mediastinal thymoma: case report

Paciente do sexo feminino, 55 anos, branca, com sinais clínicos sugestivos de miastenia gravis há aproximadamente 3 meses. A prova terapêutica com neostigmina evidenciou melhora da disfagia e ptose palpebral. Na radiografia de tórax observou-se imagem ocupando o mediastino médio com projeção à direita. A tomografia computadorizada de tórax revelou a presença de massa no mediastino médio, sendo indicado o tratamento cirúrgico. Chamou nossa atenção a localização pouco usual, já que, preferencialmente, os timomas localizam-se no mediastino superior e anterior. A evolução pós-operatória foi boa, sem complicações.

Echocardiographic changes after peritoneovenous shunt for treatment of refractory ascites

Refractory ascites is frequently a manifestation of end stage liver disease, and is most often associated with a poor prognosis. The efficacy and complications of peritoneovenous shunt have given conflicting results. The use of Denver shunt as a line of therapy is expected to add a more preload to the heart in such patients. The aim of the present echocardiographic study is to evaluate such expected changes in cardiac function in those patients. Ten patients with tense, refractory ascites [age ranged 36-52 years] were carefully selected for Denver peritoneovenous shunt and followed up clinically, and echocardiographically in the period from January 1998 to January 2000. The left ventricular outflow tract diameter was found to be sign increased after shunt operation [P<0.05], reflecting a deleterious effect on left ventricular function. In addition the right ventricular diastolic diameter as well as the tricuspid valve excursion were sign increased [p < 0.05, < 0.01 respectively]. Moreover the right ventricular function showed a sign reduction in right ventricular pre-ejection period / right ventricular ejection time RVPEP / RVET [p<0.05], reflecting both increased tricuspid valve flow as well as pulmonary hypertension with de creased right ventricular systolic function. It could be concluded that the major hemodynamic changes in cirrhotic patients with refractory ascites early after Denver shunt consist of exaggeration of hyperkinetic state and a minor rise of pulmonary artery pressure. Therefore it may be recommended that a preoperative echocardiographic evaluation of both cardiac function and pulmonary artery pressure determination is mandatory in cirrhoticpatients with refractory ascites

Does schistosomiasis play a role in the high sero prevalence of HCV antibody among Egyptians?

Many studies have demonstrated a very high prevalence of HCV antibodies among blood donors (BD) and chronic liver disease (CLD) patients in Egypt. This high prevalence might be attributed to cross reactivity between HCV antibodies and schistosome antibodies. We decided to study the association and cross serology between the presence of anti-HCV and Schistosomal infection among BD and CLD patients. Sera of blood donors and CLD patients were tested for anti-HCV by second generation ELISA. Antibodies to Schistosoma species were quantified by IHA test. Two tailed z score was used to detect significant difference. To test for cross reactivity between the two antibodies 20 BD and 20 CLD patients positive for both HCV-antibody and schistosome antibody were taken as controls. Another 20 samples also served as a control group; 10 of them seropositive for HCV only and 10 positive for IHA for schistosomiasis alone. All were subjected to: 1) RIBA-2 confirmatory test 2) Adsorption of schistosome antibodies using 100 microgram schistosome antigens per 100 microliters serum 3) Both HCV-ELISA-2 and RIBA-2 were checked after adsorption. The titre of schistosome antibodies in positive sera ranged from 1:128 to 1:1536. HCV seroprevalence was more pronounced among antischistosomal positive sera. This was seen in both BD and CLD patients where antischistosomal positive sera were at double risk to show positive HCV antibody. After adsorption of schistosome antibody, there was no change in reactivity of both ELISA-2 and RIBA-2. We conclude that HCV antibodies were significantly higher in schistosomal antibody positive Egyptians, there was no cross reactivity between the two antibodies and the high prevalence could be due to HCV transmission during anti-bilharzial parenteral therapy or due to depressed cell mediated immunity associated with schistosomal infection.

velopment and characterization of a potential sustained release melatonin formulation: a possible modulatory influence of melatonin on glutathione s-transferases enzymes in rats

In this study, melatonin treatment in rats produced a significant elevation in hepatic cytosolic activity levels of GSTs and GSH-Px as well as glutathione [GSH] content with a reduction in lipid peroxide compared with the corresponding controls. In this study, a new preparation of melatonin "melatonin resinate-loaded microcapsules" was used. It prolonged and sustained the effect of melatonin up to 6 hours instead of 24 minutes [the half life in pure melatonin]. These new preparations produced a significant marked effects of melatonin on induction of GSTs and GSH-Px enzymes systems. It was concluded that melatonin particularly melatonin resinates loaded microcapsules induced the GSTs and GSH-Px enzyme systems in liver and this effect was potent than phenobarbitone. It was also suggested that melatonin exerts its antioxidants protective effects by stimulating the activities of detoxifying enzymes and may be through its direct antioxidant effects

Evaluation of portal hemodynamics in patients with refractory ascites before and after periteneo-venous shunt

Twenty patients with tense refractory ascites due to bilharzial and/or posthepatic cirrhosis [age ranged 30-60 years] were carefully selected for Denver peritoneojugular shunt [PJS] and followed up clinically and the portal vein was examined before and after shunt for evaluation of portal hemodynamics. The shunts were effective in relieving medically resistant ascites. The portal pressure increased, especially in the early postoperative period and then gradually decreased to the preoperative value. Denver peritoneovenous shunt has a higher patency rate and it is associated with fewer complications. Partial paracentesis, potent diuretics and beta blocker was recommended immediately before operation to minimize the incidence of variceal hemorrhage after shunt due to increase in portal pressure

Diagnostic markers of physically abused children in autopsy cases

This study was performed on 15 cadavers of physically abused babies to identitydiagnostic markers, particularly at both radiological and histopathologicallevels. For every case, complete external examination and X-ray imaging weredone. Autopsy was performed and histopathological specimens were taken frombrain, heart, lungs, liver, spleen, kidneys and areas of skin containingrecent or old traumatic or pathological lesions. Samples were processed andexamined by light microscopy. Some new changes were revealed, particularly atthe histopathological level including fibrotic changes in both spleen andliver, recent bleeding on top old scars or keloids and papillomatosis of skin. Other diagnostic features were also found such as the string beaded appearanceof malunited fractured ribs, the calcified hematoma and cortical splitting oflong bones, the rheumatoid-like deformity of interpharyngeal joints and thewide- spread cautery burns. In all cases, multiplicity of traumatic lesions[particularly the old ones] was the predominating factor