Rapid differentiation of candida dubliniensis from candida albicans by early D-xylose assimilation

To determine if D-xylose [XYL] and/or alpha-methyl-D-glucoside [MDG] assimilation can be used reliably as a rapid test to differentiate Candida dubliniensis from Candida albicans at an earlier time point such as 2 h after inoculation. Thirty isolates of C. albicans and C. dubliniensis recovered from anatomical sites and clinical specimens were used. Isolates were inoculated into the API 20C AUX yeast identification system, and incubated at 30[degree sign]C. XYL and MDG assimilations were read at 2-hour intervals beginning 2 h after the initial inoculation and up to 24 h of incubation; thereafter, results were read after 48 and 72 h. Twenty-nine [97%] C. albicans isolates had assimilated XYL at 16 h and, by 24 h, all isolates were positive for XYL assimilation. None of the C. dubliniensis isolates assimilated XYL. The MDG assimilation revealed that 24, 40, 92 and 100% of C. albicans isolates became positive after 16, 24, 48 and 72 h of incubation, respectively, whereas only 3% of C. dubliniensis isolates assimilated MDG after 72 h. The findings showed that it is possible to rapidly differentiate C. albicans from C. dubliniensis isolates using the API 20C AUX carbohydrate assimilation kits after 16 h of incubation at 30[degree sign] C based on the XYL assimilation

Effects of Subtherapeutic concentrations of chlorhexidine gluconate on germ tube formation of oral candida

The main objective of this study was to investigate the effect of brief exposure to subtherapeutic concentrations of chlorhexidine gluconate on germ tube formation of Candida albicans isolates obtained from smokers, diabetics, asthmatics using steroid inhalers and healthy individuals. Forty isolates of C. albicans were used in this study. All these isolates were quantified for germ tube formation without exposure to the drug and were used as the control group for data analysis. Isolates were also exposed to three subtherapeutic concentrations of chlorhexidine gluconate [0.00125, 0.0025 and 0.005%] for 30 min [limited exposure]; the antiseptic was then removed and germ tube formation of these isolates was quantified microscopically following incubation in a germ tube-inducing medium. Compared with the unexposed controls, brief exposure to all concentrations of chlorhexidine gluconate suppressed the ability of the C. albicans isolates to form germ tubes in increasing order by 13.72% [p < 0.001 to p = 0.02], 46.16% [p < 0.001] and 72.46% [p <0.001]. These findings show that brief exposure to subtherapeutic concentrations of chlorhexidine gluconate may modulate germ tube formation of C. albicans isolates, thereby suppressing their pathogenicity, and further elucidate the pharmacodynamic mechanisms by which chlorhexidine gluconate may operate in vivo

Legionella in clinical specimens and hospital water supply facilities: molecular detection and genotyping of the isolates

To evaluate genus- and species-specific polymerase chain reactions [PCRs] for the detection of the genus Legionella and the species Legionella pneumophila in clinical specimens and hospital water supplies, and to establish a simple and reproducible random amplification of polymorphic DNA [RAPD]-PCR technique for genotyping of Legionella. A total of 70 respiratory tract specimens [bronchoalveolar lavage: n = 46; endotracheal secretions: n = 9; sputum: n = 15] from patients with atypical pneumonia, and 283 environmental samples [water: 20; swabs: 263] collected from water storage and supply facilities of the Mubarak Al-Kabeer Hospital, Kuwait, were tested by culture and genus-specific PCR for the detection of Legionella. The L pneumophila isolates were subsequently typed by serology and RAPD-PCR using serotype-specific sera and arbitrary primers, respectively. Of the 70 clinical samples, culture yielded 2 [2.9%] whereas genus-specific PCR detected Legionella in 20 [28.6%] samples. The 2 culture-positive specimens were also positive for L.-pneumophila-specific PCR. Testing of swab and water samples by culture and genus-specific PCR yielded 61 [21.6%] and 67 [23.7%] positive samples, respectively. All of the 61 culture-positive samples were also positive by genus-specific PCR and 45 of them were positive for L.-pneumophila-specific PCR. Serological typing of 43 L pneumophila isolates showed that 8 of these belonged to serotype 1 and 35 to serotype 3; however, RAPD-PCR analyses demonstrated polymorphisms among the isolates of both serotypes. A higher association between PCR and culture was observed for the environmental samples than for the clinical samples. The application of genus- and species-specific PCRs and RAPD is useful in the detection and typing of Legionella in clinical and environmental samples

Eradication of H. Pylori by quadruple or triple therapy.a comparative study

Quadruple therapy appears to be more effective than standard therapy in management of patients with helicobacter pylori infection. No data is available on the relative efficacy of triple and quadruple drug regimens from Pakistan. Consecutive patients with peptic ulcer and H. pylori infection were randomized to receive omeprazole 20 mg twice daily along with either amoxycilline [500 mg four times daily] and clarithromycin [500 mg twice daily] [Group A] or tri-protassium dicitrate hismuthate [120 mg four times daily], metronidazole [400 mg thrice daily] and tetracycline [500 mg 4 times daily] [Group B] for 10 days. Presence H. Pylori infection was looked for using an fecal antigen test before treatment and 30 days after completion of treatment. 17 of 21 patients in Group A and 16 of 23 in Group B had eradication of infection [80.9 and 69.56% respectively by protocol analysis]. Side effects occurred in 2 [1%] and 4[2%] patients in Group A and B, respectively. Discontinuation of drug was not required in any patient. Quadruple therapy for initial therapy of H. Pylori infection does not offer any advantage over standard triple therapy

Siriraj score as a tool for clinical diagnosis of stroke

Siriraj stroke score is a diagnostic tool to differentiated ischemic from haemorrhagic shock. This study was carried out to access SSS accuracy as compared to CT scan. This study was carried out in the Department of Medicine and Neurology of Mayo Hospital, Lahore. Thirty two patients were included in the study who had stroke SSS was applied as well as CT scan was done. Out of them 6% were misdiagnosed. Overall predictive accuracy was 87.5%. Siriraj stroke score is not 100% accurate. CT scan should be advised before starting definitive stroke therapy

Transversely meshed skin grafting for aesthetically sensitive areas

Meshing of split thickness skin grafts [SSG] improves the chances of their 'take' by allowing blood and exudates to escape. Traditional wide meshing has a major disadvantage of having a cosmetically compromised checkerboard or lizard skin appearance. For which reason they can not be used on aesthetically sensitive areas like head and neck and extremities. Unmeshed SSG does not ensure adequate drainage and at times results in poor 'take'. Transverse meshing ensures better drainage and its cosmetic appearance is also comparable to that of unmeshed SSG. The objective of this study has been to analyze the advantages of this novel technique in skin grafting and see its efficacy over un-meshed grafts. An original article based on a prospective, observational study. A total number of 69 patients were studied between October 1999 and April 2003. Both male and female patients of all age groups were selected, ranging between 11/2 and 70 years. Patients selected for skin grafting inc luded those with wounds caused by burns, degloving injuries of the scalp, genitalia, hands and feet and post burn contractures of the neck and extremities, and flap donor sites [see table below]. Skin grafts were harvested with a pneumatic dermatome. A mesher board of 1.5: 1 expansion was cut into two equal halves which were placed side by side with the grooved side up. Skin grafts were applied and secured in the standard fashion. The patients were followed up on outpatient basis. Graft success rate was 93% with acceptable cosmetic appearance. There was a total loss of two grafts [2.7%] and partial loss of three [4.3%]. The healing of the graft was excellent. Transverse meshing is a new technique in meshed skin grafting with improved 'take' and acceptable cosmesis as compared to unmeshed skin grafts. This technique can obviate the need for two- stage skin grafting for areas where wide meshing is not desirable

Causes and outcome of suicidal cases presented to a medical ward

Suicide is one of the leading causes of death in world but its causes and methods may vary. We enrolled patients who presented to the emergency with attempted suicide. The end point was death, discharge or leaving the hospital against medical advice. The study was designed to know the modes of committing suicide and underlying causes. Of the total 107 patients, who presented to the emergency 59 [55%] were males and 48 [45%] were females. Most common poison ingested was wheat pill in 35 [33.3%] patients followed by bleach/bathroom cleaner in 27 [25.7%], benzodiazepines in 20 [19%] and a small proportion of patients had copper sulfate, organophosphorus compounds, rat pills, lice powder, dettol and varnish. Two patients presented after hanging. Twenty eight [26%] patients died, just after reaching hospital and 10 had permanent disability. For suicide the most common poisons used were those that were easily available and without any ban on their sale. So general awareness should be created among masses about them and legal restrictions should be imposed on their sale

audit of indoor morbidity and mortality in a medical ward at a tertiay care, hospital

There is a great geographical variation in disease burden around the world, which is due primarily to environmental, genetic, social and economic factors. Similar variations exist in worldwide mortality figures from a particular disease that can be attributed almost entirely to the access and efficacy of healthcare facilities. We did this audit to identify the major causes of morbidity and mortality in patients admitted in a medical unit of a tertiary care hospital and to highlight the importance of primary prevention. The audit was carried out in West Medical Ward Mayo Hospital Lahore, Pakistan from 1st January 2004 to 31st December 2004. All patients admitted with medical problems from the Outpatient and Emergency Departments were included. During the year 2004, a total of 2045 patients were admitted, out of which maximum number of patients admitted in the ward were suffering from chronic liver disease [17%] followed by ischemic heart disease [14.4%] cerebrovascular accidents [10.4%] and renal diseases. Total number of deaths were 321 with male mortality was 167 [14.40%] and female mortality 154 [17.40%]. Chronic liver disease also had the highest mortality [16.8%] followed by cerebrovascular accidents [14%], renal disease [11.5%] and ischemic heart disease [7.8%]. Even the mortality due to chronic liver disease was significantly higher [p <0.01] than ischernic heart disease. The number of patients having the four common diseases having age 45 years or more [770] was significantly greater [p <0.0001] then the number of patients [279] in the age range of 15 to 44 years. It was observed that significantly greater number of male patients [595] had morbidity than females [462], [p <0.0001], while mortality has no difference. Chronic liver disease, ischemic heart disease and cerebrovascular accidents are the diseases putting maximum burden on our health resources and disabling our productive population. This audit highlights the fact that all these three groups of diseases can be prevented and thus obviates the need of primary prevention of these major killers

Pulmonary nocardia transvalensis infection: a case report and review

Infections due to Nocardia transvalensis are rare; only five cases of isolated primary pulmonary disease due to this species have been previously reported. Our patient is a 53-year-old diabetic who developed primary pulmonary N. transvalensis pneumonia and who was successfully treated with trimethoprim-sulfamethoxazole and amikacin. A summary of the published cases with N. transvalensis infection is included. The report emphasizes the increasing importance of N. transvalensis as an etiologic agent of pulmonary disease in immunosuppressed patients

Systemic mycoses: the changing spectrum in contemporary medicine

The last twenty years have witnessed a dramatic increase in the incidence of systemic fungal infections throughout the world. While acquired immunodeficiency syndrome [AIDS] has emerged as a single most important risk factor for endemic mycoses, a variety of iatrogenic and other factors continue to predispose a significant proportion of immunosuppressed patients to infection with fungal pathogens. Amongst the endemic mycoses, histoplasmosis has become an important opportunistic infection largely in mid-west, coccidioidomycosis in south-west and blastomycosis in south-central of the USA. In southeast Asia, penicilliosis due to Penicillium marneffei has emerged as a major endemic mycosis of AIDS patients. Opportunistic yeast infections have become more common than infections caused by filamentous fungi, occupying fourth position in the list of bloodstream pathogens in some centers. Also, their incidence, pattern of clinical presentation and species spectrum has significantly altered, largely due to more frequent and prolonged use of antifungal drugs and subsequent development of resistance. Consequently, infections with less susceptible yeast species such as Candida lusitaniae, C, krusei, C. tropicalis, C. glabrata, and Trichosporon beigelii have been reported with greater frequency. The problem of antifungal resistance is likely to expand in future as more and more patients with AIDS, bone marrow transplant, and neutropenia will need chemoprophylaxis cover. Amongst other fungal infections, aspergillosis has emerged as an important disease in bone marrow transplant recipients, cryptococcosis and penumocystosis in patients with AIDS, fusariosis in leukemics receiving cytotoxic therapy, zygomycosis in diabetics and in haemodialysis patients on deferoxamine therapy and Malassezia furfur infection in patients receiving intravenous lipid emulsions. Never before in the history of medicine, opportunistic systemic mycoses were so important as they are today. The factors contributing to the rising incidence of these life-threatening infections are unlikely to recede; rapidly expanding population of AIDS patients in Africa and Asia is just one example. Under this rapidly changing scenario, the need to create a greater awareness about their epidemiology, diagnosis and therapy is imperative

Incidence of medical problems at high terrestrial altitudes: a retrospective study

Data covering the 3 year period, 1 986-88 from the forward area hospitals [60 CCS and 50 CCS] receiving patients from units operating in high altitude areas reveal an average admission per year of 202 cases due to high altitude medical problems. Frost bite was the commonest [49.8%] high altitude medical problem followed by acute mountain sickness [AMS] [30.7%], high altitude pulmonary edema [HAPE] [13.9%], high altitude cerebral oedema [HACE] [3.1%] snow blindness [1.7%] and hypothermia [0.8%] respectively. More than 90% patients were in 20-39 years age group. Maximum number [84.4%] of high altitude cases occurred between 12000 to 20000 feet height. More [59.2%] high altitude cases occurred among lowlanders as compared to high landers [40.8%]. The disease was mild in 32% cases and severe in 63.3% cases