Oral Candida isolates in patients undergoing radiotherapy for head and neck cancer: prevalence, azole susceptibility profiles and response to antifungal treatment.

Oral pseudomembranous candidiasis and mucositis were assessed in 39 patients receiving a total dose of 39-70 Gy radiotherapy for head and neck cancer. Mucositis was scored using the Radiation Therapy Oncology Group criteria, and oral candidiasis was diagnosed on the basis of clinical evaluation and quantitative laboratory findings. Radiation-induced mucositis was observed in 9/39 patients. Only 3/39 patients discontinued radiotherapy due to acute severe mucosal effects. Candidiasis (colony-forming units 35 to > or = 60/lesion) associated with mucositis was diagnosed in 30/39 patients: the most frequent aetiology of the infection was Candida albicans (n = 23), followed by Candida glabrata (n = 3), Candida krusei (n = 2), Candida tropicalis (n = 1) and Candida kefyr (n = 1). Patients with confirmed oral pseudomembranous candidiasis were treated with either fluconazole 200 mg/day or itraconazole 200 mg/day for 2 weeks. Clinical improvement and concomitant negative Candida cultures (mycologic cure) were the criteria determining a response to antifungal treatment. Etest revealed very low voriconazole MICs (0.004-0.125 microg/ml) for all isolates, and fluconazole resistance for eight C. albicans strains (MIC > 64 microg/ml) and for the C. krusei isolates (MIC > 32 microg/ml). The same strains showed itraconazole susceptibility dose dependence (MIC 0.5 microg/ml). Despite the itraconazole susceptible dose dependent MIC readings, all patients with oral pseudomembranous candidiasis caused by these strains responded to antifungal treatment with 200 mg/day itraconazole. Oral mycologic surveillance of patients undergoing radiotherapy for head and neck malignancies and susceptibility testing of isolates may be indicated in cases with mucositis-associated confirmed oral pseudomembranous candidiasis to ensure prompt administration of targeted antifungal treatment. On the basis of the low MIC values found, clinical evaluation of voriconazole is indicated for management of oral pseudomembranous candidiasis refractory to other azoles.

Prevalence of obesity in Greek hypertensives.

An association of obesity and hypertension is well recognised and there is a direct positive relationship between body weight or body mass index (BMI) and blood pressure (BP), although the mechanisms responsible for weight-related increases of BP are still unknown. Obesity does appear to be an independent risk factor for premature mortality, especially when it is associated with other risk factors such as hyperinsulinemia and glucose intolerance (or diabetes), hyperlipidemia, and hypertension. However, there are differences among racial and ethnic subgroups. The aim of our study was the investigation of the prevalence of obesity and its severity among Greek hypertensive patients in comparison to normotensive controls. We have studied a large enough sample of Greek hypertensives consisting of 1101 patients (504 male/597 female, 23-85 years of age) and 242 normotensive controls (136 male/106 female, 23-75 years of age). In all patients and normotensive controls BMI (ie weight/height in 2mm) was measured, as well as the waist-to-hip (W/H) ratio. A BMI of less than 27 was accepted as normal, a BMI of 27-32 as indicating mild to moderate obesity, a BMI of 32-37 as an index of severe obesity, and a BMI > 37 as a measure of very severe obesity. Obesity in hypertensive patients was more frequent than in normotensive controls (62.5% vs 54.2%, P = 0.024), and hypertensive women were more commonly obese than hypertensive men (67.16% vs 56.8%, P = 0.002). Severe and very severe obesity was more common in hypertensive women than in men (20.7% vs 9.68%, P < 0.001, and 8.1% vs 0.52%, P < 0.0001, respectively), although obesity of severe and very severe degree was equally found in hypertensives and normotensives of both sexes. BMI of all hypertensives was significantly greater in comparison to that of normotensives (30.13 +/- 0.44 vs 26.74 +/- 0.76, mean +/- s.e., P < 0.0001); W/H ratio of hypertensives was significantly greater than that of normotensives, indicating more frequent central obesity in hypertensives. We conclude that obesity in Greek hypertensive patients is more frequent than in normotensive controls, while hypertensive women have more severe obesity than hypertensive men, and are more frequently obese than men.