Disseminated protothecosis: Case report and review of the literature.

BACKGROUND: Human protothecosis is an uncommon infection caused by Prototheca spp that rarely infects humans. AIM: Description of a rare disease and a review of its articles. MATERIALS AND METHODS: We reported a 24-year-old man who presented with red-brown papules and plaques on the trunk's lateral side. We reviewed the literature about disseminated protothecosis and reported our experience with a patient with protothecosis between 2021 and 2023. RESULTS: Overall, 54 cases of disseminated protothecosis were evaluated, 39 were due to P. wickerhamii, 12 were due to P. zopfii (22.2%), and three were due to Prototheca spp. We found that males were more affected (37 cases, 68.5%) than females (16 cases, 29.6%). The mean age of patients was 39.53 ± 22.48 years. However, disseminated protothecosis can affect people of any age (1-80 years). In contrast to P. wickerhamii, which causes blood, skin, brain, and gastrointestinal tract infections, P. zopfii was mainly found in the blood (7/22) and did not have a significant difference in the mortality rate (P = 0.11). DISCUSSION: Disseminated protothecosis is a rare disease in immunocompromised patients but is generally rarer in immunocompetent hosts. Several underlying disorders include immunocompromised patients, prolonged application of steroids, diabetes mellitus, malignancies, organ transplantation, AIDS, and surgeries. Amphotericin B has been the most effective agent for protothecosis and is reserved for visceral and disseminated infections. Regarding localized cutaneous types, excision or surgical debridement is used. CONCLUSION: Mulberry's appearance and appropriate cultural environments are helpful in diagnosing it.

Antimicrobial and anti-biofilm properties of oleuropein against Escherichia coli and fluconazole-resistant isolates of Candida albicans and Candida glabrata.

BACKGROUND: Side effects associated with antimicrobial drugs, as well as their high cost, have prompted a search for low-cost herbal medicinal substances with fewer side effects. These substances can be used as supplements to medicine or to strengthen their effects. The current study investigated the effect of oleuropein on the inhibition of fungal and bacterial biofilm in-vitro and at the molecular level. MATERIALS AND METHODS: In this experimental study, antimicrobial properties were evaluated using microbroth dilution method. The effect of oleuropein on the formation and eradication of biofilm was assessed on 96-well flat bottom microtiter plates and their effects were observed through scanning electron microscopy (SEM). Its effect on key genes (Hwp1, Als3, Epa1, Epa6, LuxS, Pfs) involved in biofilm formation was investigated using the quantitative reverse transcriptase-polymerase chain reaction (RT-qPCR) method. RESULTS: The minimum inhibitory concentration (MIC) and minimum fungicidal/bactericidal concentration (MFC/MBC) for oleuropein were found to be 65 mg/ml and 130 mg/ml, respectively. Oleuropein significantly inhibited biofilm formation at MIC/2 (32.5 mg/ml), MIC/4 (16.25 mg/ml), MIC/8 (8.125 mg/ml) and MIC/16 (4.062 mg/ml) (p < 0.0001). The anti-biofilm effect of oleuropein was confirmed by SEM. RT-qPCR indicated significant down regulation of expression genes involved in biofilm formation in Candida albicans (Hwp1, Als3) and Candida glabrata (Epa1, Epa6) as well as Escherichia coli (LuxS, Pfs) genes after culture with a MIC/2 of oleuropein (p < 0.0001). CONCLUSIONS: The results indicate that oleuropein has antifungal and antibacterial properties that enable it to inhibit or destroy the formation of fungal and bacterial biofilm.

Antifungal susceptibility profile of yeasts isolated from the oral cavity of cats.

BACKGROUND: Microorganisms living in the oral cavity play an important role in health and disease of the host. Cats are susceptible to oral infections, and it is documented that fungi in the oral cavity could impact these infections. Antifungal resistance has been increasing in recent years. OBJECTIVES: This study was designed to identify yeast isolates from the oral cavity of healthy cats and to evaluate their antifungal susceptibility pattern. METHODS: Oral specimens were collected from 60 cats and cultured at 37°C for 10 days. Yeasts were isolated and identified. Their antifungal susceptibility pattern was determined according to CLSI M44-A. RESULTS: Three yeast genera were isolated, including Candida spp (55.5%), Rhodotorula spp (33.3%) and Hanseniaspora spp (11.1%). Antifungal susceptibility profiling showed that, apart from a dose-dependent effect of itraconazole, Hanseniaspora spp was susceptible to all seven drugs studied. The Candida species were susceptible to all drugs except ketoconazole (sensitivity 80%) and caspofungin (sensitivity 40%). In R. glutinis and R. minuta, 100% sensitivity was observed for amphotericin B, posaconazole, ketoconazole and voriconazole. CONCLUSIONS: The results suggest that, in comparison with humans and other animals, cats have a different oral mycoflora in terms of species, number and diversity. However, these isolates have similar susceptibility patterns to those seen in isolates from other animals and humans. More studies should be done to further characterize the oral mycobiota of cats and its role in oral infections.

Experiences of Nurses in Caring for Patients with COVID-19: A Qualitative Research.

Background: The Covid-19 disease was raised as a fundamental public health problem worldwide, and nurses were exposed to many problems and challenges at the front line of fighting this disease. Therefore, the present study aimed to explain the experiences of nurses who took care of Covid-19 patients. Materials and Methods: This study was a conventional content analysis qualitative study using Granheim and Lundman approach. The study participants included 20 nurses working in Corona referral hospitals in Isfahan, Iran. Participants were selected using purposive sampling and in-depth semi-structured interviews were conducted from September 2020 to March 2021. To assess the trustworthiness of the obtained data, credibility, dependability, confirmability, and transferability criteria were used. Results: Data analysis led to the production of 700 primary codes, 15 sub-sub-categories, 5 sub-categories and 2 main categories. These two main categories consisted ofpsychological reactions and organizational challenges. Negative emotional experiences and positive emotional experiences were placed in the category of psychological reactions and expectations from superiors, lack of facilities and resources and insufficient quality of care in the category of organizational challenges. Conclusions: The results of the present study showed that managers and policy- makers should prioritize the nursing empowerment to ensure effective epidemic fight and the psychological and financial support of Covid-19 ward nurses.

Relation between interfacial shear and friction force in 2D materials.

Understanding the interfacial properties between an atomic layer and its substrate is of key interest at both the fundamental and technological levels. From Fermi level pinning to strain engineering and superlubricity, the interaction between a single atomic layer and its substrate governs electronic, mechanical and chemical properties. Here, we measure the hardly accessible interfacial transverse shear modulus of an atomic layer on a substrate. By performing measurements on bulk graphite, and on epitaxial graphene films on SiC with different stacking orders and twisting, as well as in the presence of intercalated hydrogen, we find that the interfacial transverse shear modulus is critically controlled by the stacking order and the atomic layer-substrate interaction. Importantly, we demonstrate that this modulus is a pivotal measurable property to control and predict sliding friction in supported two-dimensional materials. The experiments demonstrate a reciprocal relationship between friction force per unit contact area and interfacial shear modulus. The same relationship emerges from simulations with simple friction models, where the atomic layer-substrate interaction controls the shear stiffness and therefore the resulting friction dissipation.

Targeted chitosan nanoparticles embedded into graphene oxide functionalized with caffeic acid as a potential drug delivery system: New insight into cancer therapy.

As a novel drug delivery technology, chitosan (CHI) nanoparticles are encapsulated in graphene oxide (GO) with caffeic acid (CA). The nanocarrier technique combines targeted drug delivery with molecular imaging to provide new cancer insights. Attachment of CA, an anticancer agent for controlled drug release, to functionalized graphene oxide (GON) utilizing 3-aminopropyltriethoxysilane (APTES) was followed by encapsulation of GO with folic acid (FA) attached CHI to produce this novel system. FT-IR was used to characterize and confirm the chemical production process. Brunau-Emmet-Teller (BET) analysis was used to validate multi-holes and nanometric dimensions (1-100 nm) and assess their drug administration use. Release and loading tests showed a pH dependence and implied CA hydrogen-bonding in GON. CA encapsulation and loading percentages are 86 % and 67 %, respectively. The acidic environment (pH 5.3) of tumor cells may produce a larger release of CA, and the release rate of CA maintains a constant trend, indicating the drug is released for more than a week (because the release rate has not reached zero). The proposed method provides a potential candidate for a novel drug delivery system in cancer therapy. The resulting nanohybrid system is a new way to combine biodegradable materials, that can be used in biomedical applications.

Use of InSAR data for measuring land subsidence induced by groundwater withdrawal and climate change in Ardabil Plain, Iran.

The Ardabil plain, with an approximate area of 1097.2 km2 in northwestern Iran, has experienced land subsidence due to intensive groundwater withdrawal and long seasons of drought in recent years. Different techniques have been used to investigate and evaluate subsidence in this region including: Global Positioning Systems (GPS), Levelling, and Geotechnical methods. These methods are typically expensive, time-consuming, and identify only a small fraction of the areas prone to subsidence. This study employs an Interferometric Synthetic Aperture Radar (InSAR) technique to measure the long-term subsidence of the plain. An open-source SAR interferometry time series analysis package, LiCSBAS, that integrates with the automated Sentinel-1 InSAR processor (COMET-LiCSAR) is used to analyze Sentinel-1 satellite images from October 2014 to January 2021. Processing of Sentinel-1 images shows that the Ardabil plain has been facing rapid subsidence due to groundwater pumping and reduced rainfall, especially between May 2018 to January 2019. The maximum subsidence rate was 45 mm/yr, measured at the southeastern part of the plain. While providing significant advantages (less processing time and disk space) over other InSAR processing packages, implementation of the LiCSBAS processing package and its accuracy for land subsidence measurements at different scales needs further evaluation. This study provides a procedure for evaluating its efficiency and accuracy for land subsidence measurements by comparing its measurements with the results of the GMTSAR and geotechnical numerical modeling. The results of geotechnical numerical modeling showed land subsidence with an average annual rate of 38 mm between 2006 and 2020, which was close to measurements using the InSAR technique. Comparison of the subsidence measurements of the Ardabil plain using the LiCSBAS package with results obtained from other techniques shows that LiCSBAS is able to accurately detect land deformation at large scales (~ km). However, they may not be optimized for more local deformations such as infrastructure monitoring.

A new real-time analog circuit of Ca2+ Li-Rinzel astrocyte model based on analytical method.

Different biological models are used to study physical behaviors in neural networks. So far, various models of neural network components such as neurons, synapses, and astrocytes have been proposed. An astrocyte is one of the crucial parts introduced in multiple models. A model of astrocytes used as a good reference in various papers is the Li-Rinzel calcium model. This paper presents a real-time analog circuit of the Li-Rinzel calcium model based on common-mode (CM) in 180 nm CMOS technology. To the best of our knowledge, this work is the first report to introduce a real-time analog circuit of Li-Rinzel model in an integrated standard CMOS technology. The careful design of equations and low power consumption are essential features of this circuit. The real-time behavior is also crucial compared with the accelerated time circuits presented so far.

Understanding the rheology of nanocontacts.

Mechanical stiffness, as opposed to softness, is a fundamental property of solids. Its persistence or rheological evolution in vibrating solid-solid nanocontacts is important in physics, materials science and technology. A puzzling apparent liquefaction under oscillatory strain, totally unexpected at room temperature, was suggested by recent experiments on solid gold nano-junctions. Here we show theoretically that realistically simulated nanocontacts actually remain crystalline even under large oscillatory strains. Tensile and compressive slips, respectively of "necking" and "bellying" types, do take place, but recover reversibly even during fast oscillatory cycles. We also show that, counterintuitively, the residual stress remains tensile after both slips, driving the averaged stiffness from positive to negative, thus superficially mimicking a liquid's. Unlike a liquid, however, rheological softening occurs by stick-slip, predicting largely frequency independent stiffness with violent noise in stress and conductance, properties compatible with experiments. The baffling large amplitude rheology of gold nanocontacts and its consequences should apply, with different parameters, to many other metals.

Comparative trachea transcriptome analysis in SPF broiler chickens infected with avian infectious bronchitis and avian influenza viruses.

Infectious bronchitis virus (IBV) and avian influenza virus (AIV) are two major respiratory infections in chickens. The coinfection of these viruses can cause significant financial losses and severe complications in the poultry industry across the world. To examine transcriptome profile changes during the early stages of infection, differential transcriptional profiles in tracheal tissue of three infected groups (i.e., IBV, AIV, and coinfected) were compared with the control group. Specific-pathogen-free chickens were challenged with Iranian variant-2-like IBV (IS/1494), UT-Barin isolates of H9N2 (A/chicken/Mashhad/UT-Barin/2017), and IBV-AIV coinfection; then, RNA was extracted from tracheal tissue. The Illumina RNA-sequencing (RNA-seq) technique was employed to investigate changes in the Transcriptome. Up- and downregulated differentially expressed genes (DEGs) were detected in the trachea transcriptome of all groups. The Kyoto Encyclopedia of Genes and Genomes pathway and Gene Ontology databases were examined to identify possible relationships between DEGs. In the experimental groups, upregulated genes were higher compared to downregulated genes. A more severe immune response was observed in the coinfected group; further, cytokine-cytokine receptor interaction, RIG-I-like receptor signaling, Toll-like receptor signaling, NOD-like receptor signaling, Janus kinase/signal transducer, and activator of transcription, and apoptotic pathways were important upregulated genes in this group. The findings of this paper may give a better understanding of transcriptome changes in the trachea during the early stages of infection with these viruses.

Ring population statistics in an ice lattice model.

We calculate the distribution probability of hexagonal six-site rings in the disordered state of a cubic or hexagonal ice lattice model with ice rules perfectly obeyed. The mean-field distribution obtained is in significant agreement with those, slightly different among them, obtained by Monte Carlo simulations of the cubic or hexagonal model. The results are discussed in connection with the equilibrium and non-equilibrium transition from disorder to ferroelectric proton order.

"Picture-in-Picture" Artifact: Introduction and Characterization of a Hitherto Unrecognized Imaging Artifact in Creating Perfusion Defects in Myocardial Perfusion Single-Photon Emission Computed Tomography.

Following a moving hot spot in the projections of raw images and profound perfusion defects in myocardial perfusion single-photon emission computed tomography (SPECT) imaging of a patient, a hypothesis was postulated that the perfusion defects were artifactual, and the high activity concentration of the gallbladder may be a culprit for this phenomenon, owing to flawed event positioning function of the gamma camera due to a malfunctioning digital event processor electronics board. To depict the characteristics of this artifact, a point source containing an activity of 3 mCi of pertechnetate is placed on the scanning table with the detector facing the table (at a distance of 30 cm), and then, in other detector positions and 1-min static images are acquired accordingly. The ratio is calculated as follows: count of the artifactual focus: 1860, count of the index focus: 705,727, and artifactual-to-index focus ratio: 0.003. In testing the uniformity of gamma camera based on the National Electrical Manufacturers Association protocol, a nonuniform response was detected, seemingly, a smaller field of view (FOV) is reproduced in the main FOV causing nonuniformity more than the acceptable level. The smaller flood image lies in the upper right corner of the main flood image. In essence, the extremely bright gallbladder was the source of error, and its image was reproduced in the FOV, which was superimposed on the left ventricular myocardium in some of the projections and was propagated to SPECT images.

Modeling the self-penetration process of a bio-inspired probe in granular soils.

Soil penetration is an energy-intensive process that is common in both nature and civil infrastructure applications. Many human construction activities involve soil penetration that is typically accomplished through impact-driving, pushing against a reaction mass, excavating, or vibrating using large equipment. This paper presents a numerical investigation into the self-penetration process of a probe that uses an 'anchor-tip' burrowing strategy with the goal of extending the mechanics-based understanding of burrower-soil interactions at the physical dimensions and stress levels relevant for civil infrastructure applications. Self-penetration is defined here as the ability of a probe to generate enough anchorage forces to overcome the soil penetration resistance and advance the probe tip to greater depths. 3D Discrete element modeling simulations are employed to understand the self-penetration process of an idealized probe in noncohesive soil along with the interactions between the probe's anchor and tip. The results indicate that self-penetration conditions improve with simulated soil depth, and favorable probe configurations for self-penetration include shorter anchor-tip distances, anchors with greater length and expansion magnitudes, and anchors with a greater friction coefficient. The results shed light on the scaling of burrowing forces across a range of soil depths relevant to civil infrastructure applications and provide design guidance for future self-penetrating probes.

A case series of concomitant burn and COVID-19.

BACKGROUND: The recently emerged severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19) has become a human pandemic. Heightened inflammation, vascular hyperpermeability, acute lung injury, coagulopathy, and cardiovascular abnormalities are among the SARS-CoV-2 infection-related complications. Major burn is also associated with metabolic derangements, vascular leak, and hemodynamic instability. Burn patients are at high risk for infections and developing sepsis. COVID-19 in burn victims might worsen the clinical outcome and make their medical management challenging. RESULT: Here, we present four cases of concomitant burn and COVID-19 with different degrees of complications. They had no (three out of four) or multiple (one out of four) baseline comorbidities and all were admitted to hospital for further management. Three out of four cases demonstrated acute respiratory failure and were intubated (no longer than 7 days). It seems that one of them had COVID-19 on arrival, the other apparently contracted at outside hospital, and the last two infected during the index hospitalization. CONCLUSION: Concomitant severe burn and COVID-19 might complicate the clinical presentation and hospital course. Such combination was associated with poor outcome in a case with baseline comorbidities, beyond what was expected from the severity of burn injury. However, a more comprehensive study with larger sample size is required to make a valid conclusion. With an ongoing COVID-19 global pandemic, SARS-CoV-2 infection might be a concurrent disease with other illnesses or traumas such as burn. This dictate multidisciplinary approaches to risk stratify, screen, assess, and manage coexisting diseases. Additionally, appropriate preparations and careful precautions need to be executed in burn units to prevent COVID-19 exposure and transmission to limit potential adverse outcomes.

Effects of Bunium persicum essential oil on the reduction of spore germination, growth, and expression of FUM1 and FUM14 genes in Fusarium verticillioides isolates.

BACKGROUND AND PURPOSE: Black Cumin of Kerman (Bunium persicum) is an Iranian plant that is commonly used as an antispasmodic, carminative, and antimicrobial substance. The present study aimed to assess different components of the essence of B. persicum and its effect on antifungal activity, spore germination inhibition, and expressions of FUM1 and FUM14 genes in Fusarium verticillioides strains. MATERIALS AND METHODS: The essence was extracted by hydrodistillation and analyzed through gas chromatography-mass spectroscopy. A broth microdilution method was used for the determination of the minimum inhibitory concentration (MIC). In addition, the expression of FUM1 and FUM14 genes of toxigenic F. verticillioides was assessed by using the real-time polymerase chain reaction (RT-PCR) technique. RESULTS: Based on the findings, most of the essence consisted of γ-terpinene (15.56%), propanal, and 2-methyl-3-phenyl (14.18%). The oil showed a good antifungal activity (mean MIC value: 2556.8 µg/ml) as well as the inhibition of spore germination and mycelial growth (P<0.05). The RT-PCR demonstrated that the expression levels of FUM1 and FUM14 of B. persicum-treated F. verticillioides were 0.43 and 0.53 folds lower than the control samples, respectively. CONCLUSION: These findings revealed that the essential oil of B. persicum has different components responsible for the inhibition of mycelial growth and spore germination of F. verticillioides as well as reduction of expressions of FUM1 and FUM14 genes involving fumonisin production.

Effects of a Comprehensive Care Program on the Readmission Rate and Adherence to Treatment in Elderly Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: The low treatment adherence of patients with chronic obstructive pulmonary disease (COPD) leads to the exacerbation of their symptoms and readmission. Comprehensive care programs are among interventions that can improve the patients' adherence to treatment and prevent readmission. The present study aimed to evaluate the effects of a comprehensive care program on the adherence to treatment and readmission of COPD patients. MATERIALS AND METHODS: This randomized clinical trial was performed in a hospital in Rafsanjan, Iran, in 2017. Sixty elderly patients with COPD were randomly enrolled in this study by pair-matching. The intervention group participated in a comprehensive care program, whereas the control group received routine care. The readmission rate and adherence to treatment were measured at one-, three-, and six-month intervals. To evaluate the patients' adherence to treatment, an adherence-to-treatment questionnaire for chronic diseases was used. Data were analyzed using Chi-square test, independent t-test, and repeated measures ANOVA at a significance level of 0.05. RESULTS: A significant difference was observed between the two groups in terms of readmission at the end of the study (P=0.03). In the intervention group, the mean level of adherence to treatment and its subscales improved as compared to the control group, and there was a significant difference between the two groups. CONCLUSION: Although most of the patients in this study were old, with a rather low educational level and socioeconomic status, the care program could improve their treatment adherence and reduce the readmission rate.

Effect of microencapsulation on Saccharomyces cerevisiae var. boulardii viability in the gastrointestinal tract and level of some blood biochemical factors in wistar rats.

BACKGROUND AND OBJECTIVES: Probiotics are live microorganisms that, when administered in an adequate amount, confer a health benefit on the host through the gut. Saccharomyces cerevisiae is a widespread yeast found in nature. This microorganism has been used as a probiotic agent in recent years. In this study, the effect of microencapsulation on survival rate of S. cerevisiae var. boulardii in the simulated gastrointestinal tract medium and the impact of microencapsulated S. cerevisiae var. boulardii on some serum biochemical factors in a rat model was evaluated. MATERIALS AND METHODS: 30 male wistar rats were divided into three groups (control, rats receiving microencapsulated S. cerevisiae var. boulardii, and rats receiving S. cerevisiae var. boulardii alone). The probiotic was gavaged at a dosage of 2 gr/kg BW for 8 weeks. Blood was collected from rats at the end of the treatment period and biochemical factors were measured using Mancompany kits. RESULTS: The results showed a significant increase in viability of microencapsulated S. cerevisiae var. boulardii in comparison with free S. cerevisiae var. boulardii (p<0.05). Weight of rats in probiotic treated groups was significantly higher in comparison with the control group (p<0.05). Moreover, probiotic treatment reduced mean levels of triglycerides, cholesterol, free blood sugar and liver enzymes in rats. CONCLUSION: Microencapsulation could increase the survival rate of yeast probiotics in the gastrointestinal tract; however, more studies are needed for better understanding of the exact effect of microencapsulation on probiotics' function.

Active repurposing of drug candidates for melanoma based on GWAS, PheWAS and a wide range of omics data.

BACKGROUND: Drug repurposing is a swift, safe, and cheap drug discovery method. Melanoma disorders present low survival and high mortality rates and are challenging to diagnose and treat. Moreover, there is a high volume of worldwide investigations that are attempting to find melanoma-related genes of influence, which can be identified as responsive targets for reliable treatment. METHOD: In this study, we used a wide range of data analyses to analyze over 1100 genes and proteins of influence with respect to cutaneous malignant melanoma. Our analysis included various investigational results from genome- and phenome-wide association studies (GWAS and PheWAS, respectively), biomedical, transcriptomic, and metabolomic datasets. We then researched the DrugBank for potential melanoma targets from the selected list. We excluded known melanoma targets to obtain a list of druggable proteins. We performed a precise analysis of the drugs' pathogenesis and checked the expression profiles of the selected drugs having high associations with known anti-melanoma drugs. RESULT: We found 35 drugs that interacted with 20 unique targets. These drugs appear to have high melanoma treatment potentials. We confirmed our results with previous studies and found supporting references for 30 of these drugs. In conclusion, this investigation can be applied to various diseases for the efficient and economical repurposing of various drug compounds. For further validation, the results may be applicable for in vivo tests and clinical trials.

Systematic analysis of genes and diseases using PheWAS-Associated networks.

Several scientific sources have reported different causes of various diseases. One of these factors is genetic variation. Natural selection, molecular evolution and susceptibility to external conditions are the main causes of genetic variations. Phenome-Wide Association Studies (PheWAS) can emphasize the associations of genetic variations and diseases. The systematic analysis of these associations can highlight various important aspects of gene correlations and disease relationships. In this study, we have investigated a systematic approach to analyze associated networks of genes and diseases to explore novel scientific information. We have constructed the Associated Gene Network (AGN, n = 1769) and the Associated Disease Network (ADN, n = 503) based on common diseases and genes, respectively. We have evaluated these networks based on topological measures and compared them with a randomized null network. The comparative modular analysis based on size and quantity is a clear indication of the significance of these networks. We have found numerous novel associations of genes involved in different diseases. We have also found different diseases related to one another, which can correlate scientific evidence. We have verified our analysis through GO and KEGG enrichment for different case studies and concluded that AGN and ADN can be used as reference biological networks for various purposes such as drug design and drug repurposing.

Synergistic anticandidal activity of menthol in combination with itraconazole and nystatin against clinical Candida glabrata and Candida krusei isolates.

BACKGROUND: Candida glabrata (C. glabrata) and C. krusei are now emerging as serious hospital acquired infections in immunocompromised patients. Menthol, a terpenic compound, has been reported to have antifungal activity. OBJECTIVES: The aim of this study was to investigate the effect of menthol in combination with itraconazole or nystatin against C. glabrata and C. krusei isolates. METHODS: The effects of menthol along with itraconazole and nystatin, were evaluated by the Clinical Laboratory Standards Institute (CLSI) M44-A and CLSI M27-A3 methods. The fractional inhibitory concentration index (FICI) was determined for menthol plus itraconazole and nystatin combinations using the checkerboard method. RESULTS: The mean of minimum inhibitory concentration (MIC) values of menthol, nystatin and itraconazole were 53.2, 2.30 and 1.50 µg/ml for C. glabrata isolates and 121, 1.08 and 0.38 µg/ml for C. krusei isolates, respectively. Menthol in combination with itraconazole or nystatin exhibited the synergistic effects against all species of Candida tested. FICI values for menthol plus itraconazole and nystatin combinations ranged from 0.250 to 0.561 and 0.139 to 0.623 for C. glabrata isolates, and 0.182 to 0.750 and 0.188 to 0.760 for C. krusei, respectively. CONCLUSIONS: These results support the potential use of menthol as an anticandidal agent, and it can be used complementarily with other conventional antifungal agents.