Cutaneous effects associated with fluconazole in patients treated for coccidioidomycosis.

BACKGROUND: Fluconazole is the most commonly used antifungal treatment for various forms of coccidioidomycosis. Although we had anecdotally observed a high proportion of patients reporting cutaneous adverse effects associated with fluconazole treatment, this observation was not well described in the medical literature, and we were unsure of the additional effect of the arid desert environment of Arizona. METHODS: We performed a one-time, voluntary survey of patients with coccidioidomycosis and compared the responses of patients treated with fluconazole with those of untreated patients. RESULTS: From January 1, 2015, to August 22, 2017, 62 fluconazole-treated and 35 untreated patients with coccidioidomycosis provided consent and were enrolled in the study; demographics were similar between the two groups. Among the 62 fluconazole-treated patients, daily dosages ranged from 200 mg to 800 mg. However, most (44/62, 71%) took 400 mg daily, the typical dose for the treatment of coccidioidomycosis. The median fluconazole treatment duration at the time of study participation was 6 months. When compared with untreated patients, those taking fluconazole had more moderate to severe dry lips (74.2% [46/62] vs. 23.5% [8/34]; P < 0.001), dry skin (45.8% [27/59] vs. 22.9% [8/35]; P = 0.03), and alopecia (31.1% [19/61] vs. 11.4% [4/35]; P = 0.004). CONCLUSIONS: For the treatment of coccidioidomycosis, patients receiving fluconazole reported significantly more severe cutaneous effects, including dry lips, dry skin, and alopecia, than untreated patients. Our findings identify an association but do not prove causality.

A New Resource for STD Clinical Providers: The Sexually Transmitted Diseases Clinical Consultation Network.

An online consultation tool, the Sexually Transmitted Diseases Clinical Consultation Network is a new resource for sexually transmitted disease clinicians and clinic managers. An initial evaluation shows that most requests (29%) were from medical doctors, followed by nurse practitioners (22%). Syphilis queries comprised 39% of consults followed by gonorrhea (12%) and chlamydia (11%).

Integrative Medicine Preferences Among Coccidioidomycosis (Valley Fever) Patients.

OBJECTIVES: To understand the extent and modalities of integrative medicine strategies that patients with coccidioidomycosis (valley fever) have incorporated into their treatment regimens. DESIGN: A direct patient survey was distributed, with 100 unique responses, at a single infectious diseases clinic at an academic medical center in Arizona. Eligible patients, defined as those with confirmed coccidioidomycosis or currently under evaluation, were polled on their personal use of 36 integrative medicine modalities. Patients were also asked to indicate their level of fatigue on a 10-point scale in an attempt to correlate levels of fatigue to use of specific integrative medicine modalities. RESULTS: Of the patients surveyed, 64% had used at least one integrative medicine modality, and 53% used two or more, along with conventional medical therapy. The top three modalities were nutrition (39%), massage (27%), and breathing exercises (26%). The mean reported fatigue level was 4.7 on a 10-point scale, with a standard deviation of 3.0. There was no statistically significant association between use of a specific modality and reported level of fatigue. CONCLUSIONS: Nearly two thirds of patients (64%) surveyed had used at least one integrative medicine modality throughout the course of their therapy. Clinicians are probably unaware of the extent to which many patients, including this population, have embraced integrative medicine. Awareness of patients' goal and preferences is valuable in shared clinical decision making.

A Knowledge Management Framework and Approach for Clinical Development.

A knowledge management (KM) framework enhances knowledge gathering, sharing, application, and retention within clinical development and enables the effective and successful implementation of a clinical quality management system (QMS). The goal of managing knowledge is to improve organizational performance by getting the right information to the right people at the right time. The concepts of KM have been around for decades but, to date, have not been widely adopted within the clinical development arena. Implementing a structured approach and strategy to managing knowledge can enable more timely and informed decision making, enhance quality and productivity, and ultimately support the delivery of new products to patients. This paper outlines in general terms key elements of a clinical knowledge management (CKM) framework to assist clinical development organizations in understanding its benefits and basic components. Ideas are provided at a high level for flexible approaches and solutions aimed to enhance knowledge gathering, sharing, application, and retention within clinical development.

Dietary fat content and fiber type modulate hind gut microbial community and metabolic markers in the pig.

Obesity leads to changes in the gut microbial community which contribute to the metabolic dysregulation in obesity. Dietary fat and fiber affect the caloric density of foods. The impact of dietary fat content and fiber type on the microbial community in the hind gut is unknown. Effect of dietary fat level and fiber type on hindgut microbiota and volatile fatty acid (VFA) profiles was investigated. Expression of metabolic marker genes in the gut, adipose tissue and liver was determined. A 2 × 2 experiment was conducted in pigs fed at two dietary fat levels (5% or 17.5% swine grease) and two fiber types (4% inulin, fermentable fructo-oligosaccharide or 4% solka floc, non-fermentable cellulose). High fat diets (HFD) resulted in a higher (P<0.05) total body weight gain, feed efficiency and back fat accumulation than the low fat diet. Feeding of inulin, but not solka floc, attenuated (P<0.05) the HFD-induced higher body weight gain and fat mass accumulation. Inulin feeding tended to lead to higher total VFA production in the cecum and resulted in a higher (P<0.05) expression of acyl coA oxidase (ACO), a marker of peroxisomal ß-oxidation. Inulin feeding also resulted in lower expression of sterol regulatory element binding protein 1c (SREBP-1c), a marker of lipid anabolism. Bacteria community structure characterized by DGGE analysis of PCR amplified 16S rRNA gene fragments showed that inulin feeding resulted in greater bacterial population richness than solka floc feeding. Cluster analysis of pairwise Dice similarity comparisons of the DGGE profiles showed grouping by fiber type but not the level of dietary fat. Canonical correspondence analysis (CCA) of PCR- DGGE profiles showed that inulin feeding negatively correlated with back fat thickness. This study suggests a strong interplay between dietary fat level and fiber type in determining susceptibility to obesity.

A Brain-Machine Interface Operating with a Real-Time Spiking Neural Network Control Algorithm.

Motor prostheses aim to restore function to disabled patients. Despite compelling proof of concept systems, barriers to clinical translation remain. One challenge is to develop a low-power, fully-implantable system that dissipates only minimal power so as not to damage tissue. To this end, we implemented a Kalman-filter based decoder via a spiking neural network (SNN) and tested it in brain-machine interface (BMI) experiments with a rhesus monkey. The Kalman filter was trained to predict the arm's velocity and mapped on to the SNN using the Neural Engineering Framework (NEF). A 2,000-neuron embedded Matlab SNN implementation runs in real-time and its closed-loop performance is quite comparable to that of the standard Kalman filter. The success of this closed-loop decoder holds promise for hardware SNN implementations of statistical signal processing algorithms on neuromorphic chips, which may offer power savings necessary to overcome a major obstacle to the successful clinical translation of neural motor prostheses.

Effect of number of motile, frozen-thawed boar sperm and number of fixed-time inseminations on fertility in estrous-synchronized gilts.

There are advantages for use of frozen-thawed boar sperm (FTS) as a tool for preservation and transfer of valuable genetic material, despite its practical limitations. It was hypothesized that increasing the number of motile FTS and number of fixed-time artificial inseminations (AI) would improve pregnancy rate and litter size. Semen from six boars was frozen in 0.5mL straws at 500x10(6)cells/mL. Gilts approximately 170 days of age, were induced into estrus with PG600 and synchronized using MATRIX (synthetic progestagen). Following last feeding of MATRIX (LFM), gilts were checked twice daily for estrus. At onset of estrus, gilts were randomly assigned in a 3x2 factorial treatment design to receive 1x10(9) motile FTS (n=19), 2x10(9) motile FTS (n=19), 4x10(9) motile FTS (n=19) in a single AI at 32h after onset of estrus, or 1x10(9) motile FTS (n=18), 2x10(9) motile FTS (n=17), or 4x10(9) motile FTS (n=19) in each of the two AI at 24 and 32h following onset of estrus. Ultrasonography was performed at 12h intervals after estrus to estimate time of ovulation. Reproductive tracts were collected 28-34 days following AI. Estrus occurred at 139+/-2h (mean+/-SE) after LFM and ovulation at 33+/-1h following onset of estrus. Dose and number of inseminations did not interact or individually influence pregnancy rate at slaughter (73+/-4.2%) or numbers of normal fetuses (10.8+/-0.5). However, number of fetuses tended (P=0.14) to increase with double AI but not with dose. Boar did not affect pregnancy rate but did affect number of normal fetuses and embryonic survival (P<0.01). Longer intervals from insemination to ovulation reduced pregnancy rate (P<0.05), number of normal fetuses (P<0.001), and embryonic survival (P<0.01). Ovarian abnormalities at slaughter were associated with reduced pregnancy rate (P<0.001). The results of this experiment indicate that a double insemination using 2x10(9) motile sperm would produce the greatest number of piglets with fewest numbers of frozen sperm used, while double AI with 1x10(9) motile sperm would be most practical for pig production with limited genetic resources. Fertility was also influenced by boar, interval from insemination to ovulation, and gilt ovarian abnormalities.

Approaches to Training Practitioners in the Art and Science of Plant Disease Diagnosis.

Allowing plant pathology students to tackle fictitious or real crop problems during the course of their formal training not only teaches them the diagnostic process, but also provides for a better understanding of disease etiology. Such a problem-solving approach can also engage, motivate, and enthuse students about plant pathology in general. This paper presents examples of three problem-based approaches to diagnostic training utilizing freely available software. The first provides an "adventure-game" simulation where students are asked to provide a diagnosis and recommendation after exploring a hypothetical scenario or "case". Guidance is given on how to create these scenarios. The second approach involves students creating their own scenarios. The third uses a diagnostic template combined with reporting software to both guide and capture students' results and reflections during a real diagnostic assignment.