[Slipping rib syndrome in paediatrics: report of 4 cases]. / Síndrome de la costilla deslizante. Serie de 4 casos clínicos.

AIM OF THE STUDY: The slipping rib syndrome (SRS) is an unknown pathology for the pediatric surgeon due to its low incidence in children. The weakness of the costal ligaments allowing an area of rib hypermobility has been postulated recently as the main etiology. It produces an intermittent pain in the lower thorax or upper abdomen that can affect to the daily activities and can be the origin of unspecific chronic pain. METHODS: A retrospective review of patients diagnosed with SRS between october 2012 and march 2017 was performed. Data of demographics, symptoms, imaging studies, surgical findings and long-term follow-up were collected. RESULTS: During this period, 4 patients were diagnosed with SRS. Median age at diagnosis was 13 years (12-15 years) with a mean duration of symptoms of 13 months (12-36 months). In 2 patients the SRS was associated with Costal Dysmorphia (CD). The initial diagnosis was clinical with posterior ultrasound confirmation. Resection of the affected cartilages was performed in 3 patients and after a follow-up of 6 months (3-30 months), they all are painless and refer a good cosmetic result. One patient refused the intervention. CONCLUSIONS: The SRS is an infrequent cause of thoracic pain with an etiology not well understood. The awareness of this disease and its typical presentation can avoid unnecessary studies. The resection of the affected cartilages is a safe and effective treatment.

INTRODUCCION: El síndrome de costilla deslizante (SCD) es una entidad poco frecuente en niños. Se cree que su causa es una debilidad en los ligamentos costales que permite una hipermovilidad de las costillas. Genera un dolor intermitente en la región baja del tórax o alta del abdomen que puede afectar a las actividades de la vida diaria o generar un dolor crónico. MATERIAL Y METODOS: Revisión retrospectiva de SCD entre octubre de 2012 y diciembre de 2017. Se recogió información acerca de los datos demográficos, síntomas, estudios de imagen, hallazgos intraoperatorios, material fotográfico y seguimiento a largo plazo. RESULTADOS: Durante este periodo, 4 pacientes fueron diagnosticados de SCD. La mediana de edad al diagnóstico fue de 13 años (12-15 años) con una duración previa de los síntomas de 13 meses (12-36 meses). En 2 pacientes se asoció una dismorfia costal (DC). El diagnóstico fue clínico con confirmación ecográfica. Se realizó resección de los cartílagos afectos en 3 pacientes con un seguimiento posterior de 6 meses (3-30 meses). Actualmente se encuentran sin dolor y con un resultado estético satisfactorio. Un paciente rechazó la intervención. CONCLUSIONES: El SCD aparece en pacientes preadolescentes que en algunos casos asocian DC. Una exploración física y ecografía enfocada son las claves para un diagnóstico certero. La resección de cartílagos es efectiva a largo plazo.

Sertaconazole antifungal profile determined by a microdilution method versus nine topical substances against dermatophyte fungi.

Antifungal activity and in vitro inhibition time for sertaconazole (STZ) and 9 other topical drugs, namely amorolfine, bifonazole, clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, terbinafine, and tioconazole were determined against 124 clinical isolates of dermatophyte (12 species) fungi by the microdilution method in a liquid medium and the measurement of optical density. STZ's antifungal activity was not always affected by the tested dermatophyte genus, as was the case with the remaining antifungals. In vitro antifungal activity was at the same level for all the studied azole derivatives, but, in terms of partial inhibitory concentrations, STZ starts its in vitro inhibitory activity in a shorter time than the other tested substances, particularly in those incubation periods when the growth of the dermatophyte fungi was more developed.

Venous thromboembolism incidence in cancer patients with germline BRCA mutations.

BACKGROUND: Germline BRCA (gBRCA) mutations predispose to an increased risk of breast and ovarian cancer among other neoplasms. Recently, several genomic alterations such as ALK and ROS-1 rearrangements have been described as molecular drivers of venous thromboembolism (VTE). The association of gBRCA mutations and VTE is unknown. MATERIALS AND METHODS: We performed an observational, retrospective, single-center study to determine the VTE incidence in consecutive patients with gBRCA mutations and cancer diagnosis attended in the multidisciplinary heredofamiliar cancer unit (HFCU) of Hospital General Universitario Gregorio Marañón, Spain, from 2010 to 2019. RESULTS: One-hundred and forty-one patients were included in the analysis. The overall VTE incidence was 12.8%. The highest incidence was reported in ovarian cancer patients (20.0%), followed by patients with both ovarian and breast cancers (16.6%) and the lowest was found in breast cancer (4.9%). No difference in the type of gBRCA mutation (1 or 2) in terms of VTE rate was observed. Sixty one percent of the patients were receiving anti-cancer therapy at the time of VTE diagnosis and the majority of the events (83.3%) were diagnosed in ambulatory setting. Khorana score was of limited value to detect high-risk patients. CONCLUSIONS: The VTE incidence observed in our study is consistent with prior data described in general population of breast and ovarian cancer. The risk of VTE in these patients seems to be driven by the type of cancer. We have not observed any significant interaction of gBRCA mutation status and cancer-associated thrombosis.

Multifocal lymphangioendotheliomatosis with thrombocytopenia: phenotypic variability and response to rapamycin. / Linfagioendoteliomatosis multifocal con trombopenia: variabilidad fenotípica y respuesta a rapamicina.

INTRODUCTION: Multifocal lymphangioendotheliomatosis with thrombocytopenia (MLT) is characterized by multiple maculopapular lesions involving the stomach and the lungs, associated with thrombocytopenia as a result of platelet entrapment. Episodes of severe digestive bleeding, which are sometimes unmanageable, are one of its most frequent presentations and a cause of mortality. Our objective was to describe the various phenotypes, as well as our treatment experience. MATERIALS AND METHODS: A retrospective analysis of patients diagnosed with MLT in our vascular abnormality unit from 2007 to 2018 was carried out. Epidemiological, clinical, and evolution data were analyzed, and a long-term follow-up was performed. RESULTS: Five patients (3 boys and 2 girls) had congenital macules and erythematous papules of various sizes. They were later associated with episodes of severe hematemesis along with thrombocytopenia, which required blood product transfusion. The most frequently involved areas were the stomach and the colon. In two patients, multiple bilateral pulmonary nodules were noted. The anatomical pathology examination showed extended vessels with a prominent, hobnail endothelium, as well as intraluminal papillary projections in the dermis. Immunohistochemical analysis was CD-31 positive and CD-34 positive in a characteristic manner. Two patients were treated with mTOR inhibitors (rapamycin), with a progressive decrease in extracutaneous involvement and platelet recovery, but with a poor response in dermal lesions. Two patients were treated with vincristine, with a reduction of digestive bleeding episodes. No deaths were reported in our series. CONCLUSION: MLT is characterized by hematological and cutaneous involvement - sometimes minimal -, with potential lesions in other internal organs. Its heterogeneous presentation, which may start with severe digestive bleeding, makes this rare pathology difficult to diagnose. mTOR inhibitors have opened up new treatment possibilities.

INTRODUCCION: La linfangioendoteliomatosis multifocal con trombopenia (LMT) es una anomalía, caracterizada por múltiples lesiones maculo-papulosas con afectación visceral gástrica y pulmonar, asociado a trombopenia por atrapamiento plaquetar. Una de sus presentaciones más frecuentes es en forma de episodios de hemorragia digestiva severa, en ocasiones inmanejable, y que es la responsable de su mortalidad. Nuestro objetivo es describir los diferentes fenotipos, así como nuestra experiencia en su tratamiento. MATERIAL Y METODOS: Hemos realizado un análisis retrospectivo de los pacientes diagnósticos de LMT según las características histológicas típicas entre 2007 y 2018 en nuestra unidad de anomalías vasculares. Se analizaron datos epidemiológicos, clínicos y de evolución, así como seguimiento a largo plazo. RESULTADOS: Cinco pacientes (3 hombres y 2 mujeres) presentaron al nacimiento máculas y pápulas eritematosas de diferentes tamaños a los que más adelante se les asoció episodios de hematemesis graves junto a trombopenia, que llegaron a requerir transfusión de hemoderivados. Las regiones más afectadas fueron el estómago seguido del colon. En dos pacientes se detectaron múltiples nódulos pulmonares bilaterales. La anatomía patológica describió vasos alargados con endotelio prominente y en tachuela junto a proyecciones papilares intraluminales en dermis. La inmunohistoquímica fue positiva de forma característica para CD-31 y CD-34. Dos pacientes fueron tratados con inhibidores de mTOR (rapamicina) con disminución progresiva de la afectación extracutánea y recuperación plaquetar, pero con una pobre respuesta de las lesiones dérmicas. Dos pacientes fueron tratados con vincristina con reducción de los episodios de sangrado digestivo. No se registró ningún fallecimiento en nuestra serie. CONCLUSION: La LMT se caracteriza por una afectación cutánea, a veces mínima, y hematológica que puede asociar lesiones en otros órganos internos. La presentación heterogénea, pudiendo debutar con hemorragias digestivas severas, hacen de esta entidad una patología de difícil diagnóstico. Los inhibidores de mTOR han abierto una nueva vía que arroja cierta esperanza para el tratamiento de esta patología tan poco frecuente.

[Initial management of the patients with psychiatric involvement in hospital emergency departments: a systematic review].

This article is a systematic review of studies that have investigated the initial management of patients with psychiatric conditions in hospital emergencies services in order to establish practical recommendations. A systematic review of the literature was carried out, consisting of studies published from 2010 to 2020, available in any language, consulting Cochrane Library Plus, PubMed, IBECS, LILACS and MEDLINE. The quality of the studies included in this review was assessed by the AMSTAR2 tool and the FCL 3.0 platform, together with the PRISMA statement. Results from the eleven papers selected showed that improvements in staff training, available resources, appropriate use of restraint and appropriate choice of medication can help to improve the care of patients with mental pathology in hospital emergency services. The same management for any other patient is recommended. However, if the patient is agitated or uncooperative, verbal, pharmacological and/or mechanical restraint (in this order) may be necessary. Keywords. Psychiatry. Psychomotor agitation. Crisis intervention. Hospital emergency service.

The Effect of Hydration on Urine Color Objectively Evaluated in CIE L*a*b* Color Space.

Urine color has been shown to be a viable marker of hydration status in healthy adults. Traditionally, urine color has been measured using a subjective color scale. In recent years, tristimulus colorimetry developed by the International Commission on Illumination (CIE L*a*b*) has been widely adopted as the reference method for color analysis. In the L*a*b* color space, L* indicates lightness ranging from 100 (white) to 0 (black), while a* and b* indicate chromaticity. a* and b* are color directions: -a* is the green axis, +a* is the red axis, -b* is the blue axis, and +b* is the yellow axis. The L*a*b* color space model is only accurately represented in three-dimensional space. Considering the above, the purpose of the current study was to evaluate urine color during different hydration states, with the results expressed in CIE L*a*b* color space. The study included 28 healthy participants (22 males and 6 females) ranging between the age of 20 and 67 years (28.6 ± 11.3 years). One hundred and fifty-one urine samples were collected from the subjects in various stages of hydration, including morning samples after 7-15 h of water deprivation. Osmolality and CIE L*a*b* parameters were measured in each sample. As the urine osmolality increased, a significant linear increase in b* values was observed as the samples became more pronouncedly yellow (τb = 0.708). An increase in dehydration resulted in darker and significantly more yellow urine, as L* values decreased in lightness and b* values increased along the blue-yellow axis. However, as dehydration increased, a notable polynomial trend in color along the green-red axis was observed as a* values initially decreased, indicating a green hue in slightly dehydrated urine, and then increased as urine became more concentrated and thus more dehydrated. It was determined that 74% of the variance seen in urine osmolality was due to CIE L*a*b* variables. This newfound knowledge about urine color change along with the presented regression model for predicting urine osmolality provides a more detailed and objective perspective on the effect of hydration on urine color, which to our knowledge has not been previously researched.

Collagen-like fragments: excretion in urine of patients with Paget's disease of bone.

Patients with Paget's disease of bone excrete, in the urine, polypeptides that have amino acid composition and other properties resembling those of fragments of collagen. The pattern of isotope incorporation in vivo suggests that these fragments are derived from collagen that has been synthesized and rapidly degraded, or that they are rapidly synthesized but not incorporated into tropocollagen molecules.

Activity of caspofungin and voriconazole against clinical isolates of Candida and other medically important yeasts by the CLSI M-44A disk diffusion method with Neo-Sensitabs tablets.

In vitro activity of caspofungin and voriconazole against 184 clinical isolates of Candida and other medically important yeasts in comparison with that of fluconazole, ketoconazole, itraconazole and amphotericin B was determined by using a disk diffusion method (Neo-Sensitabs) standardized according to the recommendations of the CLSI documents M44-A and M44-S1 (same medium: Mueller-Hinton plus methylene blue; inoculum and minimal inhibitory concentration/zone breakpoints). Seventy-two percent of clinical isolates were susceptible to caspofungin, 23.6% showed an intermediate susceptibility (most of them were Candida parapsilosis) and 4.3% were resistant (values for Candida spp. were 71.2, 23.8 and 5%, respectively). For voriconazole, 96.7% of clinical isolates were susceptible and 3.3% were resistant (Candida spp.: 96 and 3.8%, respectively). Both caspofungin and voriconazole showed high activity against a wide variety of clinically important yeasts.

[Excessive daytime sleepiness and sleep hygiene of working adults in Spain]. / Somnolencia diurna excesiva e higiene del sueño en adultos trabajadores de España.

BACKGROUND: To calculate the prevalence of excessive daytime sleepiness (EDS) (through the Epworth Sleepiness Scale, ESE) and to identify the personal and working variables predicting the risk of EDS. METHODS: Cross-sectional study performed on 476 civil servants from Murcia (October 2013 - February 2016). Prevalence of EDS and bad sleep hygiene (LSH) were determined from scores on the Epworth Sleepiness Scale and Sleep Hygiene Scale (SHS), respectively, and their association with different variables was obtained from a self-administered questionnaire. Independent predictors of EDS were identified by multivariate logistic regression. RESULTS: EDS was less prevalent (16.7%) than LSH (23.4%). Women scored higher in ESE (7.5 vs 6.3; p=0,001) and suffered twice the EDS of men (23.0 vs 10.7%, p<0.001). Workers with EDS scored higher on SHS (34.3 vs 32.7; p=0.044) and had LSH more frequently (38.7 vs 24.9%, p=0.014). Smokers were predominantly women (57.0%; p=0.087) with LSH (50.0 vs 25.8 and 18.9% amongst ex-smokers and non-smokers, p<0.001). Being a woman OR=2.5, 95%IC: 1.4-4.3; p<0.001) and having bad sleep hygiene (OR=1.8 95%IC: 1.0-3.2, p=0.032) were predictive factors irrespective of suffering from EDS. CONCLUSIONS: EDS was present in civil servants in the region of Murcia, and was higher in women than men. Excessive daytime sleepiness is strongly associated with bad sleep hygiene and became a woman.

Urinary polypeptides related to collagen synthesis.

Of the total urinary hydroxyproline in normal subjects and those with skeletal disorders, between 4 and 20% was nondialyzable. In some patients with Paget's disease of bone, hyperparathyroidism with osteitis fibrosa, hyperphosphatasia, and extensive fibrous dysplasia the total urinary hydroxyproline was sufficiently high to permit purification of this polypeptide hydroxyproline by gel filtration and ion exchange chromatography. The partially purified polypeptides had molecular weights between 4500 and 10,000 and amino acid compositions and physical properties resembling those of gelatin. The polypeptide fractions also contained neutral sugar and glucosamine. These fragments had been shown to be susceptible to cleavage by purified bacterial collagenase suggesting the presence of the sequence-Pro-X-Gly-Pro-Y-. After administration of proline-(14)C to patients with Paget's disease hydroxyproline-(14)C was excreted in the urine. The hydroxyproline-(14)C specific activity reached a peak in 2-4 hr and declined rapidly. The specific activity of the polypeptide (retentate) portion was severalfold greater than that of the raw urine and diffusate. When the labeled urines were subjected to gel filtration the hydroxyproline-(14)C fractions of highest molecular weight which were eluted first from the columns had the highest specific activities. Exposure of the hydroxyproline-(14)C-containing polypeptides to bacterial collagenase rendered them dialyzable. Four patients with hyperparathyroidism and osteitis fibrosa were studied before and after removal of a parathyroid adenoma, a period of transition from a predominance of bone collagen resorption to one of relatively increased bone collagen synthesis. The total urinary hydroxyproline fell rapidly after operation whereas the ratio of the polypeptide fraction to the total rose three- to fourfold. The results of these studies suggest that the urinary polypeptides represent fragments of collagen related to collagen synthesis. Changes in the ratio of these peptides to total hydroxyproline in the urine may serve as an index of new bone formation in patients with skeletal disorders.

In vitro activity of voriconazole against dermatophytes, Scopulariopsis brevicaulis and other opportunistic fungi as agents of onychomycosis.

Using a reference microdilution method, we studied the antifungal susceptibility to voriconazole and fluconazole of 304 clinical isolates from four species of onychomycosis-causing dermatophytes, 196 isolates of dermatophytes not related to nail infection as well as Scopulariopsis brevicaulis, Fusarium spp. and Scytalidium dimidiatum. Results showed a high antifungal activity of voriconazole against dermatophytes (geometric mean minimal inhibitory concentration (MIC)=1.14 microg/mL; MIC for 50% of the organisms (MIC(50))=0.062 miccrog/mL; MIC for 90% of the organisms (MIC(90))=0.25 microg/mL). For S. brevicaulis, the in vitro activity of voriconazole was considerably lower (geometric mean MIC=8.52 microg/mL; MIC(50) and MIC(90)=16 microg/mL). Although voriconazole is not among the drugs recommended for the management of onychomycosis, it can be a useful alternative for recalcitrant infections.

Comparison of tablet and disk diffusion methods for fluconazole and voriconazole in vitro activity testing against clinical yeast isolates.

We have compared a commercially available tablet diffusion method for the in vitro antifungal susceptibility testing of fluconazole (FCZ) and voriconazole (VCZ) with the disk diffusion method M44 (CLSI) with 282 clinical yeast isolates. The superior stability of antifungal agents in tablets can explain the differences for each category of susceptibility by both methods.Neo-Sensitabs tablets antifungal susceptibility testing showed an excellent correlation (0.98 for FCZ and 0.98 for VCZ at 24h and 0.96 for FCZ and 0.94 for VCZ at 48 h ), a reduced percentage of disagreements (4.6% and 8.2% for FCZ at 24h and 48 h respectively; 1.1% and 2.1% for VCZ at 24h and 48 h respectively) and the absence of statistically significant difference in comparison with the reference protocol for performing antifungal susceptibility testing with the agar diffusion method.

Antifungal agents: mode of action in yeast cells.

Different kinds of mycoses, especially invasive, have become an important public health problem as their incidence has increased dramatically in the last decades in relation to AIDS, hematological malignancies, transplant recipients and other immunosuppressed individuals. Management of fungal infections is markedly limited by problems of drug safety, resistance and effectiveness profile. Current therapy for invasive mycoses uses a relatively reduced number of antifungal drugs, such as amphotericin B, fluconazole and itraconazole. Other new antifungal agents from old and new chemical families, like voriconazole, posaconazole, ravuconazole, caspofungin and micafungin, have been introduced into the armamentarium for fungal infections management. This review is focused on the mode of action of those antifungal drugs used against pathogenic yeasts. The interaction of amphotericin B with ergosterol and other membrane sterols results in the production of aqueous pores of drug and the ergosterol biosynthetic pathway is the target of the allylamines, phenylmorpholines and azole antifungal agents. The main molecular target of azole antifungals is the cytochrome P-450 protein Erg11p/Cyp51p. Echinocandins, a new class of antifungal drugs, are fungal secondary metabolites that act against beta-1-3-D-glucan synthesis. The phenylmorpholines, of which amorolfine is the sole representative in human therapy, affect two targets in the ergosterol pathway: Erg24p (delta 14 reductase) and Erg2p (delta 8-delta 7 isomerase). The sordarins group are protein synthesis inhibitors that work by blocking the function of fungal translation elongation factor 2. Other protein inhibitors are zofimarin, BE31045, SCH57504, xylarin, hypoxysordarin and GR135402. In order to overcome the problems derived from the exploitation of azole drugs, macrolides and echinocandins, novel targets were explored. Proposed antifungal drugs have been developed against potential targets like the N-myristylation of fungal proteins, with inhibitors like myristate and histidine analogues or myristoylpeptide derivatives, aminobenzothiazoles, quinolines and benzofurans. Polymerization of cell wall carbohydrates from uridine di-phospho sugars is another potential target.

[Identification and in vitro antifungal susceptibility of vaginal Candida spp. isolates to fluconazole, clotrimazole and nystatin]. / Identificación y sensibilidad antifúngica in vitro de Candida spp. de origen vaginal a fluconazol, clotrimazol y nistatina.

OBJECTIVE: The aim of this study was to identify and determine the in vitro antifungal susceptibility testing to clotrimazole, fluconazole, and nystatin of 145 clinical isolates of Candida spp. METHODS: M27-A3 microdilution method was used to determine minimal inhibitory concentrations (MIC) and partial MICs (MIC50 and MIC90) of drugs. A total of 145 isolates were studied, 126 were C. albicans, 16 C. glabrata, 2 C. parapsilosis y 1 C. tropicalis. RESULTS: MIC50 and MIC90 for FLZ against C. albicans were 0.25 mg/L and 1 mg/L respectively and for C. glabrata was achieved at 8 mg/L and 16 mg/L for fluconazole. Five isolates of C. albicans and one isolate of C. tropicalis were in vitro resistant to fluconazole (M27-S4). In C. albicans MIC50 and MIC90 for clotrimazole were of 0.03 mg/L and 0.06 mg/L, respectively. These values for C. glabrata were 0.25 mg/L and 1 mg/L, respectively. Five C. glabrata and 1 C. tropicalis were in vitro resistant to clotrimazole. MIC50 and MIC90 of nystatin were of 1 mg/L and 2 mg/L, respectively for C. albicans and C. glabrata. CONCLUSIONS: In this study, C. albicans is the most frequently isolated yeast, followed by C. glabrata. The antifungals tested were found to be in vitro active for the isolates, except for 6 isolates for fluconazole and 6 to clotrimazole.

Ciclopiroxolamine: in vitro antifungal activity against clinical yeast isolates.

The in vitro susceptibility of 225 clinical isolates of yeasts to ciclopiroxolamine (CPO) was compared with that of clotrimazole, econazole, ketoconazole, miconazole, tioconazole, fluconazole, itraconazole and nystatin using a standardized agar diffusion method (NeoSensitabs). Two hundred and eight strains of yeasts comprising 16 species of Candida and 22 strains belonging to other yeast genera were tested. One strain (0.4%) was resistant, four strains (1.8%) of intermediate susceptibility and 220 strains (97.3%) susceptible to CPO. More strains were susceptible to CPO than to the other antifungals studied. Susceptibility patterns of antifungal agents were not linked to species. The in vitro antifungal susceptibility profile of CPO was better than topical azole derivatives or fluconazole and itraconazole against a wide variety of clinically important yeasts.

Comparative evaluation of four commercial tests for presumptive identification of Candida albicans.

Four commercially available tests (Albicans ID2, Chromalbicans Agar, CHROMagar Candida, and BactiCard Candida) and the germ tube (GT) test for presumptive identification of Candida albicans were evaluated using clinical isolates of C. albicans (n=89) and of non-albicans yeasts (n=107). Sensitivities and specificities of all tests regarding the identification of C. albicans were greater than 92%, except for Chromalbicans Agar plates (88.7% after 48 h) and their specificity was 86%. Overall, the four commercial systems were easy to use and are good systems for the routine identification of C. albicans.

In vitro antifungal activity of sertaconazole against 309 dermatophyte clinical isolates.

Three hundred and nine strains belonging to 11 species of dermatophyte moulds were tested against sertaconazole following mainly the National Committee for Clinical Laboratory Standards (M38-P) for filamentous fungi. However, several important factors such as the temperature (28 degrees C vs 35 degrees C) and time of incubation (4-10 d vs 21-74 h), have been modified. Sertaconazole was active against all the clinically important dermatophyte moulds involved in human infections tested. Overall geometric mean MIC of sertaconazole was 0.21 microg/ml with a MIC range of 0.01-8 microg/ml. MIC50 and MIC90 were respectively of 0.25 and 1 microg/ml. Sertaconazole was very active against Epidermophyton floccosum, Trichophyton rubrum, Trichophyton tonsurans and Microsporum canis (geometric means 0.08, 0.13, 0.13 and 0.19 microg/ml respectively). Microsporum audouinii had the lowest susceptibility in the study (geometric mean 0.59 microg/ml). Considering MIC50 and MIC90 these differences were significantly in favor of the activity of sertaconazole against E. floccosum (0.06 and 0.5 microg/ml respectively).

Antifungal activity of amphotericin B and itraconazole against filamentous fungi: comparison of the Sensititre Yeast One and NCCLS M38--a reference methods.

The susceptibilities of 81 clinical isolates of Aspergillus spp., Fusarium spp., and Scedosporium spp., to amphotericin B and itraconazole were determined by the colorimetric microdilution method Sensititre and the reference microdilution method of NCCLS standard M38-A for filamentous fungi. No major discrepancies were found and agreement ranged between 86.4% to 84% and 69.1% to 86.4% for amphotericin B and itraconazole respectively at 48 h and 72 h of incubation by using the recommended endpoints. Within two two-fold dilutions, high levels of agreement were found in general for amphotericin B at 48 or 72 h (86.4 to 87.7%) and itraconazole (91.4 to 93.8%). Relatively better agreement was found for itraconazole at 72 h of incubation and 48 for amphotericin B.

Comparative study of the in vitro antifungal activity of bifonazole, naftifine and sertaconazole against yeasts.

The in vitro activity of three antifungal agents was tested and compared against 151 yeast strains, including ten Candida species, Cryptococcus neoformans, Rhodotorula rubra, and Trichosporon cutaneum. Minimum inhibitory concentrations (MICs) were determined by a microdilution technique in Shadomy modified liquid medium. The mean MICs of sertaconazole (0.34 mg/L) were lower than those of naftifine (16.3 mg/L) and bifonazole (13.2 mg/L). These results suggest that sertaconazole is more active against Candida spp than other topical agents such as bifonazole and naftifine.

Sertaconazole: in-vitro antifungal activity against vaginal and other superficial yeast isolates.

The in vitro susceptibilities of 183 clinical yeast isolates to sertaconazole (STZ) were compared to their susceptibilities to clotrimazole (CTZ), econazole (ECZ), ketoconazole (KTZ), miconazole (MNZ), fluconazole (FLZ), itraconazole (ITZ), tioconazole (TCZ), amphotericin B (AMB) and flucytosine (5FC) by using a commercial agar diffusion method. Strains were isolated from vaginal and other superficial clinical samples (18 species of Candida and five strains belonging to other yeast genera). Only one strain (0.5%) was resistant to STZ out of 87.4% of susceptible strains (n=160). The percentage of susceptible strains was higher than those obtained with the other agents evaluated and the percentage of resistant strains was lower than for most of the other antifungals. The pattern of susceptibility of C. albicans to STZ, TCZ, ITZ and CLZ was similar and superior to the pattern of susceptibility of this species to MNZ, ECZ, FLZ, 5FC and KTZ. C. dubliniensis was more susceptible to STZ, MNZ, MNZ, FLZ, ITZ, CLZ than to TCZ, ECZ, 5FC, AMB or KTZ. Ten susceptible strains to STZ were resistant to FLZ and one strain was resistant to ITZ. The overall antifungal activity of STZ in vitro against a wide range of clinically important yeasts from vaginal and cutaneous samples indicates the therapeutic potential of this agent for the treatment of infections caused by these fungi. However, the activity of STZ and the clinical value of in vitro data need to be verified in human clinical trials.