Detection and analysis of potential drug-drug interactions among patients admitted to the cardiac care unit in a tertiary care hospital.

OBJECTIVE: This study aimed to estimate how prevalent potential drug-drug interactions (pDDIs) were in patients with cardiovascular diseases who were hospitalized for more than 24 hours, and to determine the risk factors associated with these pDDIs. PATIENTS AND METHODS: A prospective observational study was conducted on patients admitted to the cardiac care unit in a tertiary care hospital. We included two hundred medical records of cardiovascular disease patients who were prescribed more than one drug. These medical records were analyzed for pDDIs using the Micromedex drug interaction checker database. Data were analyzed using Descriptive statistics. Chi-square test and the Pearson correlation coefficient were applied. RESULTS: PDDIs were prevalent in 95% of the analyzed medical records, with at least one detected pDDI per record. Within the 200 medical records, 430 potentially interacting drug pairs were identified, with the majority resulting in moderate and major interactions. Aspirin/clopidogrel (111), furosemide/aspirin (89), enoxaparin/clopidogrel (89) and Lisinopril/aspirin (60) were the most common interacting pairs. Whereas, aspirin, heparin, clopidogrel, furosemide, ranitidine and Lisinopril were the most frequently implicated drugs in DDIs. CONCLUSIONS: PDDIs were common among hospitalized cardiovascular patients. PDDIs were associated with age and number of drugs prescribed. The routine integration of an online drug interactions screening tool may improve the ability of pharmacists to identify cardiac patients at higher risk of potential drug interactions and conduct appropriate interventions thereafter.

The influence of the COVID-19 pandemic on the psychological well-being of college students: a cross-sectional study.

OBJECTIVE: Even before the outbreak of the COVID-19 pandemic, concerns regarding college students' mental health were on the rise due to the increasing number of students afflicted with mental health issues. Exposure to numerous pandemic-related measures exacerbated existing issues with anxiety, depression, and stress. This study aimed to assess depression, anxiety, and stress levels among university students in the Aseer region in Saudi Arabia. SUBJECTS AND METHODS: Data were collected from eligible individuals using a web-based, self-administered DASS-21 questionnaire. This questionnaire consists of 21 questions with a rating scale of 0-3. Each of the psychological factors of depression, anxiety, and stress was categorized as normal, mild, moderate, severe, and extremely severe. Results were expressed using descriptive statistics as proportions, and the Mann-Whitney/Kruskal-Wallis' test was used to evaluate the presence of a significant difference between each of the socio-demographic factors of the respondents and the psychological outcomes. RESULTS: Respondents aged between 18-24 years reported higher rates of extremely severe depression than other age groups. Females had higher rates of depression, especially severe and extremely severe forms. Extremely severe anxiety had a relatively high prevalence across all age groups. Extremely severe stress was more common among respondents aged between 18-24 years, while respondents older than 34 years reported the highest prevalence of severe stress. The Mann-Whitney/Kruskal-Wallis' tests showed statistically significant differences between participants in the different groups. CONCLUSIONS: The COVID-19 pandemic had a high psychological impact on university students, which indicates that a psychological support program should be implemented to reduce this impact.

Prehypertension among young adult females in Dammam, Saudi Arabia.

The aim of present study was to determine the prevalence of prehypertension and associated risk factors among young adult females in Dammam, Saudi Arabia. A cross-sectional study was conducted on a sample of about one-third of female students enrolled in 4 colleges of the University of Dammam. They were screened for high blood pressure and associated cardiovascular risk factors by an interview questionnaire. Weight and height, waist and hip and blood pressure measurements and random blood glucose testing were done. The results revealed that 13.5% of the 370 students were prehypertensive. The most prevalent risk factor for cardiovascular diseases was physical inactivity (53.2%), followed by overweight/obesity (29.1%); 16.3% of prehypertensive students had 3 or more risk factors. Logistic regression analysis revealed that overweight/ obesity was the strongest predictor of prehypertension. Our study indicates a need for routine blood pressure measurements and risk assessment in young adult females in Saudi Arabia.

Fully 3D refraction correction dosimetry system.

The irradiation of selective regions in a polymer gel dosimeter results in an increase in optical density and refractive index (RI) at those regions. An optical tomography-based dosimeter depends on rayline path through the dosimeter to estimate and reconstruct the dose distribution. The refraction of light passing through a dose region results in artefacts in the reconstructed images. These refraction errors are dependant on the scanning geometry and collection optics. We developed a fully 3D image reconstruction algorithm, algebraic reconstruction technique-refraction correction (ART-rc) that corrects for the refractive index mismatches present in a gel dosimeter scanner not only at the boundary, but also for any rayline refraction due to multiple dose regions inside the dosimeter. In this study, simulation and experimental studies have been carried out to reconstruct a 3D dose volume using 2D CCD measurements taken for various views. The study also focuses on the effectiveness of using different refractive-index matching media surrounding the gel dosimeter. Since the optical density is assumed to be low for a dosimeter, the filtered backprojection is routinely used for reconstruction. We carry out the reconstructions using conventional algebraic reconstruction (ART) and refractive index corrected ART (ART-rc) algorithms. The reconstructions based on FDK algorithm for cone-beam tomography has also been carried out for comparison. Line scanners and point detectors, are used to obtain reconstructions plane by plane. The rays passing through dose region with a RI mismatch does not reach the detector in the same plane depending on the angle of incidence and RI. In the fully 3D scanning setup using 2D array detectors, light rays that undergo refraction are still collected and hence can still be accounted for in the reconstruction algorithm. It is found that, for the central region of the dosimeter, the usable radius using ART-rc algorithm with water as RI matched medium is 71.8%, an increase of 6.4% compared to that achieved using conventional ART algorithm. Smaller diameter dosimeters are scanned with dry air scanning by using a wide-angle lens that collects refracted light. The images reconstructed using cone beam geometry is seen to deteriorate in some planes as those regions are not scanned. Refraction correction is important and needs to be taken in to consideration to achieve quantitatively accurate dose reconstructions. Refraction modeling is crucial in array based scanners as it is not possible to identify refracted rays in the sinogram space.

Neural network based forward prediction of bladder pressure using pudendal nerve electrical activity.

Individuals with spinal cord injury or neurological disorders have problems in urinary bladder storage and in voiding function. In these people, the detrusor of bladder contracts at low volume and this causes incontinence. The goal of bladder control is to increase the bladder capacity by electrical stimulation of relative nerves such as pelvic nerves, sacral nerve roots or pudendal nerves. For this purpose, the bladder pressure has to be monitored continuously. In this paper, we propose a method for real-time estimating the bladder pressure using artificial neural network. The method is based upon measurements of electroneurogram (ENG) signal of pudendal nerve. This approach yields synthetic bladder pressure estimates during bladder contraction. The experiments were conducted on three rats. The results show that neural predictor can provide accurate estimation and prediction of bladder pressure with good generalization ability. The average error of 1-second and 5-second ahead prediction of bladder pressure are 9.62% and 10.54%, respectively.

Effects of refractive index mismatch in optical CT imaging of polymer gel dosimeters.

PURPOSE: Proposing an image reconstruction technique, algebraic reconstruction technique-refraction correction (ART-rc). The proposed method takes care of refractive index mismatches present in gel dosimeter scanner at the boundary, and also corrects for the interior ray refraction. Polymer gel dosimeters with high dose regions have higher refractive index and optical density compared to the background medium, these changes in refractive index at high dose results in interior ray bending. METHODS: The inclusion of the effects of refraction is an important step in reconstruction of optical density in gel dosimeters. The proposed ray tracing algorithm models the interior multiple refraction at the inhomogeneities. Jacob's ray tracing algorithm has been modified to calculate the pathlengths of the ray that traverses through the higher dose regions. The algorithm computes the length of the ray in each pixel along its path and is used as the weight matrix. Algebraic reconstruction technique and pixel based reconstruction algorithms are used for solving the reconstruction problem. The proposed method is tested with numerical phantoms for various noise levels. The experimental dosimetric results are also presented. RESULTS: The results show that the proposed scheme ART-rc is able to reconstruct optical density inside the dosimeter better than the results obtained using filtered backprojection and conventional algebraic reconstruction approaches. The quantitative improvement using ART-rc is evaluated using gamma-index. The refraction errors due to regions of different refractive indices are discussed. The effects of modeling of interior refraction in the dose region are presented. CONCLUSIONS: The errors propagated due to multiple refraction effects have been modeled and the improvements in reconstruction using proposed model is presented. The refractive index of the dosimeter has a mismatch with the surrounding medium (for dry air or water scanning). The algorithm reconstructs the dose profiles by estimating refractive indices of multiple inhomogeneities having different refractive indices and optical densities embedded in the dosimeter. This is achieved by tracking the path of the ray that traverses through the dosimeter. Extensive simulation studies have been carried out and results are found to be matching that of experimental results.

Psoralens percutaneous permeation across the human whole skin and the epidermis in respect to their polarity (in vitro study).

8-methoxypsoralen (8-MOP), 5-methoxypsoralen (5-MOP) and 4,5',8-trimethylpsoralen (TMP) are commonly used in PUVA therapy [psoralen (P) + ultraviolet light A (UVA) irradiation] to treat skin diseases such as psoriasis and vitiligo. In order to predict the choice of the suitable drug(s) for topical applications, with appropriate dosage, percutaneous permeation of the psoralens, in connection with their solubilities and partition coefficients in an octanol/water system, were investigated. The percutaneous penetration experiments were accomplished by the deposit of ethanolic psoralen solution onto human skin and epidermis fragments mounted on Franz cells. Six cells were employed for each psoralen solution and for the whole skin layer as well as for the epidermis. The diffused psoralens in the receptor solution (1.4%, of human serum albumin) were quantified by using high performance liquid chromatography. The solubilities and the partition coefficients (PC) were carried out in an octanol/water system, in triplicate by using spectrofluorimetry. The results demonstrated that cumulated permeated quantities (ng/cm2) over 24 h, across the whole skin and the epidermis were in the following order for the three psoralens: 8-MOP > 5-MOP > TMP. The lipophilicity, expressed via the log PC, was as follows: 1.93 +/- 0.01 (8-MOP), 2.00 +/- 0.01 (5-MOP) and 3.14 +/- 0.01 (TMP). It was inversely correlated with cumulated penetrated amounts over 24 h in both whole skin and epidermis. From these results, TMP could be predicted as the most convenient psoralen for topical applications, because of its weak penetrability. Considering the relationship between psoralens lipophilicity and permeation, only 5-MOP and 8-MOP could be used, topically or orally, especially in the case of generalised skin disorders.

Skin care in childhood.

Childhood (3 to 9 years) is a calm period of constant growth throughout which social contacts are discovered and intelligence and discretion take place. Consequently, most diseases are infectious. Microrelief was found twice shallower and skin (epidermis + dermis) twice thinner than in adults. Intervals between furrows were reduced parallel to total body surface, thus ruling out the possible existence of special shelters favouring bacterial growth. Sweating is lower, as are skin surface lipid levels, in contrast to the post-natal period, inducing dryness of skin. Although total skin stiffness in vivo was found to be identical to young adult skin, skin chapping is much more frequent. Since detergents as well as extended hot baths may reduce the stratum corneum water binding capacity, they should be used with discretion. Hence, skin care in this period of age should be based upon different criteria than in adults.

Peak blistering point: influence on fluid levels of 5-MOP in human skin in vivo after systemic administration.

The concentration of 5-methoxypsoralen (5-MOP) in suction blister fluid (SBF) after oral intake was determined in relation to the peak blistering point. Interstitial fluid was obtained from nine healthy male volunteers by applying mild suction (300-350 mmHg) to the skin of the volar aspect of the forearm. Blisters were raised at three different times: 18 h prior to drug administration (group I); 2 h prior to drug administration (group II); and during drug ingestion (group III). SBF levels of 5-MOP were determined in each group of blisters 2 h after oral administration of 1.2 mg/kg micronized 5-MOP. The results showed a statistically significant difference in the concentrations of 5-MOP between each group of blisters. The highest concentration of 5-MOP in the SBF was found in group III and the lowest in group II blisters. These findings suggest that the point of peak blistering in relation to drug administration needs to be known in each pharmacological study using suction blisters.

Treatment of psoriasis with a new micronized 5-methoxypsoralen tablet and UVA radiation.

Since 1974, phototherapy with psoralen and ultraviolet A (UVA) has been used successfully for the treatment of psoriasis. However, undesirable side effects, including phototoxicity, nausea, stomach pain and headaches, have led investigators to develop new psoralen compounds. 5-Methoxypsoralen (5-MOP) has thus been introduced as an alternative to 8-MOP because of its less pronounced side effects. Since the absorption kinetics and bioactivity of 5-MOP are known to be variable, a new micronized tablet form (5-MOPm) has been developed. In an open randomized study, oral treatments with 5-MOP or 5-MOPm plus UVA radiation were compared in 22 psoriatic patients. Skin type and initial psoriasis area severity index did not differ significantly between treatment groups. Serum concentrations were significantly higher (320 vs 85.82 ng/ml) and occurred earlier (51.8 vs 229.09 min) with 5-MOPm. In addition, a reduction in PASI of more than 90% was achieved sooner (10.63 vs 17.27 treatments) and with a lower cumulative UVA dose (145.89 vs 232.11 J/cm2), in the group treated with 5-MOPm. No side effects were observed with 5-MOPm. Our data indicate that 5-MOPm has a higher bioavailability, clinical efficacy and tolerability than the commonly used 5-MOP.

Serum free 5-methoxypsoralen fraction in health and psoriasis: relationship with human serum albumin concentration.

Human serum albumin is known to be the main carrier of 5-methoxypsoralen (5-MOP) in serum. As hypoalbuminaemia may occur in psoriasis with inflammatory syndrome, variability of the free 5-MOP fraction in serum can be expected. The free 5-MOP fraction was determined by equilibrium dialysis in serum samples obtained from 18 psoriatic patients and 18 control subjects. The median free 5-MOP fraction was not significantly different in the psoriatic group (fu = 4.75%) than in the control group (fu = 5%). However, there was a significantly larger variability of the free fraction in the psoriatic group (2.7 to 8.6%) than in the healthy group (3.2 to 6.8%) (p = 0.002). The binding index of 5-MOP (ratio of bound to free concentrations) was correlated with human serum albumin level (r = 0.784). This work confirms that the 5-MOP fraction in human serum is principally serum albumin dependent, as has been described with in vitro models. Free drug monitoring of 5-MOP is discussed.

Lipophilicity determination of psoralens used in therapy through solubility and partitioning: comparison of theoretical and experimental approaches.

The aim of this study was to determine and to compare experimental and theoretical solubilities (S) as well as partition coefficients (PC) in an octanol/water system of psoralen (P), 8-methoxypsoralen (8-MOP), 5-methoxypsoralen (5-MOP) and 4,5',8-trimethylpsoralen (TMP). For each psoralen, experimental results were performed in triplicate with a spectrofluorimetric technique. The measurements were achieved 10 times for each solution. The obtained order of the solubilities in pure octanol was 5-MOP approximately TMP > P > 8-MOP, while in water-saturated octanol it was expressed as follows: TMP approximately 5-MOP > P > 8-MOP. However, the following order was found for hydrophobicity: TMP > 5-MOP > 8-MOP > P. The solubility ratios (SR) in pure octanol and water were assessed (mean +/- SD): 3.13 +/- 0.01 (P), 2.60 +/- 0.01 (8-MOP), 3.75 +/- 0.01 (5-MOP), and 5.11 +/- 0.01 (TMP). In saturated phases, they were 3.27 +/- 0.01, 2.63 +/- 0.01, 3.85 +/- 0.01, and 5.32 +/- 0.01, respectively. The PCs were determined with low concentrations according to the Dearden and Bresnen32 method and they were 1.67 +/- 0.01, 1.93 +/- 0.01, 2.00 +/- 0.01, and 3.14 +/- 0.01, respectively. Solubility parameters (delta), in Hildebrand unit (H) or in (cal/cm3)1/2, were evaluated. They confirmed the polarity of psoralens, previously expressed through the PC, although the positional isomers (5-MOP and 8-MOP) revealed no difference. Hildebrand's approach to the solubility of regular solutions and Yalkowsky's concept of the solubility of nonelectrolytes and weak electrolytes in an octanol/water system permitted a comparison of the theoretical and experimental results. The perspective of this work is to use the physicochemical properties of the psoralens in practice for insuring convenient experimental assays and the prediction, in vitro, of the percutaneous absorption of these compounds.

Comparison of Franz cells and microdialysis for assessing salicylic acid penetration through human skin.

The purpose of the present study was to compare Franz cells (FC) and microdialysis (MD) for monitoring the skin absorption of salicylic acid (SA). The influence of pH on SA flux was also assessed by these two techniques. Excised abdominal human skin was used in the experiments. SA was dissolved in phosphate buffer solutions of pH 2, 5 and 7 (2 mg/ml). SA concentrations in the receptor FC solutions and in MD samples were assessed by high performance liquid chromatography (HPLC). The results demonstrate that the flux of SA decreased with increased pH. The profiles permeation determined by Franz cells and microdialysis were similar. However, whatever the pH, the SA flux was higher with microdialysis than with Franz cells. The results showed that SA percutaneous permeation conformed to the pH partition hypothesis. The flux of SA was different when it was determined by the two techniques. The collect of SA, by these two techniques is different. The results of the two techniques are compared and discussed.

Methicillin-resistant Staphylococcus aureus: profiles oceans apart--Canadian and Saudi Arabian experiences.

Methicillin-resistant Staphylococcus aureus (MRSA), a pathogen which has increased over the past three decades, is responsible for nosocomial infections and adverse patient outcomes. It is a pathogen of global importance. Rates of patient colonization or infection vary greatly internationally. Lower rates have been observed in Canada and Saudi Arabia compared to the United States and United Kingdom. Although these lower rates may appear reassuring, the trend in MRSA observed in two capital cities, Winnipeg, Canada and Riyadh, Saudi Arabia are consistent with a widespread global increase in MRSA.

La microscopie confocale: interet pour l'analyse du relief cutané. Un outil d'évaluation dermo-cosmétique.

Nowadays, the determination of human skin microtopography is usually carried out by methods based on mechanical techniques (profilometry and surfometry), or founded on optical conception (shadowing method and profilometry). Negative skin replicas made of a silicone rubber material (Silflo((R))) or positive casts performed from an epoxy resin (Araldite((R))), are used to assess the skin microstructure. Skin surface microtopography is quantified by measuring furrows depths and spaces between them. An original application using confocal scanning laser microscope (CLSM) is described in this paper. The CLSM gives simultaneously images of the skin surface associated with quantitative measurements of the microtopography. With this apparatus, it is easy to achieve perfect skin replica images with assessment of its microstructure, before and after applications of topical medicines or cosmetic products to evaluate the skin surface restoration. It is worth to mention that it is indispensable to analyse the same skin surface (same plateaux and same furrows). For this reason, it is necessary to localize exactly and to replicate the same skin surface area (4 mm(2)) before and after the cosmetic use, whatever the extended period of the topical application.

Seroepidemiological study of Toxoplasma gondii infection in the human population in the Eastern Region.

OBJECTIVE: Toxoplasma gondii is an an obligate intracellular protozoan parasite that causes toxoplasmosis. The infection is worldwide, particularly in warm and moist climates. Few studies have been conducted on the prevalence of subclinical or overt disease in Saudi Arabia. No population-based study was conducted or the seroprevalence of toxoplasmosis in humans in Saudi Arabia and this initiated the present study. The present study aimed at studying seroprevalence of Toxoplasma IgG and IgM antibodies in sera from 5 areas in the Eastern Region of Saudi Arabia. METHODS: A population based epidemiological approach, prevalence according to lifestyle (urban or rural), gender (male or female) occupation and age. RESULTS: Inactive toxoplasmosis (IgG levels) is of rather high prevalence in the human population in the Eastern Region of Saudi Arabia (25%). On the other hand, active toxoplasmosis (acquired during pregnancy) is of rather low prevalence in this study (5%). Active toxoplasmosis (IgM levels) is positively related to the level of exposure, high in farmers and employees in village rural areas and low in children and students in urban areas. CONCLUSION: Patients with active toxoplasmosis are to be treated and made aware of their situation. Hygienic conditions in areas of rather high prevalence of active toxoplasmosis are to be more strictly imposed to minimize transmission of the disease.

Efficacy of recruitment maneuver for improving the brain dead marginal lungs to ideal.

BACKGROUND: Because of the shortage of lungs for transplantation, finding the suitable lungs in brain-dead donors is an important issue. Recruitment maneuver is a strategy aimed at re-expanding collapsed and edematous lung tissue. The aim of this study was to assess the efficacy of this maneuver on improving marginal lungs for transplantation. METHODS: From 127 brain-dead potential donor which were evaluated for lung donation in Masih Daneshvari Organ Procurement Unit of Tehran, Iran, 31 (25%) had marginal lungs for transplantation. These donors had normal chest X ray or bilateral infiltration and had PaO2 200-300 mm Hg with FIO2 100%. The recruitment maneuver was performed and arterial blood gas was obtained before and after maneuver. The maneuver lasts for 2 hours with continuous check of O2 saturation and patient's hemodynamic during. Finally, patients with normal bronchoscopy and PaO2/FIO2 >300 mm Hg were considered good candidates for lung transplantation. The frequency (%) and mean ± SD were used for description of variables and the Wilcoxon test was used for comparison between pre- and post-maneuver PaO2 with FIO2 100%. RESULTS: The mean ± SD of PaO2/FIO2 with 100% FIO2 of patients before and after recruitment were 239 ± 62 and 269 ± 91, respectively. Recruitment maneuver could convert 10 marginal lungs (32%) to appropriate ones (PaO2 > 300) and finally 8 lungs were transplanted. CONCLUSIONS: Findings of this study showed that recruitment maneuver could convert inappropriate lungs to appropriate ones in one third of brain-dead patients who had marginal lung condition. So, it is recommended that this maneuver is considered in the assessment protocol of lungs for donation.

Microbial pattern of bronchoalveolar lavage in brain dead donors.

BACKGROUND: We assessed bronchoalveolar lavage (BAL) cultures of brain dead donors seeking to achieve better donor management and decrease transplant complications. Determining the most common source of some postoperative infections causing morbidity and mortality among lung recipients would help to reach this goal. MATERIALS AND METHODS: This prospective study was performed on 80 brain dead donors from August 2008 to August 2009. Donors with partial pressure of arterial O2 to the fraction of inspired O2 (PaO2/FIO2)>300 mm Hg and a normal chest x-ray underwent bronchoscopy to obtain a BAL. FINDINGS: The mean donor age was 30±14 years and 50 (63%) were males with 21 (26%) showing a positive history for smoking and 32 (40%) with turbid tracheal secretions. Chest x-ray was abnormal in 49 (61%). Positive culture BAL results were observed among 30 (38%) patients: there were 17 (90%) bacterial and 6 (22%) fungal. Finally, 16 donors (20%) were considered suitable lung donors, allowing 10 lung transplantations. CONCLUSION: Only 20% of donors had acceptable lungs for transplantation. The high rates of positive bacterial and fungal BAL cultures in donors suggest the need for more aggressive critical care management and antibiotic therapy which may be beneficial to prevent future infections in recipients. Further prospective studies are needed to assess the correlation between donor BAL results and posttransplant morbidity and mortality.

Survival of Iranian patients on lung transplant waiting list: is there any difference?

OBJECTIVE: Lung transplantation is the last treatment option for end-stage pulmonary diseases. Reviewing the characteristics of patients on the lung transplant waiting list is a helpful way to evaluate and prioritize the patients in need of special care. Because we have no information about mortality on the lung transplantation waiting list in Iran, the aim of this study was to evaluate the characteristics and survival rates of these patients. METHODS: The file of lung transplant candidates listed between 2005 and 2010 were evaluated for patient demographic data, type of disorder, waiting list time, and outcomes of death, transplantation, or alive. RESULTS: The 131 patients on our list in this period revealed a mean age of 37±14 years with 86 (66%) males. The most common disorder among waiting list patients was pulmonary fibrosis (n=52; 40%). Among the 17 (13%) patients who were transplanted, most (35%) suffered from pulmonary fibrosis. The mean waiting time to transplantation was 17.2±11.8 months. Twenty-two patients (7%) died while on the waiting list. The mortality rate was unexpectedly highest among cystic fibrosis patients and then those with bronchiectasis. The mean survival time for all non-transplant patients based on the Kaplan-Meier method was 27.4 months and their 2-year survival rate was 74% based on life tables. CONCLUSION: Although pulmonary fibrosis patients show the poorest survival on lung transplant waiting lists, in other countries, patients with cystic fibrosis and bronchiectasis displayed the worst survival on the Iranian list probably due to their poor rehabilitation and sputum evacuation. We concluded that it is necessary for every center to evaluate the characteristics of its patient cohort to match the activity according to the needs.

Concomitant cryptococcosis and burkholderia infection in an asymptomatic lung transplant patient with cystic fibrosis.

Concomitant pulmonary infections with Cryptococcus neoformans and Burkholderia cepacia in lung transplant recipients are very rare and create unique diagnostic and therapeutic dilemmas. Herein, we present a double lung transplant patient with cystic fibrosis who was found to have coinfection with these two rare organisms, though he was completely asymptomatic.