Myxedema crisis and ovarian hyperstimulation in a child with Down syndrome.

OBJECTIVES: Myxedema crisis, a fatal complication of severe hypothyroidism, is extremely rare in children and treatment guidelines are lacking. Since availability of intravenous levothyroxine is limited in resource poor settings, myxedema crisis can be treated with oral levothyroxine and/or oral liothyronine (if necessary), in the absence of cardiac risk factors, thus hastening the recovery and significantly decreasing the associated morbidity and mortality. In the background of untreated hypothyroidism, a possible association of ovarian hyperstimulation syndrome (OHSS) and reactive pituitary hyperplasia should be kept in mind, thus preventing unnecessary interventions. CASE PRESENTATION: A 13-year-old girl child with Down syndrome, presented with myxedema crisis, as initial presentation of untreated hypothyroidism. CONCLUSIONS: Annual screening, timely diagnosis of hypothyroidism, and early initiation of thyroid hormone supplementation will prevent associated physical and neurocognitive morbidity in children, especially those with Down syndrome. Importance of oral liothyronine supplementation in myxedema crisis, has been highlighted in this case report.

Species distribution and antifungal susceptibility among clinical isolates of Candida parapsilosis complex from India.

BACKGROUND: Candida parapsilosis is recognized as a species complex: Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis are three distinct but closely related species. AIMS: To determine the species and antifungal susceptibility of members of the C. parapsilosis complex, isolated from clinical samples. METHODS: Isolates identified as C. parapsilosis complex by VITEK® 2 system were included. Antifungal susceptibility test was done using the VITEK® 2 semi-automated system. The distribution of the species in the complex was determined by multiplex PCR. RESULTS: Among the seventy-seven C. parapsilosis complex isolates, C. parapsilosis sensu stricto (57.1%) was the commonest species, followed by C. orthopsilosis (40.2%) and C. metapsilosis (2.5%). All three species were susceptible to amphotericin B, caspofungin and micafungin. Among C. parapsilosis sensu stricto isolates, 16% were resistant to fluconazole while 2.2% showed dose dependent susceptibility. Also, 18.2% of C. parapsilosis sensu stricto isolates showed dose dependent susceptibility to voriconazole. CONCLUSIONS: C. parapsilosis sensu stricto was the most commonly isolated member of the C. parapsilosis complex and it showed high resistance to fluconazole. A high prevalence of C. orthopsilosis (40.2%) was also noted.

Gaussian Fuzzy Number for STR-DNA Similarity Calculation Involving Familial and Tribal Relationships.

We performed locus similarity calculation by measuring fuzzy intersection between individual locus and reference locus and then performed CODIS STR-DNA similarity calculation. The fuzzy intersection calculation enables a more robust CODIS STR-DNA similarity calculation due to imprecision caused by noise produced by PCR machine. We also proposed shifted convoluted Gaussian fuzzy number (SCGFN) and Gaussian fuzzy number (GFN) to represent each locus value as improvement of triangular fuzzy number (TFN) as used in previous research. Compared to triangular fuzzy number (TFN), GFN is more realistic to represent uncertainty of locus information because the distribution is assumed to be Gaussian. Then, the original Gaussian fuzzy number (GFN) is convoluted with distribution of certain ethnic locus information to produce the new SCGFN which more represents ethnic information compared to original GFN. Experiments were done for the following cases: people with family relationships, people of the same tribe, and certain tribal populations. The statistical test with analysis of variance (ANOVA) shows the difference in similarity between SCGFN, GFN, and TFN with a significant level of 95%. The Tukey method in ANOVA shows that SCGFN yields a higher similarity which means being better than the GFN and TFN methods. The proposed method enables CODIS STR-DNA similarity calculation which is more robust to noise and performed better CODIS similarity calculation involving familial and tribal relationships.