Phenotypic variability and therapeutic implications of Candida species in patients with oral lichen planus.

We investigated the prevalence and phenotypic variation of Candida species in oral lichen planus (OLP) and the therapeutic implications of our findings. Eighty patients with clinically and histopathologically confirmed cases of OLP (64 non-erosive, 16 erosive) and a control group of 80 healthy individuals with no predisposing factors for oral candidiasis were examined for evidence of Candida infection. Oral swabs and smears were obtained for cytology and culture. Identification, speciation and antifungal susceptibility tests of Candida isolates were performed using an automated microbial identification system. Fifty percent of erosive OLP cases, 28% of non-erosive cases and none of the controls showed evidence of Candida. Candida albicans was found predominantly in non-erosive OLP, while other Candida species were predominate in erosive OLP. Non-Candida albicans isolates (C. glabrata, C. krusei) were resistant to the commonly used antifungals, clotrimazole and fluconazole. Candida infection is common in cases of OLP. We recommend antifungal sensitivity testing prior to antifungal therapy for the erosive form of OLP.

Dexamethasone implant in diabetic macular edema in real-life situations.

PURPOSE: To report outcome of eyes with recalcitrant and naive eyes with diabetic macular edema (DME) treated with intravitreal dexamethasone implants (Ozurdex) injection. METHODS: Retrospective multicenter data analysis of eyes with DME treated with Ozurdex implant and with minimum follow-up of at least one year after the first implant. Data collected included demographic details, history of presenting illness, past treatment history, clinical examination details including visual acuity at presentation, and follow-up with imaging and treatment details. Paired sample t-test was used to measure mean differences between pre- and post-implant values obtained at baseline and last follow-up. RESULTS: A total of 79 eyes (62 subjects) were included. Sixty-four eyes had been previously treated; 15 eyes were naive. Among the previously treated eyes, mean interval between first Ozurdex injection and any previous treatment was 7.69±8.2 months. In naive eyes, the visual acuity improved from baseline 0.58±0.25 to 0.44±0.33 logMAR at last follow-up (P=0.05). In eyes that had been previously treated, the improvement was from 0.65±0.34 at baseline to 0.48±0.35 logMAR (P=0.01). Mean treatment-free interval was 6.5±4.5 months. Nine eyes were steroid responder with controlled intraocular pressure (IOP), none showed any spike in IOP during the follow-up period. CONCLUSIONS: Ozurdex implant could be a good alternative for recalcitrant as well as naive eyes with DME. The visual gain after initial implant injection was fairly maintained, with additional treatment usually after 6 months in naive eyes. Ozurdex appeared safe even in steroid responders with good control of IOP with antiglaucoma medications.

Randomized double-blind crossover study of the efficacy of a tart cherry juice blend in treatment of osteoarthritis (OA) of the knee.

OBJECTIVE: To assess the efficacy of tart cherry juice in treating pain and other features of knee osteoarthritis (OA). METHODS: 58 non-diabetic patients with Kellgren grade 2-3 OA were randomized to begin treatment with cherry juice or placebo. Two 8 oz bottles of tart cherry juice or placebo were consumed daily for 6 weeks with a 1 week washout period before switching treatments (crossover design). Western Ontario McMaster Osteoarthritis Index (WOMAC) scores and walking times were recorded prior to and after each treatment period. Additionally, plasma urate, creatinine and high sensitivity C-reactive protein (hsCRP) were recorded at baseline, after the first treatment period and after the second treatment period. Acetaminophen was allowed as a rescue drug and self reported after each treatment period. Treatment effect was examined with repeated measures analysis of variance (ANOVA) using an intention-to-treat (ITT) analysis. RESULTS: There were five withdrawals during the cherry juice treatment (four adverse events (AEs)) and seven withdrawals during the placebo treatment (three AEs). WOMAC scores decreased significantly (P < 0.01) after the cherry juice treatment but not after the placebo treatment (P = 0.46); differences between treatments were not significant (P = 0.16). hsCRP declined during the cherry juice treatment vs placebo (P < 0.01). The decline in hsCRP was associated with WOMAC improvement (P < 0.01). Walking time, acetaminophen use, plasma urate and creatinine were unaffected by treatments. CONCLUSIONS: Tart cherry juice provided symptom relief for patients with mild to moderate knee OA, but this effect was not significantly greater than placebo. Tart cherry juice lowered hsCRP levels and this effect was associated with improved WOMAC scores.

Successful therapeutic management of concurrent subclinical Eimeria leukarti and Babesia (Theileria) equi infection in a mare.

The occurrence of Eimeria leukarti infection in equine is being sporadically documented despite its cosmopolitan prevalence. A Marwari mare, aged 3 years and 6 months and owned by a socio-economically weaker class of labourer of royal families, was suffering from non specific enteric disorders. Detailed systemic clinical examination of mare confirmed subclinical enteric infection with E. leukarti and piroplasms of Babesia (Theileria) equi in the circulating erythrocytes. She was therapeutically managed with synchronous administration of specific and supportive therapy with success. Non specific clinical manifestations of the disease in equines, its debatable pathogenic significance, predisposing immunosuppressive impact of concurrent B. (T.) equi in circulating erythrocytes and probable reasons for under reporting of the disease in equines, etc. have been discussed.

An occurrence of clinical eperythrozoonosis in a German Shepherd dog and its therapeutic management.

Eperythrozoon spp.-a rickettsial (Mycoplasma) pathogen of the mammalian erythrocytic cell membrane, has been recognised to cause non specific, sporadic, febrile and haemolytic clinical disease in a variety of livestock, especially food animals. However, clinical eperythrozoonosis in companion animals seems not documented so far. An adult male German shepherd dog, aged 10.5 years and weighing 45 kg with clinical history of persistent mild fever in morning hours, depression and anorexia for the past 5 days and nasal bleeding for the past few months, was presented to clinicians for therapeutic management. Microscopic examination of Giemsa stained blood smear evidenced characteristic light pinkish to blue stained cocci and/or short rod shaped pathogens identified as Eperythrozoon canis, nesting in the depressions on the periphery of erythrocyte cell membrane as well as extra cellular free bodies in the plasma. Rhinoscopic detailed investigation failed to demonstrate any lesion in the nasal passage that could be attributed to the frequent nasal bleeding for the past few months. The dog was subsequently therapeutically managed with success using specific therapy and followed by supportive therapy. Finally, the predisposing factors of the disease, reasons for frequent nasal bleeding, clinical course of the disease in canines and its public health significance vis-à-vis future projections have been discussed.

Economic burden of comorbidities in patients with psoriasis is substantial.

BACKGROUND: Psoriasis is frequently associated with comorbidities. OBJECTIVE: To estimate the incremental economic burden associated with comorbidities in patients with psoriasis, accounting for psoriasis severity. METHODS: Patients continuously enrolled ≥6 months after a randomly selected psoriasis diagnosis date were selected from the Ingenix Impact National Managed Care Database (1999-2004). Comorbidities identified during the 6-month study included: psoriatic arthritis, cardiovascular disease, depression, diabetes, hyperlipidemia, hypertension, obesity, cerebrovascular diseases and peripheral vascular disease. Resource utilization and costs during the 6-month follow-up period were compared for patients with ≥1 comorbidity vs. those without and for patients with a specific comorbidity vs. those without. Adjusted incidence rate ratios (IRRs) and odds ratios (ORs) were estimated for resource utilization using negative binomial and logistic regression models, respectively. Adjusted incremental costs associated with comorbidities were reported using general linear models with log-link and gamma distributions or two-part models. Models controlled for age, sex and psoriasis severity. RESULTS: A total of 114,512 patients were included; 51% had ≥1 comorbidity. Hyperlipidemia (27%) and hypertension (25%) were most prevalent. Patients with comorbidities were more likely to experience urgent care [OR (95% confidence interval (CI))=1.58 (1.51-1.65)] than patients without comorbidities. They also had significantly greater hospitalization rates [IRR (95% CI)=2.27 (2.13-2.42)] and outpatient visits [IRR (95% CI)=1.53 (1.52-1.55)]. Compared with patients who did not have comorbidities, patients with comorbidities incurred $2184 (P<0.001) greater total costs. CONCLUSION: Comorbidities present a significant economic burden in patients with psoriasis.

Adalimumab for moderate to severe chronic plaque psoriasis: efficacy and safety of retreatment and disease recurrence following withdrawal from therapy.

BACKGROUND: Adalimumab is effective for moderate to severe chronic plaque psoriasis; however, data regarding retreatment following withdrawal and subsequent relapse are limited. OBJECTIVES: To evaluate the efficacy and safety of adalimumab if interrupted and then resumed in patients with moderate to severe psoriasis. METHODS: Patients in a long-term adalimumab open-label extension study (NCT00195676) who achieved a Physician's Global Assessment (PGA) score of 'Mild' (2), 'Minimal' (1) or 'Clear' (0) were withdrawn from adalimumab and monitored for relapse to PGA of 'Moderate' (3) or worse. The subgroup of interest had stable psoriasis control, defined as PGA of 0/1 for ≥12 weeks on every other week (eow) dosing before withdrawal. Relapsing patients were retreated with adalimumab (80 mg at week 0 and 40 mg eow starting at week 1). PGA, Psoriasis Area and Severity Index responses, fatigue, pharmacokinetics and immunogenicity were assessed. RESULTS: In total, 525 patients were withdrawn from adalimumab; the subgroup with stable psoriasis control comprised 285 patients. Of these, 178 relapsed (median=141 days) before treatment reinitiation and 107 did not relapse. Patients without relapse by 40 weeks off therapy reinitiated adalimumab. Rates of PGA 0/1 after 16 weeks of adalimumab retreatment were 89% for patients without relapse and 69% for patients who relapsed. Relapsers experienced significantly less fatigue after retreatment. Nine patients (3%) had serious adverse events (two were infections). No rebound or allergic reactions occurred. CONCLUSIONS: Adalimumab-treated patients who discontinued therapy and subsequently relapsed had a good likelihood of regaining clinical efficacy following adalimumab reinitiation.

Anti-arthritic activity of various extracts of Sida rhombifolia aerial parts.

Aerial parts of the plant Sida rhombifolia Linn. (Malvaceae) were extracted successively to produce various extracts. These extracts were screened for various parameters of anti-arthritic activity, such as adjuvant-induced arthritis, motor performance, mean distance travelled, and histopathological study. Results showed that the polar constituents (ethanol and aqueous extracts) of the plant S. rhombifolia were useful in the treatment of arthritis.

Diethylene glycol poisoning in Gurgaon, India, 1998.

OBJECTIVE: To discover the cause of acute renal failure in 36 children aged 2 months to 6 years who were admitted to two hospitals in Delhi between 1 April and 9 June 1998. METHODS: Data were collected from hospital records, parents and doctors of the patients, and district health officials. Further information was obtained from house visits and community surveys; blood and stool samples were collected from other ill children, healthy family members and community contacts. Samples of drinking-water and water from a tube-well were tested for coliform organisms. FINDINGS: Most of the children (26/36) were from the Gurgaon district in Haryana or had visited Gurgaon town for treatment of a minor illness. Acute renal failure developed after an episode of acute febrile illness with or without watery diarrhoea or mild respiratory symptoms for which the children had been treated with unknown medicines by private medical practitioners. On admission to hospital the children were not dehydrated. Median blood urea concentration was 150 mg/dl (range 79-311 mg/dl) and median serum creatinine concentration was 5.6 mg/dl (range 2.6-10.8 mg/dl). Kidney biopsy showed acute tubular necrosis. Thirty-three children were known to have died despite being treated with peritoneal dialysis and supportive therapy. CONCLUSION: Cough expectorant manufactured by a company in Gurgaon was found to be contaminated with diethylene glycol (17.5% v/v), but a sample of acetaminophen manufactured by the same company tested negative for contamination when gas-liquid chromatography was used. Thus, poisoning with diethylene glycol seems to be the cause of acute renal failure in these children.

Selenium levels in dilated cardiomyopathy.

Thirty-seven dilated cardiomyopathy cases have been studied and compared with 20 normal controls. Serum selenium levels in relation to coronary risk factors were studied. Serum samples were analysed for selenium, total cholesterol, high density lipoprotein(HDL) cholesterol, triglycerides and glucose levels. Smoking, alcohol intake, positive family history, psychosocial tension, obesity, hypercholesterolaemia, hypertriglyceridaemia and hyperglycaemia were found in the following percentages 27%, 8%, 5%, 73%, 41%, 38%, 81%, 46% respectively in dilated cardiomyopathy patients. Low selenium (< 4.5 micrograms/dl) and HDL cholesterol levels and high total cholesterol, triglycerides, low density lipoprotein cholesterol, very low density lipoprotein cholesterol and glucose levels were observed in dilated cardiomyopathy cases compared to controls. The present results support the concept that low selenium levels along with other risk factors play an important role in developing dilated cardiomyopathy.

Genetic heterogeneity in familial exudative vitreoretinopathy; exclusion of the EVR1 locus on chromosome 11q in a large autosomal dominant pedigree.

BACKGROUND/AIMS: Familial exudative vitreoretinopathy (FEVR) is associated with mutations in the Norrie disease gene in X linked pedigrees and with linkage to the EVR1 locus at 11q13 in autosomal dominant cases. A large autosomal dominant FEVR family was studied, both clinically and by linkage analysis, to determine whether it differed from the known forms of FEVR. METHODS: Affected members and obligate gene carriers from this family were examined by slit lamp biomicroscopy, indirect ophthalmoscopy, and in some cases fluorescein angiography. Patient DNAs were genotyped for markers at the EVR1 locus on chromosome 11q13. RESULTS: The clinical evaluation in this family is consistent with previous descriptions of FEVR pedigrees, but linkage analysis proves that it has a form of FEVR genetically distinct from the EVR1 locus on 11q. CONCLUSION: This proves that there are at least three different loci associated with comparable FEVR phenotypes, a situation similar to that existing for many forms of retinal degeneration.

Dilatation and stenting for naso-lacrimal duct obstruction: a pilot project.

PURPOSE: Obstruction of the naso-lacrimal duct has traditionally been treated by dacryocystorhinostomy. This pilot project aimed to evaluate the use of stents as an alternative approach to the treatment of naso-lacrimal duct obstruction. METHODS: Six patients with naso-lacrimal duct obstruction underwent a pre-procedural dacryocystogram to confirm the site of obstruction. Under local anaesthesia, they subsequently underwent dilatation of the naso-lacrimal duct using a guide wire and a plastic dilator aided by fluoroscopy and digital subtraction imaging. The stent was then placed with its head in the lacrimal sac and tail protruding out of the naso-lacrimal duct into the inferior meatus. Dacryocystography was repeated to confirm patency. Patients were followed up for a minimum of 12 months. RESULTS: The procedure was successfully completed in four of the six patients. In one patient, we failed to negotiate the guide wire and in one, a false passage was created. All four successful cases were rendered asymptomatic and their lacrimal passages remained patent at 12 months. CONCLUSION: Naso-lacrimal duct dilatation and stenting is a viable alternative to conventional dacryocystorhinostomy in the treatment of naso-lacrimal duct obstruction and merits a larger trial.

Higher prevalence of abdominal aortic aneurysms in patients with carotid stenosis but without diabetes.

BACKGROUND: We compared abdominal aortic aneurysm (AAA) prevalence in 3 groups of patients at the Hines Veterans Affairs Medical Center: (1) patients with 50% or more carotid stenosis, (2) patients with less than 50% stenosis, and (3) patients screened for the Aneurysm Detection and Management (ADAM) study. METHODS: Of all the patients referred to the vascular laboratory for carotid duplex examination during a 12-month period, patients with 50% or more carotid stenosis underwent ultrasonography of the abdominal aorta unless they had a previous scan or previous aortic surgery (group 1, n = 374). Patients with less than 50% carotid stenosis who had been screened for ADAM comprised group 2 (n = 139). They were compared with all patients screened for ADAM at our center during the same time period (group 3, n = 2477). RESULTS: AAA of 3.0 cm or more were present in 18.2%, 12.2%, and 7.2% of groups 1, 2, and 3, respectively; AAA of 4.0 cm or more were present in 8.3%, 5.8%, and 2.1% of groups 1, 2, and 3, respectively. Among patients with carotid stenosis, those patients without diabetes accounted for the observed increase in prevalence (21.9 % > or = 3.0 cm and 10.2% > or = 4.0 cm vs 9.2% and 2.8% in patients with diabetes). CONCLUSIONS: The relative risk of AAA is 2 to 3 times greater in patients with carotid stenosis compared with patients undergoing routine screening. However, only patients without diabetes account for the increased prevalence. Selective AAA screening of patients who are not diabetic with carotid stenosis is recommended.

An epidemiological study of drug abuse in urban population of madhya pradesh.

The present epidemiological survey was carried out to estimate the prevalence and pattern of drug abuse in urban population of Madhya Pradesh because such studies were lacking from this state. In the population of 5326, we found that 38.6% were current users. In order of frequency, the drugs used were - tobacco (36.8%), alcohol (26.5%), painkillers (9.8%), cannabis (4.1%), tranquilizers (2.4%) and opium (1.6%). Among tobacco users, 52.4% were using gudakhu.

Bromocriptine treatment of nonfluent aphasia.

Using a double-blind, placebo-controlled, crossover design, we studied the effect of bromocriptine (15 mg daily) in 20 men with chronic nonfluent aphasia. The study was conducted over a 28-week period in two phases. In phase I, the patients received either bromocriptine or placebo; in phase II the treatments were crossed over. We evaluated each patient's language and nonverbal cognitive skills at the beginning and end of each phase and 6 weeks after completion of phase II. When compared with placebo treatment, bromocriptine did not significantly improve the patient's speech fluency, language content, overall degree of aphasia severity, or nonverbal cognitive abilities. Based on these results, bromocriptine is not recommended as monotherapy for the treatment of chronic nonfluent aphasia.

Primary intraventricular hemorrhage in adults: clinical features, risk factors, and outcome.

BACKGROUND AND PURPOSE: Nontraumatic primary intraventricular hemorrhage in adults is uncommon. The purpose of this study was to identify clinical features, risk factors, and outcome of primary intraventricular hemorrhage in adults. METHODS: We identified computed tomography scans for nontraumatic primary intraventricular hemorrhage performed between 1982 and 1993 at our institutions and reviewed medical records to determine clinical features, risk factors, and outcomes of these patients. RESULTS: Of 14 cases studied, the onset of symptoms was acute in all and the most common symptom was headache (78%), followed by nausea/vomiting (71%), and mental status change (71%). Seizures as well as focal neurologic deficits were uncommon. The associated risk factors were hypertension in 7 cases, aneurysm or arteriovenous malformation in 5, coagulopathy in 1, and fibromuscular dysplasia in 1 case. Five patients died acutely, and all of the survivors returned to functional independence. The patients with lethargy, pupillary and extraocular movement abnormalities, quadriparesis, hydrocephalus, and aneurysmal intraventricular hemorrhage had worse outcomes. CONCLUSION: Patients with nontraumatic primary intraventricular hemorrhage present with sudden onset of diffuse neurologic symptoms. The mortality in early phase is high (36%) and the prognosis for survivors is good. Factors correlating with the outcome are discussed.

Silent cerebral infarction in patients with nonrheumatic atrial fibrillation. The Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators.

BACKGROUND: Cerebral infarction in patients with atrial fibrillation may vary from being clinically silent to catastrophic. The prevalence of silent cerebral infarction and its effect as a risk factor for symptomatic stroke are important considerations for the evaluation of patients with atrial fibrillation. METHODS AND RESULTS: This Veterans Affairs cooperative study was a double-blind controlled trial designed primarily to determine the efficacy of warfarin for the prevention of stroke in neurologically normal patients with nonrheumatic atrial fibrillation. It also was designed to evaluate patients with silent cerebral infarction. Computed tomography scans of the head were performed at entry, at the time of any subsequent stroke, and at termination of follow-up on all patients who completed the study without a neurological event. Of 516 evaluable scans performed at entry, 76 (14.7%) had evidence of one or more silent cerebral infarcts. Age (P = .011), a history of hypertension (P = .003), active angina (P = .012), and elevated mean systolic blood pressure (P < .001) were associated with the presence of this finding. Silent cerebral infarction occurred during the study at rates of 1.01% and 1.57% per year for the placebo and warfarin treatment groups, respectively (NS). Silent cerebral infarction at entry was not an independent predictor of later symptomatic stroke, but active angina was a significant predictor; 15% of the placebo-assigned patients with angina developed a stroke compared with 5% of the placebo-assigned patients without angina. CONCLUSIONS: Silent cerebral infarction is frequently seen in asymptomatic patients with atrial fibrillation. Age, history of hypertension, active angina, and elevated mean systolic blood pressure were associated with silent infarction at entry. The sample size was too small to determine whether warfarin had an effect on the incidence of silent infarction during the trial. Active angina at baseline was the only significant independent predictor for the later development of symptomatic stroke.