Epidemiology, risk factors and antimicrobial profile of Vulvovaginal Candidiasis (VVC): A study among women in the central region of Saudi Arabia.

BACKGROUND: Candida spp. is a fungal resident of the normal microbiota of gastrointestinal tract, reproductive mucosa and oral cavity. Hence, a majority of the healthy population may be prone to the most common fungal infection such as candidiasis that can be caused by any species of Candida. In women, vaginitis or vulvovaginal candidiasis (VVC) forms a significant part of urogenital infections with a high recurrence rate thus posing a public health issue worldwide. OBJECTIVES: The aim of this study was to determine the prevalence of VVC, its possible risk factors and the antifungal susceptibility of the species isolated from women attending a hospital in the central region of Saudi Arabia. METHODS: Samples of high vaginal swabs (HVS) were obtained from 208 women aged 15-64 years with signs and symptoms of VVC. The samples were cultured on Sabouraud agar plates (SDA) and incubated at 30°C for 10 days. Candida spp. were initially identified using morphologic characteristics, wet mount, germ tube test and finally confirmed with Vitek 2. RESULTS: Among the samples, 34% were culture positive. Out of the positive samples, 68% were Candida albicans, followed by C. tropicalis (27%) and C. glabrata (2.7%). Majority of the C. albicans (16%) were observed in women between ages of 21-30 years. All the isolates were sensitive to the antifungals tested. Also, the presence of Candida spp. did not correlate to risk factors such as pregnancy, diabetes and use of antibiotics. CONCLUSIONS: Prevalence of vulvovaginal candidiasis was observed in the central region of Saudi Arabia with the predominant organism as Candida albicans.

Comparison of Two Sampling Methods for Assessing Halyomorpha halys (Hemiptera: Pentatomidae) Numbers in Soybean Fields.

Sampling soybean fields for the brown marmorated stink bug, Halyomorpha halys Stål (Hemiptera: Pentatomidae), can be challenging. Both adults and nymphs have a "startle response" and drop to the ground with even the slightest disturbance. This behavior could reduce the effectiveness of the traditional sweep net and ground cloth sampling methods. In 2013 and 2014, in Virginia, Delaware, and Maryland, we evaluated a visual plant inspection method that consisted of counting the number of brown marmorated stink bug nymphs and adults seen on soybean plants in a 2-min inspection period while walking carefully between two rows. After a 30-min interval, which allowed the stink bugs to reposition in the canopy, the area was resampled using 15 sweeps with a 38-cm-diameter sweep net. In total, 76 soybean fields and 2,042 paired comparisons were used to determine a strong linear relationship between sampling methods (y = 0.984x + 0.4359, R2 = 0.6934, where y = brown marmorated stink bugs/2-min visual count and x = brown marmorated stink bugs/15 sweeps). An average visual count of 5.4 brown marmorated stink bugs in 2 min was estimated as being equivalent to the current economic threshold of 5 stink bugs per 15 sweeps. Visual inspection appears to be an effective method for assessing brown marmorated stink bug populations in soybeans.

Drug resistance profile of human Mycobacterium avium complex strains from India.

PURPOSE: To determine minimum inhibitory concentration (MIC) of various anti-tuberculosis drugs for Mycobacterium avium complex (MAC) strains isolated from clinical samples. METHODS: Forty-nine human isolates of MAC were tested for susceptibility to nine chemotherapeutic agents. All isolates were from Indian patients suffering from chronic pulmonary mycobacteriosis. Drug susceptibility was performed both by agar dilution and MIC method. MIC values were analysed, both visually and by enzyme-linked immunosorbent assay reader. RESULTS: More than 40% of the MAC isolates were sensitive to ciprofloxacine (48.98%), amikacin (46.94%) and roxithromycin (42.86%) by the MIC method. In contrast, the isolates showed high degree of resistance to the first line antituberculosis drugs: only 28.6% were sensitive to rifampicine, 22.85% to isoniazid and ethambutol each and 36.7% were sensitive to streptomycin. In addition, 22.85% of the strains were sensitive to clofazimine and 34.7% to kanamycin. CONCLUSIONS: Results of the study confirm the suitability of the rapid broth micro dilution (MIC) method as a simple yet reliable method to assay for the drug susceptibility of nontuberculosis mycobacterium.

Depression in medical disorders.

This review highlights the occurrence of depressive disorders in medically ill patients. It discusses the difficulties in diagnosing depression in the medically ill due to the vegetative symptoms of depression which are also a feature of many medical diseases. Depression in the medically ill may be due to the disease itself, its psychological reaction, due to complications because of metabolic or other disturbances, or due to the medications for the treatment of the disease. The role of active consultation liaison between medical specialists and mental health professionals will help provide total care to the medically ill.

Mania in hiv infection.

Mania in HIV infected individuals is an uncommon clinical presentation. It can, however, complicate any stage of the HIV infection. We herewith report a set of three case reports of patients with HIV infection who developed manic episodes. The cases highlight some aspects of the plausible relationship between HIV infection and mania. HIV infection could be revealed by manic episode, it could itself also be associated with increased cycling in bipolar patients. Mania could be secondary to HIV or zidovudine therapy (though the etiological role of the latter is as yet unclear). Mania could also occur as a reaction to awareness to having HIV infection. These relationships are important for both the physician and the psychiatrist as they have important therapeutic and prognostic implications.

Depression: psychosocial basis.

Normal emotions like sadness need to be differentiated from depressive illnesses. A number of psychological and social theories have been proposed to explain depression in the psychosocial context in which it occurs. A multifactorial bio-psychosocial approach to causation of depression provides a holistic understanding of the patient and also helps to plan appropriate pharmacological and psychosocial therapies to treat the patient.

Mental hospitals in India.

This review traces the history of the mental hospital movement, initially on the world stage, and later in India, in relation to advances in psychiatric care. Mental hospitals have played a significant role in the evolution of psychiatry to its present statusThe earliest hospital in India were established during the British colonial rule. They served as a means to isolate mentally ill persons from the societal mainstream and provide treatments that were in vogue at the time. Following India's independence, there has been a trend towards establishing general hospital psychiatry units and deinstitutionalization, while at the same time improving conditions in the existing mental hospitals.Since 1947, a series of workshops of superintendents was conducted to review the prevailing situations in mental hospitals and to propose recommendations to improve the same. Implementation of the Mental Health Act, 1987, and grovernmental focus upon mental hospital reform have paved way for a more specific and futuristic role for mental hospitals in planning psychiatric services for the new millenium, especially for severe mental illnesses.

A questionnaire survey of psychiatrists attitudes towards genetic counselling.

Genetic counselling in psychiatry aims at facilitating mentally ill patients and their relatives to make informed choices after understanding what is known about the genetics of a given mental disorder This area of practice is a recent development in mental health care. This study surveyed the attitudes and practices of Indian psychiatrists towards genetic counselling. Fifty-nine out of 150 randomly selected psychiatrists completed a semi-structured questionnaire assessing various aspects of genetic counselling in practice.The results show that there is a felt need for genetic counselling among patients. Most of the respondents provide information regarding the hereditary nature and risk of inheritance of mental illnesses in single sessions of less than 30 minutes duration in clinical situations. Most psychiatrists (76%) felt that genetic counselling is feasible in practice, but 24% felt inadequate knowledge, illiteracy among patients and time constraints as some hindering factors for the same. Genetic counselling was considered to be important in planning management for patients by most respondents. The need to improve their knowledge and skills in the genetic understanding of mental illnesses was also reported. These results have implications for future practice of genetic counselling in the Indian setting.

A case report of carisoprodol dependence.

Carisoprodol is a centrally acting skeletal muscle relaxant whose active metabolite is meprobamate. There have been few reports of carisoprodol abuse from India. This is a report of a case with carisoprodol dependence. The patient also had poly substance abuse of alcohol, nicotine, benzodiazepine and dextropropoxyphene. Although no specific withdrawal syndrome could be identified, the patient had symptoms of anxiety, insomnia, restlessness and craving. Clinicians must be aware of the dependence potential of carisoprodol and need to be cautious in its prescription, especially in view of its free availability in the Indian market.

Expression, purification and kinetic characterization of wild-type human ornithine transcarbamylase and a recurrent mutant that produces 'late onset' hyperammonaemia.

Ornithine Transcarbamylase Deficiency, an X-linked disorder, is the most common cause of inherited urea cycle disorders. Approx. 90 mutations that produce reduced levels of ornithine transcarbamylase (OTCase) activity have been identified in patients [Tuchman (1993) Hum. Mutat. 2, 174-178; Tuchman and Plante (1995) Hum. Mutat. 5, 293-295]. A model of the three-dimensional structure of OTCase, developed on the basis of its homology to the catalytic subunit of Escherichia coli aspartate transcarbamylase (ATCase) [Tuchman, Morizono, Reish, Yuan and Allewell (1995) J. Med. Genet. 32, 680-688], and in good agreement with the crystal structure of Pseudomonas aeruginosa OTCase [Villeret, Tricot, Stalon and Dideberg (1995) Proc. Natl. Acad. Sci. U.S.A. 92, 10762-10766], indicates that many mutations that produce severe clinical symptoms are at the active site or buried in the interior of the protein. However, one of the few recurrent mutations, R277W, an alteration that produces a milder phenotype of ornithine transcarbamylase deficiency, is located in the model in a loop remote from the active site that is analogous to a similar loop (the 240's loop, a flexible loop of the catalytic chain of Escherichia coli aspartate transcarbamylase, comprised of residues 230-250) of ATCase. Human wild-type OTCase and the R277W mutant have been cloned and overexpressed in E. coli and a rapid and efficient purification method utilizing the bisubstrate analogue, Ndelta-(phosphonacetyl)-L-ornithine, has been developed and used to purify both proteins. Gel chromatography indicates both are trimeric. The pH dependence of the kinetic parameters of the wild-type enzyme is similar to that of E. coli OTCase [Kuo, Herzberg and Lipscomb (1985) Biochemistry 24, 4754-4761], suggesting that its catalytic mechanism is similar, although its maximal activity is approx. 10-fold less. Compared with the wild-type, the R277W mutant has nearly 70-fold lower affinity for L-ornithine, shows no substrate inhibition, and its thermal stability is reduced by 5 degrees C. Its reduced affinity for L-ornithine, which in turn results in lower activity at physiological concentrations of ornithine, as well as its reduced stability, may contribute to the clinical effects that it produces.