In vitro susceptibility of filamentous fungi from mycotic keratitis to azole drugs.

OBJECTIVE: The in vitro antifungal activities of azole drugs viz., itraconazole, voriconazole, ketoconazole, econazole and clotrimazole were investigated in order to evaluate their efficacy against filamentous fungi isolated from mycotic keratitis. METHODS: The specimen collection was carried out from fungal keratitis patients attending Aravind eye hospital and Post-graduate institute of ophthalmology, Coimbatore, India and was subsequently processed for the isolation of fungi. The dilutions of antifungal drugs were prepared in RPMI 1640 medium. Minimum inhibitory concentrations (MICs) were determined and MIC50 and MIC90 were calculated for each drug tested. RESULTS: A total of 60 fungal isolates were identified as Fusarium spp. (n=30), non-sporulating moulds (n=9), Aspergillus flavus (n=6), Bipolaris spp. (n=6), Exserohilum spp. (n=4), Curvularia spp. (n=3), Alternaria spp. (n=1) and Exophiala spp. (n=1). The MICs of ketoconazole, clotrimazole, voriconazole, econazole and itraconazole for all the fungal isolates ranged between 16 µg/mL and 0.03 µg/mL, 4 µg/mL and 0.015 µg/mL, 8 µg/mL and 0.015 µg/mL, 8 µg/mL and 0.015 µg/mL and 32 µg/mL and 0.06 µg/mL respectively. From the MIC50 and MIC90 values, it could be deciphered that in the present study, clotrimazole was more active against the test isolates at lower concentrations (0.12-5 µg/mL) when compared to other drugs tested. CONCLUSION: The results suggest that amongst the tested azole drugs, clotrimazole followed by voriconazole and econazole had lower MICs against moulds isolated from mycotic keratitis.

Prediction of forced expiratory volume in spirometric pulmonary function test using adaptive neuro fuzzy inference system.

Spirometry is the most frequently performed clinical test to assess the dynamics of pulmonary function in human subjects. It measures airflow from fully inflated lungs through forced expiratory maneuver and generates large data set. However, these investigations often result in incomplete data sets due to the inability of the children and patients to perform this test. Hence, there is a requirement for prediction of significant parameters from the available incomplete data set. In this work, the results of model based prediction of two such significant parameters, Forced Expiratory Volume in one second (FEV1) and, Forced Expiratory Volume in six seconds (FEV6), are reported. The measured spirometric parameters are given as inputs to the Adaptive Neuro Fuzzy Inference System (ANFIS) which classifies data sets using fuzzy system based multilayer architecture. Triangular, Trapezoidal, Gaussian, Pi and Gbell membership functions are used to train and test the prediction process. The performance of the model is evaluated by computing their prediction error statistics of average value, standard deviation and root mean square. Results show that ANFIS model is capable of predicting FEV1 and FEV6 in both normal and abnormal subjects. Trapezoidal membership function predicted FEV1 with high precision and accuracy using a set of 21 rules. Similar prediction accuracy is observed in FEV6 using Gaussian membership function. Further, it is observed that prediction accuracy is found to be high for normal subjects with better correlation with measured values. It appears that this method is useful in enhancing diagnostic relevance of spirometric investigations in case of children and patients who are not able to perform the test as FEV1 and FEV6 are the useful indices to characterize pulmonary abnormalities.

Insulin resistance and lipid alterations in subclinical hypothyroidism.

INTRODUCTION: It is known that dyslipidemia and increased insulin resistance were associated with overt hypothyroidism, but their association with subclinical hypothyroidism is conflicting. Aim was to evaluate insulin resistance and lipid alterations in subclinical hypothyroidism. METHODS: Fifty consecutive cases of subclinical hypothyroidism are the subjects of the study. The cases are compared with age, gender and BMI matched controls. Lipid profile, insulin levels, FPG are assessed after overnight fast. Insulin resistance is calculated using HOMA-IR. The correlation between TSH& lipid prolife, TSH & IR was assessed. RESULTS: Total cholesterol (169.37±32.83 vs. 154.5±18.71, p= 0.031) & low density lipoprotein cholesterol (105.76±26.92vs 93.80±16.67, p=0.037) were significantly higher in cases compared to controls. High density lipoprotein cholesterol (44.23±4.65 vs 42.26±3.20, p=0.0507) was lower in cases which showed a trend towards significance. Triglycerides (97.64±39.44 vs. 92.96±43.49,p=0.65) , fasting insulin levels (11.74±7.16 vs 9.77±5.54,p=0.211) and Insulin resistance (2.30±1.49 vs. 1.78±1.09, p=0.11) were elevated but did not differ significantly between the two groups. CONCLUSION: Subclinical hypothyroidism is associated with elevation of TC, LDL-C and non significant increase in TG and insulin resistance. Both lipid profile and insulin resistance did not correlate with severity of hypothyroidism.

A Comparative study of examination scores and quantitative sensory testing in diagnosis of diabetic polyneuropathy.

CONTEXT: Many advances have taken place in the detection of diabetic polyneuropathy with respect to examination scores, electrophysiological techniques and quantitative sensory testing. AIM: This study aims to evaluate the discriminative power of the Diabetic Neuropathy Examination Score (DNE), 10-g Semmes-Weinstein Monofilament Examination (SWME) and Quantitative Sensory Testing by Vibration Perception Threshold (VPT) in the diagnosis of diabetic polyneuropathy and seek an optimal screening method in diabetic clinic. MATERIALS AND METHODS: Hundred consecutive patients with Type 2 diabetes were subjected to Diabetic Neuropathy Symptom Score, DNE score, Semmes-Weinstein monofilament examination, Vibration Perception Threshold and Nerve Conduction Studies; mean +/- SD for the various characteristics were calculated. Sensitivity and specificity for the DNE, SWME and VPT were calculated, taking NCS as gold standard. RESULTS: Seventy one of 100 subjects had evidence of neuropathy confirmed by Nerve Conduction Studies, while 29 did not have neuropathy. The DNE score gave a sensitivity of 83% and a specificity of 79%. The sensitivity of SWME was 98.5% and specificity was 55%. Vibration Perception Thresholds yielded a sensitivity of 86% and a specificity of 76%. CONCLUSIONS: A simple neurological examination score is as good as Vibration Perception threshold in evaluation of polyneuropathy in a diabetic clinic. It may be a better screening tool for diagnosis of diabetic polyneuropathy in view of the cost effectiveness and ease of applicability.

Type 1 renal tubular acidosis with sensorineural deafness.

We report a case of Type 1 Renal Tubular Acidosis (RTA) in association with sensorineural deafness. Inherited Type 1 RTA is usually autosomal dominant, though there is a rarer recessive form associated with nerve deafness. Simple alkali replacement can correct the systemic metabolic defect, but does not appear to ameliorate hearing loss.

Comparison of spinal vs general anesthesia via laryngeal mask airway in inguinal hernia repair.

HYPOTHESIS: The use of laryngeal mask airway and propofol in inguinal hernia repair results in shorter operative and recovery room times. DESIGN: Randomized control trial. SETTING: University hospital. PATIENTS: From May 2000 to March 2002, a convenience sample of 79 patients was invited to participate; 34 entered the study. Fifteen patients were randomized to subarachnoid block, and 18 patients were randomized to laryngeal mask airway. No patients withdrew from the study because of adverse effects. All study subjects were followed up for 6 months. INTERVENTION: General anesthesia via laryngeal mask airway or lidocaine subarachnoid block anesthesia for inguinal hernia repair. MAIN OUTCOME MEASURES: Operative and recovery room times; surgeon evaluation of the adequacy of the anesthetic technique; 36-Item Short-Form Health Survey scores before and after operation. RESULTS: Total time from entry into the operating room to discharge home was slightly longer in the subarachnoid block group (285 vs 262 minutes; 95% confidence interval, 251-317 minutes) but this difference was not statistically or clinically significant. Patient satisfaction was high with both techniques; patient-reported outcomes were the same. Surgeons rated muscle relaxation and exposure better with the subarachnoid block. CONCLUSIONS: We found no differences between short-acting spinal anesthesia and general anesthesia via laryngeal mask airway with intravenous propofol in efficiency or in early or late outcomes after elective inguinal hernia repair. Surgeon and patient preferences appear to be the most important reasons for selecting an anesthetic technique for individual patients undergoing inguinal hernia repair.

Preparation and evaluation of [166Ho] holmium-dimethyl diethylenetriaminepentaaceticacid (DMDTPA) as potential radiopharmaceutical for endovascular radiation therapy (EVRT).

Holmium-166 with its favorable radiation characteristics could be used in endovascular radionuclide therapy (EVRT) technique in liquid filled low-pressure balloon angioplasty. 166Ho-dimethyl di ethylene triamine penta acetic acid (DMDTPA) was prepared and its biodistribution carried out to evaluate its suitability as an EVRT formulation. DMDTPA was synthesized, characterized and was complexed with 166Ho. The complex was stable at 37 degrees C in human serum environment and at room temperature for 48 h. Biodistribution studies in mice revealed rapid renal clearance (approximately 90% of the injected dose in 30 min p.i.) with insignificant retention in any of the major organs including bone. The studies show that 166Ho-DMDTPA is a good formulation which can be explored as an EVRT source.