A Clinico-mycological, Antifungal Drug Sensitivity and Therapeutic Study of Extensive Dermatophytosis in Coastal Andhra Pradesh.

Background: In India, an increased prevalence of chronic, recurrent, and recalcitrant dermatophytosis is being observed. The present study assesses the clinico-mycological profile, antifungal drug sensitivity and therapeutic efficacy of various systemic antifungal drug regimens, in extensive dermatophytosis patients of coastal Andhra Pradesh. Materials and Methods: One hundred and fifty clinically diagnosed cases of extensive dermatophytosis affecting more than one body region were enrolled. Skin samples were taken for direct microscopy and fungal culture. Antifungal drug sensitivity testing was done with broth microdilution test. Therapeutic efficacy of systemic antifungal drug regimens was determined by randomly dividing the patients into 5 groups of 30 each. Results: The most common clinical patterns observed were tinea corporis et cruris (62.7%) followed by extensive tinea corporis (11.3%). KOH and culture positivity were seen in 132 (88%) and 84 cases (56%) respectively. Trichophyton mentagrophytes was isolated in 78 cases (92.8%) followed by Microsporum gypseum in 6 patients (7.1%). The overall mean minimum inhibitory concentration values for itraconazole (0.04 µg/mL) were low when compared to griseofulvin (4.61 µg/mL) and terbinafine (6.9 µg/mL) (P < 0.05). Combination of itraconazole and griseofulvin achieved highest clinical and mycological cure rates (93.1%). Among patients receiving single drugs, itraconazole had higher cure rates (71.4%) compared to terbinafine (59.2%) and griseofulvin (53.8%) (P < 0.05). Conclusion: Trichophyton mentagrophytes has replaced Trichophyton rubrum as the predominant species causing dermatophytosis in Andhra Pradesh, presenting with a severe phenotype. Itraconazole was found to be the most effective drug both in vivo and in vitro. A combination of systemic drugs should be considered in cases of monotherapy failure and in recalcitrant dermatophytosis.

Metabolic risk factors in first acute coronary syndrome (MERIFACS) Study.

OBJECTIVES: In acute coronary syndrome (ACS) patients the focus is on major conventional risk factors - CRF [diabetes, hypertension, elevated low-density cholesterol (LDL-C) and smoking] whereas others - specific metabolic risk factors - MRF [high-density lipoprotein cholesterol (HDL-C), body-mass index (BMI), waist-hip ratio (WHR), and triglycerides, and HbA1c get less attention. METHODS: This is a prospective case-control observational study from 15 tertiary care hospitals in India. CRF and MRF in patients presenting with first incidence of ACS (n = 2153) were compared with matched controls (n = 1210). RESULTS: Propensity score matching (PSM) yielded 1193 cases and matched 1210 controls. Risk factor prevalence in cases vs. controls were CRF: hypertension - 39.4% vs 16.4% (p < 0.0001), diabetes - 42.6% vs 12.7% (p < 0.0001), smoking - 28.3% vs 9.3% (p < 0.0001) and elevated LDL-C - 70.2% vs 57.9% (p < 0.0001). MRF: High BMI - 54.7% vs 55.1% (p = 0.84), increased waist: hip ratio 79.5% vs 63.6% (p < 0.0001), high HbA1c - 37.8% vs 14.9% (p < 0.0001), low HDL-C - 56.2% vs 42.8% (p < 0.0001) and elevated triglycerides - 49.7% vs 44.2% (p = 0.007). Adjusted Odds ratios by multivariate analysis were CRF: hypertension - 2.3 (p < 0.001), diabetes - 4.7 (p < 0.001), high LDL-C - 3.3 (p < 0.001) and smoking- 6.3 (p < 0.001). MRF: High waist: hip ratio - 2.4 (p < 0.001) high HbA1c - 3.2 (p < 0.001), low HDL-C 2.2 (p < 0.001) and elevated triglycerides - 0.878 p = 0.17. CONCLUSION: In India, the risk of ACS conferred by specific metabolic risk factors (High waist: hip ratio, Low HDL-C and High HbA1c) is comparable to that caused by CRF.

A fast, validated UPLC method coupled with PDA-QDa detectors for impurity profiling in betamethasone acetate and betamethasone phosphate injectable suspension and isolation, identification, characterization of two thermal impurities.

For impurity profiling of betamethasone acetate and betamethasone phosphate injectable suspensions, a quick, verified stability indicating UPLC technique incorporating the detectors PDA-QDa had been established. This method with an analysis time of 12min could able to separate all possible degradation impurities. Two of the thermal impurities have been identified in positive mode of detection by using QDa detector and isolated by using preparative HPLC. The method works at a flow rate of 0.5mL/min in column: Poroshell 120 EC C18 (100×2.1)mm, 1.9µm, maintained temperature precisely at 40°C. The M/Z values in ESI positive mode for the two new degradation impurities have been identified (M+H) as 393.22 (DP1), 363.17 (DP2) and confirmed by 1H NMR. The approach was also verified in accordance with the rules of ICH Q2 (R1). From LOQ quantity value to 150% quantity of specified concentration (2% for betamethasone and 0.5% for other impurities), the technique of UPLC-PDA-QDa was proven to be linear and accurate. Precision and ruggedness results showed˂5% RSD. Accuracy results showed more than 95% recovery from LOQ till 150% of impurity specification. This UPLC-PDA-QDa methodology was found specific, precise, stable and robust for quantification of all possible degradation impurities. The proposed method has been transferred to quality control laboratories to access the impurity profile during product storage.

Assay of tirofiban and identification of oxidative impurity in aqueous injection by using UPLC-PDA/QDa detectors.

The basic objective of this study is to propose a short, reliable, mass compatible ultra-performance liquid chromatography (UPLC) method to confirm the identity of impurities and to estimate the assay and purity of Tirofiban simultaneously in aqueous injection (5mg/100mL bag). Aqueous formulations are susceptible to oxidation, hence the possible oxidative degradation impurities of Tirofiban were studied in this experiment by using UPLC coupled with photodiode array/Quadrupole Dalton Analyzer (PDA/QDa) detectors. The required separations were achieved in the column: ACQUITY HSS T3 (100×2.1) mm, 1.7µm, operated at 30°C by using 0.02% Triethyl amine (TEA) in water, pH 2.8 with formic acid as solution-A and 0.1% formic acid in 9:1 acetonitrile, water as solution-B. Binary gradient flow is delivered at the rate of 0.5mL/min and the detection of impurities specifically carried out at 227nm using empower3 software. RP-UPLC/PDA with QDa detector was used for the experiment. The method was linear and accurate from the concentrations: 0.04 to 0.38µg/mL for impurity-A and 0.04 to 75µg/mL for Tirofiban. The major unknown degradation impurity generated during the oxidative degradation has been identified as N-oxide derivative (Impurity-B) [(M+H)+ 455.1] by using QDa detector operated in an electro spray positive ion mode by applying a voltage of 0.8kV. This method was further validated as per ICH Q2 (R2) guidelines. Hence, the proposed method is said to be a fast, sensitive and comprehensive technique, which could give a clear idea about the assay and impurity profile of Tirofiban injection.

Comorbidities in Lichen Planus: A Case-control Study in Indian Patients.

BACKGROUND: Many previous studies have observed an association of lichen planus (LP) with one or two comorbidities such as diabetes mellitus and thyroid dysfunction. This study was undertaken to determine the association of LP with common comorbidities including diabetes mellitus, dyslipidemia, metabolic syndrome, thyroid dysfunction, and hepatitis C virus (HCV) infection. MATERIALS AND METHODS: The study included 75 patients with clinical diagnosis of LP and 75 age- and sex-matched controls. After taking complete history, general examination and thorough dermatological examination were performed in all cases. Fasting serum samples were taken from all cases and controls and assayed for fasting plasma glucose, lipid profile, T3, T4, and thyroid-stimulating hormone levels, and anti-HCVantibodies. Metabolic syndrome was diagnosed according to 2005 revised National Cholesterol Education Programme's Adult Treatment Panel III. Two-sample Student's t-test was used for statistical analysis. RESULTS: Increased triglyceride levels were seen in 26 cases (34.67%) compared with 14 controls (14%), which was significant (P = 0.024). Statistically significant increased prevalence of increasedlow-density lipoprotein levels (P = 0.027), low high-density lipoprotein levels (P = 0.0189), and diabetes mellitus (P = 0.0217) was also observed in LP. Metabolic syndrome (P = 0.656) and hypothyroidism (P = 0.117) were not significantly associated with LP. Strong association was observed between oral LP and hypothyroidism. All patients screened for anti-HCV antibodies were found to be negative. CONCLUSION: There is a clear associationof LP with dyslipidemia and diabetes mellitus. Screening for dyslipidemia and diabetes mellitus in all patients of LP will help in early detection, initiation of treatment, and prevent long-term morbidity.

Fiber technology in space maintainer: a clinical follow-up study.

Various space maintainers are used in pediatric dentistry. However, their construction requires time consuming laboratory procedures. Recently fiber-reinforced composite resin (FRCR) has been introduced for various application in dentistry. Polyethylene fibers appear to have the best properties in elasticity, translucency, adaptability, tenaciousness, resistance to traction and to impact. The purpose of this study was to clinically evaluate the long-term effect of FRCR space maintainer made with Ribbond(®) bondable reinforcement ribbon in children over a period of 18 months. A total of thirty FRCR space maintainers were applied to 30 children between the age group of 6 to 9 years old, follow-up visits were done at 1, 6, 12 and 18 months. The data obtained was subjected to statistical analysis. Maxillary appliances survived more than mandibular appliances. Mean survival time of space maintainer were found to be 12 months (minimum 1 and maximum 18 months). The present study suggested that FRCR space maintainers (Ribbond(®)), which was observed for up to 18 months, can be accepted as a successful alternative to conventional band-loop space maintainer only for short periods.

Coronary collaterals by transthoracic echocardiography in coronary artery disease.

Demonstration of coronary collaterals has been mostly done by coronary angiographic techniques. Coronary collaterals have been demonstrated by transthoracic echocardiography for patients with anomalous origin of coronary arteries from pulmonary artery. Indirect assessment of collaterals to an infarct-related artery has been done using myocardial contrast echocardiography. We describe in this article 3 patients with coronary artery disease in whom coronary collaterals were demonstrated by transthoracic echocardiography before angiography. To our knowledge, coronary collateral demonstration by transthoracic echocardiography before angiography in patients with coronary artery disease has not been previously reported.