Combination Versus Monotherapy for the Treatment of HIV Associated Cryptococcal Meningitis.

OBJECTIVE: To study the efficacy of anti Cryptococcal treatment by cerebrospinal fluid (CSF) fungal negativity after two weeks of treatment with amphotericin B alone or combined with fluconazole in treatment of HIV associated Cryptococcal meningitis (CM). MATERIALS AND METHODS: A total of 84 human immunodeficiency virus (HIV) associated CM patients confirmed by CSF culture positivity were recruited for the study. Patients were randomly divided into two groups. Group A was given amphotericin B alone whereas Amphotericin B in combination with fluconazole was given in group B for the treatment of CM. Patients were followed for 14 days. RESULTS: Maximum number of patients was in the age group 21-49 y. All the 84 patients had <100 CD4 counts/µl. After 14 days of the treatment in group A and B, there was no significant difference in terms of fever, headache and neck stiffness as a clinical outcome. But in group B there was improved in altered sensorium and focal neurological deficit as compared to group A. After 14 days of the treatment CSF culture negativity was more in group B as compared to group A. CONCLUSION: Amphotericin B in combination with fluconazole is recommended for the treatment of HIV associated CM.

Papillary cystadenocarcinoma of the mammary gland with metastases to the gastrointestinal tract in a Himalayan brown bear (Ursus arctos).

A 17-yr-old, multiparous female brown bear (Ursus arctos) bred in captivity at the Himalayan Nature Park, Kufri, Shimla, Himachal Pradesh, India, died after a short progressive illness of 2 wk duration. Clinically, the bear had dyspnea and was pyretic, inappetent, and lethargic. Within the right pectoral mammary gland was an 11-cm diameter, round, firm, subcutaneous mass. At postmortem examination, the mammary gland revealed a well-differentiated, multinodular infiltrative mass with multiple nonuniform cystic spaces. These cystic spaces were filled with watery, opaque white to yellow contents. Additionally, multifocal, nodular, ovoid intraluminal masses that extended transmurally from the mucosal surface to the serosa were detected in the duodenum and jejunum. Histopathologic examination revealed papillary cystadenocarcinoma of the mammary gland with metastases to the intestine, which has not been documented previously in Himalayan brown bears.