Fungal colonization in gastric ulcers

Until now studies on fungal colonization of gastric ulcers were retrospective involving small series of patients. This prospective study of 50 patients with gastric ulcers (25 benign and 25 malignant) revealed colonization by Candida in 17 (34%) cases. There was no significant difference in colonization between benign and malignant ulcers. Follow up revealed no difference in healing of ulcers with or without fungal colonization.

Penicillium species causing onychomycosis

Onychomycosis caused by mould infection is rare. A 40 year old male patient presented with dystrophic finger nails and multiple, erythematous lesions with slightly raised borders and scaling all over the body. The patient was a known diabetic. He did not respond to griseofulvin. Samples from nails and skin scales were cultured. From the nails, Penicillium species and from the skin scales. Trichophyton rubrum were isolated. Ketoconazole therapy (200 mg twice daily x 4 mths) led to complete cure with negative cultures and normalization of nails.

Molds in onychomycosis

BACKGROUND

Onychomycosis is a major cause of nail dystrophy. The causative organisms in onychomycosis are dermatophytes, Candida and molds. A variety of molds have been isolated from nails.

METHODS

Nail scrapings and clippings were collected from 100 cases and inoculated on slants containing SDA with cycloheximide 0.5 mg/mL, chloramphenicol 0.05 mg/mL, and SDA with chloramphenicol 0.05 mg/mL.

RESULTS

The culture positivity rate for molds was 22%. The predominant mold isolates were Aspergillus species (86.4%, Fusarium oxysporum (4.5%), Curvularia species (4.5%) and Penicillium species (4.5%).

CONCLUSION

Primary invasion of nails by molds can cause onychomycosis.

Hemorheologic approach in the treatment of diabetic foot ulcers

Pentoxifylline, a new trisubstituted methylxanthine derivative, is the most well known of a new group of hemorheologic agents. It has been shown to improve hemorheologic abnormalities associated with diabetes and atherosclerosis. The authors examined the role of pentoxifylline in the treatment of diabetic foot ulcers. Forty diabetic patients with foot ulcerations were included in the study, 20 of whom received conventional therapy and 20 received pentoxifylline (400 mg three times a day) in addition. Healing of ulcers after eight weeks of treatment was significantly higher in those on pentoxifylline, and the patients needed less mutilating surgery. Administration of pentoxifylline in addition to conventional therapy was significantly superior in the management of diabetic foot ulcers.

Ultrasound-guided needle aspiration of amoebic liver abscess

This prospective study was carried out on 200 patients with clinically, ultrasonographically and serologically confirmed amoebic liver abscess. The role of ultrasound-guided needle aspiration in addition to medications was evaluated compared to drug treatment alone. Both the groups were monitored clinically and sonographically for up to 6 months after diagnosis. The initial response (after 15 days) was better in the aspirated group (P < 0.05) but resolution of abscess after 6 months were similar. There was a more rapid clinical response in the aspirated group, particularly in those with larger (> 6 cm) abscesses and there were no complications. Percutaneous ultrasound-guided needle aspiration is a safe diagnostic and therapeutic approach which enhances clinical recovery, accelerates resolution, especially in large abscesses, and prevents complications.

Glycemic control and its relationship to diabetic foot ulcers

Glucosylhaemoglobin (HbA1) was estimated in 60 diabetic patients, 30 with foot ulceration and 30 without foot lesions. Peripheral neuropathy and vascular disease were commonly found in the ulcer' group. The mean HbA1 level in diabetics without ulcers was 9.77 +/- 2.34, while the corresponding level in diabetics with ulcers was 14.14 +/- 3.63. The difference in values is statistically highly significant (p less than 0.001) suggesting that foot ulcers are more likely to occur in poorly controlled diabetic patients.

Bacteriology of diabetic foot ulcers

Seventy five diabetic foot ulcers were cultured using optimal aerobic and anaerobic microbiologic techniques. There were a total of 223 isolates (162 aerobes and 61 anaerobes) representing an average of 2.97 bacterial species per specimen. Mixed organisms were the most common isolates. Staphylococcus aureus was the commonest isolate being recovered in 60% of cases. Anaerobic organisms were isolated in 46 patients (61.33%) and the most frequent anaerobe isolated was Bacteroides fragilis. The other organisms predominantly isolated were Proteus, Klebsiella, Pseudomonas, Peptoccus and Clostridia. Antibiogram showed discouraging pattern with commonly used antibiotics. Metronidazole and gentamicin were the most effective antimicrobial agents against anaerobic and aerobic organisms respectively. Appreciation of the causative organisms in diabetic foot and their antibiotic sensitivity is essential for institution of appropriate antibiotic therapy.

Clinico-pathological profile of lymphomas in south India: a prospective rural referral hospital study of 103 cases

A prospective clinical and histopathological study of 103 patients with lymphomas is reported. Of these, 72 (69.9%) had non-Hodgkin's lymphoma (NHL) and 31 (30.1%) had Hodgkin's lymphoma (HL). The median age at presentation was 34 and 43 years for Hodgkin's and non-Hodgkin's lymphoma respectively, which is lower than that seen in the West. Fever and superficial lymphadenopathy were the commonest presenting features and 'B' symptoms were present in over 60% of both groups. Seventy-five per cent of NHL and 64.5% of HL presented in stages III and IV of the disease.

Aetiology of diabetic foot ulceration

A prospective study of 150 diabetic patients was undertaken with the aim of determining the factors associated with the development of foot ulcerations. Seventy five patients had foot ulceration and 75 had no foot lesions. Peripheral (78.7%) and autonomic (38.7%) neuropathy were more commonly found in the "ulcer" group, as were vascular insufficiency (49.3%) and hyperlipidaemia (60%). Renal failure (9.3%) and ketoacidosis (20%) were also commoner in patients with foot ulceration. Most, if not all, of the aetiological factors are related to prolonged uncontrolled hyperglycaemia.

Electrocardiographic abnormalities in cerebrovascular accidents

The electrocardiographic abnormalities found in 100 patients with acute cerebrovascular disease and previously normal hearts are described. The abnormalities were more often seen in patients with intracerebral and subarachnoid hemorrhages. The most common changes were Q-Tc Prolongation and ST segment and T wave abnormalities. The mechanisms of these electrocardiographic abnormalities appear to be multiple.

Nosocomial complicated urinary tract infections: A rural based referral hospital study

A three-year retrospective study of urinary tract infection in 891 patients was conducted at a rural based hospital in coastal Karnataka, South India. Eighty-eight per cent of the patients had complicated urinary tract infections with predominantly nosocomial organisms such as Klebsiella as opposed to the normally more common uncomplicated infection with E. coli. The reasons for this seem to be the delay in referral, resulting in late correction of the underlying structural causes of the infections. In our series of patients, the association of prolonged indwelling catheter drainage with complicated urinary tract infection suggests that non-urologists should adopt alternative measures such as clean intermittent catheterization, and reduce the period of indwelling catheters to the shortest time possible. More judicious selection and timing of antibiotic therapy might prevent the development of resistant organisms.

Serum apoproteins A and B and the lecithin: cholesterol acyl transferase activities in liver cirrhosis and hepatic coma patients

Serum apoproteins A and B and LCAT activities were estimated in 80 patients, 46 with posthepatic cirrhosis and 34 with alcoholic cirrhosis. The cirrhosis patients were also divided into compensated, decompensated, and hepatic coma subgroups. Apo-A and LCAT activities were significantly decreased in both cirrhotic groups without any significant difference between posthepatitic and alcoholic cirrhotic groups, while Apo-B was decreased in hepatic coma patients only. The decompensated cirrhosis patients showed lower Apo-A levels than the compensated cirrhosis patients and hepatic coma patients showed still lower levels compared to decompensated subgroup, while no significant decrease was observed in LCAT activities between compensated and decompensated cirrhosis patients. Apo-A level was correlated more significantly with serum albumin level than the LCAT activity. The study confirms that Apo-A level is highly related to the degree of liver injury and also suggests that this decrease may be mainly due to impaired liver synthesis and that the serum levels of Apo-A and Apo-B can be utilized in the differential diagnosis of chronic liver diseases.