Using data mining to predict emergency department length of stay greater than 4 hours: Derivation and single-site validation of a decision tree algorithm

OBJECTIVES

Health services have an imperative to reduce prolonged patient length of stay (LOS) in ED. Our objective is to develop and validate an accurate prediction model for patient LOS in ED greater than 4 hours using a data mining technique.

METHODS

Data were collected from a regional Australian public hospital for all ED presentations between 1 January 2016 and 31 December 2017. A decision tree algorithm was built to predict patients with an ED LOS >4 hours. A total of 33 attributes were analysed. The performance of the final model was internally validated. Clinically relevant patterns from the model were analysed.

RESULTS

The accuracy of the model was 85%. We identified that patients at our site who were at high risk of ED LOS >4 hours were those who were waiting in ED for a medical consultation, or those who were waiting for a urology, surgical, orthopaedic or paediatric consultation if the request for consultation occurred more than 2 hours after the patient was first seen by an ED doctor.

CONCLUSION

This model performed very well in predicting ED LOS >4 hours for each individual patient and demonstrated a number of clinically relevant patterns. Identifying patterns that influence ED LOS is important for health managers in order to develop and implement interventions targeted at those clinical scenarios. Future work should look at the utility of displaying individual patient risk of ED LOS >4 hours using this model in real-time at the point-of-care.

ROMPI-CDSA: ring-opening metathesis polymerization-induced crystallization-driven self-assembly of metallo-block copolymers

Polymerization-induced self-assembly (PISA) and crystallization-driven self-assembly (CDSA) are among the most prevailing methods for block copolymer self-assembly. Taking the merits of scalability of PISA and dimension control of CDSA, we report one-pot synchronous PISA and CDSA via ring-opening metathesis polymerization (ROMP) to prepare nano-objects based on a crystalline poly(ruthenocene) motif. We denote this self-assembly methodology as ROMPI-CDSA to enable a simple, yet robust approach for the preparation of functional nanomaterials.

An FBG magnetic sensor for oil flow monitoring in sandstone core

Monitoring the oil movement using a non-contact optical fiber probe during enhanced oil recovery is a novel technique to increase the efficiency of the process by distinguishing the oil position in the reservoir. A partially unclad fiber Bragg grating (FBG) coated with Fe₃O₄ nanoparticles as a magnetic field sensor is experimentally demonstrated. A series of six FBGs reflecting different wavelengths are fixed on the surface of sandstone. Nanofluids containing magnetite nanoparticles and alkaline-surfactant-polymer are injected continuously in two separate steps into the sandstone, which is saturated with 20% oil and 80% brine. The chamber is equipped with a solenoid that acts as a magnetic field generator. The changes in the magnetic field strength depended on the FBG-solenoid distance and the density of localized injected nanoparticles near the FBGs leads to a shift of the reflected wavelength of each single FBG accordingly. The shift is caused by the interference of different propagating modes reflected from the core-cladding and cladding-magnetite layer interfaces. The intensity of the FBG spectra decreases by injecting the nanofluid and vice versa for surfactant injection. The sensor response time of ∼21 s confirms the high reliability and repeatability of the sensing scheme. Movement of oil along the sandstone alters the wavelength shift in the FBG spectra.

Monitoring the oil movement using a non-contact optical fiber probe during enhanced oil recovery is a novel technique to increase the efficiency of the process by distinguishing the oil position in the reservoir.

Evaluation of Corrosion and Tarnishing of Intra-oral Nickel Chromium and Gold-alloy Cast Crown

Although esthetic factors might limit by the presentation of materials used, all-metal complete cast crown should always be offered to patients requiring restoration of endodontically treated posterior tooth. The complete cast crown has the highest longevity of all fixed restorations. It could be used to rebuild a single tooth or a retainer for a fixed prosthesis. It involves all the axial walls as well as the occlusal surface of the tooth to be restored. All restorations are placed in the oral environment in contact with the gingival tissue. Thus clinicians must choose nontoxic or least toxic metal alloys, since any release of elements that might cause reactions. This study was designed to observe clinical responses of nickel chromium alloy and gold alloy cast crown and provide guidance to ascertain the best alloy for cast metal crown, which serves better functional restoration.

Huge Splenomegaly with Pancytopenia Due to Gaucher's Disease in a 22 Years Old Woman

Gaucher's disease is one of the important storage disorders. It belongs to the lysosomal storage disorders group. There is defective activity of an enzyme named β-glucosidase which ultimately renders the cell of macrophage lineage loaded with glucocerebrosides. There is multi-organ involvement that manifests as hepatosplenomegaly, variable cytopenias, skeletal disorders, neurological features etc. When serum β-glucosidase level is below 15% of mean normal activity Gaucher's disease is confirmed. Enzyme replacement is the definitive treatment. Here we report a case of type 1 or non-neuropathic form Gauchers disease presented with feeling of a lump in left upper abdomen and progressive generalized weakness and hepatosplenomegaly. Her complete blood count revealed pancytopenia and bone trephine biopsy showed Gaucher's cells. Diagnosis and management may be delayed as this disease is rare. Clinical and bone marrow examination is the mainstay of diagnosis. So emphasis should be given in this regard.

Etiological Evaluation of Patients with Lymphadenopathy by Clinical, Histopathological and Microbiological Assessment

Lymph node enlargement is a common presenting complaint in outpatient and inpatient department. The present observational cross sectional study was conducted in department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period from December 2014 to May 2016 to evaluate etiologies of significant lymphadenopathy by clinical, histopathological and microbiological assessment. Biopsy/FNA materials of 177 patients of 18-75 years age range with significant lymphadenopathy were sent for histopathology/cytology, Gram stain & culture, AFB stain & culture and Gene Xpert. Among them, 102(57.62%) were granulomatous lymphadenitis, 52(29.38%) were lymphoma, 12(6.78%) reactive lymphadenitis, 7(3.95%) metastatic malignancy, 2(1.13%) atypical lymphoid hyperplasia, 1(0.57%) myeloid sarcoma and 1(0.57%) chronic sialadenitis. Growth of MTB was on 23(22.55%) cases; among 102 granulomatous lymphadenitis and Gene Xpert was positive in 73(71.56%) cases with 100% Rif. sensitive. Gene Xpert is an important tool for diagnosis of tuberculous lymphadenitis. Time of symptoms to diagnosis of most of the TBL patients was within 2-8 months.

Motor Outcome of Stroke Patients with Low Dose Levodopa Therapy

Stroke is one of the leading cause of disability worldwide. Motor function deficits due to stroke contribute to overall low quality of life. The objective was of this study is to observe functional motor outcome after stroke with low dose Levodopa therapy. This prospective follow up study was carried out in the Department of Neurology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2014 to June 2016 to see the effect of low dose of Levodopa (110mg) on motor outcome after stoke disability. Motor deficit was measured by Medical Research Council (MRC) grading and Rivermead Mobility Index (RMI) score. Two groups were selected by simple random method, consisted of both ischemic and hemorrhagic stroke. All the patients of both the groups were suffering from at least some post stroke motor disability and attended full course of physiotherapy. The group (L) received 110mg Levodopa with physiotherapy. On the other hand (NL) group received only physiotherapy. They were all followed up for four times within two months of time and were assessed for recovery of motor function. Mean age was 59.03±11.56 years in Levodopa (L) group and 57.10±12.41 years in the Non Levodopa (NL) group; Males were predominant in both groups. Ninety three (77.50%) cases had ischemic stroke and 27(22.50%) cases had hemorrhagic stroke. Most common risk factors were hypertension and smoking. No known risk factor was detected in 8 (6.67%) patients. Single or multiple risk factors were confirmed in 112 patients (93.33%). MRC score was significantly higher both in affected upper and lower limb in Levodopa group comparing non Levodopa group at 4th visit. RMI score was also significantly higher in Levodopa group comparing non Levodopa group at 4th visit. The Levodopa (L) group showed better recovery pattern than Non Levodopa (NL) group. It can be concluded that motor recovery was better with administration of a single low dose of Levodopa in combination with physiotherapy. Motor outcome was significantly higher in levodopa group than non-levodopa group.

Process based simulation of tree growth and ecosystem services of urban trees under present and future climate conditions

Global processes of urban growth lead to severe environmental impacts such as temperature increase with an intensification of the urban heat island effect, and hydrological changes with far reaching consequences for plant growth and human health and well-being. Urban trees can help to mitigate the negative effects of climate change by providing ecosystem services such as carbon storage, shading, cooling by transpiration or reduction of rainwater runoff. The extent of each ecosystem service is closely linked with the tree species as well as with a tree's age, size, structure and vitality. To evaluate the ecosystem services of urban trees, the process-based growth model CityTree was developed which is able to estimate not only tree growth but also the species-specific ecosystem services including carbon storage, transpiration and runoff, shading, and cooling by transpiration. The model was parametrized for the species small-leaved lime (Tilia cordata), robinia (Robinia pseudoacacia), plane (Platanus×acerifolia) and horse chestnut (Aesculus hippocastanum). The model validation for tree growth (stem diameter increment, coefficient of correlation=0.76) as well as for the water balance (transpiration, coefficient of correlation=0.92) seems plausible and realistic. Tree growth and ecosystem services were simulated and analyzed for Central European cities both under current climate conditions and for the future climate scenarios. The simulations revealed that urban trees can significantly improve the urban climate and mitigate climate change effects. The quantity of the improvements depends on tree species and tree size as well as on the specific site conditions. Such simulation scenarios can be a proper basis for planning options to mitigate urban climate changes in individual cities.

Crystallization-Driven Self-Assembly of Metallo-Polyelectrolyte Block Copolymers with a Polycaprolactone Core-Forming Segment

We report crystallization-driven self-assembly (CDSA) of metallo-polyelectrolyte block copolymers that contain cationic polycobaltocenium in the corona-forming block and crystallizable polycaprolactone (PCL) as the core-forming block. Dictated by electrostatic interactions originating from the cationic metalloblock and crystallization of the PCL, these amphiphilic block copolymers self-assembled into two-dimensional platelet nanostructures in polar protic solvents. The 2D morphologies can be varied from elongated hexagons to diamonds, and their stability to fragmentation was found to be dependent on the ionic strength of the solution.

Clinical Scoring Versus Chlamydia Antibody Titre as a Tool in Predicting Tubal Patency in Subfertile Women

This study was done to compare the predictive capacity of Clinical scoring and Chlamydia antibody titre in predicting tubal patency. This cross sectional comparative study was done in Institute of Child and Mother Health, Dhaka, Bangladesh from January 2018 to December 2018. Eighty eight infertile women with normal ovarian reserve and their husbands with normal semen parameters were purposively included. After taking written informed consent, Clinical scoring, Chlamydia antibody titre and Hysterosalpingography of the study population were done. Data expressed as mean and standard deviation. Logistic regression analysis was done. The predictive capacity was analyzed by sensitivity, specificity, positive and negative predictive value and relative risk. Area under the Curve of Receiver Operating Characteristic was done. A p value <0.05 was considered as statistically significant. Fifty three and half percent had bilateral and 8% had unilateral tubal block and 38.5% had bilateral patent tubes. Clinical scoring versus Hysterosalphingography and Chlamydia antibody titre versus Hysterosalphingography of the study population had sensitivity 87.04% and 48.15%, specificity 76.47% and 58.82%, positive predictive value 82.95% and 52.27%, negative predictive value78.79% and 41.67% and relative risk 5.42 and 0.84 respectively. The Clinical Scoring is better than Chlamydia Antibody Titre as a tool in predicting tubal patency.

Estimation of Vitamin D levels among Physicians Working in a Tertiary Level Hospital of Bangladesh

Vitamin D is essential for the body to regulate calcium and phosphate levels and mineralization of bone. It is synthesized in the skin after ultraviolet radiation exposure or obtained in the diet to a less extent. Vitamin D deficiency is attracting attention due to higher prevalence in different populations. Physicians of Bangladesh are supposed to be vulnerable to low Vitamin D levels owing to long indoor work hours in both government and private settings. The study was conducted to evaluate Vitamin D status among physicians working in a tertiary level public hospital of Bangladesh. The cross sectional descriptive study was carried out at Mymensingh Medical College Hospital during the period of January 2018 to June 2018. Data were collected from purposively selected 102 doctors of different levels using a case record form. Interview, measurements and laboratory investigations were done accordingly. Vitamin D levels were categorized as deficient (<20.00ng/L), Insufficient (20.00-29.00ng/L), Sufficient (30.00-100.00ng/L) and Potential Toxicity (>100.00ng/L). Among 102 doctors 79(77.5%) were male and 23(22.5%) were female. Maximum (60.8%) were in the age group of 31 years to 50 years. Mean±SD age of the subjects was 49.9±3.61years. Vitamin D deficiency was found in 19(18.6%) subjects and insufficiency was in 49(48.0%) of the subjects. On the other hand 34(33.3%) subjects had sufficient Vitamin D levels. Potential Vitamin D toxicity was not found in any of the subjects. Vitamin D deficiency was found more in female (30.4%) than male (15.2%) but insufficiency was found more in male (50.6%) than female (39.1%). The study revealed that 66.6% physicians had either deficiency or insufficiency of Vitamin D. Exposure to sunlight, dietary intake and Vitamin D supplementation should be considered to increase the status of Vitamin D levels in Physicians of Bangladesh.

Immune response to temperature stress in three bivalve species: Pacific oyster Crassostrea gigas, Mediterranean mussel Mytilus galloprovincialis and mud cockle Katelysia rhytiphora

Summer mortality of some bivalve species is often associated with the change of environmental temperature. This study compares the response of immunological parameters to temperature change in three marine bivalves: Pacific oyster Crassostrea gigas, Mediterranean mussel Mytilus galloprovincialis and mud cockle Katelysia rhytiphora. Each species was exposed to three temperatures, 15 °C, 20 °C and 25 °C for 14 days. The total haemocyte count (THC), phagocytosis, reactive oxygen species (ROS) and the activity of antioxidant enzymes such as superoxide dismutase (SOD) and catalase (CAT) were used as indicators to measure the response of each species to different temperatures. The highest temperature (25 °C) significantly increased the THC and phagocysis of haemocytes in all species. The SOD and CAT activities in the haemocytes of M. galloprovincialis and K. rhytiphora rapidly increased with temperature elevation, concomitantly with the increase of ROS ions. In contrast, the increases of ROS and SOD in C. gigas only occurred from 20 °C to 25 °C, suggesting that this intertidal species is more adaptive to different temperature levels. This study indicates that the activities of antioxidant enzymes can reflect the immune response of marine bivalves to thermal stress. Intertidal species such as Pacific oysters have a greater tolerance to thermal stress than subtidal species (e.g. Mediterranean mussel) and demersal species buried in sand (e.g. cockle).

Gold Nanoparticles with Antibiotic-Metallopolymers toward Broad-Spectrum Antibacterial Effects

Bacterial infection has evolved into one of the most dangerous global health crises. Designing potent antimicrobial agents that can combat drug-resistant bacteria is essential for treating bacterial infections. In this paper, a strategy to graft metallopolymer-antibiotic bioconjugates on gold nanoparticles is developed as an antibacterial agent to fight against different bacterial strains. Thus, these nanoparticle conjugates combine various components in one system to display enhanced bactericidal efficacy, in which small sized nanoparticles provide high surface area for bacteria to contact, cationic metallopolymers interact with the negatively charged bacterial membranes, and the β-lactam antibiotics' sterilzation capabilities are improved via evading intracellular enzymolysis by β-lactamase. This nanoparticle-based antibiotic-metallopolymer system exhibits an excellent broad-spectrum antibacterial effect, particularly for Gram-negative bacteria, due to the synergistic effect of multicomponents on the interaction with bacteria.

Haemophagocytic Lymphohistiocytosis in a 16-Year-Old Boy

Haemophagocytosis encompasses phagocytosis of erythrocytes, leukocytes, platelets and their precursors by macrophages in bone marrow and other tissues. Haemophagocytic lymphohistiocytosis (HLH) usually presents with high fever, pancytopenia, splenomegaly, lymphadenopathy, haemophagocytosis in bone marrow, liver, lymphnodes or CSF. We report coagulase negative Staphylococcus induced HLH in a 16 year old boy presenting with high grade fever, lymphadenopathy, hepatosplenomegaly, pancytopenia with neutropenic sepsis in the department of Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 28th November 2016. He responded to high dose dexamethasone and management of neutropenic sepsis. This might give a guidance in the management of haemophagocytic syndrome at the earliest time to prevent morbidity and mortality.

Macromolecular-clustered facial amphiphilic antimicrobials

Bacterial infections and antibiotic resistance, particularly by Gram-negative pathogens, have become a global healthcare crisis. We report the design of a class of cationic antimicrobial polymers that cluster local facial amphiphilicity from repeating units to enhance interactions with bacterial membranes without requiring a globally conformational arrangement associated with highly unfavorable entropic loss. This concept of macromolecular architectures is demonstrated with a series of multicyclic natural product-based cationic polymers. We have shown that cholic acid derivatives with three charged head groups are more potent and selective than lithocholic and deoxycholic counterparts, particularly against Gram-negative bacteria. This is ascribed to the formation of true facial amphiphilicity with hydrophilic ion groups oriented on one face and hydrophobic multicyclic hydrocarbon structures on the opposite face. Such local facial amphiphilicity is clustered via a flexible macromolecular backbone in a concerted way when in contact with bacterial membranes.

Metallo-polyelectrolytes as a class of ionic macromolecules for functional materials

The fields of soft polymers and macromolecular sciences have enjoyed a unique combination of metals and organic frameworks in the name of metallopolymers or organometallic polymers. When metallopolymers carry charged groups, they form a class of metal-containing polyelectrolytes or metallo-polyelectrolytes. This review identifies the unique properties and functions of metallo-polyelectrolytes compared with conventional organo-polyelectrolytes, in the hope of shedding light on the formation of functional materials with intriguing applications and potential benefits. It concludes with a critical perspective on the challenges and hurdles for metallo-polyelectrolytes, especially experimental quantitative analysis and theoretical modeling of ionic binding.

Response of Proliferative Lupus Nephritis with Pulse Cyclophosphamide Therapy during Induction Period: A Single Centre Study in Bangladesh

This prospective study was conducted to assess the response of proliferative lupus nephritis with pulse cyclophosphamide therapy during induction period in the department of Nephrology of Dhaka Medical College, Dhaka, Bangladesh from December 2012 to November 2013. A total of 35 clinically diagnosed SLE patients of class III/IV lupus nephritis were included. But 3 patients were dropped out during follow-up, therefore finally 32 patients (class III = 4, class IV = 28) were studied. The patients were evaluated for response on the basis of proteinuria, serum creatinine & active sediment in urine after 6th cycle of cyclophosphamide and 62.5% patients achieved complete response, 25% patients achieved partial response & 12.5% patients achieved no response. The factors favored complete response was early clinical presentation (7 months duration), proteinuria ≤3gm/day& normal renal function during their initial presentation. And higher anti ds DNA titre was an independent predictor for partial response/no response.

Pyrolysis of water hyacinth in a fixed bed reactor: Parametric effects on product distribution, characterization and syngas evolutionary behavior

In this investigation, the effect of operating parameters on product distribution for the conversion of water hyacinth into most valuable product bio oil as well as char and gases are investigated. To observe the parametric effect on product distribution, the temperature was varied 300-600 °C, heating rate 10-50 °C/min, particle size of the feed <0.5-2.5 mm and carrier gas nitrogen flow rate 0-12 lpm. The highest bio-oil yield of 44.9 wt% was obtained at 350 °C, 30 °C/min, particle feed size less than 0.5 mm and 6 lpm. The results show that the product yield is strongly influenced by the temperature variation whereas weakly affected by the heating rate. The biomass and the products were characterized by ultimate, proximate, DTG, FTIR, ¹H NMR, and GC-MS. Syngas evolution increase with the increase of temperature except CO₂. The quality of bio-oil is perspective as a source of value-added chemicals and char is a promising source for the production of carbonaceous materials as well as solid fuel.

Role of Liver Biopsy in the Diagnosis of Neonatal Cholestasis due to Biliary Atresia

Biliary atresia is the commonest cause of cholestatic jaundice. Early diagnosis & surgical correction helps long time survival & prevent development of cirrhosis. This study was conducted to find out the role of liver biopsy in the diagnosis of biliary atresia having positive hepatobiliary scintigraphy as there is chance of false positivity. This cross sectional study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh at Paediatric Gastroenterology & Nutrition Department from January 2014 to June 2015. All admitted patients with the diagnosis of neonatal cholestasis were evaluated clinically and by scintigraphy for biliary atresia. Having positive hepatobiliary scintigraphy but highly suggestive of biliary atresia were enrolled for this study. A total of 108 cases were initially selected. Among them 33 patients showed no excretion of tracer during hepatobiliary scintigraphy. Liver biopsy was done in these 33 cases. All cases (100%) had history of passage of pale or acholic stool. Fractionated serum bilirubin of >2mg/dl was found all of the cases. Histological scoring system reveals typical features of biliary atresia in 27(81.8%). Two had no conclusive histology of biliary atresia, four had features of neonatal hepatitis (12.1%). In this study, percutaneous liver biopsy with histological analysis by scoring system was found useful for the correct diagnosis of biliary atresia.

Highly Conducting Hybrid Silver-Nanowire-Embedded Poly(3,4-ethylenedioxythiophene):Poly(styrenesulfonate) for High-Efficiency Planar Silicon/Organic Heterojunction Solar Cells

Embedding nanowires, such as silver nanowires (AgNWs), in a transparent conductive polymer poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) to enhance its conductivity is technologically important for improving the performances of devices comprising transparent conductive layers. Addition of nanowires in the highly conducting form of cosolvent (ethylene glycol) or mixed-cosolvent (ethylene glycol and methanol) modified PEDOT:PSS could change the nanowire structure and significantly alter the conductivity. Here, we report a simple method to embed AgNWs in PEDOT:PSS efficiently to improve its conductivity. By incorporating nanowires in the mixed cosolvent matrix prior to addition into PEDOT:PSS, this method preserves the structure of the nanowires while enabling conductivity enhancement. In contrast, the addition of AgNWs into cosolvent-premodified PEDOT:PSS leads to breaking of nanowires and conductivity impediment. The hybrid films with efficiently embedded AgNWs and mixed-cosolvent-modified PEDOT:PSS show a sheet resistance of 104 Ω/□, which is among the lowest ever reported for the as-deposited films, with conductivity enhancement of 33% relative to that of mixed-cosolvent-modified PEDOT:PSS. The resulting planar heterojunction solar cell (HSC) based on AgNW-embedded PEDOT:PSS exhibits a power conversion efficiency of greater than 15%. This demonstrates the importance of reducing sheet resistance by integrating nanowires into the PEDOT:PSS matrix as effective charge-transfer conduits interconnecting the highly conducting quinoid chains. The present approach to efficiently embed AgNWs in PEDOT:PSS could be readily extended to other nanowires or nanoparticles for improving the performance of PEDOT:PSS for applications in not just HSCs but indeed other electronic devices that require both transparent and highly conductive layers.

Comparison among Different Culture Media for the Detection of Dermatophytes

Dermatophytes are a group of closely related fungi that have the capacity of invading the keratinized tissue of human to produce infections known as dermatophytosis which is commonly referred to as ringworm. Other than routine microscopy, different culture media are available for the detection of dermatophytes from patient's specimen. This cross sectional study was designed to evaluate the outcome of three different culture media and microscopy for the detection of dermatophytes from clinical samples. Skin, hair and nail samples from 84 clinically suspected cases of dermatophytosis who attended at OPD of Dermatology Department, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from July 2014 to June 2015 were screened by direct microscopic examination using potassium hydroxide (KOH) mount. All the samples were inoculated for culture in Sabouraud's Dextrose Agar (SDA), Dermatophytes Test medium (DTM) and Sabouraud's Cycloheximide Chloramphenicol Agar (SCCA). The percentage of samples positive by microscopy was 37.5%, whereas the rate of positivity by culture was 47.6% which showed that culture was more sensitive than microscopy for the diagnosis of dermatophytosis. The efficiency of SDA and SCCA was found to be almost equal. There was no statistically significant difference between SDA and DTM in primary isolation of dermatophytes, though isolation rate was slightly higher in DTM. Though direct examination by microscopy is an efficient screening technique, culture should be done for accurate diagnosis. As DTM is easy to evaluate even without handling the growth of culture in the laboratory, it is recommended to use as screening medium for the detection of dermatophytes.