Iranian National Survey on Tinea Capitis: Antifungal Susceptibility Profile, Epidemiological Characteristics, and Report of Two Strains with a Novel Mutation in SQLE Gene with Homology Modeling

BACKGROUND

The data on the epidemiological and antifungal susceptibility profile of tinea capitis (TC) in Iran has not been updated in recent decades. This report presents the Iranian epidemiological and drug susceptibility data regarding the distribution of dermatophytes species isolated by six national mycology centers for a period of one year (2020-2021).

MATERIAL AND METHODS

A total of 2100 clinical samples from individuals suspeted to TC were subjected to mycological analysis of direct microscopy and culture. For definite species identification, the culture isolates were additionally subjected to PCR-RFLP and PCR-sequencing of the ITS ribosomal DNA (ITS-rDNA) region. Antifungal susceptibility profiles for eight common antifungal drugs were determined by CLSI M38-A3 guidelines. The SQLE gene was partially amplified and sequenced in two terbinafine-resistant and two susceptible T. mentagrophytes isolates to elucidate probable substitutions involved in resistance.

RESULTS

TC (n = 94) was diagnosed in 75 children (79.8%) and 19 adults (20.2%) by direct microscopy and culture. Frequency of TC was significantly more among males (66 males = 70.2% vs 28 females = 29.8%). The prevalent age group affected was 5-9 years (39.36%). Thirty-two (34.04%) T. mentagrophytes, 27 (28.7%) T. tonsurans, 14 (14.9%) M. canis, 13 (13.8%) T. violaceum, 5 (5.32%) T. indotineae, 2 (2.1%) T. benhamiae, and 1 (1.1%) T. schoenleinii were identified as the causative agents. MIC values of isolates showed susceptibility to all antifungal agents, except for fluconazole and griseofulvin with GM MIC of 11.91 μg/ml and 2.01 μg/ml, respectively. Terbinafine exhibited more activity against isolates, with GM MIC 0.084 μg/ml followed by ketoconazole (0.100 μg/ml), econazole (0.107 μg/ml), itraconazole (0.133 μg/ml), butenafine (0.142 μg/ml), and miconazole (0.325 μg/ml). Two resistant T. mentagrophytes isolates harbored missense mutations in SQLE gene, corresponding to amino acid substitution F397L. Remarkably, one unique mutation, C1255T, in the SQLE sequence of two terbinafine-susceptible T. mentagrophytes strains leading to a change of leucine at the 419th position to phenylalanine (L419F) was detected.

CONCLUSIONS

T. mentagrophytes, T. tonsurans, and M. canis remained the main agents of TC in Iran, however less known species such as T. indotinea and T. benhamiae are emerging as new ones. Terbinafine could still be the appropriate choice for the treatment of diverse forms of TC.

State-of-the-art predictive modeling of heavy metal ions removal from the water environment using nanotubes

In this research, molecular dynamics (MD) simulation is used to investigate the efficiency of carbon nanotubes (CNT) and boron nitride nanotubes (BNNT) in removing lead ions from contaminated waters. Then the effect of functionalizing nanotubes with -COO- and COOH- functional groups and the nanotubes' absorption performance of two different concentrations of lead ions are studied. To better evaluate adsorption process, the set of descriptors, such as interaction energies, radial distribution function, etc., are calculated. The MD results show that the absorption performance is significantly improved by modifying the surface of CNT and BNNT with functional groups. In addition, the adsorption capacity increases in higher concentrations of Pb ions at BNNTCOO- and CNTCOOH systems. The interaction energy of BNNTCOO- with a concentration of 50 lead ions is - 2879.28 kJ/mol, which is about 106 kJ/mol more negative than BNNTCOO- at a concentration of 20 lead ions. Also, it is observed that the functionalization of both nanotubes with -COO- increases their absorption capacity. The obtained results from this study provide significant information about the mechanisms of lead adsorption on the surface of nanotubes.

Direct molecular analysis of Malassezia species from the clinical samples of patients with pityriasis versicolor

Background and Purpose

Species identification of Malassezia using culture-dependent methods is time-consuming due to their fastidious growth requirements. This study aimed to evaluate a rapid and accurate molecular method in order to diagnose the pityriasis versicolor (PV) and identify Malassezia species from direct clinical samples.

Materials and Methods

Skin scraping or tape samples from patients with PV and healthy volunteers as the control group were collected. Diagnosis of PV was confirmed by direct microscopic examination. The DNA extraction was performed according to the steel-bullet beating method. Polymerase chain reaction-restriction fragment length polymorphism assay using HhaI restriction enzyme was applied for the identification and differentiation of Malassezia species.

Results

The PCR method was able to detect Malassezia in 92.1% of specimens which were also confirmed with microscopic examination. Statistically, a significant association was observed between the results of the two assays (P < 0.001). Moderate agreement was identified between the two methods to diagnose the PV in both populations (Kappa: 0.55). Considering microscopic examination as the gold standard method for confirmation of PV, the sensitivity, specificity, positive predictive value, and negative predictive value values of the PCR assay for recognition of PV were 85%, 75%, 92%, and 60%, respectively. M. globosa and M. restricta were the most prevalent species isolated from patients.

Conclusion

In this study, the two-step molecular method based on the amplification of the D1/D2 domain and digestion of the PCR product by one restriction enzyme was able to diagnose and identify Malassezia directly from clinical samples. Consequently, it can be said that the molecular-based method provides more facilities to identify fastidious species, such as M. restricta.

P-047 The effects of dietary branched-chain amino acids on mice semen parameters and plasma amino acids profile

Study question

Are there any differences between the effect of each member of the branched-chain amino acids (BCAAs) on sperm parameters and plasma amino acids profile?

Summary answer

Valine supplementation had destructive effects on sperm parameters and viability. However, blood amino acids profile were similar among treatments.

What is known already

BCAAs, a group of three essential amino acids, have a crucial role on protein synthesis, besides being strongly associated with impaired glucose and fat metabolism. Although BCAAs supplements are one of the most demanding products for the fitness industry to increase the lean body mass and boost exercise performance, little information exists on the advantages and disadvantages of dietary BCAAs on male fertility.

Study design, size, duration

Fifty NMRI mature male mice were divided into five groups and were fed diets as follow: Control (CTR): 2.4% Beta-alanine, Leucine (Leu): 1.18% Leu + 1.2% Beta-alanine, Isoleucine (Ile): 0.58% Ile + 1.8% Beta-alanine, Valine (Val): 0.65% + 1.7% Beta-alanine, and BCAAs (Leu:Ile:Val ratio of 2:1:1): 2.4% BCAA: 1.18% Leu + 0.58% Ile + 0.65% Val. After 5 weeks, testes and epididymides were dissected, and sperm parameters and plasma amino acids profile were assessed.

Participants/materials, setting, methods

Semen parameters were evaluated by a Computer-Aided Semen Analysis (CASA) system. Plasma amino acids concentrations were determined by HPLC. Data were analyzed using SPSS and statistical differences among various groups were determined by ANOVA and Tukey’s post-hoc test.

Main results and the role of chance

Higher BCAAs intake, particularly Val, increased the destructive mechanisms on sperm viability. The results showed no significant difference on body weight after 40 days. Sperm concentration (8.4 vs. 4.5 ×106), progressive motility (51.5 vs. 27.2 %), and viability (67 vs. 56 % for CTR and Val group, respectively) decreased dominantly in the Val group compared to CTR (p≤0.05). The immotile parameter was significantly higher in the Val group compared to the CTR (p≤0.05). In addition, there were no significant differences on plasma amino acids profile.

Limitations, reasons for caution

The current study's limitation is that only one level of BCAAs was used. Given the potential role of Val on sperm cell death, further data on different levels of all BCAAs, especially Val administration and evaluation of the related mechanisms are needed.

Wider implications of the findings

The findings of our study show, for the first time, that individual levels of Ile and Leu have different effects on sperm parameters compared with all BCAAs or Val. More attention should be given to BCAAs supplementation and semen quality that was previously ignored.

Trial registration number

not applicable

Analysis of molecular resistance to azole and echinocandin in Candida species in patients with vulvovaginal candidiasis

Background and Purpose

Vulvovaginal candidiasis (VVC) is considered the most common mucosal infection caused by Candida species. Azoles were considered the first-line treatment for VVC or recurrent vulvovaginal candidiasis (RVVC) in both healthy and immunocompromised populations. Recently, azole-resistant isolates, especially among non-albicans Candida samples have been encountered. This study aimed to evaluate the antifungal susceptibility profile of Candida spp. isolated from VVC or RVVC patients and assess the molecular resistance mechanism of Candida spp. to azole and echinocandin.

Materials and Methods

Point mutation analysis was performed on the ERG11 and FKS candidate genes of azole- and caspofungin-resistant Candida albicans and Candida glabrata isolates. Real-time polymerase chain reaction was performed to gain insight into the differential expression of ERG11 mRNA.

Results

Variations in the amino acid D116E were observed in fluconazole- and itraconazole-resistant C. albicans strains, and changes in amino acid E517Q were observed only in fluconazole-resistant C. albicans strains. No polymorphisms were observed in the complete sequence alignment of the ERG11 gene in one azole-resistant C. glabrata isolate. The mutation triggered the changes in the amino acid serine in the reference gene FKS1 by the leucine at position 642 (S642L) of the isolates.

Conclusion

In patients with persistent or recurrent infection, the choice of an antifungal agent is often challenging and requires monitoring of the antifungal susceptibility of the colonizing strain. C. albicans and C. glabrata isolates can be resistant to azole and caspofungin antifungal agents without mutations in the ERG 11 and HS1 regions of the FKS1 gene.

The epidemiology and etiology of onychomycosis in 2 laboratory centers affiliated to Tehran university of medical sciences during 2019-2020

Background and Objectives

Onychomycosis is caused by dermatophyte species, non-dermatophyte moulds (NDMs), and accounts for roughly 50% of all nail diseases. As the prevalence of onychomycosis is increasing, new epidemiologic documents may help with treatment and prevention. The present investigation aims to determine the epidemiological profile of onychomycosis in 2 mycology laboratories.

Materials and Methods

A cross-sectional study conducted during eight months (2019-2020) on 169 patients with positive nail mycology tests referred to two mycological laboratory centers affiliated with Tehran University of Medical Science. The nail clippings were examined by direct smear and culture. Also, molecular assays were performed if needed.

Results

10% of nail lesions referred to Razi Hospital (RH), and 30% of nail lesions referred to TUMS mycology laboratory were positive. Middle age (40-60) suffer more from onychomycosis. Aspergillus flavus, Trichophyton mentagrophytes, and Candida albicans were the most common etiologic agents in each of the three main classes of fungi causing onychomycosis. Females were more infected. NDMs were the predominant etiologic agents, and toenails were the most common site of onychomycosis.

Conclusion

The pattern of etiologic agents and clinical signs of onychomycosis differs according to geographical region and age, so repeated epidemiological surveys of onychomycosis seem to be fundamental.

Accuracy of static digital surgical guides for dental implants based on the guide system: A systematic review

In the present study, we tried to review the current literature, focusing on the effect of different guide systems on the accuracy of the digital surgical guides. A search in PubMed's database, without any date restriction, was performed using keywords based on the PICO question. 54 of the 2378 articles' were chosen for full-text assessment. Articles were screened using predetermined inclusion and exclusion criteria. 21 articles were included in the qualitative assessment. Descriptive analysis was performed for numeric parameters using mean ± standard deviation. Six types of guide systems were used in the included articles. The commonest guide system was SimPlant (45.64%) followed by NobleGuide (23.00%). The pooled mean angle deviation, global coronal deviation, and global apical deviation were 3.43 mm (95% CI = 2.96, 3.90), 1.16 mm (95% CI = 0.98, 1.24) and 1.35 mm (95% CI = 1.11, 1.59), respectively. The maximum mean(SD) of angle deviation, global coronal deviation, and global apical deviation happened in Stent Cad 4.1(1.86) degrees, NobleGuide 1.86(0.56) mm, and OnDemend3d 1.56(1.48) mm, respectively. Although a final statement could not be made on which system is better, it is certain that the software affects the deviation and could be as important as the implant itself. CLINICAL SIGNIFICANCE: The choice of guide systems used for the production of static guide systems which was studied in this article could affect the accuracy of the implant placement procedure.

Drug Sensitivity Profile of Fungi Isolated from Onychomycosis Patients and Evaluation of Squalene Epoxidase Mutation in One Terbinafine-Resistant Trichophyton mentagrophytes Species

Background: The resistance to treatment of onychomycosis is increasingly reported. The present study aimed to assess the antifungal activity of itraconazole, terbinafine, luliconazole, and efinaconazole against dermatophytes, molds, and also yeast isolated from patients with onychomycosis. Furthermore, the mechanism of resistance to terbinafine in resistant Trichophyton mentagrophytes species was evaluated using the squalene epoxidase (SQLE) gene sequence. Methods: A total of 71 fungal isolates were collected from 97 patients with suspected onychomycosis. The identification of fungal species was performed using conventional and molecular approaches. In vitro drug susceptibility for itraconazole, terbinafine, luliconazole, and efinaconazole was carried out using the broth microdilution method according to the CLSI-M60 and CLSI-M38 3rd ed., respectively. The SQLE gene of one terbinafine-resistant T. mentagrophytes was amplified using the specific primers. Results: Efinaconazole and luliconazole demonstrated higher effectiveness against all isolates in the study. One mismatch was detected at position 1177, which showed A → C change associated with Phe397Leu amino acid substitution of the SQLE protein in terbinafine-resistant T. mentagrophytes. Conclusion: The occurrence of resistant strains of organisms causing onychomycosis should be considered and evaluated. Furthermore, the identification of amino acid changes responsible for resistance to antifungals is a useful consideration in drug-target interaction.

Efficacy of a vaginal tablet as a Persian medicine product on vulvovaginal candidiasis: a double-blind, randomised, placebo-controlled trial

Context: In Persian medicine, topical ingredients such as Rosa damascena Mill. (Rosaceae), are usually recommended for the treatment of uterine diseases. Scientific evaluation of these historical documents can be valuable for finding new potential use in conventional medicine.Objective: This clinical trial was performed to determine whether the use of the 'ward' vaginal tablet, which contains Rosa damascena, Punica granatum L. (Punicaceae), Querqus infectoria Oliv. (Fagaceae), Myrtus communis L. (Myrtaceae) and Nardostachys jatamansi (D.Don) DC. (Caprifoliaceae) could alleviate the symptoms of vulvovaginal candidiasis.Materials and methods: A parallel double-blinded placebo-controlled study was done. Eighteen to fifty-year-old women with vulvovaginal candidiasis were divided into the 'ward' and placebo groups, 46 individuals in each group. The 'ward' group received the 'ward' vaginal tablet containing 200 mg of dried extract. Placebo group received a placebo (composed of corn starch and lactose). One tablet was applied through the vagina for 7 consecutive nights.Results: Two weeks after medication administration, the vaginal discharge sample of patients was re-cultured; 29 patients (63.045%) in the 'ward' group and 6 (13.04%) patients in the placebo group had negative culture (p < 0.001). All clinical symptoms including itching, irritation, and vaginal discharge were significantly reduced in the 'ward' group compared with the placebo group following the intervention and the follow up (p < 0.05).Discussion and conclusions: The findings suggest the 'ward' vaginal tablet could ameliorate vulvovaginal candidiasis. Future larger studies are recommended due to compare the therapeutic effect of the 'ward' vaginal tablet with common treatments.

Sensitive and selective colorimetric detection of Cu (II) in water samples by thiazolylazopyrimidine-functionalized TiO2 nanoparticles

In this study, a new thiazolylazopyrimidine-functionalized TiO₂ nanosensor (TiO₂-TAP) has been developed for sensitive and selective colorimetric detection of Cu²⁺ in water samples. Thiazolylazopyrimidine (TAP) as an azo ligand and TiO₂-TAP as highly selective nanosensor were successfully prepared through the diazo coupling reaction and surface chemical modification, respectively. Characterization of TiO₂-TAP NPs using Fourier transmission infrared (FT-IR), field emission scanning electron microscopy (FESEM), energy dispersive X- ray spectroscopy (EDX), and X-ray diffraction (XRD) analysis revealed that the TiO₂ NPs were effectively modified with the synthesized epoxy-activated thiazolylazopyrimidine. The synthesized azo ligand containing azo chromophore (N=N) produce color and make a stable complex formation with Cu²⁺ based on charge-transfer transduction in the detection system. The color change of TiO₂-TAP solution from yellow to red occur directly after few seconds of addition of Cu²⁺ ions, as a result of surface complexation. The TiO₂-TAP has revealed high affinity, sensitivity and selectivity for copper ion over other competing metal ions in aqueous media. The experimental data revealed that the Cu²⁺ ions was sensed and adsorbed by the TiO₂-TAP at optimal pH 5.0. The results also confirmed that the TiO₂-TAP has a wide linear detection range for Cu²⁺ (0.01 to 12.5 μM). From UV-vis titration experiment, the limit of detection (LOD) for Cu²⁺ ions was found to be 2.51 nM. The proposed method was successfully applied for the sensitive and selective detection of Cu²⁺ in tap water, sea water and well water. In addition, Cu²⁺ recovery improved using the TiO₂-TAP containing N, S and O atoms as chelating sites. Therefore, the developed nanosensor with great features like the cost-effective, excellent sensitively and selectively, short response times and high adsorption efficiency for Cu²⁺ can be utilized in any physical and biological conditions.

Registration of fluorescein angiography and optical coherence tomography images of curved retina via scanning laser ophthalmoscopy photographs

Accurate and automatic registration of multimodal retinal images such as fluorescein angiography (FA) and optical coherence tomography (OCT) enables utilization of supplementary information. FA is a gold standard imaging modality that depicts neurovascular structure of retina and is used for diagnosing neurovascular-related diseases such as diabetic retinopathy (DR). Unlike FA, OCT is non-invasive retinal imaging modality that provides cross-sectional data of retina. Due to differences in contrast, resolution and brightness of multimodal retinal images, the images resulted from vessel extraction of image pairs are not exactly the same. Also, prevalent feature detection, extraction and matching schemes do not result in perfect matches. In addition, the relationships between retinal image pairs are usually modeled by affine transformation, which cannot generate accurate alignments due to the non-planar retina surface. In this paper, a precise registration scheme is proposed to align FA and OCT images via scanning laser ophthalmoscopy (SLO) photographs as intermediate images. For this purpose, first a retinal vessel segmentation is applied to extract main blood vessels from the FA and SLO images. Next, a novel global registration is proposed based on the Gaussian model for curved surface of retina. For doing so, first a global rigid transformation is applied to FA vessel-map image using a new feature-based method to align it with SLO vessel-map photograph, in a way that outlier matched features resulted from not-perfect vessel segmentation are completely eliminated. After that, the transformed image is globally registered again considering Gaussian model for curved surface of retina to improve the precision of the previous step. Eventually a local non-rigid transformation is exploited to register two images perfectly. The experimental results indicate the presented scheme is more precise compared to other registration methods.

A simple pyrimidine based colorimetric and fluorescent chemosensor for sequential detection of copper (II) and cyanide ions and its application in real samples

In this study, a new pyrimidine-based chemosensor (PyrCS) has been developed for sequential detection of copper (II) and cyanide ions. The PyrCS has revealed high sensitivity and selectivity toward copper ion over other metal ions in aqueous media. The PyrCS as an optical probe exhibited a distinct color change and a bathochromic shift in UV spectra in the presence of copper ion in a few seconds due to the formation of stable complex (PyrCS-Cu²⁺). The results confirmed that the PyrCS has a widely linear detection range of 0.3-30 μM toward Cu²⁺. The calculated limit of detection for Cu²⁺ ions was low as 0.116 μM. Moreover, the fluorescent intensity of PyrCS at 507 nm was significantly quenched in the presence of Cu²⁺ and Fe²⁺ ions. Additionally, complex PyrCS-Cu²⁺ was successfully used to detect cyanide ions via Cu²⁺ displacement approach. The free PyrCS was recovered after adding the CN‾ ions in a few seconds due to the formation of the stable copper cyanide complex Cu(CN)_x. The calculated LOD for CN‾ ions was low as 0.320 μM. The data also clarified that the other competing anions did not create a clear color change in solutions. Since the proposed method could provide a vivid colorimetric response in the presence of detected analytes within the pH range of 3-9, we can claim that the developed chemosensor can be utilized in any physical and biological conditions.

Relationship between antifungal susceptibility profile and virulence factors in Candida albicans isolated from nail specimens

INTRODUCTION

The aim of this study was to evaluate some virulence factors in Candida albicans isolates from patients with onychomycosis and determine the correlation between these factors and the antifungal resistance profile.

METHODS

Seventy species of C. albicans were confirmed using polymerase chain reaction amplification of the HWP1 gene. According to the Clinical & Laboratory Standards Institute guidelines, the susceptibility profile of four antifungal agents was investigated, and the production of aspartyl protease, phospholipase, haemolysin, and biofilm was determined. The correlation between these profiles was also investigated.

RESULTS

The isolates indicated different levels of resistance and production of virulence factors. Significant correlations were observed between the minimum inhibitory concentration (MIC) of fluconazole/itraconazole and biofilm production, between phospholipase production and fluconazole/itraconazole MIC, and between fluconazole MIC and hemolytic activity in C. albicans isolates. The results also showed significant correlations between phospholipase activity and biofilm production.

CONCLUSIONS

Our findings will contribute to a better understanding of the pathogenesis of C. albicans and characterize the relationship between virulence factors and antifungal resistance, which may suggest new therapeutic strategies considering the possible involvement of the virulence mechanism in the effectiveness of treatment.

First case of superficial infection due to Naganishia albida (formerly Cryptococcus albidus) in Iran: A review of the literature

Background and Purpose:

Naganishia albida (formerly Cryptococcus albidus) is a non-neoformans cryptococcal species rarely isolated as a human pathogen.

Case report:

Herein, we present the case of a 26-year-old Iranian man with a superficial cutaneous lesion in the axilla. The initial treatment for pityriasis versicolor by clotrimazole was unsuccessful. We performed skin sampling based on the standard protocol and conducted further investigations by the conventional laboratory tests and molecular analysis of the skin samples. All the mentioned analyses revealed N.albida as the causative agent of infection. The minimum inhibitory concentration (MIC) analysis was carried out for the isolated agent, and the patient was treated using 100 mg daily of oral itraconazole.

Conclusion:

N. albida can be the causative agent of some superficial infections. This is the first report on the successful detection and treatment of a superficial skin infection due to N. albida by oral itraconazole.

The first report of onychomycosis caused by Cryptococcus friedmannii (Naganishia friedmannii) a basidiomycetous yeast

Yeasts are common etiologic agents of onychomycosis. This study reported a case of onychomycosis due to Cryptococcus friedmannii (Naganishia friedmannii). This yeast was isolated of the right great toenail of 57-year-old man. Microscopic examination of nail scrapings showed budding cells with thin capsule. Sequence analyzes of the internal transcribed spacer regions was closely related to Cryptococcus friedmannii. The results of susceptibility testing showed the Cryptococcus friedmannii to be sensitive to fluconazole, itraconazole and amphotericin B.

Growing Incidence of Non-Dermatophyte Onychomycosis in Tehran, Iran

BACKGROUND

Non-dermatophyte onychomycosis (NDO) is caused by a wide range of mold fungi other than dermatophytes, and has been reported at various rates in different countries worldwide. Studies on the incidence of NDO in the community are essential for understanding its epidemiology and control, as well as for the appropriate treatment of these infections.

OBJECTIVES

In this study, the incidence of NDO in Tehran, Iran, was compared to the incidence of onychomycoses due to dermatophytes and yeasts.

METHODS

From 2014 through 2015, samples from a total of 1,069 patients with suspected fungal nail diseases, who were referred to three medical mycology laboratories in Tehran, were collected and subjected to direct examination (all samples) and culture (788 samples). Differentiation of the causative agents of onychomycosis was based on microscopic observation of characteristic fungal elements in the nail samples and growth of a significant number of identical colonies on the culture plate.

RESULTS

Based on only direct microscopy, onychomycosis was diagnosed in 424 (39.6%) cases, among which 35.8% were caused by dermatophytes, 32.7% by yeasts, and 29.3% by non-dermatophyte molds (NDMs), while 2.2% were mixed infections. Direct exam was significantly more sensitive than culture for the diagnosis. The most commonly isolated NDMs were Aspergillus spp. (69.3%, n = 52), followed by Fusarium spp. (n = 7). The other isolated species were Paecilomyces spp., Scopulariopsis spp., Acremonium spp., Cladosporium spp., and Chrysosporium spp., with only one case of each.

CONCLUSIONS

An increasing frequency of NDO compared to onychomycosis due to other causative agents has been noticeable over the past few years in Iran. This epidemiological data may be useful in the development of preventive and educational strategies.

In vitro activity of econazole in comparison with three common antifungal agents against clinical Candida strains isolated from superficial infections

Background and Purpose:

Candida species are the most common organisms involved in superficial fungal infections, worldwide. Although econazole is among the most frequently used topical formulations for the treatment of candidiasis, no information is available regarding the susceptibility profiles of Candida species in Iran.

Materials and Methods:

In vitro susceptibility of 100 clinical Candida isolates belonging to 6 species from superficial candidiasis of Iran towards to econazole was compared with three other common antifungal agents including itraconazole, fluconazole, and miconazole. Minimum inhibitory concentrations (MICs) values were analyzed according to the Clinical and Laboratory Standards Institute (CLSI) M38-A3 document. All isolates were previously identified to the species level, using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) on ITS region.

Results:

The MIC of econazole, itraconazole, miconazole, and fluconazole were within the range of 0.016-16, 0.032-16, 0.016-16, and 0.25-64 μg/ml, respectively. In general, econazole and miconazole were more active against Candida isolates, compared to the other two agents.

Conclusion:

The present study demonstrated that for Candida albicans isolates, miconazole and econazole had the best effect, but in non-albicans Candida species, itraconazole and miconazole displayed more activity than other antifungal agents.

The First Case of Total Dystrophic Onychomycosis Caused by Aspergillus clavatus Resistant to Antifungal Drugs

Onychomycosis is a common fungal infection of nails which is mainly caused by dermatophyte species and less often by yeasts and non-dermatophyte molds. We present a case of onychomycosis due to Aspergillus clavatus for the first time worldwide. The patient was an immunocompetent 32-year-old woman who identified with Psoriasis of the nail. The presence of A. clavatus in a nail sample was confirmed using microscopic and culture analysis followed by PCR of the β-tubulin gene. After antifungal susceptibility test, it is revealed that the isolate was resistant to the majority of common antifungal drugs, but finally the patient was treated with itraconazole 200 mg daily. A. clavatus and drug-resistant A. clavatus have not previously been reported from onychomycosis.

Solid phase extraction of ultra-trace amounts of Ag+ by using octadecyl silica membrane disks modified with a new fulvalen derivative

A simple method for the rapid extraction and determination of ultra-trace amounts of Ag+ ions using octadecyl-bonded silica membrane disks modified with a recently synthesized fulvalen (tetramethyltetrathiafulvalen) (TMTTF) and graphite furnace atomic absorption spectrometry is presented. The extraction efficiency and influence of the flow rate, pH, nature of the counter ion and type and the least amount of eluent for the stripping of Ag+ from disks and breakthrough volume were evaluated. The maximum capacity of the membrane disks modified by 5 mg of TMTTF used was found to be 482 +/- 6 micrograms Ag+. The detection limit of the proposed method is 1.0 ng/dm3. The method was applied to the recovery of Ag+ ions from different synthetic and water samples.

A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults

OBJECTIVE

Older adults hospitalized for nondisabling diagnoses can lose functional ability. Lack of exercise or physical activity during the acute illness and recovery may be contributory. This study evaluated whether increased exercise in hospital and afterward would shorten length of stay and improve physical function at 1 month.

DESIGN

A randomized controlled trial.

SETTING

A 700-bed community-based hospital with academic and teaching programs.

PARTICIPANTS

Three hundred patients (mean age 78.2 years +/- 5.6) with nondisabling medical and surgical diagnoses who were admitted to an acute care hospital between December 1990 and April 1992. All patients had an expected length of stay 5 or more days, were ambulatory before admission, and were not expected to die within 12 months.

INTERVENTION

A hospital-based general exercise program was administered to intervention patients along with encouragement to continue the program, self-administered, at home.

MEASUREMENTS

The primary outcome was hospital length of stay. Secondary outcomes at 1 month post-discharge included measures of physical function and other general health indicators.

RESULTS

There was no significant difference in length of stay between treatment and control groups controlling for baseline characteristics and diagnoses. The intervention was associated with better function in instrumental activities of daily living (beta = .433 (95% CI, 0.044-0.842)) at 1 month but no change in perceived general health status and other measures of physical function.

CONCLUSIONS

An exercise program started during hospitalization and continued for 1 month did not shorten length of stay but did improve functional outcome at 1 month.