Surgical risk assessment in Hiv-infected patients treated within the penitentiary system of Kemerovo region

Aim. To assess the surgical risk in HIV-infected patients who received the surgical treatment within the penitentiary system of Kemerovo Region.Materials and Methods. We retrospectively analysed the physical status and the extent of surgical risk in 296 HIV-infected patients who underwent elective (n = 201) or emergency (n = 95) surgery in Hospital №1 (Kemerovo) from 2015 to 2018. Physical status was assessed according to American Society of Anesthesiologists (ASA) Physical Status Classification System. Surgical risk was scored according to Moscow Scientific Society of Anesthesiologists and Critical Care.Results. The majority of patients had 3 (48.4 and 36.3% in emergency and elective patients, respectively) or 4a (30.5 and 45.8% in emergency and elective patients, respectively) stages of HIV infection. Opportunistic infections were diagnosed in 49.3% of patients and were always accompanied by superficial mycoses. Physical status of most patients (47.4% and 63.7% in emergency and elective patients, respectively) corresponded to ASA physical status class 3. Emergency patients mainly had surgical risk class 3 (n = 50, 52.6%) while elective patients often had surgical risk class 2 (n = 106, 52.7%). The prevalence of postoperative complications, most often impaired wound healing, was 9.8%.Conclusion. More than 80% of HIV-infected patients who underwent surgical interventions within the penitentiary system of Kuzbass were at III or IV stages of HIV infection, entailing a high frequency of opportunistic diseases such as superficial mycoses and dictating the need to include antifungal treatment into the surgical treatment. Impaired wound healing was the most frequent postoperative complication.

Isolation of Dermatophytes from Clinically Suspected Cases of Superficial Fungal Infections

Dermatophytes are keratinophilic fungi responsible for dermatophytoses which are superficial mycoses affecting skin, hair and nails. The aim of the study was to isolate dermatophytes from clinically suspected cases of superficial fungal infections. This study was carried out at the Department of Microbiology, Grant Government Medical College & Sir J.J Group of Hospitals, Mumbai. A total of 279 clinically suspected cases of superficial fungal infections were included in the present study. The specimens like skin scraping, nail and hair were collected with all aseptic precautions and were first examined under microscope on KOH mount and then inoculated on to duplicate slopes of Sabouraud dextrose agar (plain) and SDA (Chloramphenicol and Cycloheximide). Lactophenol cotton blue preparations were made of each fungal growth and were identified using specific tests like slide culture, hair perforation and urease test. Out of the 279 clinically suspected cases of superficial mycoses, maximum involved the skin (65.23%) and a total of 216 (77.42%) cases were of clinically suspected dermatophytoses. KOH mount examination alone could detect 144 (66.66%) cases out of the 216 clinically suspected cases of dermatophytoses. A total 162 isolates were confirmed in which maximum dermatophytes 122 (75.30%) were found. Amongst the dermatophytes, T. rubrum was the commonest pathogenic species isolated followed by T. mentagrophytes. Other species isolated were T. tonsurans, M. gypseum, E. floccosum, T. verrucosum and M. audouinii, T. rubrum and T. mentagrophytes were mainly isolated from Tinea unguium followed by Tinea corporis cases. M. gypseum was isolated only from Tinea capitis cases whereas M. audouinii was isolated only from Tinea unguium cases. Dermatophytoses are the most common types of superficial cutaneous fungal infections. The incidence of Dermatophytoses is increasing in India due to widespread and indiscriminate use of corticosteroids and antifungal agents without performing appropriate microbiological investigations.

Performance results of the improved working classification of superficial mycoses of the skin in carrying out their clinical and epidemiological monitoring

The results of testing of the improved working classification of superficial mycoses of the skin and its appendages (SMS) in the Republic of Azerbaijan for the period of 2012-2016 are presented. Given the variety of classifications of fungal skin diseases, many years of clinical experience have shown that none of them fully meets the requirements of a practicing physician. The author has developed and improved the classification of mycoses of the skin and its appendages, which will facilitate the diagnosis and the appointment of therapy, since this classification takes into account the tissue and topographic localization of the mycotic process, which greatly facilitates the diagnosis by dermatovenerologists, and will also reveal the true prevalence of mycotic pathology. Based on the traditional form No. 9, among 246 cases of superficial mycoses of the skin and its appendages identified in the city of Baku for the period of 2012-2016, the largest number of patients (79.44±2.6%) were diagnosed with mycoses of the scalp – 32, 52±1.21%, smooth skin mycoses – 30.08%±1.28 multi-colored lichen – 14.80%±1.01, which corresponds to the frequency of occurrence of these forms of SMS at the age of 11-20 years (44.01±3,1%) and 0-10 years (39.08±3.1%), leaders in the age line of groups with SMS in Baku. A reliable statistical difference was revealed in the detection of superficial mycoses of the skin and its appendages in the city of Baku during the study period. Based on the developed working classification, the nosological structure of the incidence of SMS in the city of Baku for the period 2012-2016 is represented by the following – 1919 episodes: mycoses of the scalp – 675 patients (35.17±1.1%); mycoses of smooth skin – 638 patients (33.25±1.1%); multi-colored lichen – 264 patients (13.76±0.8%); combined mycoses of smooth skin and scalp – 134 patients (6.98±0.6%); onychomycoses – 97 patients (5.05±0.5%); purulent-infiltrative form of mycoses – 66 patients (3.44±0.4%); skin candidiasis – 19 patients (0.99±0.2%); feet of the mycoses – 19 patients (0.99±0.2%); inguinal epidermophytosis – 7 patients (0.36±0.1%). The prevalence of nosologies preserved in the largest number of patients (1578 patients – 82.23±0.9%), mycoses of the scalp – 35.17±1.1% (675 patients), smooth skin mycoses – 33.25±1.1% (638 patients), multicolored lichen – 13.76%±0.8 (264 patients). The greatest number of patients with SMS was also detected in the age group of 11-20 years (42.12±3.1%) and 0-10 years (40.32±3.1%). The data of a comparative analysis of the results of the developed and improved classification of superficial mycoses of the skin and its appendages with the data of the traditional reporting form, made it possible to expand the scope of the analyzed nosologies and increase the objectivity of statistical data for assessing the epidemiological situation in the study region.

Clinico-Mycological Study of Superficial Mycoses in a Tertiary Health Care Centre of Southern Assam

Background-Superficial Mycosis, which is the most common fungal infection affecting human beings, includes Dermatophytosis and Dermatomycoses, which are the infections of superficial keratinized layer of skin, nail & hair by Dermatophytes and non Dermatophytic moulds or yeasts respectively. This clinical entity is very common in hot, humid tropical climate of India with prevalence ranging from 30-60% but its precise case magnitude and epidemiology in North eastern India cannot be stated as there are only few studies conducted. So, this study is undertaken to 1) Find the prevalence of Superficial Mycosis in a tertiary health care centre of Southern Assam. 2) Study the clinical profile of the cases 3) Isolate and identify the causative agents of Superficial mycosis. Materials & Method- The study has been conducted on 250 samples from clinically suspected and untreated cases of superficial mycosis from Aug 2017 to Dec 2018. 2 separate sets of samples from edge of skin lesion/nail /hair were collected, of which 1 sample was subjected to direct microscopy with (10-40) % KOH and the other part was subjected to 2 sets of fungal culture in SDA tubes at 25°C and 37°C & followed for 3 weeks. In Culture positive cases, fungal identification was based on colony morphology, pigment production & LPCB mount. For confirmation of isolates, Slide Culture and biochemical tests were done. Result-Out of total 250 samples,115 samples (46%) showed presence of fungal elements in KOH examination, of which 73 were culture positive and of the KOH negative samples 10 samples were culture positive, thus making the prevalence 33.2% (83/250). Clinically, Tinea corporis was the most common form of both superficial mycosis & Dermatophytosis and Pityriasis Versicolor has been found the most common Dermatomycosis. Males(21-50yrs) were affected by superficial mycosis more than Females(16-30yr). Trichophyton mentagrophyte was the mostly isolated agent causing superficial mycosis. Keywords: Superficial mycoses, prevalence, Assam, Slide Culture, Urease.

Study of Dermatophytosis in a Tertiary Care Centre in Central India

BACKGROUND Mycoses are assuming greater significance both in developed and developing countries particularly due to advent of immunosuppressive drugs and diseases. Dermatophytosis is most common type of cutaneous fungal infections seen in man, though in past few decades non-dermatophytes are also assuming importance. Present study is undertaken to know the pattern of dermatophytosis from our region. METHODS An observational study was conducted on 150 samples of patients with complaints of superficial mycoses. Samples were processed for microscopy on potassium hydroxide (KOH) mount and culture on Sabouraud’s dextrose agar (SDA) with and without cycloheximide and chloramphenicol. Any growth was identified by conventional technique. RESULTS One hundred and fifty samples consisting of 86 skin and 64 nails were studied. Most samples were seen in rainy season and males were predominantly affected. Adults from age of 21 - 50 years were most commonly affected. Most common clinical presentation was tinea corporis (70.93 %). In dermatophytic causes, T. mentagrophytes (36.21 %), T. tonsurans (27.59 %) followed by T. rubrum (15.52 %) were common isolates. In non-dermatophytic causes, candida spp. followed by aspergillus spp. were commonest isolates. CONCLUSIONS Tinea corporis is found to be the commonest presentation. Along with dermatophytes, non-dermatophytic fungi are also emerging as the cause of superficial mycoses. In non-dermatophytic fungi, candida is the commonest species, which is now a days showing drug resistance; hence, identification of causative agent is important for correct and prompt treatment. KEY WORDS Dermatophytosis, Non-Dermatophytic Fungi, Dermatophytic Fungi

Cutaneous manifestations in patients with chronic kidney disease on hemodialysis

<p class="abstract"><strong>Background:</strong> Chronic kidney disease (CKD) is associated with several cutaneous manifestations as a result of CKD per se, underlying disease(s) leading to it or the treatment thereof. Cutaneous manifestations get altered following hemodialysis. We studied the prevalence of various dermatoses and the effect on pruritus in patients with CKD on hemodialysis.</p><p class="abstract"><strong>Methods:</strong> Seventy-three patients with CKD having at least one cutaneous manifestation undergoing hemodialysis in Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune were included.</p><p class="abstract"><strong>Results:</strong> Sixty-four (87.67%) of the participants belonged to the age group of 40-69 years; 28 (38.35%), to the sixth decade. The male to female ratio was 1.8:1. Forty-eight patients (65.75%) suffered from diabetes mellitus, 37 of these also from hypertension. Xerosis (72.6%), pallor (65.8%) and pruritus (60.3%) were the common manifestations. The intensity of pruritus remained unchanged in 82% of those affected. Nail changes were seen in 47.9% cases (half-and-half nail, 19.2%; subungual hyperkeratosis, 11%; leukonychia, 6.8%; melanonychia, 6.8%; Beau’s lines, 4.1%). Infections were observed in 32.8% cases (superficial mycoses, 19.2%; bacterial, 6.8%; scabies, 4.1%; viral, 2.7%). Dyspigmentation was documented in 30.1% (hyperpigmentation, 21.92%; yellow tinge, 8.22%), hair changes in 23.3% (sparse scalp hair,16.4%; lusterless hair, 6.9%), acquired perforating dermatoses in 19.2%, and arteriovenous shunt dermatitis in 2.7% cases.</p><p class="abstract"><strong>Conclusions:</strong> Xerosis was the commonest finding and pruritus, the commonest symptom; the intensity of the latter remained largely unaffected by hemodialysis. Half-and-half nail was the most common nail change and superficial mycoses, the most common infection.</p><p class="abstract"> </p>