Prevalence of Candida glabrata and its response to boric acid vaginal suppositories in comparison with oral fluconazole in patients with diabetes and vulvovaginal candidiasis

Objective: A large proportion of vulvovaginal candidiasis (VVC) in diabetes is due to non-albicans Candida species such as C. glabrata and C. tropicalis. Observational studies indicate that diabetic patients with C. glabrata VVC respond poorly to azole drugs. We evaluated the response to oral fluconazole and boric acid vaginal suppositories in diabetic patients with VVC. Research Design And Methods: A total of 112 consecutive diabetic patients with VVC were block randomized to receive either single-dose oral 150-mg fluconazole or boric acid vaginal suppositories (600 mg/day for 14 days). The primary efficacy outcome was the mycological cure in patients with C. glabrata VVC in the two treatment arms. The secondary outcomes were the mycological cure in C. albicans VVC, overall mycological cure irrespective of the type of Candida species, frequencies of yeast on direct microscopy, and clinical symptoms and signs of VVC on the 15th day of treatment. Intention-to-treat (ITT; n = 111) and per-protocol (PP; n = 99) analyses were performed. Results: C. glabrata was isolated in 68 (61.3%) and C. albicans in 32 (28.8%) of 111 subjects. Patients with C. glabrata VVC showed higher mycological cure with boric acid compared with fluconazole in the ITT (21 of 33, 63.6% vs. 10 of 35, 28.6%; P = 0.01) and PP analyses (21 of 29, 72.4% vs. 10 of 30, 33.3%; P = 0.01). The secondary efficacy outcomes were not significantly different in the two treatment arms in the ITT and PP analyses. Conclusions: Diabetic women with C. glabrata VVC show higher mycological cure with boric acid vaginal suppositories given for 14 days in comparison with single-dose oral 150-mg fluconazole

Aspirin and low-molecular weight heparin combination therapy effectively prevents recurrent miscarriage in hyperhomocysteinemic women.

The management of recurrent pregnancy loss (RPL) still remains a great challenge, and women with polycystic ovarian syndrome (PCOS) are at a greater risk for spontaneous abortion. Treatment with low-molecular-weight heparin (LMWH) has become an accepted treatment option for women with RPL; however, the subgroup of women, who are likely to respond to LMWH, has not been precisely identified. The present study evaluated the efficacy of LMWH with reference to PCOS and associated metabolic phenotypes including hyperhomocysteinemia (HHcy), insulin resistance (IR) and obesity. This prospective observational study was conducted at Institute of Reproductive Medicine, Kolkata, India. A total of 967 women with history of 2 or more consecutive first trimester abortions were screened and 336 were selected for the study. The selected patients were initially divided on the basis of presence or absence of PCOS, while subsequent stratification was based on HHcy, IR and/or obesity. The subjects had treatment with aspirin during one conception cycle and aspirin-LMWH combined anticoagulant therapy for the immediate next conception cycle, if the first treated cycle was unsuccessful. Pregnancy salvage was the sole outcome measure. The overall rate of pregnancy salvage following aspirin therapy was 43.15%, which was mostly represented by normohomocysteinemic women, while the salvage rate was lower in the HHcy populations irrespective of the presence or absence of PCOS, IR, or obesity. By contrast, aspirin-LMWH combined therapy could rescue 66.84% pregnancies in the aspirin-failed cases. Logistic regression analyses showed that HHcy remained a significant factor in predicting salvage rates in the PCOS, IR, and obese subpopulations controlled for other confounding factors. With regard to pregnancy salvage, combined anticoagulant therapy with aspirin and LMWH conferred added benefit to those with HHcy phenotype

Structure, genesis and scale selection of the tropical quasi-biweekly mode

The quasi-biweekly mode (QBM) and the 30–60 day mode are two major intraseasonal oscillations (ISOs) in the tropics. The QBM is known to have a major influence in determining the active and break conditions of the Indian monsoon during the northern summer. A westward-propagating equatorial Rossby wave with quasi- biweekly period influences the Australian monsoon during the northern winter. Universality between the summer and winter QBM is established through analysis of daily circulation and convection data for 10 years. It is shown that the mean spatial structure of the QBM in circulation and convection resembles that of a gravest meridional mode equatorial Rossby wave with wavelength of about 6000 km and westward phase speed of approximately 4.5 m s-1. However, the maximum zonal wind occurs at around 5°N (5°S) during the northern summer (winter). The wave structure appears to be translated northward (southward) by about 5° during the northern summer (winter). The relationship between outgoing long-wave radiation and circulation data indicates that the mode is driven unstable by coupling with moist convection. Similarity in temporal and spatial characteristics of the mode during the two seasons leads us to propose that the same mechanism governs the genesis and scale selection of the mode in both the seasons. An acceptable mechanism for genesis and scale selection of the QBM has been lacking. In the present study, a mechanism for genesis and scale selection of the observed QBM is proposed. A simple 2½ -layer model that includes a steady Ekman boundary layer (BL) formulation incorporating effect of entrainment mixing is constructed for the convectively coupled equatorial waves. Without influence of the background mean flow, moist feedback in the presence of frictional BL convergence drives the gravest meridional mode equatorial Rossby wave unstable with observed wavelength and period but with zonal winds symmetric about the equator. Potential temperature perturbation associated with the Rossby wave is in phase with relative vorticity perturbation at low level. The BL drives moisture convergence in phase with the relative vorticity at the top of the BL. Release of latent heat associated with the BL convergence enhances the potential temperature leading to a positive feedback. The mean flow over the Indian Ocean and western Pacific at low levels is such that the zero ambient absolute vorticity or the 'dynamic equator' shifts to around 5°N (5°S) during summer (winter) and results in a shift of the unstable Rossby waves towards the north (south) by about 5°. The resulting structure of the unstable Rossby mode resembles the observed structure of the biweekly mode. It is shown that neither evaporation–wind feedback nor vertical shear of the mean flow is crucial for the existence of the mode. However these processes marginally modify the growth rate and make the structure of the unstable wave more realistic

Structure, genesis and scale selection of the tropical quasi-biweekly mode

The quasi-biweekly mode (QBM) and the 30-60 day mode are two major intraseasonal oscillations (ISOs) in the tropics. The QBM is known to have a major influence in determining the active and break conditions of the Indian monsoon during the northern summer. A westward-propagating equatorial Rossby wave with quasi-biweekly period influences the Australian monsoon during the northern winter. Universality between the summer and winter QBM is established through analysis of daily circulation and convection data for 10 years. It is shown that the mean spatial structure of the QBM in circulation and convection resembles that of a gravest meridional mode equatorial Rossby wave with wavelength of about 6000 km and westward phase speed of approximately 4.5 m s-1. However, the maximum zonal wind occurs at around 5°N (5°S) during the northern summer (winter). The wave structure appears to be translated northward (southward) by about 5° during the northern summer (winter). The relationship between outgoing long-wave radiation and circulation data indicates that the mode is driven unstable by coupling with moist convection. Similarity in temporal and spatial characteristics of the mode during the two seasons leads us to propose that the same mechanism governs the genesis and scale selection of the mode in both the seasons. An acceptable mechanism for genesis and scale selection of the QBM has been lacking. In the present study, a mechanism for genesis and scale selection of the observed QBM is proposed. A simple 2½-layer model that includes a steady Ekman boundary layer (BL) formulation incorporating effect of entrainment mixing is constructed for the convectively coupled equatorial waves. Without influence of the background mean flow, moist feedback in the presence of frictional BL convergence drives the gravest meridional mode equatorial Rossby wave unstable with observed wavelength and period but with zonal winds symmetric about the equator. Potential temperature perturbation associated with the Rossby wave is in phase with relative vorticity perturbation at low level. The BL drives moisture convergence in phase with the relative vorticity at the top of the BL. Release of latent heat associated with the BL convergence enhances the potential temperature leading to a positive feedback. The mean flow over the Indian Ocean and western Pacific at low levels is such that the zero ambient absolute vorticity or the 'dynamic equator' shifts to around 5°N (5°S) during summer (winter) and results in a shift of the unstable Rossby waves towards the north (south) by about 5°. The resulting structure of the unstable Rossby mode resembles the observed structure of the biweekly mode. It is shown that neither evaporation-wind feedback nor vertical shear of the mean flow is crucial for the existence of the mode. However these processes marginally modify the growth rate and make the structure of the unstable wave more realistic

Assessment of Efficacy of Transforaminal Epidural Steroid Injection for Management of Low Back Pain with Unilateral Radiculopathy in Industrial Workers: A Randomized Control Trial

Introduction: Disability related to chronic Low Back Pain (LBP) is a multi-factorial phenomenon, associated with high social and health costs, with a prevalence ranging from 11 to 76%. Significant and long-lasting pain relief can be achieved with transforaminal epidural steroid injection. Surgery is indicated for those patients with progressive neurological deficits or severe LBP refractory to conservative measures. Aim: To evaluate the efficacy of transforaminal epidural steroid injection through pelvic angle measurement, pain and disability measurements in patients with LBP and radiculopathy. Materials and Methods: This prospective randomized controlled study was conducted in Department of Pain in ESI institute of pain management for the industrial workers at Kolkata, India between October 2015 and September 2016. Sixty patients aged between 18 to 60 years, who attended pain clinic with complaints of LBP with unilateral radiculopathy due to lumber disc herniation were included in this trial. Patients were divided into 2 groups (30 patients in each group); Group I: Test group received single transforaminal epidural steroid injection with deposteroid (20 mg) and 0.25% bupivacaine (total 2 ml) together with oral medications and exercises at day 0. Group II: Control group received only medications and exercises on day 0/visit 1. Each patient was followed up for one month at visit 2. Each patient was assessed with Numeric Rating Scale (NRS) for pain intensity and modified Oswestry Disability Index (ODI) for measurement for disability and pelvic angle measurement on affected side. Results: During study period, 60 confirmed patients were included in the analysis. NRS for pain intensity measurement between visit 1(V1) and 2 (V2), showed significant improvement (p-value is < 0.001) in group I. ODI scores between 2 visits showed better outcome in group I. Pelvic angle measurement of affected limb on second visit in both groups as compared to first visit, showed significant improvement, but changes are more evident in group I than group II. Conclusion: Transforaminal epidural injection not only decreases pain and disability due to pain significantly but also decreases pelvic angulations significantly after one month in lumber disc herniation with unilateral radiculopathy

Aspirin and low-molecular weight heparin combination therapy effectively prevents recurrent miscarriage in hyperhomocysteinemic women.

The management of recurrent pregnancy loss (RPL) still remains a great challenge, and women with polycystic ovarian syndrome (PCOS) are at a greater risk for spontaneous abortion. Treatment with low-molecular-weight heparin (LMWH) has become an accepted treatment option for women with RPL; however, the subgroup of women, who are likely to respond to LMWH, has not been precisely identified. The present study evaluated the efficacy of LMWH with reference to PCOS and associated metabolic phenotypes including hyperhomocysteinemia (HHcy), insulin resistance (IR) and obesity. This prospective observational study was conducted at Institute of Reproductive Medicine, Kolkata, India. A total of 967 women with history of 2 or more consecutive first trimester abortions were screened and 336 were selected for the study. The selected patients were initially divided on the basis of presence or absence of PCOS, while subsequent stratification was based on HHcy, IR and/or obesity. The subjects had treatment with aspirin during one conception cycle and aspirin-LMWH combined anticoagulant therapy for the immediate next conception cycle, if the first treated cycle was unsuccessful. Pregnancy salvage was the sole outcome measure. The overall rate of pregnancy salvage following aspirin therapy was 43.15%, which was mostly represented by normohomocysteinemic women, while the salvage rate was lower in the HHcy populations irrespective of the presence or absence of PCOS, IR, or obesity. By contrast, aspirin-LMWH combined therapy could rescue 66.84% pregnancies in the aspirin-failed cases. Logistic regression analyses showed that HHcy remained a significant factor in predicting salvage rates in the PCOS, IR, and obese subpopulations controlled for other confounding factors. With regard to pregnancy salvage, combined anticoagulant therapy with aspirin and LMWH conferred added benefit to those with HHcy phenotype

Clinical and biochemical characteristics and pregnancy outcomes in the aspirin, and aspirin+LMWH-treated populations.

<p>Values are expressed as mean ± S.D.</p><p>HHcy: hyperhomocysteinemia (Hcy>12 µmol/l); IR: insulin resistance (HOMA2-IR>2.1); NIR: non-insulin resistance; HOMA-2-IR: homeostatic model assessment 2-insulin resistance; obesity: BMI ≥30 kg/m²; pregnancy salvage: uneventful continuation of pregnancy at least until 36^th week.</p>a, b, c<p>Values with different superscripts in a row under specific treatment population differ significantly.</p><p>a <i>vs.</i> b: P<0.037; b <i>vs.</i> c: P<0.002; a <i>vs.</i> c: P<0.016.</p