Clinical and Mycological Profile of Dermatophytosis

Clinical and Mycological Profile of Dermatophytosis A CLINICAL AND MYCOLOGICAL PROFILE OF DERMATOPHYTOSIS IN KLES DR PRABHAKAR KORE HOSPITAL AND MEDICAL RESEARCH CENTRE, BELGAUM† Dolly M.B.B.S. Department of Dermatology, J.N. Medical College, Belgaum, India B. S. Manjunathswamy M.D .Department of Dermatology, J.N. Medical College, Belgaum, India S.G.Karadesai M.D. Department of Microbiology, J.N. Medical College, Belgaum, India ABSTRACT Aim: To study the clinical and mycological profile of dermatophytosis in tertiary care hospital. Background and objectives: Dermatophytosis, a group of taxonomically closely related keratinophilic fungi called dermatophytes varies with geographical area as well as climatic conditions and there is vide variation in the spectrum of dermatophytic isolates. This study was aimed to understand the clinical and mycological profile of dermatophytosis. Methodology: The present one year cross sectional study from January 2013 to December 2013 was done in the Department of Dermatology, Venereology and Leprosy, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum A total of 125 patients presenting with dermatophyte skin infection were subjected to clinical examination and KOH examination for fungi and culture. Results: The commonest clinical forms noted were Tinea corporis (52%) and Tinea cruris (43.2%). Most of the patients were males (67.2%) (male to female ratio 2:1) and Tinea corporis was the commonest clinical diagnosis (48.81%). The commonest age group was 21 to 30 years (36%) and had Tinea corporis (56%) commonly. 36.8% of the patients had duration of > 35 weeks. The commonest morphological variant was noted as annular (37.6%). The KOH examination was positive in 78.4% cases and culture was positive for fungus in 64.8% of the cases. In patients with positive culture, T. mentagrophyte was the commonest isolate (48.15%). The commonest dermatophyte isolated was Trichophyton (88.64%). Conclusion: There is wide variation in the clinical and mycological profile of dermatophytosis. The detection of emerging organisms may be help in the treatment and adequacy of current pharmacologic regimens. Key words: Dermatophytosis; Mycological profile; Skin infection; Tinea corporis; Tinea cruris; Introduction Dermatophytosis is characterized by the infection of keratinized tissues such as the epidermis, hair and nails. Distribution of dermatophytes varies with geographical area. Further, there is wide variation in the spectrum of dermatophytic isolates. To understand the burden and trend of dermatophytosis, surveillance of the disease plays an important role. Considering the above facts the present study was designed to know the clinical and mycological profile of dermatophytosis so as to elaborate the epidemiological data in the region which will help in understanding the disease pattern and burden which may not only aid in taking adequate measures to prevent the transmission but also help in preventing spread of infection thereby reducing the disease burden. Materials and method This one year cross sectional study of 125 patients presenting with dermatophytes skin infection was conducted in the Department of Dermatology, Venereology and Leprosy, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum from January 2013 to December 2013. Patient who are on antifungal treatment and cases who did not provide informed consent were excluded from the study. A detailed history was taken regarding duration and progress of lesion in past age, sex, and occupation. A complete dermatological examination for type of the lesion, morphology and distribution was done along with general physical examination. Clinical material was collected for KOH examination and culture using standard mycological techniques. SDA (Sabourauds Dextrose Agar) with cycloheximide and chloramphenicol were used for culture. The media were incubated at 250C and 370C for a minimum period of three weeks. Positive cultures were examined both macroscopically and microscopically for species identification. Results: Based on the clinical examination findings the commonest clinical forms noted were Tinea corporis, Tinea cruris, Tinea pedis, Tinea unguim, Tinea capitis, Tinea faciei, Tinea mannum and Tinea barbae. Multiple clinical forms were present in almost one fifth of the study population and the commonest clinical form was noted as Tinea cruris with Tinea corporis. Most of the patients were males (67.2%) with male to female ratio of 2:1 and 48.81% of the males had clinical type of Tinea corporis. The commonest age group was 21 to 30 years (36%) and had Tinea corporis (56%) commonly. Most of the patients (36.8%) reported duration of > 35 weeks. Maximum cases were noted in the month of August (16%). The commonest morphological variant was noted as annular (37.6%). The KOH examination for fungus was positive in 78.4% of the cases and culture was positive for fungus in 64.8% of the cases. Among the patients with positive culture, T. mentagrophyte was the commonest isolate noted in 48.15% of the patients. The commonest dermatophyte isolated was noted as Trichophyton (88.64%). Discussion: In our study various clinical forms dermatophytic infections were noted. The commonest clinical form was Tinea corporis (52%) followed by Tinea cruris (43.2%), Tinea pedis (9.60%), Tinea unguim (7.2%), Tinea capitis (2.40%), Tinea faciei and Tinea mannum (1.60% each), and Tinea barbae (0.8%). A recent study from Mysore Karnataka by Surendran KAK et al1 also observed Tinea corporis (44.3%) as the most common clinical pattern. In our study multiple sites were involved among 23 cases. Of these, Tinea cruris and Tinea corporis were present in 17 (73.91%) and Tinea corporis and Tinea pedis in three (13.04%) cases. In the present study males were commonly affected that is, almost two third of the patients (67.2%) were males with male to female ratio of 2:1. Tinea corporis was the commonest clinical type of dermatophytosis among males (48.81%) while in females it accounted among 58.54% of the patients. Sen SS et al2 and Jain N et al3 reported 48% and 37% of the male with Tinea corporis while Bindu V et al4 reported 54.6% of males. In this study, maximum patients belonged to age between 21 to 30 years (36%) and the next common age group was 31 to 40 year (19.2%). This was in accordance with a recent study from Mysore by Surendran KAK et al,1 Karnataka where maximum number of cases encountered in the age group of 16-30 years (44%) followed by the age group of 31-45 years (26%). Other studies by Sen SS et al2 from Guwahati in 2006 and Sahai S et al5 from Lucknow in 2011 also reported commonest age group as 21 to 30 years (44% and 32.4% respectively). Among them 45 patients with age between 21 to 30 years, 25 (56%) had Tinea corporis and 8 (18%) had Tinea cruris. Similar findings were noted by Bindu V et al,4 Singh S et al,2 Sen SS et al2 and Jain N et al.3 In this study maximum cases were noted between June to September (37.6%) with peak in the month of August (16%) which is similar to the findings of Kalla G et al57 and Sumana V et al.6 In this study the commonest morphological variant was noted as Annular (37.6%). The present study KOH examination for fungus and culture was positive in 78.4% and 64.8% of the cases respectively. Of the 98 cases with positive KOH examination for fungus, 81 (82.65%) cases had positive culture. A study by Belukar et al.7 showed culture positivity of 71%, which was much higher and close to the present study. In this study, T. mentagrophyte was the commonest isolate noted in 48.15% of the patients followed by T. Rubrum (43.21%). In a study recent study from Mysore by Surendran KAK et al,1 T. rubrum was the chief organism isolated with a percentage of 67.5% while T. mentagrophytes (20%) isolates were found second in frequency. T. mentagrophytes are relatively more prevalent in south India.1 Conclusion: The KOH examination for fungus was positive in 78.4% of the cases and culture was positive for fungus in 64.8% and in patients with positive culture, T. mentagrophyte was the commonest isolate followed by T. rubrum (43.21%). Overall there is wide variation in the clinical and mycological profile of dermatophytosis. Further KOH examination for fungus and culture play an important role in the diagnosis of dermatophytosis. References 1.Surendran K, Bhat RM, Boloor R, Nandakishore B, Sukumar D. A clinical and mycological study of dermatophytic infections. Indian J Dermatol 2014;59:262-7 2.Sen SS, Rasul ES. Dermatophytosis in Assam. Indian J Med Microbiol 2006;24:77-8. 3.Jain N, Sharma M, Saxena VN. Clinico-mycological profile of dermatophytosis in Jaipur, Rajasthan. Indian J Dermatol Venereol Leprol 2008;74(3):274-5. 4.Bindu V, Pavithran K. Clinico-mycological study of dermatophytosis in Calicut. Indian J Dermatol Venereol Leprol 2002;68(5):259-61. 5.Sahai S, Mishra D. Change in spectrum of dermatophytes isolated from superficial mycoses cases: First report from central India. Indian J Dermatol Venereol Leprol 2011; 77(3): 335-6. 6.Sumana V, Singaracharya MA. Dermatophytosis in Khammam (Khammam district, Andhra Pradesh, India). Indian J Pathol Microbiol 2004;47(2):287-9. 7.sBelukar DD, Barmi RN, Karthikeyan S, Vadhavkar RS. A Mycological study dermatophytosis in Thane. Bombay Hosp J 2004;46:2.

Evidence suggests a link between Late Onset

It is a primary degenerative disease of the cerebral cortex. It accounts for over 65% of all dementia cases, commonest cause of dementia. First described by Alzheimer in 1907 and named after him by Kraeplin. It is a progressive brain damage. It destroys brain cells, causing problems with memory, thinking and behavior. The incidence is about 2 – 7 % at ages above 65yrs. This doubles after every additional 5yrs to 8-10% at 80yrs and 30-40% at 90yrs. Rare below 50yrs. This progressive increase in incidence with age has caused significant medical, social and economic concerns in nations with growing number of elderly people.It is the 6th leading cause of death in the United States. It does not have any current cure; treatment available is targeted at presenting symptoms. Pathology Aetiology: The cause is unknown. However there is increased incidence in Down’s syndrome. The risk is also higher with increased free radical formation and failure of antioxidant defenses which ma y contribute to the degeneration [SOD is reduced by 25% in the frontal cortex and hippocampus]. It is occasionally familial. Besides, genetic studies show linkage between Familial AD and loci on chromosomes 1, 14 & 21.Late onset AD is a heterogenous disorder. Evidence suggests a link between Late Onset AD and atherosclerosis, inflammation and cholesterol. Linkage has also been found to a gene locus on chromosome 19q. There is also a strong association between Alzheimer disease and amyloid proteins. In this disease condition, there is a breakdown in some of the synapses that serve the function of information storage, processing and memory; this spreads to other cells and over time, these cells die. Such affected cells are surrounded by plaques and contain characteristic tangles.Macroscopy: Macroscopic examination of the brain shows a variable degree of cortical atrophy with widened sulci. These changes are pronounced in the frontal, temporal and parietal lobes. Hydrocephalus ex vacuo -compensatory ventricular enlargement occurs due to parenchyma loss. Microscopy: Microscopic examination shows senile plaques, neurofibrillary tangles and amyloid angiopathy. All these changes are also found in the brains of elderly because they are features of aging. The pathologic changes seen in this disease begin first in the entorhinal cortex, spread to the hippocampus and isocortex and eventually to the neocortex.Senile plaques: are spherical collections of dilate neuritic processes which surround a central amyloid core. The neuritic processes are also called dystrophic neuritis; are silver-staining and contain paired helical filaments, abnormal mitochondria and synaptic vesicles. The periphery is occupied by microglial cells and astrocytes. The amyloid core is stained by Congo red stain; it contains abnormal proteins predominantly amyloid proteins. There are also diffuse plaques in those with Down syndrome; these lack the neuritic processes seen in senile plaques.Neurofibril lary tangles: bundles of filaments in the cytoplasm of the neurons encircling the nucleus. They are vivid as fibrillary structures with silver staining although they are also basophilic with Hematoxylin and Eosin stain. These structures contain paired helical and straight filaments; the former contain protein tau, Microtubule-associated protein [MAP2] and ubiquitin. The quantities of these tangles correspond to the degree of dementia. Another pathologic feature is Amyloid angiopathy which is an invariable finding in Alzheimer disease associated with amyloid protein.Besides, there is also accumulation of intraneuronal vacuoles in the cytoplasm. Amyloid angiopathy, hirano bodies are mostly within the frontal, parietal and temporal cortex, hippocampus and substantia inominata. There is also marked reduction in Ach, NE, 5-HT. Diagnosis Alzheimer disease usually becomes clinically apparent as insidious impairment of higher mental functions with changes in mood and behaviour. Later progre ssive impairment in orientation, memory, attention and concentration worsens.Eventually patient becomes mute, immobile and severely disturbed. The diagnosis of Alzheimer disease is based on a combination of clinical and pathologic presentations. There are impaired cognitive functions, Psychotic features such as delusion and hallucinations, and depression. The course is relentlessly progressive. Survival rate varies between 8 & 10yrs Management includes Good history, mental state and thorough physical examination. Every patient must be thoroughly evaluated to determine the extent and severity of the disease.Psychometric testing – for confirmation, Mini Mental State Examination ,7-min screening, mental test score, clinical dementia rating, Wechsler adult intelligence scale [WAIS: current IQ to previous I Q] Investigation: these physical investigations are useful to access the physical status of the patient; identify any physical illness and determine co-morbidities. Blood test : full haemogram, Erythrocyte Sedimentation Rate, C-Reactive Protein, urea and electrolyte, Fasting and random blood sugar, liver function test, Ca, Vitamin B12, Folate assay, Thyroid function test.Imaging: Chest X-Ray, cranial CT scan, MRI, PET, SPECT, angiography Others: Lumbar Puncture and CSF analysis, brain biopsy for histology Treatment Generally, goal of treatment is to maintain remaining ability as far as possible to preserve dignity, relieve distressing symptoms, slow disease progression & provide care for as long as possible in the familiar home environment. Patients should be made aware of their condition if possible. Inform patient the nature of the disease so that they can adapt favorably to existing conditions.Family support is an important part of the treatment plan: Counseling of the relatives & careers, family support and medical problems of the careers also deserve particular attention. The emphasis here is to encourage family members to show understanding for pati ent’s condition and help them live well with the condition. Behavioral methods that have been suggested include re- enforcement, shaping, desensitization, prompts & other practical aids to cope with forgetfulness. Drug treatment: there is not cure for Alzheimer disease but some drugs have proven useful in patients.These drugs are used based on their mechanism of action and the pathogenesis of the disease. These include: Antioxidants: these are useful to reduce free radicals implicated as etiologic agents for AD. Anticholinesterases, such as neostigmine, physostigmine increase, Ach levels. Antipsychotics are indicated to control paranoid delusions while antidepressants may be indicated when depressive symptoms are prominent. Prevention: recent evidence suggests that participation in cognitively demanding activities in later life can be preventive. Prognosis The changes in Alzheimer disease are irreversible.The disease is terribly progressive and the biological history can rare ly be altered. This makes the prognosis unfavorable. However, palliative measures can be adopted to alleviate the deficit and preserve remaining functions. References Cummings J, Cole G: Alzheimer Disease, JAMA 287:2335, 2002 Braak H, Braak E: Frequency of Stages of Alzheimer-related lesions in different age categories. Neurobiol Aging 18:351; 1997 Braak H, Braak E: Neuropahtological staging of Alzheimer-related changes. Acta Neuropathol [Berl] 82:239; 1991 Mirra SM, Hart MN, Terry RD: Making the diagnosis of Alzheimer’s disease. Arch Pathol Lab Med 117:131, 1993

One of the Most Neglected Options for A Separate Peace Essay Topics

One of the Most Neglected Options for A Separate Peace Essay Topics Conflicts are another means to determine someone's true character. Nevertheless, the vital ones take work. The 5-Minute Rule for a Separate Peace Essay Topics Conflict between friends can be worked out. Conflict in a friendship sometimes takes a very long time and be very tough to resolve. Divorce is never a simple matter to do. If you're thinking how to prevent divorce and help save marriage, then be a buddy to your spouse, too. The Advantages of a Separate Peace Essay Topics What you ought to do is suggest your own plan on how peace can be accomplished. The title usually means there are various kinds of peace you can have. You should choose the time apart to concentrate on your own needs too. If it's so, then you'll be having some difficult time for a student along with being a writer. Attempting to pass a plan for a new grade separation can be challenging as a result of the obtrusiveness and the pric e. The large bodily structures that are required to create this sort of roadway are significant and costly. Other forms of grade separations include junctions that connect over three roads. Different types of Separations There are plenty of forms of grade separations that may be used. There's harmonious growth as opposed to a transaction. He's got the ability to enter that wave and get to the destination. There can be delay in the marriage and likewise some hurdles. And surrender to silence once in a little while. The Downside Risk of a Separate Peace Essay Topics There are quite a few other conflicts within this story. The war appears to have the greatest affect on Leper out of all of the boys. Likewise Gene's narration gets dispassionate at the makeshift trial the moment it will become clear that his secret crime is going to be revealed. Along with telling the Biblical story it's linking with the battles of the moment. What Everybody Dislikes About a Separate Peace E ssay Topics and Why When a conflict occurs you can see the things that they do and the way they react to the circumstance. Natives born within this quarter are proud and selfish and they're more worried about material increase and self-respect in society etc.. In the start, Finny had a naive and idealistic attitude to the war. Poverty Kosovo is among the poorest regions in Europe. Now that you know the importance and aim of the topic in your essay, it's important to check at possible topics for A distinct peace essay. The very best discursive essay topics are the ones that are controversial and that may be argued about with varying points of view and opinions it can be hard to write. This relationship isn't a legitimate dialogue but a monologue. A different peace essay topics for this essay, choose 1 area of symbolism and learn more about the importance of the symbolism with regard to the themes in the. In the English classroom, though, a text has traditionally been a bit of literature. Furthermore, we've got experts in just about all scientific disciplines to make sure your paper is going to be written by real specialist and based upon an exhaustive research. They need to be able to know the reach of your essay by taking a look at your topic together with have an interest to read your real paper. So far as the students are involved, writing a research paper is among the toughest and frustrating endeavor in their opinion. Marriage isn't all about romantic love. He believes in God along with in optimism. And, like always, Essay Thinker is here in order to provide help. You shouldn't have a narrow topic that isn't sufficient to cover your subject. Having time alone with each other is the sole possibility that you've got to explore the problems that you have with one another. Even though most students find it fun and simple to compose an essay on a particular subject, many fa ce problems in deciding on the correct topic. It simply evolves as the 2 subjects continue to mesh and grow with one another over the class of time. Thus, for your convenience, you have a superb chance to monitor the development of the assigned writer and make sure an essay will be ready in a timely method. Writing quality essays is the principal use of our services. Order top-notch essay at this time and certified specialists will do their very best to supply you with higher quality at affordable price. What all you will need is getting the assistance from a specialist and EssaysChief is going to be the expert that you seek out. If you have to, sacrifice some of your hobbies so that you're able to have quality time'' with the individual you married. Furthermore, viewing the content on those websites, requesting additional info, or transmitting information by means of a contact form doesn't form an attorney-client relationship with the sponsoring attorney. Our site provides custom writing help and editing support.

The Impact of Philosophy on Government - 1413 Words

Between the time of Machiavelli’s The Prince and Locke’s Second Treatise of Government, the concept of government evolved greatly. There were several philosophers that contributed their ideas and helped build the foundation for the governments we have today. Niccolo Machiavelli, an Italian philosopher, who lived from 1469 – 1527, became well known with his ideas and concepts of government. Machiavelli in his book The Prince, a guide of how to rule dedicated to Lorenzo de’ Medici, ruler of Florence at that time, clearly exposed his concepts about what he thought a ruler had to do to be respected and admired. Machiavelli believed that whoever possessed the power had the right to command, however, he stated that the†¦show more content†¦Hobbes left very clear in his work that for a government to be powerful it had to have a strong central authority. His ideas had a great impact on the Federalists during the first steps of the creation of the US laws. Hobbes concept that men were weak and needed to be guided made the Federalist lead to create the Federal Constitution of 1787 since they also saw the American people unable to defend themselves and keep the country as a strong nation against the foreign menace. Another important philosopher of the early 17th century was Baruch de Spinoza, a Dutch philosopher born in 1632. His ideas were the most radical of the early modern period. His Treatise, The Ethics: Treatise on the Emendation of the Intellect, was a very ambitious document. What Spinoza expressed here are his ideas of truth about God, nature and especially ourselves; as well as the highest principles of society, religion and the well being of men. He studied Hobbes and Machiavelli’s works intensely but he differ from them in a major way. He did not believe that there was a supernatural power or God that had to settle the differences among men or to punish them if they did not act properly. 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