Context: Oral candidiasis is the most common oral opportunistic infection has seen in the immunocompromised patients. Apart from C. albicans the non-Candida albicans Candida species, which are less susceptible to the commonly used antifungal drugs are major etiological agent for candidiasis. Thus, the treatment strategy for candidiasis should be different in case of multiple species infection. Aims: The aim of this present study is to compare the antifungal susceptibility patterns of Candida species isolated from mono species and multiple species oral Candidal carriage. Materials and Methods: The species of Candida, isolated from mono and multiple species oral Candidal carriage of the healthy and immunocompromised patients were used for the experiment. Antifungal susceptibility test was performed by using disk diffusion susceptibility method on Methylene blue Glucose- Mueller-Hinton agar. Statistical Analysis Used: Paired student's t-test. Results: In this, present study, variability in antibiogram of Candida species isolated from mono species and the corresponding species isolated from multiple species combinations were reported. The susceptibility ranking for antifungal drugs for the strain isolated from mono species OPC (C. albicans > C.tropicalis > C. glabrata > C.krusei) and for the strains isolated from multiple species combination (C. albicans > C. glabrata > C.krusei > C.tropicalis) for mean of the five antifungal drugs combined were reported. Species of C. albicans and C. tropicalis were reported more resistant towards anti fungal agents when these present in mono-species condition, whereas; C. krusei and C. glabrata were more susceptible when these present in mono-species condition. Polyenes (amphotericin-B and nystatin) compounds were found to be most effective than azoles against Candida spp. isolated from multi-species lesions as none of the strain were shown resistant towards these drugs, conversely; a significant fraction of C. tropicalis and C. albicans isolated from mono-species lesion were shown resistant toward polyenes compound tested. Conclusions: The findings of this study shows statistically insignificant diverse antifungal susceptibility pattern of Candida species isolated from mono and multiple species Oropharyngeal Candidiasis combinations.

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Background: Enteric-coated systems are most commonly used for colonic drug delivery and constitute a majority of commercially available preparations for colon targeting. This pH variation in different segments of gastrointestinal has been exploited for colon-specific delivery. Coating the drug core with pH-sensitive polymers, these polymers are insoluble in acidic media, but dissolves at a pH of 6 or more, thereby providing protection to the drug core in the stomach and to some extent in the SI releasing the drug in the colon. Aim: The present study aimed to statistically optimize a colon-specific drug delivery system of prednisolone for the treatment of inflammatory bowel disease. Materials and Methods: A 3 ² full factorial design was used for optimization. The independent variables employed were amount of hydroxyethyl guar (HEG) and % CWG each at three levels. The dependent variables were % CDR at 5 hours, % CDR at 12 hours, and t_50% (time required for 50% drug release). The tablets were prepared by the wet granulation method using novel guar gum derivative HEG as a polysaccharide. The formulated tablets were evaluated for weight variation, thickness, hardness, friability, drug content, and swelling index. The tablets were coated with 10% w/v solution of Eudragit L100 and Eudragit S100 (1:4) in IPA using 20% w/w triethyl citrate as plasticizer. The coated tablets were evaluated for in vitro dissolution studies in different pH media mimicking the transit of tablet from stomach to colon. Results and Conclusions: Differential scanning calorimetry studies showed no incompatibility of drug with other excipients. The optimized formulation F9 containing 30% HEG and 9% CWG showed 10.09% drug release after 5 hours (lag phase) and 60.76% drug release after 12 hours. Drug release was accelerated in the presence of rat caecal contents and indicated the degradation of polysaccharide by colonic microflora. The optimized formulation was subjected to an in vivo X-ray imaging study in albino rabbit to trace the movement and behavior of the tablet in gastrointestinal tract. A short-term stability study of the optimized formulation showed no significant changes in physical appearance, drug content, and in vitro dissolution profile when stored at 40 ± 2°C/75 ± 5% RH for 3 months. The designed system can be potentially used as a carrier for colon delivery of prednisolone by regulating drug release in stomach and small intestine.

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Extradural hematoma (EDH) after ventriculoperitoneal shunt procedure is a rare, dangerous but easily manageable complication. It is more common in children and young adults presumably due to relatively lax adhesion of dura to calvarium. We report a case of a 20-year-old male with acqueductal stenosis who underwent ventriculoperitoneal shunt procedure and was discharged after 1 week. A follow-up computed tomographyscan 2 months later showed a chronic ossified EDH in the left frontal reigon. The ventricular catheter was in position and the ventricles were decompressed. Because the patient was asymptomatic, he was managed conservatively. A brief discussion of factors that lead to formation of EDH is included, with stress on techniques to prevent or minimize such complications.

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Background: Nicotine dependence is a chronic and relapsing disease. Oxidant components of cigarette smoke reduce nitric oxide (NO) production and/or inhibit its function. Objectives: The aim of this study was to assess serum NO, peroxynitrite ONOO and C-reactive protein in smoker individuals using the Fagerström test for nicotine dependence. Materials and Methods: A total number of 50 male smoker subjects and 20 non-smoker subjects serving as controls were recruited in this study. The Fagerström test of nicotine dependence was used to assess the level of nicotine dependence. Venous blood was obtained from each subject and serum was separated for the following tests: C-reactive protein, NO and ONOO. Results: The mean values of C-reactive proteins in the smokers were less than 6 mg/L and there was no significant difference in the C-reactive protein level between levels of nicotine dependence according to the Fagerström test scoring. A non-significant low serum NO level was observed in smokers, which did not correlate with C-reactive protein. A significant high serum ONOO level was observed in smokers compared with non-smoker subjects, which did not correlate with C-reactive protein. Conclusions: The study concludes that serum ONOO level may serve as an initial marker to point the impact of smoking on human beings. Its elevation preceded the decline in serum NO level and the evidence of inflammation.

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Objectives: The current study aimed to review the cases of imperforate anus, their demographic distribution, associated anomalies, results of management, and defining cases that require further management. Materials and Methods: A total of 123 cases of different types of imperforate anus were managed over a period of 20 years. Results: The patient group comprised 70 males and 53 females. Recto-vestibular fistula was the commonest type seen (27%), followed by ano-perineal fistula (20%). Only two cases of cloaca (1.6%) and one iatrogenic recto-vaginal fistula were seen. The commonest associated anomaly was hypospadius (79.6%) in males, followed by hydronephrosis and abnormal sacrum in both sexes. Most cases were managed by posterior sagittal anorectoplasty (72%). Voluntary bowel control and fecal continence were found in 100% of cases with ano-perineal fistula, in 93.3% of cases with recto-vestibular fistula, and in 63% of those with recto-urethral fistula. Fecal soiling was found in 12 patients; three of them had sacral anomalies and they were offered Malone appendicostomy. Eleven patients had mucosal prolapse; in two of them the prolapse was complete. Five patients possessed mislocated anus but kept clean by daily enemas and diet control. Conclusions: Although the number of cases with imperforate anus treated in our hospital was relatively small, the outcome of management was favorable and matching with reports from specialized centers. It is advisable to keep those patients under regular follow-up and updating their contact information frequently for further assistance.

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Cataracts are opacities of the crystalline lens. Because they frequently interfere with normal visual development, they represent an important problem in pediatric ophthalmology. Despite dramatic improvement in the treatment of pediatric cataract, it continues to be a major cause of decreased vision and blindness in children. By far, the most common cause of poor visual results after surgery is irreversible amblyopia.

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Cervical pregnancy is the implantation of pregnancy in the endocervical canal; it is an infrequent form of ectopic gestation which accounts for 0.15% of all ectopic pregnancies. Diagnosis and treatment has changed dramatically in the last 20 years. Early detection by endovaginal ultrasound is desirable in order to plan management early and avoid serious and often life-threatening complications. A 24-year-old lady presented with 6 weeks of amenorrhoea with vaginal bleeding. She was diagnosed to have cervical ectopic pregnancy on ultrasound and was successfully treated with single-dose methotrexate.

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Although dengue meningitis is a rare presentation of dengue infection, our aim is to focus on atypical presentation of dengue meningitis that may appear in dengue endemic area like the Makkah region. We report two cases of clinical meningitis with positive dengue virus (DENV) IgM in cerebrospinal fluid, followed for minimal 3 months for their prominent attacks of migraine like headache, phobia, and arrhythmia. With special consideration to attacks time, type, severity, and respond to classical therapy, using regular ECG monitoring, visual analogue pain score, and neuropsychological assessments were done. Both cases showed resistant migraine like headaches to classic anti-migraine therapy except for strong NSAID and narcotics with tendency to have severe to extreme severe daily migraine like headache on early to late afternoon time, associated with non-fatal arrhythmias and extreme death phobia, that resolve slowly in a minimal 3 months period. In conclusion, dengue meningitis in the endemic area may present atypically.

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Panniculitis and polyarthritis may rarely complicate a pancreatic disease; this association is defined as PPP-syndrome and is characterized by significant morbidity and mortality. Panniculitis is related to subcutaneous (liquefactive) fat necrosis with secondary skin changes due to the local activity of pancreatic enzymes released during different pancreatic diseases (inflammatory, acute and chronic, and neoplastic). The reported incidence of association of panniculitis and pancreatitis is 2-3% of all pancreatic diseases, while the complete PPP-syndrome is reported in very few cases. Here, we report a 49-year-old man with acute on chronic pancreatitis who presented to us with abdominal pain, arthritis, and multiple subcutaneous swellings which were present all over the body (generalized) unlike the commonly reported below-knee distribution, and this is what makes our case different. Biopsy from the subcutaneous swellings revealed fat necrosis and USG abdomen showed features of pancreatitis.

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Objectives: To evaluate risk factors for retained products of conception (RPOC) after surgical evacuation (SE) using transvaginal sonography (TVS) and success of medical and surgical management. Study Design: Retrospective open-label study included 270 women after SE done for abortion; 204 were completely evacuated and 66 had RPOC randomly equally subjected to medical or surgical treatment. Results: There was a significant difference between the two study groups regarding GA at SE (lower in the complete evacuation group) 7.32 ± 1.352 vs. 10.23 ± 1.572, experience of the obstetrician (higher in complete evacuation group) and adverse effects as vaginal bleeding, abdominal pain, and fever (lower in the complete evacuation group). Success of both medical and surgical treatment of retained products showed a statistically nonsignificant difference. Nausea and headache showed nonsignificant difference between the two groups while most side effects reported were more in the medical group as diarrhea (12 vs. 1), fever (9 vs. 0), hot flushes (10 vs. 0), abdominal pain (9 vs. 2), and vaginal bleeding (9 vs. 2). Few side effects were reported more in the surgical group such as vomiting (13 vs. 2) and tiredness (12 vs. 2). Conclusion: TVS is recommended following D and E in patients at high risk for RPOC for whom medical and surgical treatment are effective.

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Introduction: It is possible that progressive renal insufficiency leads to altered hepcidin metabolism, subsequently affecting the enteric absorption of iron and the availability of iron stores. Because of the previous absence of an accurate serum assay, most studies of hepcidin in humans have been performed using a urinary assay. We conducted this study to evaluate the level of serum prohepcidin in anemia of chronic kidney disease (CKD) patients, with close analysis of data to different hematological parameters, especially iron markers. Subjects and Methods: This is an analytical cross-sectional case-control study involving: Group I - 20 patients of CKD on hemodialysis, nine males and 11 females, and their age ranged from 8.6 to 17 years; Group II - 10 patients of CKD stage 3 and 4, six females and four males, and their age ranged from 8.1 to 15 years on conservative treatment; and Group III, 10 control participants with normal kidney function, seven males and three females, and their with age ranged from 8 to 16 years. Diseased patients had six patients on intravenous iron supplementation. All participants met the following criteria at the time of sampling: A stable clinical state and no thrombosis or infection, with controlled blood pressure, no more than twice of the normal SGOT and SGPT. All participants were subjected to full medical history, thorough clinical examination and laboratory evaluation (kidney functions, liver functions, C-reactive protein, serum levels of hepcidin prohormone using ELISA, serum levels of iron, ferritin and total iron binding capacity (TIBC), hemoglobin, hematocrit, intact parathormon level (iPTH), serum albumin, serum cholesterol and triglycerides. Results : Our study demonstrated a significant rise in serum prohepcidin levels in the diseased groups, a significant rise in serum ferritin and no significant difference between TIBC and serum iron levels between the diseased groups and the control group. A significant positive correlation was demonstrated between serum prohepcidin levels and serum ferritin, while a significant negative correlation was revealed between serum prohepcidin and hemoglobin, hematocrit and TIBC. We did not find a significant correlation between serum prohepcidin and C reactive protein (CRP) as an inflammatory marker in our patients. No significant difference was detected in prohepcidin levels in the patients who were on intravenous iron therapy in comparison with who were not. Conclusion : We concluded that there is a positive association between serum prohepcidin level and serum ferritin and other conventional markers of iron metabolism in CKD patients.

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