Faecal fungal flora in healthy volunteers and inpatients

The faecal fungal flora was analysed in healthy volunteers and inpatients. Self-obtained stool swabs from volunteers (n = 228) and inpatient stool-samples (n = 34) were cultured on Inhibitory-Mould-Agar plates. All yeast isolates were identified. Fungi were detected in 51.8% of volunteers; the majority (88.1%) had single species. The prevalence increased steadily with age. Candida albicans was detected in 62.7%, non-albicans Candida species in 22.0%, yeasts--other than Candida in 20.3% and moulds in 8.5% of volunteers with fungi. No gender-related differences were noted in the prevalence or types of yeast. Candida glabrata and C. krusei were detected in adults only. Intra-household species-similarity (excluding C. albicans) was noted in seven of 31 (22.6%) households with fungi in two or more members. Inpatients had higher prevalence of yeast (88.2%) with a single species in the majority (73.3%). Yeasts other than Candida were less common in inpatients (3.3%; P = 0.013) whereas C. glabrata was significantly more prevalent (33.3 versus 2.5%; P < 0.001). This study delineates the faecal fungal flora in volunteers and inpatients. Most subjects harbour a single species that may be shared with other households. The prevalence is somewhat higher in adults and the types of yeast may vary with age. Finally, C. glabrata appears to be acquired nosocomially.     

"Endonyx" onychomycosis: a new modality of nail invasion by dermatophytes

Three patients with onychomycosis due to Trichophyton soudanense with an "endonyx" type of nail invasion are presented. Endonyx onychomycosis is clinically characterized by a diffuse milky-white discolouration of the affected nail, in the absence of nail bed hyperkeratosis or onycholysis. Nail plate surface and nail thickness are normal. The pathology shows a contrast between the great number of fungal hyphae visible in the nail plate and the absence of fungal elements in the nail bed. The nail bed does not show inflammatory changes or hyperkeratosis and adheres strictly to the lowermost layers of the nail plate. The hyponychium is normal and does not contain hyphae. The endonyx pattern of nail infection appears to be specific to T. soudanense nail invasion and may possibly reflect the high affinity of T. soudanense to hard keratins.     

Effects of beta-blockers on neurohormonal activation in patients with congestive heart failure

The effect of beta-adrenoceptor antagonists (beta-blockers) on neurohormonal activation in patients with congestive heart failure has been the subject of study in numerous small clinical trials. Short term therapy with beta-blockers is associated with a variable acute neurohormonal response which may be determined by the pharmacology of the agent under study and the baseline characteristics of the patient population. Long term therapy with beta-blockers devoid of intrinsic sympathomimetic activity (partial agonist activity) is associated with evidence of decreased plasma markers of activation of the sympathetic nervous system, the renin-angiotensin system, and endothelin-1. Beta1-selective and nonselective beta-blockers appear to be associated with evidence of decreased neurohormonal activation, with differential effects on beta-adrenoceptor density. Agents with partial agonist activity appear to differ from pure antagonists, with some studies reporting evidence of increased neurohormonal activation. The mechanisms by which beta-blockers reduce neurohormonal activation and the clinical relevance of changes in adrenergic function to their use in the treatment of heart failure require further investigation.     

Association of insomnia with quality of life, work productivity, and activity impairment

Purpose  To assess the association of insomnia with health-related quality of life (HRQOL), work productivity, and activity impairment. Methods  Data were obtained from the 2005 US National Health and Wellness Survey. Subjects were assigned to the insomnia group (diagnosed insomnia experienced at least a few times a month) or the noninsomnia group (no insomnia or sleep symptoms). HRQOL was assessed using the short form 8 (SF-8) (mental and physical scores). The work productivity and activity impairment questionnaire (WPAI) assessed absenteeism (work time missed), presenteeism (impairment at work), work productivity loss (overall work impairment), and activity impairment. Linear regression models were used to control for potential confounders. Results  A total of 19,711 adults were evaluated (5,161 insomnia, 14,550 noninsomnia). Subjects in the insomnia group had significantly lower SF-8 physical (−5.40) and mental (−4.39) scores and greater activity impairment scores (+18.04) than subjects in the noninsomnia group (P < 0.01 for all). Employed subjects in the insomnia group had greater absenteeism (+6.27), presenteeism (+13.20), and work productivity loss (+10.33) scores than those in the noninsomnia group (P < 0.01 for all). Conclusions  Insomnia is significantly associated with poorer physical and mental quality of life and work productivity loss and activity impairment.     

Mechanisms of hypertension in patients with terminal kidney failure on programmed hemodialysis

The state of some mechanisms involved in AP regulation was studied in 18 patients with terminal renal failure (TRF) on programmed hemodialysis for 7-9 mos. The imbalance of extra- and intracellular sodium, potassium and water causing hypertension, was noted in TRF patients. TRF patients revealed (against a background of the normal activity of plasma renin) a high activity of carboxycathepsin resulting in the creation of conditions for enhanced kinin degradation playing a depressor role and for intense angiotensin II formation, being an important mechanism of persistent hypertension. An increase in the activity of carboxycathepsin can be one of the reasons of hyperaldosteronemia detected in the patients. A single session of hemodialysis does not significantly influence the activity of carboxycathepsin.