Female genital tract bacterial coisolates with Candida albicans in patients without clinical vaginitis.

OBJECTIVE: In vitro, Candida albicans has demonstrated the ability to inhibit replication of selected bacteria. Little information exists on the impact of C. albicans on the vaginal bacterial flora in vivo. The purpose of this study is to identify the coexisting bacterial flora when C. albicans is isolated from vaginal cultures submitted to a hospital-based testing facility for reasons other than vulvovaginitis. METHODOLOGY: All specimens (240) received from ambulatory care clinics over a six-month period were cultured for aerobic and anaerobic bacteria and Candida species. Those specimens submitted for cervicitis, vaginitis, or vaginal discharge and those from which yeasts other than C. albicans were isolated were eliminated. To control for sample biases, a subgroup composed of all pregnant women for whom cultures were done as screening procedures was similarly studied. Chi-square analyses, comparing the prevalence of individual bacteria isolated with and without the presence of C. albicans, were done for all study populations using SPSS for Windows software (1994). RESULTS: Two hundred and forty consecutive specimens were bacteriologically analyzed. Of the 220 vaginal samples used in the study, C. albicans was isolated in 44 instances (20%). Neither the presence of the lactobacilli nor the presence of Gardnerella vaginalis markedly influenced the isolation rate of C. albicans. The group B streptococci had a greater probability of coisolation when C. albicans was present (27.3% verses 16%), but this was not statistically significant (P < 0.8). Dissociation between the presence of C. albicans and the coisolation of Peptostreptococcus species and anaerobic gram-positive cocci and/or bacilli was noted (P < 0.0819), while the incidence of gram-positive aerobic bacilli was reduced in the presence of C. albicans (30/176 [17.1%] versus 6/44 [13.6%]), this reduced incidence was not statistically significant. Isolation data of the subgroup of pregnant women supported these observations. CONCLUSION: Within the limitations of the study, statistically, the data suggests that an inverse relationship exists between the presence of C. albicans and recovery of Peptostreptococcus and anaerobic gram-positive cocci and bacilli.     

Adaptation of Quality by Design-Based Development of Isradipine Nanostructured–Lipid Carrier and Its Evaluation for In Vitro Gut Permeation and In Vivo Solubilization Fate

The present study demonstrated the systematic adaptation of quality by design-integrated approach for the development of novel nanostructured lipid carrier (NLC) of an anti-hypertensive drug isradipine (ISD) to address the inherent challenges such as low solubility and low oral bioavailability. Plackett-Burman design was used for preliminary screening of significant process and formulation variables (p <0.05), which were further processed using Box-Behnken design for the attainment of optimization goal that is, mean particle size (85.7 ± 7.3 nm), drug entrapment efficiency (87.4 ± 3.29%), and in vitro drug release characteristics (92.89 ± 5.47%). The optimized ISD-NLC formulation also demonstrated well-dispersed uniform-shaped particles (polydispersity index 0.207 ± 0.029), high gastrointestinal fluid stability (zeta potential ?10.17 ± 0.59 mV), and higher in vitro gut permeation (21.69 ± 2.38 μg/cm² of ISD-NLC as compared to 11.23 ± 1.74 μg/cm² in ISD suspension). Furthermore, lipolysis studies were performed for the purpose of in vivo fate, and significantly higher drug content of ISD from ISD-NLC in aqueous phase was found (72.34 ± 4.62%) as compared to drug suspension (3.01 ± 0.91%). Relative bioavailability of ISD-NLC and ISD suspension was increased by 4.2-fold and 1.78-fold in the absence and presence of cycloheximide which is a lymphatic uptake inhibitor revealing lymphatic uptake of ISD-NLC in bioavailability improvement. Hence, systematic adaptation of quality by design integrated approach improved gut permeation and potential solubilizaton fate (dynamic lipolysis) of ISD-NLC, which further improved the lymphatic uptake and biodistribution of drug thereby promisingits in vivo prospect and clinical efficacy.     

Maternal risk factors for perinatal septicemia due to the Enterobacteriaceae

Cases of perinatal septicemia due to the Enterobactericeae, which manifest in the first 24 hr of life were analyzed for the presence or absence of the maternal risk factors defined in the CDC group B streptococcus (GBS) risk-factor protocol. Microbiological data involving blood culture isolates were reviewed for the recovery of an Enterobacteriaceae from January 1975 through June 1995. Enterobacteriaceae perinatal septicemia was defined as the recovery an Enterobacteriaceae from one or more set of blood cultures in the first 24-36 hr of life in conjuncture with clinical evidence of neonatal stress in the first 24 hr. A case would also be considered of perinatal origin for cultures obtained up to 36 hr provided that evidence of clinical disease was present in the first 24 hr of life. Fifteen cases of perinatal septicemia due to the Enterobacteriaceae were analyzed. All but four shared one or more maternal risk factors. The maternal risk criteria established to avert early-onset GBS disease are commonly encountered in women destined to have newborns with perinatal septicemia due to the Enterobacteriaceae. Antibiotic selection for risk-driven protocols for GBS avoidance may need to be broadened to address the issue of coverage for penicillin-sensitive and penicillin-resistant Enterobacteriaceae.     

Living cytology--revisited. In vitro demonstration of intraabdominal adenocarcinomatosis.

An in vitro culture technique, "living cytology", was used in a single-blind study to study 36 paracentesis and 7 intracystic fluid specimens for possible adenocarcinomatosis. Islets of epithelial cells were demonstrated only in the 20 patients who were ultimately shown to have intraabdominal adenocarcinomatosis. Ten patients with nonmalignant conditions and 6 patients with nonmetastatic malignancies did not exhibit a comparable pattern. One of the 7 intracystic fluid specimens grew out epithelial islets similar to those observed in patients with intraabdominal adenocarcinomatosis.     

Development of low-affinity, membrane-targeted Ca2+ sensors suitable for measuring presynaptic Ca2+

1. Our aim is to measure near-membrane Ca(2+) flux within the presynaptic terminals of central neurons by modifying new genetically encoded Ca(2+) sensors to develop tools capable of measuring localized Ca(2+) signals. 2. We used standard recombinant DNA technologies to generate the DNA coding for a fusion construct of a modified fluorescent 'pericam' Ca(2+) biosensor with a presynaptic P2X7 receptor (P2X7R). The Ca(2+) sensitivity of the biosensor was modified by rational site-directed mutagenesis of the calmodulin portion of the pericam. 3. Biosensor-receptor fusions were transfected into expression systems for evaluation. Expression studies in HEK-293 cells showed that biosensor-receptor fusion construct-delivered protein was localized exclusively to the plasma membrane, confirming that fusion did not affect the ability of the receptor to undergo normal protein synthesis and trafficking. 4. The Ca(2+)-dependent fluorescence of the pericam portion of the fusion protein was also retained. Site-direct mutagenesis within the calmodulin moiety of the pericam significantly reduced the Ca(2+) affinity of the complex. The dynamic range of the sensor following this modification is better matched to the higher Ca(2+) levels expected within presynaptic Ca(2+) microdomains.     

Infectious morbidity associated with pelvic exenteration

Forty-six consecutive cases of pelvic exenteration were retrospectively reviewed to identify the infectious morbidity incurred with this procedure in the absence of prophylactic antibiotic administration. Thirty (65%) of these patients required antibiotics (other than urinary tract suppressants) during their hospitalizations. Twenty-one patients (46%) had serious infections. Asymptomatic bacteruria (72%), pelvic cellulitis (70%), abdominal wound infections (28%), pyelonephritis (15%), and septicemia (15%) were the most common infections encountered. Analysis of the data identified several areas in which infectious morbidity could be circumvented without antibiotic therapy.     

Rubella antibody titer. The significance of low-titered rubella antibodies

The hemagglutination inhibition (HAI) test is not mathematically precise and reproducible. Thus, it is critical to know whether or not the threshold titer (1 : 10) of detectable rubella antibody is indicative of true immunity. Three patients with a 1 : 10 HAI titer presented with subsequent rubella during gestation. Ninety postpartum patients with a HAI titer of 1 : 10 were vaccinated and the rubella antibody titers were reassessed. Seventeen percent of these patients responded to the vaccine challenge with an eightfold or greater rise in titer. Thus, we recommend that the patient with a low HAI titer (1 : 10) should be considered to have marginal immunity to rubella and should be vaccinated.