Faris Nassar

Different components in human serum inhibit multiplication of Cryptococcus neoformans and enhance fluconazole activity.

The inhibitory effect of human serum on the multiplication of Cryptococcus neoformans and the interaction with fluconazole were studied. Compared with cryptococcal multiplication in RPMI 1640 medium alone, 5% human serum in medium inhibited multiplication by 76% +/- 6% (n = 8). The inhibitory effect of human serum was donor independent, [corrected] heat stable (56 degrees C, 30 min), and not due to albumin or globulin. Bovine and murine sera were not inhibitory at that concentration. A fungistatic concentration of fluconazole (5.0 micrograms/ml) in medium plus 5% human serum resulted in 40% +/- 5% (n = 8) killing (reduction of inoculum CFU) in a 24-h assay. Bovine or murine sera did not have the enhancing effect, and this human serum activity was heat stable and donor independent. At 2.5 micrograms of fluconazole per ml, fungistasis by fluconazole plus human serum was significantly greater than with either alone. Higher serum concentrations [corrected] potentiated fluconazole more. At higher fluconazole concentrations (e.g., 20 micrograms/ml) fluconazole alone could kill, but serum potentiated this. A fluconazole-resistant isolate (MIC, 100 micrograms/ml) was not killed by fluconazole (5.0 micrograms/ml) in 5% human serum, but human serum potentiated the partial fluconazole inhibition. When human serum was dialyzed (molecular weight cutoff, 6,000 to 8,000) against phosphate-buffered saline, it lost the ability to synergize with fluconazole for killing Cryptococcus organisms but not the capacity to inhibit multiplication. Filtration of serum suggested the filtrate with a molecular weight of < 10,000 could interact synergistically with fluconazole for killing but could not inhibit cryptococcal multiplication. These findings indicate that human serum has two components, one (macromolecular) with a unique ability to inhibit C. neoformans and a low-molecular-weight component that enhances fluconazole anticryptococcal activity.

Intravenous Immunoglobulin for Treatment of Toxic Epidermal Necrolysis

We report three female patients suffering from toxic epidermal necrolysis, with 30% to 70% epidermal detachment. Alleged causative agents were dipyrone, dibenzazepine, and allopurinol. All patients were treated by intravenous immunoglobulins (IVIG) and survived without further complications, although poor prognostic factors such as concomitant diabetes, large areas of epidermal detachment, and pancytopenia were present. We report these cases with emphasis on the concept that prompt diagnosis, withdrawal of causative drugs, and immediate treatment are imperative for the favorable outcome of the disease. Our patients can be added to the list of those patients who were successfully treated by IVIG, as indicated in this review of the literature.

Genotypic Differences of Candida albicans and C. dubliniensis Isolates Related to Ethnic/Racial Differences within the Same Geographic Area

Candida albicans and C. dubliniensis genotype differences among Israeli ethnic groups were assessed. Isolates from Jews (51), Arabs (35) and Druze (25) were genotyped. The distributions among ethnic groups were not different, however they differed (p = 0.002) from global populations. Therefore, C. albicans and C. dubliniensis genotype distribution differences in Israel are related to changes in all ethnic groups.

The role of empirical albendazole treatment in idiopathic hypereosinophilia - a case series.

Hypereosinophilia can lead to life-threatening organ damage when associated with eosinophilic infiltration of tissues. Although it is associated with a broad variety of diseases, sometimes no other abnormalities are detected. The authors present a novel approach to the treatment of hypereosinophilia, especially when an underlying cause fails to be detected.

Monounsaturated Fat Enriched with Olive Oil in Non-alcoholic Fatty Liver Disease

Publisher Summary The pathogenesis of non-alcoholic fatty liver disease (NAFLD) includes insulin resistance, lipotoxicity, increased exposure of hepatocytes to TNF-α, and increased oxidative stress. Etiologic mechanism of NAFLD includes increased influx of free fatty acids to the liver from dietary triglycerides and from free fatty acids that are released from adipocytes during fasting, reduced free fatty acid β-oxidation, reduced hepatic secretion of triglycerides-rich lipoprotein, and increased lipid per oxidation. An impaired postprandial triglyceride response has been recently reported in patients with NASH (non-alcoholic steatohepatitis) and may play a role by favoring triglyceride accumulation in the liver. Diet and nutrition, in particular the amount and type of fat intake, were recently linked to insulin resistance, increased risk of developing type 2 diabetes, and impaired postprandial lipid metabolism. Moreover, animal and human models suggest that dietary factors can affect fatty infiltration and lipid peroxidation in different types of liver disease including NAFLD. Although few studies of the effects of different diets on NAFLD have been performed in humans, the Mediterranean diet has been proposed for the prevention of metabolic syndrome, hypertension, and cardiovascular disease. The major part of its beneficial effect is a high supply of energy coming from monounsaturated fatty acids (MUFA), mainly from olive oil. This chapter describes dietary sources of MUFA, dietary habits and their relation to insulin resistance and postprandial glucose and triglyceride levels in NASH, the mechanism by which olive oil ameliorates fatty liver, experimental and clinical studies of olive oil and NAFLD, and future perspectives.

P366 Carcinoma of Papilla Vateri presenting as recurrent acute pancreatitis

Tumors of the Papilla of Vater can cause several clinical symptoms, the most prominent being jaundice, weight loss, anorexia, fever, abdominal pain and itching (1). Acute pancreatitis as a presenting symptom of ampullary carcinoma is rare. Few previous cases have been described in the literature (2,3). The prognosis of patients with jaundice is unfavorable in comparison with non icteric patients at the time of diagnosis (4) due to different staging, hence more complications, but not due to different histology. We report here a case of recurrent pancreatitis that was the only presentation of Vater ampullary carcinoma diagnosed by endoscopic ultrasound followed by duodenoscopy with guided biopsy. Recurrent pancreatitis without identifiable cause, particularly in elderly patients, could suggest tumor of the head of pancreas or the periampullary region among other causes such as intraductal papillary mucinous tumor, microlithiasis etc. An endoscopic ultrasound can allow earlier diagnosis and mandates biopsy in these cases.