Both type 2 diabetes and hypothyroidism are highly prevalent disorders in the community. The existing data regarding prevalence of hypothyroidism in patients with diabetes comes mostly from small studies. There are only two studies with a sample size of more than 1000 diabetic patients, none of which have been done in South Asians. The present study evaluated patients with type 2 diabetes for presence of hypothyroidism and the clinical factors associated with it. The demographic, anthropometric, clinical, and biochemical parameters of consecutively enrolled patients with diabetes were systematically collected and analyzed. A total of 1152 middle aged patients with type 2 diabetes with a mean duration of diabetes of around 10 years were enrolled. Nearly 40 percent of the patients were obese and overweight, respectively, for South Asian standards and abdominal obesity was seen in around 90% patients. Clinical hypothyroidism (TSH>10 mIU/ml) was present in 113 of patients (9.83%) and another 68 patients (5.9%) had subclinical hypothyroidism (TSH 5-10 mIU/ml). Anemia (odds ratio : 2.19), overweight/obese status (odds ratio 2.07), and known dyslipidemia (odds ratio : 1.99) were found to have independent association with clinical hypothyroidism. HbA1c, abdominal obesity, poor control of hypertension, lipid parameters, microalbuminuria, and renal dysfunction showed no difference among patients with hypothyroidism when compared with euthyroid patients. Subclinical hypothyroid patients had no difference in any of the above analyzed parameters when compared to the euthyroid patients. This study shows that a significant proportion of type 2 diabetes patients suffer from clinical or subclinical hypothyroidism and screening for the same may be appropriate.

Onychomycosis is a fungal nail infection which is relatively common and difficult to treat. Treatment modalities include nail avulsion, surgical debridement and combination therapy with oral and topical antifungal drugs. In spite of a host of available drugs, clinical cure rates remain discouraging. Drug toxicities, prolonged regimens, lack of patient compliance, and high keratin affinity of drugs are all contributive factors. Efinaconazole is a novel topical triazole antifungal agent that has shown excellent in vitro activity against both dermatophyte and non-dermatophyte fungi causing onychomycosis. This study presents the in vitro susceptibility profiles of 44 common non-dermatophyte fungi against efinaconazole and itraconazole, another azole drug used in the treatment of onychomycosis.

Availability of molecular methods, gene sequencing, and phylogenetic species recognition have led to rare fungi being recognized as opportunistic pathogens. Fungal keratitis and onychomycosis are fairly common mycoses in the tropics, especially among outdoor workers and enthusiasts. The frequently isolated etiological agents belong to genera Candida, Aspergillus, and Fusarium. Within the genus Fusarium, known to be recalcitrant to prolonged antifungal treatment and associated with poor outcome, members of the Fusarium solani species complex are reported to be most common, followed by members of the Fusarium oxysporum SC and the Fusarium fujikuroi SC (FFSC). Morphological differentiation among the various members is ineffective most times. In the present study, we describe different species of the FFSC isolated from clinical specimen in south India. All twelve isolates were characterized up to species level by nucleic acid sequencing and phylogenetic analysis. The molecular targets chosen were partial regions of the internal transcribed spacer rDNA region, the panfungal marker and translation elongation factor-1α gene, the marker of choice for Fusarium speciation. Phylogenetic analysis was executed using the Molecular Evolutionary Genetics Analysis software (MEGA7). In vitro susceptibility testing against amphotericin B, voriconazole, posaconazole, natamycin, and caspofungin diacetate was performed following the CLSI M38-A2 guidelines for broth microdilution method. The twelve isolates of the FFSC were F. verticillioides (n = 4), F. sacchari (n = 3), F. proliferatum (n = 2), F. thapsinum (n = 1), F. andiyazi (n = 1), and F. pseudocircinatum (n = 1). To the best of our knowledge, this is the first report of F. andiyazi from India and of F. pseudocircinatum as a human pathogen worldwide. Natamycin and voriconazole were found to be most active agents followed by amphotericin B. Elderly outdoor workers figured more among the patients and must be recommended protective eye wear.

BACKGROUNDBone and joint infections are painful for patients and frustrating for both doctors and patients. Osteomyelitis presents a variety of challenges to the physician. The severity of the disease is staged depending upon the infection's particular features, including its aetiology, pathogenesis, extent of bone involvement, duration, and host factors. The high success rates of antimicrobial therapy in most infectious diseases have not yet been achieved in bone and joint infections.

Objective:To estimate the incidence of invasive pneumococcal disease and pneumonia, distribution of pneumococcal serotypes, and antibiotic susceptibility in children aged 28 days to <60 months. Design: Hospital-based surveillance.Setting:; South Bangalore, India.Participants: 9950 children aged 28 days to <60 months with clinical suspicion of invasive pneumococcal disease or pneumonia.

ContextNoncompliance with thyroxine therapy is the most common cause of poor control of hypothyroidism. An open-label prospective study to compare once-weekly thyroxine (OWT) with standard daily thyroxine (SDT) was undertaken.DesignPatients taking thyroxine doses of >3 μg/kg/d, with or without normalization of TSH, were included and administered directly observed OWT or nonobserved SDT according to patient preference based on their weight for 6 weeks. Furthermore, patients on OWT were advised to continue the same at home without supervision.ResultsTwenty six of 34 patients on OWT and 7 of 18 patients on SDT achieved a TSH <10 μIU/mL (P < 0.05), and 2 patients from the SDT arm were lost to follow-up. During home treatment, 15 of 25 at 12 weeks and 19 of 23 contactable patients at a median follow-up of 25 months maintained TSH below target. Thyroxine absorption test was unable to predict normalization of TSH at 6 weeks of OWT therapy. No adverse events were seen with OWT-treated patients over the 12-week follow-up period. OWT has significantly higher efficacy (OR = 5.1) than SDT for patients with thyroxine-resistant hypothyroidism and is not associated with side effects.ConclusionOWT benefits a majority of patients in the long-term treatment of thyroxine-resistant hypothyroidism, in the real-world setting.

Objective: To evaluate the effect of prophylactic probiotic Bacillus clausii treatment on the need and duration of phototherapy in new born babies. Design: Open labeled clinical trial.Setting: Level II obstetric ward of a teaching hospital in Southern India.Participants: A total of 1043 babies with a gestational age of more than 35 weeks were enrolled in the study. There were 510 babies in the probiotic Bacillus clausii intervention group and 533 babies in the control group.Intervention: Intervention group babies < 37 weeks received 2 ml of Bacillus clausii (2.5 ml for those >37 weeks) twice a day for 3 days. Main outcome measure: The outcome measures were (i) Need of phototherapy and (ii) Duration of phototherapy.Results: A total of 32 babies in control group and 17 in intervention group required phototherapy. This difference in need for phototherapy was statistically significant between the two groups (p 0.04). Treatment with probiotic reduced the risk of need for phototherapy by 44% (RR 0.56, 95% CI 0.32, 0.99).The median duration of phototherapy in the intervention group was 18 hrs ( IQR 16.50, 24.00) and that of control group was 24 hrs (IQR 18.00, 48.00). This difference in duration of phototherapy was statistically significant (p=0.027). No adverse drug reactions were noticed in the intervention group. What is already known:The management of neonatal jaundice depends on phototherapy and exchange transfusion. What this study adds:Prophylactic probiotic therapy appears to reduce the need and duration of phototherapy in neonatal jaundice. Conclusion:Prophylactic treatment of probiotic Bacillus clausii for three consecutive days reduced both the need as well as the duration of phototherapy in newborn babies.

OBJECTIVE | Reduction of atherosclerotic cardiovascular disease (ASCVD) risk in patients with diabetes requires proper management of lipid parameters. This study aimed to find the pattern of dyslipidemia and scope of ASCVD risk reduction in patients with diabetes by lipid management.METHODS | Clinical, biochemical, and medication profiles of all patients with diabetes attending a tertiary diabetes care hospital over a 2-year period were collected. The prevalence of various lipid abnormalities was determined after excluding patients with thyroid dysfunction and those on lipid-lowering medications. Patients were stratified according to LDL cholesterol, HDL cholesterol, and triglyceride levels, and other clinical parameters were compared among the groups. The adequacy of statin treatment was assessed based on American Diabetes Association guidelines.RESULTS | Nine hundred and seventy-one patients were included. The prevalence of hyperlipidemia was 40.0%, of whom 14.6% were newly diagnosed. The most common lipid abnormality was elevated LDL cholesterol. Higher A1C and fasting blood glucose values were found to be associated with higher LDL cholesterol levels. Twenty-seven percent of patients with indications for treatment with statins were receiving them. Of those being treated with statins, 42.6% had an LDL cholesterol level $100 mg/dL. CONCLUSION | In South Indian patients with type 2 diabetes and fair glycemic control, high LDL cholesterol is the predominant lipid abnormality. There remains a huge potential for ASCVD risk reduction in this population if the knowledge practice gap is addressed.Type 2 diabetes requires proper management of lipid parameters and hypertension in addition to glycemic control to ensure prevention of chronic complications, especially negative macrovascular outcomes. The prevalence of macrovascular complications of diabetes is much higher in Indians than in Caucasians, even though the prevalence of microvascular complications is comparable in these populations (1,2).Only a few studies of lipid parameters in Indian patients with diabetes have been conducted. This knowledge deficit is particularly worrisome with regard to the population of South India, and especially in the state of Kerala, where the predicted risk of atherosclerotic cardiovascular disease (ASCVD) is the highest among the Indian states, with an age-standardized state-level mean 10-year ASCVD risk of 30.4% among males (3). The prevalence of dyslipidemia among people $30 years of age in South India is 74.8% in urban populations (4).International guidelines on the treatment of dyslipidemia in patients with type 2 diabetes advocate aggressive lowering of LDL cholesterol in patients with diabetes based on strong evidence from clinical trials. Therapeutic inertia with regard to glucose, blood pressure, and lipid management in patients with diabetes has been demonstrated in multiple studies around the world (5,6). This study assesses the prevalence and pattern of dyslipidemia, as well as the