Can metabolically generated CO 2 enhance Candida albicans biofilm formation within central venous catheters used in preterm infants?:An in vitro study

Candida albicans is responsible for the majority of invasive fungal infections in preterm infants. Biofilm formation within indwelling central venous catheter (CVC) used for these preterm babies leads to CVC related infections and may lead to antifungal resistance. Metabolically generated CO 2 can act as a communicating molecule triggering the yeast to filamentous transition that is essential for the pathological effects caused by C. albicans. The aim of this study was to demonstrate that CO 2 generated by C. albicans contributes to biofilm-formation in central venous catheters utilised in preterm infants. An in vitro model with neonatal CVCs, using established CO 2 bio indicator strain (CO 2 -BIS) to determine whether there is an accumulation of metabolic CO 2 within the catheters, which may be influencing C. albicans biofilm formation was developed. Biofilms formed within CVC lines showed an enhanced recovery of CO 2 -BIS (p=0.06) when co-incubated with another CO 2 donor C. albicans strain CAI4. This indicated that the metabolically generated CO 2 from neighbouring CAI4 cells within the biofilm had generated sufficient CO 2 to complement the growth demand of CO 2 -BIS. Therefore, these results highlight the importance of high concentrations of CO 2 in the circulatory system, which enhances fungal pathogenicity and may lead to invasive candidiasis. KEYWORDS: Candida albicans, biofilm, central venous catheters, metabolic CO

Multi centre study from Malaysia on student preparedness for clinical learning- Perspectives of lecturers and students from medicine, pharmacy and allied health sciences

Objectives: To determine the characteristics important in health profession students’ preparedness for clinical learning from the perspectives of lecturers and studentsMethods: A descriptive cross sectional study was conducted at International Medical University, Perdana University and Monash University in Malaysia. All lecturers involved in preparing students for clinical learning in medicine, dentistry, nursing, pharmacy, nutrition and dietetics, chiropractic and Chinese medicine and immediate preclinical students were invited. We explored views regarding student preparedness on knowledge and understanding, willingness to learn, professionalism, communication and interaction, personal attributes and interpersonal skills rated on a 7 point Likert scale in a questionnaire with 62 items.Results: A total of 187 lecturers and 317 students participated. Fifty percent of lecturers had 5-9year of experience. Neither the lecturers nor the students had differentiated or identified specific characteristics as more important over the others but rated all 62 items as important (score >5) for training. The mean score of the 6 themes for lecturers and students respectively were for knowledge and understanding (5.44,5.09), willingness (5.95,5.51), professionalism (5.89,5.49), communication and interaction (5.54,5.34), personal attributes (5.54,5.35) and interpersonal skills (5.54,5.38). Interesting suggestions such as promotion of inter-professional learning among student from different disciplines, case discussions as a team with other professional categories, self reflection for lecturers regarding their attitudes towards students and teaching methods had been stated by students.Conclusions: Both lecturers and students deem that the knowledge and understanding is not the most important characteristic that makes a student better prepared for clinical learning.

Validation of wet mount microscopy against Trichomonas culture among women of reproductive age group in Western province, Sri Lanka

Abstract. Wet mount microscopy is the most commonly used diagnostic method for trichomoniasis in clinical diagnostic services all over the world including Sri Lanka due to its availability, simplicity and is relatively inexpensive. However, Trichomonas culture and PCR are the gold standard tests. Unfortunately, neither the culture nor PCR is available for the diagnosis of trichomoniasis in Sri Lanka. Thus, it is important to validate the wet mount microscopy as it is the only available diagnostic test and has not been validated to date in Sri Lanka. The objective was to evaluate the validity and reliability of wet mount microscopy against gold standard Trichomonas culture among clinic based population of reproductive age group women in Western province, Sri Lanka. Women attending hospital and institutional based clinics were enrolled. They were interviewed and high vaginal swabs were taken for laboratory diagnosis by culture and wet mount microscopy. There were 601 participants in the age group of 15-45 years. Wet mount microscopy showed 68% sensitivity, 100% specificity, 100% positive (PPV) and 98% negative predictive values (NPV) (P=0.001, kappa=0.803) respectively against the gold standard culture. The area under the ROC curve was 0.840. Sensitivity of wet mount microscopy is low. However it has high validity and reliability as a specific diagnostic test for trichomoniasis. If it is to be used among women of reproductive age group in Western province, Sri Lanka, a culture method could be adopted as a second test to confirm the negative wet mount for symptomatic patients