Candida tropicalis: insight into the characteristics and outcome of adult patients admitted in medical and surgical intensive care units

Background: Non albicans species are emerging increasingly as significant ICU pathogens.  The increasing incidence of C. tropicalis infections is a significant problem because of its ability to develop rapid resistance to fluconazole.Methods: The study was designed to isolate, evaluate the risk factors and outcome of C. tropicalis infection from intensive care units. Identification was done by the biochemical methods. A total of 89 patients culture positive for C. tropicalis were selected for retrospective analysis over a period of one year. We collected various data about risk factors and outcome from the medical records.Results: A total of 89 patients culture positive for Candida tropicalis were analysed. Majority of these culture isolates were obtained from their blood (59.55%) followed by urine samples (31.46%). The indwelling devices (93.2%) remained a highest risk followed by prolonged administration of antibiotic therapy (92.1%) and admission in ICU for more than a week (88.8%). Overall mortality rate was 31.5%. Mortality was higher in patients with longer total length of stay in hospital (89.3%; p 1.000), indwelling devices (85.7%; p 0.5663) and in whom the antimicrobial therapy was administered for prolonged duration (82.1%; p 0.7581), although these factors remained statistically insignificant. 92.1% of isolates were sensitive to amphotericin B and showed 52.8%; 9.0% sensitivity to itraconazole and fluconazole respectively.Conclusions: C. tropicalis is now classified as the third or fourth NAC species being commonly isolated from clinical samples and associated with persistent systemic infections leading to a longer stay in the hospital. Several virulence factors seem to be responsible for high dissemination and mortality

Original Article Section: Ophthalmology Pattern of Ocular Morbidity among Children Referred Through a National Screening Program in a Tertiary Hospital in Northern India

ABSTRACT Background: The Rashtriya Bal Swasthya Karyakram (India) is directed towards achieving universal health coverage among children by early detection of diseases. Under the scheme, children are screened at the level of schools and community and are thereafter referred to tertiary centre. The purpose of study was to identify common causes of ocular morbidity in children screened and referred through this national screening program. Methods: Retrospective analysis of records of all children who presented to our centre with ocular problems over a period of one year (2015) was undertaken. Clinical diagnosis was recorded on a seven point scale based on major anatomical involvement. An analysis of causes of visual impairment was undertaken with a special emphasis on avoidable and treatable causes. Results: A total of 851 subjects presented with ocular problems (mean age 9.5±4.9 years); of them 819 were classified into seven major clinical groups and subgroups. Most common clinical group was that of strabismus (59.9%), followed by refractive errors (16.9%), lids related disorders (6.2%), orbit and adnexal developmental defects (4.6%), lenticular (3.3%), corneal and conjunctival (3.2%) and retinal disorders (2.1%). A total of 49.7% cases had avoidable or treatable causes of visual impairment. Conclusion: A national program with capacity to screen and ensure appropriate referral facilities resulted in intervention in many cases with avoidable and treatable causes of visual impairment. A varied pattern of ocular morbidity was found among the referred cases; our study could provide a platform for a target oriented approach towards planning and implementation of such screening programs

Trends and patterns of second-hand smoke exposure amongst the non-smokers in India-A secondary data analysis from the Global Adult Tobacco Survey (GATS) I & II.

ObjectivesThe primary objective of the present study was to compare the prevalence and patterns of second-hand smoke (SHS) exposure in the home, workplace, public places, and at all three places amongst the non-smoker respondents between the two rounds of Global Adult Tobacco Survey (GATS) in India. The secondary objectives were to assess the differences in various factors associated with SHS exposure among non-smokers.Study designThis secondary data analysis incorporated data generated from the previous two rounds of the cross-sectional, nationally representative GATS India, which covered 69,296 and 74,037 individuals aged 15 years and above. Exposure to the SHS at home, workplace, and public places amongst the non-smokers were the primary outcome variables. Standard definitions of the surveys were used.ResultsThe overall weighted prevalence of exposure to SHS amongst the non-smokers inside the home and public places reduced. In contrast, the prevalence in the workplace increased marginally in round II compared to I. The proportion of adults who were exposed to SHS at all three places did not change much in two rounds of surveys. A decrease in the knowledge of the respondents exposed to SHS at home and public places was observed about the harmful effects of smoking in round II. Age, gender, occupation, place, and region of respondents were found to be significant determinants of SHS exposure at all the three places on multinomial logistic regression analysis.ConclusionsThe study calls for focused interventions in India and stringent implementation of anti-tobacco legislation, especially in the workplaces for reducing the exposure to SHS amongst the non-smokers and to produce encouraging and motivating results by next round of the survey

Outcome of routine testing for HCV and HBV in patients attending and admitted in various surgical units of a tertiary care institute

Background: Hepatitis B and C virus remain leading causes of morbidity and mortality. Unfortunately, once inflicted, these infections show poor response to the available treatment modalities. So the focus remains on preventive strategies, to avoid spread of infection. There is lack of routine serological screening prior to surgery which is one of the factors responsible for increased disease transmission. Material and Methods: The present study involved retrospective analysis of 9272 routine blood samples from all ages and both sexes who were attending and admitted in different surgical departments. These patients were screened by rapid immunochromatographic assay for qualitative detection of anti- HCV antibodies and HBsAg to know their carrier status prior to any surgical intervention. Results: Out of 9272 samples tested, 155 (3.6%) tested positive for anti- HCV antibodies and 162 (3.26%) for HBsAg. Seroprevalence of HCV was 3.77 %( 96) and 3.36% (59) in male and female respectively, with preponderance among age group of 41-60 (43.87%) and 21- 40 years (39.35%). HBsAg detection revealed seropositivity of 3.89 %( 93) in males; 2.67 %( 69) in females, with predominance in young adults of 21-40 (43.83%) followed by 41-60 (24.07%) years. Maximum number of seropositive cases for both HCV and HBV were from General surgery department as 63.23% & 53.09% respectively. Conclusion: The study estimated high prevalence of HBV and HCV on routine screening of patients reporting to various surgical departments. Healthcare providers have significantly high risk of infectivity along with further transmission of the disease if pre-operative screening and standard precautions are not followed strictly

Psychological Impact and factors associated with COVID-19 inpatients at a tertiary care institute (Designated as COVID-19 Hospital)

Background: An important clinical consequence seen in a significant proportion of COVID-19 patients is psychological impairment. By analyzing the prevalence of stress, anxiety, depression and their socio-demographic correlates; the current research aimed to examine the psychological burden among COVID-19 patients.Methodology: This was a cross-sectional hospital-based study. An exit interview of COVID-19 patients was conducted at the time of discharge using a semi-structured proforma. For assessing psychological impact of COVID-19, Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS) were used. Ethical clearance was taken from Institutional Ethics Committee. Appropriate statistical tests were applied to compare the means of various psychological scores (stress, anxiety, and depression) w.r.t. different socio-demographic variables.Results: A total of 114 COVID-19 patients were studied. 50% were native of other Indian states. 79% patients had symptoms of stress on PSS while 30.7% and 34.2% of patients had definite anxiety and depressive symptoms on HADS.Statistically significant difference in perceived stress scores was noted w.r.t. age (p=0.049), educational status (p=0.047), occupation (p=0.006) and COVID-19 infection in fellow family members (t=-3.351; p=0.001). Mean difference of HADS depression score was found to be statistically significant w.r.t occupation (p=0.021), native place of residence (p=0.007) and COVID-19 infection in fellow family members (t=-2.739; p=0.007).Conclusion: Age, education, occupation, native residential place and COVID-19 infection in family were factors associated with higher psychological burden in COVID-19 patients

Non-communicable diseases risk factors and their determinants: A cross-sectional state-wide STEPS survey, Haryana, North India.

BACKGROUND:Recent studies have documented high variation in epidemiologic transition levels among Indian states with noncommunicable disease epidemic rising swiftly. However, the estimates suffer from non-availability of reliable data for NCDs from sub populations. In order to fill the knowledge gap, the distribution and determinants of NCD risk factors were studied along with awareness, treatment and control of NCDs among the adult population in Haryana, India. METHODS:NCD risk factors survey was conducted among 5078 residents, aged 18-69 years during 2016-17. Behavioural risk factors were assessed using STEPS instrument, administered through an android software (mSTEPS). This was followed by physical measurements using standard protocols. Finally, biological risk factors were determined through the analysis of serum and urine samples. RESULTS:Males were found to be consuming tobacco and alcohol at higher rates of 38.9% (95% CI: 35.3-42.4) and 18.8% (95% CI: 15.8-21.8). One- tenth (11%) (95% CI: 8.6-13.4) of the respondents did not meet the specified WHO recommendations for physical activity for health. Around 35.2% (95%CI: 32.6-37.7) were overweight or obese. Hypertension and diabetes were prevalent at 26.2% (95% CI: 24.6-27.8) and 15.5% (95% CI: 11.0-20.0). 91.3% (95% CI: 89.3-93.3) of the population had higher salt intake than recommended 5gms per day. CONCLUSION:The documentation of strikingly high and uniform distribution of different NCDs and their risk factors in state warrants urgent need for evidence based interventions and advocacy of policy measures