Clinical spectrum and factors impacting outcome of Candida auris: a single center study from Pakistan

Background: An outbreak of Candida auris began globally in 2014 including Pakistan and since then it has emerged as a nosocomial multi-drug resistant pathogen. The aim of this study was to assess the clinical spectrum and outcome of patients, from a single center in Pakistan, in whom C. auris was isolated. Methods: A retrospective study was conducted on 92 patients; ≥16 years with at least one culture positive for C. auris, at the Aga Khan University Hospital Karachi, Pakistan from Sept 2014-Mar 2017.Demographics, clinical history, management and outcome were studied. A logistic regression model was used to identify the risk factors for mortality. Results: We identified 92 patients with C. auris (193 isolates), of whom 52.2% were males. Mean age was 54.14 ± 20.4 years. Positive cultures were obtained after a median hospital stay of 14 days. Most patients had a history of surgery (57.6%), antibiotic use (95.6%), ICU stay (44.6%), indwelling lines (88.04%) and isolation of another multi-resistant organism (52.2%).Most patients were symptomatic (70.7%). Amongst these, 38 had candidemia while 27 had non-candidemia infections. Sites of infection included central lines (35), urinary tract (19), peritonitis (4), nosocomial ventriculitis (1), empyema (1), fungal keratitis (1) otitis externa (1) and surgical site (1). Fluconazole resistance was 100% while 28.5 and 7.9% were Voriconazole and Amphotericin resistant respectively. Overall crude mortality was 42.4% while 14-day mortality was 31.5%. Both infected and colonized cases shared similar mortality (46.2% vs 33.3%; p-value = 0.25). Among infected cases mortality was high in candidemia compared to non-candidemia (60.5% vs 25.9%) in which deaths related to C. auris were 34.2% vs 22.2% respectively. On multivariate analysis candidemia (AOR 4.2, 95% CI: 1.09-16.49; p-value = 0.037) was associated with greater mortality with source control being the only protective factor for mortality (AOR 0.22, 95% CI: 0.05-0.92; p-value0.038] while ICU stay, rapidity of blood culture clearance, DM, malignancy and MDR co-infection had no impact. Conclusion: Patients with C.auris from a single center in Pakistan have a wide clinical spectrum with line associated infection being the predominant site of infection. Candidemia leads to high mortality while source control improves outcome

Client Satisfaction Towards Quality of Health Services: an Assessment at Primary Healthcare of District Gujranwala

This survey designed to evaluate the satisfaction level and the factors that affect the patient satisfaction regarding health care delivery services with the aim to improve the services in the primary health care settings of Gujranwala. A Cross Sectional Study done on randomly selected patients attending the basic health units of Gujranwala, with more than18 years of age. Pretested structured "Liker scale questionnaire" was used for data collection. Out of total respondents, 62 (41.3%) clients were satisfied with the services provided by the basic health units of Gujranwala. The factors identified to determine patient satisfaction were accessibility of services, behavior of staff, health education, level of cleanliness, drug availability and miscellaneous services. Not a single ranked area of satisfaction noticed. Client\u27s occupation and income had significant relationship with the patient satisfaction level. Gender, age, and education of clients were not contributing factors; they not affect the client satisfaction level.Less than half clients were satisfied with the services provided by the basic health units. Management of health facilities needs to improve the services

Host Kinase Activity is Required for Coxiella burnetii Parasitophorous Vacuole Formation

Coxiella burnetii is the etiologic agent of human Q fever and targets alveolar phagocytic cells in vivo wherein the pathogen generates a phagolysosome-like parasitophorous vacuole (PV) for replication. C. burnetii displays a prolonged growth cycle, making PV maintenance critical for bacterial survival. Previous studies showed that C. burnetii mediates activation of eukaryotic kinases to inhibit cell death, indicating the importance of host signaling during infection. In the current study, we examined the role of eukaryotic kinase signaling in PV establishment. A panel of 113 inhibitors was analyzed for their impact on C. burnetii infection of human THP-1 macrophage-like cells and HeLa cells. Inhibition of 11 kinases or two phosphatases altered PV formation and prevented pathogen growth, with most inhibitor-treated cells harboring organisms in tight-fitting phagosomes, indicating kinase/phosphatase activation is required for PV maturation. Five inhibitors targeted protein kinase C (PKC), suggesting a critical role for this protein during intracellular growth. The PKC-specific substrate MARCKS was phosphorylated at 24 h post-infection and remained phosphorylated through 5 days post-infection, indicating prolonged regulation of the PKC pathway by C. burnetii. Infection also altered the activation status of p38, myosin light chain kinase, and cAMP-dependent protein kinase, suggesting C. burnetii subverts numerous phosphorylation cascades. These results underscore the importance of intracellular host signaling for C. burnetii PV biogenesis

Effects of hydrostatic and uniaxial stress on the Schottky barrier heights of Ga-polarity and N-polarity n-GaN

We report measurements of the Schottky barrier heights of Ni/Au contacts on Ga-polarity and N-polarity n-GaN under hydrostatic pressure and applied in-plane uniaxial stress. Under hydrostatic pressure the two different polarities of GaN yield significantly different rates of Schottky barrier height increase with increasing pressure. Uniaxial stress parallel to the surface affects the Schottky barrier height only minimally. The observed changes in barrier height under stress are attributed to a combination of band structure and piezoelectric effects

MgZnO/AlGaN heterostructure light-emitting diodes

We report on p-n junction light-emitting diodes fabricated from MgZnO/ZnO/AlGaN/GaN triple heterostructures. Energy band diagrams of the light-emitting diode structure incorporating piezoelectric and spontaneous polarization fields were simulated, revealing a strong hole confinement near the n-ZnO/p-AlGaN interface with a hole sheet density as large as 1.82x10(13) cm(-2) for strained structures. The measured current-voltage (IV) characteristics of the triple heterostructure p-n junctions have rectifying characteristics with a turn-on voltage of similar to3.2 V. Electron-beam-induced current measurements confirmed the presence of a p-n junction located at the n-ZnO/p-AlGaN interface. Strong optical emission was observed at similar to390 nm as expected for excitonic optical transitions in these structures. Experimental spectral dependence of the photocurrent confirmed the excitonic origin of the optical transition at 390 nm. Light emission was measured up to 650 K, providing additional confirmation of the excitonic nature of the optical transitions in the devices

Learning from the experiences of Black, Asian and Minority Ethnic (BAME) university students who withdraw from their undergraduate degree

Abstract: Students from a Black, Asian and Minority Ethnic (BAME) background are more likely to withdraw from their undergraduate degree in the United Kingdom (UK). It is therefore important to explore withdrawal experiences and perspectives that relate to this population of students to increase both student retention and success. Thirteen UK-domiciled, full-time undergraduate, first-degree entrants from a BAME background, who had withdrawn from a post-1992 university in the West Midlands, took part in a semi-structured interview. The present study explored BAME student experiences of withdrawal which covered personal, academic and social concerns. Using a thematic analysis approach, five themes were developed: (a) academic issues, (b) does anybody even care? (c) balancing part-time employment alongside HE, (d) family perception and pressure and (e) the importance of social integration. Participants often discussed withdrawal as a holistic experience whereby although certain aspects were more prominently spoken about, generally withdrawal was a materialisation of more than one problematic area. There is a need for institutions to further understand the challenges faced by BAME students in order to provide more localised support and intervention to improve BAME retention, success and experiences within higher education (HE)

Comparison of nutrient composition of wild Dioscorea species consumed by ethnic groups of Odisha in India with commercially cultivated roots and tubers

799-802This study was carried out to analyze the nutrient composition of wild tubers belonging to Dioscorea genus of the Dioscoreaceae family consumed by the ethnic groups in the Jeypore District of Koraput region in Odisha, India. The collected tubers are significant storehouses of energy and nutrition and also, they are known to produce large quantities of energy in relatively less time than the other crops. We have selected six wild species of Dioscorea collected from Odisha among the twenty-six reported species of India, along with five locally available cultivated tuber varieties of different genera from Tamil Nadu markets for comparison. The objective of this study is to understand the major source of nutrition of the ethnic groups, who consume local plant varieties collected from the wild and also to compare them with that of commercially available cultivated varieties in the view of the prevailing biodiversity and the varied agro-climatic conditions in India

Comparison of nutrient composition of wild Dioscorea species consumed by ethnic groups of Odisha in India with commercially cultivated roots and tubers

This study was carried out to analyze the nutrient composition of wild tubers belonging to Dioscorea genus of the Dioscoreaceae family consumed by the ethnic groups in the Jeypore District of Koraput region in Odisha, India. The collected tubers are significant storehouses of energy and nutrition and also, they are known to produce large quantities of energy in relatively less time than the other crops. We have selected six wild species of Dioscorea collected from Odisha among the twenty-six reported species of India, along with five locally available cultivated tuber varieties of different genera from Tamil Nadu markets for comparison. The objective of this study is to understand the major source of nutrition of the ethnic groups, who consume local plant varieties collected from the wild and also to compare them with that of commercially available cultivated varieties in the view of the prevailing biodiversity and the varied agro-climatic conditions in India

AmpliBASE MT: a Mycobacterium tuberculosis diversity knowledgebase

AmpliBASE MT is an online databank of high-resolution DNA fingerprints representing fluorescent amplified fragment length polymorphism (FAFLP) profiles or amplitypes developed for the Mycobacterium tuberculosis complex strains from 48 different countries. AmpliBASE MT is based on a relational database management system that is hyperlinked to visualize genotyping results in the form of DNA fingerprint images for individual strains. A flexible search system based on systematic comparisons of fragment sizes in base pairs allows inter-laboratory comparison of FAFLP profiles. Besides this, the database also displays previously published data on IS6110 profiles, spoligotypes, MIRU-VNTRs and large sequence polymorphisms along with the FAFLP records that will give the overall comparisons. Being the first of its kind, AmpliBASE MT is expected to be a very helpful tool in strengthening the concept of 'geographic genomics' and will be very helpful to molecular epidemiologists and those interested in diagnostic development for tuberculosis