Evaluation of Candida Scoring Systems to Predict Early Candidemia: A Prospective and Observational Study at a Tertiary Care Hospital, Uttarakhand.

BACKGROUND: Candidemia in critically ill patients is usually a severe and life-threatening condition. Furthermore, due to its nonspecific presentation, it is difficult to diagnose leading to delayed treatment, prolonged hospitalization, and increased health-care costs with increase in morbidity and mortality. OBJECTIVES: In view of lack of data on "Candida scoring systems," this study was designed to evaluate the effectiveness of these scoring systems in predicting the development of candidemia among the Intensive Care Unit patients. MATERIALS AND METHODS: The "Candida score" was calculated at the onset of systemic inflammatory response syndrome, sepsis, or shock. Various scoring systems were compared using the area under the receiver operating characteristic curve. RESULTS: Among all three bedside risk scoring systems to predict candidemia both Leon score and Wenzel score offered significant discrimination between candidemic and noncandidemic patients with P = 0.000 and 0.001, respectively. The area under the curve for the scoring systems was 0.946 (95% confidence interval [CI] = 0.89-1) and 0.818 (95% CI = 0.687-0.949). CONCLUSION: Leon scoring system was found to have highest specificity, diagnostic accuracy, and positive likelihood ratio among all. Thus, we might conclude that a Leon score of ≥2.5 was most suitable for diagnosis of candidemia with significant accuracy and shortening of turnaround time when compared to the gold standard of blood culture. To the best of our knowledge, this is the first report on the subject.

Nutritional status of adult patients with pulmonary tuberculosis in rural central India and its association with mortality.

Under-nutrition is a known risk factor for TB and can adversely affect treatment outcomes. However, data from India are sparse, despite the high burden of TB as well as malnutrition in India. We assessed the nutritional status at the time of diagnosis and completion of therapy, and its association with deaths during TB treatment, in a consecutive cohort of 1695 adult patients with pulmonary tuberculosis in rural India during 2004 - 2009.Multivariable logistic regression was used to obtain adjusted estimates of the association of nutritional status with deaths during treatment. At the time of diagnosis, median BMI and body weights were 16.0 kg/m(2)and 42.1 kg in men, and 15.0 kg/m(2)and 34.1 kg in women, indicating that 80% of women and 67% of men had moderate to severe under-nutrition (BMI<17.0 kg/m(2)). Fifty two percent of the patients (57% of men and 48% of women) had stunting indicating chronic under-nutrition. Half of women and one third of men remained moderately to severely underweight at the end of treatment. 60 deaths occurred in 1179 patients (5%) in whom treatment was initiated. Severe under-nutrition at diagnosis was associated with a 2 fold higher risk of death. Overall, a majority of patients had evidence of chronic severe under-nutrition at diagnosis, which persisted even after successful treatment in a significant proportion of them. These findings suggest the need for nutritional support during treatment of pulmonary TB in this rural population.

Clinicomicrobiological profile of women with vaginal discharge.

One hundred and ten patients presenting with vaginal discharge were investigated for microbiological spectrum of vaginitis and outcome of treatment. Laboratory-documented disorder could be ascertained in 86 patients (78%). Bacterial vaginosis was the commonest aetiology (43.6%), followed by candidiasis (10%), trichomoniasis (9.1%), senile vaginitis (5.4%) and vaginitis of unknown origin (5.4%). Endocervicitis was seen in 13.6% patients and urinary tract infection in 1.8%. Complete relief of symptoms was seen in 77 patients (70%).

Chikungunya fever, falciparum malaria, dengue fever, Japanese encephalitis... are we listening to the warning signs for public health in India?

The 2005-epidemic of Chikungunya fever highlights the weaknesses of public health in India. The failure to control mosquitoes, and the illnesses transmitted by them, has resulted in recurrent outbreaks all over the country. This is inevitable given the larger scenario: neglect of the basic requirements of health; poor political support for health; a weak public health capacity; centralised programmes for control based on selective interventions, and poorly-planned development projects which have created conditions ideal for the outbreak of disease. All these issues are concerns for public health ethics and must be addressed to tackle the problems posed by mosquito-borne as well as other communicable diseases.

Self-assembly of flexible supramolecular metallacyclic ensembles: structures and adsorption properties of their nanoporous crystalline frameworks.

The syntheses, structures, and N2 adsorption properties of six new supramolecular metallacycles are reported. Flexible ditopic linkers, 1-4, with systematically varied lengths and conformational degrees of freedom were synthesized utilizing ester linkages. They were used in combination with (dppp)M(OTf)2, where M = Pt(II) and Pd(II), and cis-(Me3P)2Pt(OTf)2 to form flexible supramolecular metallacycles 5-10 in 88-98% isolated yields. Their structures were characterized via multinuclear NMR and X-ray crystallography. The metallacycles stack to form porous structures in the crystalline state. The pore dimensions depend on both the phosphorus ligands attached to the metals and the flexible linkers. Adsorption studies on the porous materials show that 5a, 6, 8, and 9 held 11.7, 16.5, 5.7, and 6.8 cm3/g STP of N2 at 77 K, respectively. A guest-exchange study with nitromethane and toluene reveals that the nanopore in 5 is flexible, a property which was transferred from the linker to the supramolecular structure in the solid state.