A complete clinico-epidemiological and microbiological profile of candidemia cases in a tertiary-care hospital in Western India.

Objective: To identify different Candida spp along with antifungal susceptibility pattern and risk factors associated with candidemia. Design setting and patients: This retrospective observational study was conducted in a tertiary-care academic hospital in Jaipur, Western India, for 3 years (July 2017-June 2020). Methods: Blood cultures were performed according to standard microbiological methods, and only 1 isolate per patient was included in the study. Isolates of Candida spp were identified using a VITEK-2 automated system and matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antifungal susceptibility tests were performed using the broth microdilution assay according to the Clinical and Laboratory Standards Institute guidelines. Results: Of 3,443 blood cultures received from suspected sepsis cases, candidemia was identified in 95 (2.8%). In addition to Candida tropicalis (n = 36; 38%) and Candida parapsilosis (n = 17; 18%), 10 isolates of Candida auris comprised the fourth most common cause of candidemia. Presence of central venous catheter and diabetes were statistically significant risk factors for development of candidemia by NAC. Resistance to fluconazole was 36%, resistance to voriconazole was 20%, resistance to 5-flucytosine was 4%, and resistance to amphotericin-B was 7%. C. auris isolates were more resistant than other NAC spp. We detected no resistance among the echinocandins. Conclusions: The emergence of highly resistant isolates like C. auris emphasizes the need for constant monitoring of candidemia cases for species identification and routine antifungal susceptibility so that appropriate measures can be taken to reduce the related morbidity and mortality.

Efficacy of Locking Miniplates in Managing Mandibular Fractures without Intermaxillary Fixation.

Background: In maxillofacial trauma, the most commonly encountered are mandibular fractures requiring treatment. Managing these fractures with rigid fixation abolish the intermaxillary fixation (IMF) requirement with reduction and early return to function. Aims: The present trial was carried out to assess clinically the effectiveness of new locking bone plate screw system postsurgically in mandibular fracture cases without IMF. Materials and Methods: In 18 subjects, the fracture site was exposed, fracture segments were reduced and approximated keeping the occlusal relationship is desirable using locking 2 mm mini plates and screws without IMF. The subjects were followed every week for initial 4 weeks followed by evaluation for up to 6 months every month to assess clinical and radiographic healing and the results were formulated. Results: Road traffic accident was the cause in 10 subjects (55.5%), followed by assault in 22.2% (n = 4) subjects, and fall from height in 16.6% (n = 3) subjects. Parasymphysis was involved in 44.4% (n = 8), followed by symphysis in 11.1% (n = 2) subjects. A minor complication of wound dehiscence was seen in 5.5% (n = 1) subjects that were managed conservatively and a major complication of infection was also seen in 1 subject that required removal of the plate at 4 weeks of follow-up. Following plate removal, IMF was done for that subject. All other sites were healed uneventfully. Primary healing in bone was seen in 94.4% (n = 17) subjects and it was not seen in the case with infection. Conclusion: Within the limitations, the present study concluded that the locking miniplate system is highly effective and reliable in treating mandibular fractures with acceptable results and a very low postoperative complications rate.

Images: Sleep-disordered breathing and hypoventilation in a child with obesity and hypothalamic dysfunction.

Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare and potentially lethal disorder of respiratory control, autonomic, and hypothalamic dysfunction of unknown etiology. We report a 15-year-old girl with ROHHAD who developed hyperphagia and rapid weight gain of 16 kg between 2.5 and 4 years of age and cardiorespiratory arrest at 4 years. Initial polysomnography showed central sleep apnea and severe oxygen desaturations without hypoventilation. Mild obstructive sleep apnea and intermittent hypoxemia were identified at 4.5 years, following which nocturnal bilevel positive airway pressure therapy was initiated. At 6 years, she developed sleep-related hypoventilation, and subsequent polysomnograms continued to show obstructive sleep apnea and hypoventilation requiring bilevel positive airway pressure. Clinicians interpreting polysomnograms should become familiar with the evolution of sleep-disordered breathing in ROHHAD and that hypoventilation may develop over time. Our case highlights the importance of serial polysomnography in patients with ROHHAD and optimal ventilatory management. CITATION: Ghosh R, Malik M, Daley TC, Kasi AS. Images: Sleep-disordered breathing and hypoventilation in a child with obesity and hypothalamic dysfunction. J Clin Sleep Med. 2022;18(1):339-342.

Cutaneous leishmaniasis in Bikaner, India: Clinicoepidemiological profile; parasite identification using conventional, molecular methods and CL Detect™ rapid test, a new Food and Drug Administration-approved test.

BACKGROUND AND OBJECTIVE: Cutaneous Leishmaniasis (CL) is a dermal manifestation caused by various species of Leishmania. This is the most common Leishmanial syndrome seen worldwide and is emerging as and threatens to become an uncontrollable disease. The present study was planned to understand the current epidemiology of CL in the conventionally endemic area of Bikaner, Rajasthan. Species characterization was also done. MATERIAL AND METHODS: The diagnostic modalities used in the study were microscopy, histopathologic examination, antigen testing and confirmation and species characterization by PCR. Field evaluation of the new antigen detection kit approved by FDA in 2016 CL Detect™ IC-RDT was done and its results compared with other available diagnostic tests. RESULTS: A total of 14 cases with 25 skin lesions presented to the Skin OPD during the six month study period (January to June 2018). Out of these, 5 were males and 9 were females, average age being 32 yrs. Students and housewives of poor socio economic group were the most frequently affected groups. Lesions were found on the exposed areas of the body, mainly on the upper limbs and facial region. Majority of them were ulcerated plaques. Out of 14 cases under study, antigen test confirmed 7 positives; thereby yielding a positive rate of 50% against 71.4% for microscopy, 72.7% for PCR and a mere 38.5% for histopathology. Species characterization revealed Leishmania tropica as the causative organism. INTERPRETATION AND CONCLUSION: The study indicates that the number of cases have declined substantially over the past decade in Bikaner. Despite being the oldest technique used, microscopy still is a good option for diagnosis. Combined with PCR, diagnostic accuracy and hence utility is increased multifold. In its current form, IC-RDT may not be very useful.

Association of Maternal Risk Factors to Congenital Anomalies among Infants: A Community Based Study in Rural Areas of Haryana, India.

OBJECTIVES: The present study was aimed at assessing Association of Maternal Risk Factors to congenital anomalies of infants. MATERIAL AND METHODS: This community based retrospective and cross-sectional study was carried out in 23 rural sub-centres of block Beri, district Jhajjar (Haryana, India) among 920 mothers. A predesigned pretested semistructured questionnaire was used to collect information. Univariate analysis along with logistic regression analysis was performed. RESULTS: The prevalence of congenitally malformations was 1.2%. Most common congenital malformations were cleft lip/palate (18.18%) and hydrocephalus (18.18%). Mothers with < 3 years gap between pregnancies had higher prevalence (1.7%) of congenital malformations in live births. Mothers with previous history of congenital malformation (8.3%) and abortions (13.6%) had higher prevalence of congenitally malformed babies with 2.6 and 4 times higher odds of having a malformed baby. CONCLUSION: The study concluded that mothers with risk factors like extreme of ages, illiteracy, bad obstetric history, history of previous congenitally malformed baby are at increased risk of fetal congenital malformation.

Prevalence and correlates of overweight/obesity among adolescents in an urban city of north India.

BACKGROUND AND OBJECTIVES: Obesity and overweight is a growing pandemic affecting millions of adolescents in developed as well as developing countries. Obesity is associated with the onset of major chronic diseases leading to complications and also psychosocial problems in adolescents. The greater concern is that the risks of obesity during childhood will persist into adolescence and adulthood. The objectives of the study were to assess the prevalence of being overweight and obesity and to study the associated risk factors. MATERIALS AND METHODS: 1900 adolescents in the age group of 10-19 years were included in the study. A predesigned and pretested questionnaire which included the variables such as going to school by bus or cycle, eating habits, playing video/computer games or outdoor games and sibling count were recorded. Body weight and height were recorded in subjects for calculating body mass index (BMI). International Obesity Task Force (IOTF) classification was used for the estimation of being overweight and obese. RESULTS: The mean age of the study subjects was 14.84 years (SD = 2.81). Mean weight increased from 34.7 to 55.09 kg from the age group 10-13 to 17-19 years. Mean height also increased from 1.34 to 1.57 m from the age group 10-13 to 17-19 years. Similarly, the mean body mass index was 19.23 at 10-13 years, followed by 21.11 at 14-16 years and 22.46 at 17-19 years. On binary logistic regression analysis, female gender, bus as a mode of transport, not playing games, and single sibling were found to have independent association with prevalence of being overweight.

Hierarchically structured, hyaluronic acid-based hydrogel matrices via the covalent integration of microgels into macroscopic networks.

We aimed to develop biomimetic hydrogel matrices that not only exhibit structural hierarchy and mechanical integrity, but also present biological cues in a controlled fashion. To this end, photocrosslinkable, hyaluronic acid (HA)-based hydrogel particles (HGPs) were synthesized via an inverse emulsion crosslinking process followed by chemical modification with glycidyl methacrylate (GMA). HA modified with GMA (HA-GMA) was employed as the soluble macromer. Macroscopic hydrogels containing covalently integrated hydrogel particles (HA-c-HGP) were prepared by radical polymerization of HA-GMA in the presence of crosslinkable HGPs. The covalent linkages between the hydrogel particles and the secondary HA matrix resulted in the formation of a diffuse, fibrilar interface around the particles. Compared to the traditional bulk gels synthesized by photocrosslinking of HA-GMA, these hydrogels exhibited a reduced sol fraction and a lower equilibrium swelling ratio. When tested under uniaxial compression, the HA-c-HGP gels were more pliable than the HA-p-HGP gels and fractured at higher strain than the HA-GMA gels. Primary bovine chondrocytes were photoencapsulated in the HA matrices with minimal cell damage. The 3D microenvironment created by HA-GMA and HA HGPs not only maintained the chondrocyte phenotype but also fostered the production of cartilage specific extracellular matrix. To further improve the biological activities of the HA-c-HGP gels, bone morphogenetic protein 2 (BMP-2) was loaded into the immobilized HGPs. BMP-2 was released from the HA-c-HGP gels in a controlled manner with reduced initial burst over prolonged periods of time. The HA-c-HGP gels are promising candidates for use as bioactive matrices for cartilage tissue engineering.

Hormonal regulation of IGFBP-2 proteolysis is attenuated with progression to androgen insensitivity in the LNCaP progression model.

The identification of molecular determinants involved in the promotion of metastasis and development of androgen insensitive prostate cancer (AI-PCa) is necessary to discriminate aggressive from indolent disease and to identify therapeutic targets for advanced disease. Overexpression of one particular member of the insulin like growth factor (IGF) axis, IGFBP-2, is implicated in the development of AI-PCa and other cancers. Using the LNCaP human PCa progression model, we show that the AI and metastatic prostate cancer cell line C4-2B4 expresses greater amounts of secreted IGFBP-2 than the androgen sensitive (AS), non-metastatic LNCaP progenitor cell line. Further, the ability of androgens to decrease extracellular IGFBP-2 levels is attenuated in the AI and metastatic C4-2 cell line. The ability of androgen to negatively regulate extracellular IGFBP-2 levels was blocked by Casodex in a dose-dependent manner. The mechanism underlying the androgen-induced downregulation of secreted IGFBP-2 appears to involve extracellular proteolysis, resulting in the production of IGFBP-2 fragments lacking the ability to bind IGF-I and IGF-II. As C4-2 cells have an attenuated ability to proteolyze IGFBP-2 in response to androgen and C4-2B4 cells express greater amounts of IGFBP-2, our data implies that the diminished regulation of IGFBP-2 and loss of associated proteolytic fragments play a role in the increased metastatic behavior of these cells in vivo. Furthermore, our results suggest that either increased levels of intact IGFBP-2 or decreased levels of IGFBP-2 proteolytic fragments could serve as a biomarker to monitor for progression to AI-PCa.