Purpose
A systematic epidemiological study on intensive care unit (ICU)-acquired candidemia across India.
Method
A prospective, nationwide, multicentric, observational study was conducted at 27 ...Indian ICUs. Consecutive patients who acquired candidemia after ICU admission were enrolled during April 2011 through September 2012. Clinical and laboratory variables of these patients were recorded. The present study is an analysis of data specific for adult patients.
Results
Among 1,400 ICU-acquired candidemia cases (overall incidence of 6.51 cases/1,000 ICU admission), 65.2 % were adult. Though the study confirmed the already known risk factors for candidemia, the acquisition occurred early after admission to ICU (median 8 days; interquartile range 4–15 days), even infecting patients with lower APACHE II score at admission (median 17.0; mean ± SD 17.2 ± 5.9; interquartile range 14–20). The important finding of the study was the vast spectrum of agents (31
Candida
species) causing candidemia and a high rate of isolation of
Candida tropicalis
(41.6 %). Azole and multidrug resistance were seen in 11.8 and 1.9 % of isolates. Public sector hospitals reported a significantly higher presence of the relatively resistant
C. auris
(8.2 vs. 3.9 %;
p
= 0.008) and
C. rugosa
(5.6 vs. 1.5 %;
p
= 0.001). The 30-day crude and attributable mortality rates of candidemia patients were 44.7 and 19.6 %, respectively. Logistic regression analysis revealed significant independent predictors of mortality including admission to public sector hospital, APACHE II score at admission, underlying renal failure, central venous catheterization and steroid therapy.
Conclusion
The study highlighted a high burden of candidemia in Indian ICUs, early onset after ICU admission, higher risk despite less severe physiology score at admission and a vast spectrum of agents causing the disease with predominance of
C. tropicalis.
Well-being is a positively-framed, holistic assessment of health and quality of life that is associated with longevity and better health outcomes. We aimed to identify county attributes that are ...independently associated with a comprehensive, multi-dimensional assessment of individual well-being.
We performed a cross-sectional study examining associations between 77 pre-specified county attributes and a multi-dimensional assessment of individual US residents' well-being, captured by the Gallup-Sharecare Well-Being Index. Our cohort included 338,846 survey participants, randomly sampled from 3,118 US counties or county equivalents.
We identified twelve county-level factors that were independently associated with individual well-being scores. Together, these twelve factors explained 91% of the variance in individual well-being scores, and they represent four conceptually distinct categories: demographic (% black); social and economic (child poverty, education level <high school, high school diploma/equivalent, college degree, household income, % divorced); clinical care (% eligible women obtaining mammography, preventable hospital stays per 100,000, number of federally qualified health centers); and physical environment (% commuting by bicycle and by public transit).
Twelve factors across social and economic, clinical care, and physical environmental county-level factors explained the majority of variation in resident well-being.
Let G be an undirected simple connected graph. We say a vertex u is eccentric to a vertex v in G if d(u,v)=max{d(v,w):w∈V(G)}. The eccentric graph of G, say Ec(G), is a graph defined on the same ...vertex set as of G and two vertices are adjacent if one is eccentric to the other. We find the structure and the girth of the eccentric graph of trees and see that the girth of the eccentric graph of a tree can either be zero, three, or four. Further, we study the structure of the eccentric graph of the Cartesian product of graphs and prove that the girth of the eccentric graph of the Cartesian product of trees can only be zero, three, four or six. Furthermore, we provide a comprehensive classification when the eccentric girth assumes these values. We also give the structure of the eccentric graph of the grid graphs and the Cartesian product of two cycles. Finally, we determine the conditions under which the eccentricity matrix of the Cartesian product of trees becomes invertible.
ObjectiveTo identify county characteristics associated with high versus low well-being among high-poverty counties.DesignObservational cross-sectional study at the county level to investigate the ...associations of 29 county characteristics with the odds of a high-poverty county reporting population well-being in the top quintile versus the bottom quintile of well-being in the USA. County characteristics representing key determinants of health were drawn from the Robert Wood Johnson Foundation County Health Rankings and Roadmaps population health model.SettingCounties in the USA that are in the highest quartile of poverty rate.Main outcome measureGallup-Sharecare Well-being Index, a comprehensive population-level measure of physical, mental and social health. Counties were classified as having a well-being index score in the top or bottom 20% of all counties in the USA.ResultsAmong 770 high-poverty counties, 72 were categorised as having high well-being and 311 as having low well-being. The high-well-being counties had a mean well-being score of 71.8 with a SD of 2.3, while the low-well-being counties had a mean well-being score of 60.2 with a SD of 2.8. Among the six domains of well-being, basic access, which includes access to housing and healthcare, and life evaluation, which includes life satisfaction and optimism, differed the most between high-being and low-well-being counties. Among 29 county characteristics tested, six were independently and significantly associated with high well-being (p<0.05). These were lower rates of preventable hospital stays, higher supply of primary care physicians, lower prevalence of smoking, lower physical inactivity, higher percentage of some college education and higher percentage of heavy drinkers.ConclusionsAmong 770 high-poverty counties, approximately 9% outperformed expectations, reporting a collective well-being score in the top 20% of all counties in the USA. High-poverty counties reporting high well-being differed from high-poverty counties reporting low well-being in several characteristics.
The threat posed by antibiotic resistance is of increasing concern in low- and middle-income countries (LMICs) as their rates of antibiotic use increase. However, an understanding of the burden of ...resistance is lacking in LMICs, particularly for multidrug-resistant (MDR) pathogens.
We conducted a retrospective, 10-hospital study of the relationship between MDR pathogens and mortality in India. Patient-level antimicrobial susceptibility test (AST) results for Enterococcus spp., Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. were analyzed for their association with patient mortality outcomes.
We analyzed data on 5103 AST results from 10 hospitals. The overall mortality rate of patients was 13.1% (n = 581), and there was a significant relationship between MDR and mortality. Infections with MDR and extensively drug resistant (XDR) E. coli, XDR K. pneumoniae, and MDR A. baumannii were associated with 2-3 times higher mortality. Mortality due to methicillin-resistant S. aureus (MRSA) was significantly higher than susceptible strains when the MRSA isolate was resistant to aminoglycosides.
This is one of the largest studies undertaken in an LMIC to measure the burden of antibiotic resistance. We found that MDR bacterial infections pose a significant risk to patients. While consistent with prior studies, the variations in drug resistance and associated mortality outcomes by pathogen are different from those observed in high-income countries and provide a baseline for studies in other LMICs. Future research should aim to elucidate the burden of resistance and the differential transmission mechanisms that drive this public health crisis.
Kinnow, a hybrid developed by crossing two cultivars of mandarin i.e. King (Citrus nobilis) x Willow leaf (Citrus deliciosa) accounts for its high economic productivity and possess high processing ...quality along with great aromatic flavour. Kinnow mandarin cultivation occupies 4,73,000 ha of land in India with an annual production of 62,65,000 MT (Anonymous, 2021) and Punjab is the leading Kinnow producing state in India. Fruit drop is a major problem in Kinnow mandarin causing serious damage in the quality and yield of the fruit. During 2020–21, the symptoms of fruit drop were observed in Kinnow orchards of Punjab as; drying of twigs from the tip downwards, brown discoloured circular areas on stem-end of the fruit, rotting, and dropping of the fruit. To identify the casual agent, the infected fruit tissue bits (2 mm) was surface sterilized with 1% mercuric chloride solution for 30–40 s and given three washings of distilled water and placed on whatman filter paper-1 to soak all the excessive moisture. The bits was placed on Potato Dextrose Agar (PDA) plates and incubated at 25 ± 1 °C. The colony colour ranged from creamy white to light gray with orange conidial mass in the centre. Based on various morphological characteristics i.e., conidial shape, size, spore production, presence or absence of fruiting body and size of fruiting body the fungus was identified as Colletotrichum siamense. For molecular confirmation ITS region, actin (ACT) and beta-tubulin2 (TUB2) genes were amplified using primers ITS-6/ITS-4, ACT-512F/ACT-783R and T1/Bt2b, respectively. PCR amplicons for three loci (ITS, ACT and TUB2) were sequenced and sequences were deposited in GenBank as accession numbers OQ857285, OQ983464 and OQ983465 for isolate no. C-4 and OQ888798, OQ983466 and OQ983467 for isolate no. C-19, respectively. The BLAST analysis and multigene phylogenetic analysis showed that the isolates collected in present study were phylogenetically similar to the C. siamense. Thus, based on morphological, phylogenetic analysis and pathogenicity assays, the causal agent was identified as Colletotrichum siamense. This is the first report of C. siamense causing fruit drop of kinnow mandarin in Punjab, India.
•Fruit drop is a major problem in Kinnow mandarin in Punjab, India.•The casual agent has been identified as Colletotrichum siamense.•This is the first report of C. siamense causing kinnow fruit drop in Punjab, India.
Dengue was earlier a disease of children. But with increasing incidence in adults, dengue is increasingly encountered in infants and sometimes in neonates. The usual mode of transmission in neonates ...is vertical. We report a neonate with horizontal transmission of dengue. Dengue should be considered in the differential diagnosis of neonatal septicemia especially during dengue season even in the absence of maternal symptoms, to ensure proper case management.
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