Candida auris is an emerging fungal pathogen showing resistance to most of the currently available antifungal drugs. The pathogen is spreading rapidly worldwide. It mainly affects immunocompromised individuals such as intensive care unit patients, adults, and newborns who are treated in health care facilities. The isolates can be recovered from a variety of specimens, including mucocutaneous swabs, urine, respiratory specimens, and body fluids; however, bloodstream infections are the most commonly observed invasive infections. The advent of C. auris as a human fungal pathogen has been directly linked to the occurrence of new virulence traits and its ability to adhere to various surfaces to form a multidrug-resistant biofilm. With the lack of distinctive traits in C. auris, its identification has been problematic. The commercially available biochemical tests often misdiagnose the pathogen to phylogenetically related Candida haemulonii species making it difficult for clinicians to initiate proper antifungal treatment in patients. Emergence of resistant isolates has further posed a new challenge to the limited therapeutic options. This review highlights the risk factors involved in infection, virulence traits of C. auris, diagnostic methods, and mechanism of drug resistance along with novel antifungal drugs against this fungal pathogen which could provide direction for future work on it.

Background: Neonates being nonverbal are unable to express their pain leading to underestimation of their pain and hence insufficient pain relief. Neonatal pain is assessed by pain scales based on the behavioural and physiological changes that occur in response to painful stimuli. This cross sectional study was conducted at a tertiary care centre using Premature Infant Pain Profile (PIPP) score with 4% lidocaine as local anaesthetic agent to produce surface anaesthesia of skin prior to intravenous cannulation. Methods: Sample size was collected by simple randomisation method. Our study groups included 50 term and 50 preterm neonates with POG of 28-40 weeks requiring IV cannulation. Heart rate (HR), SpO 2 , facial expressions and behavioural state were noted before venipuncture and after venipuncture using PIPP scale. Same cohort of patients was assessed for pain response after applying 4% lidocaine cream during future venipuncture with help of PIPP score. Results: The PIPP score in preterm group before and after anesthesia was 11.28 AE 3.72 and 9.58 AE 3.39. PIPP score in term group before and after anesthesia was 11.54 AE 2.84 and 9.04 AE 2.97. There was reduction in mean PIPP score after using topical anesthetic agent in both study groups and the results were statistically significant. Conclusion: This study found that topical anesthetic agents were effective in reducing pain during venipuncture. Based on the facts of the study, it is recommended that pain scoring should be a part of routine monitoring in neonatal intensive care units and appropriate measures should be used to reduce pain.

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Background There is a lack of studies on cystic fibrosis (CF) outcomes in children from developing countries like India. Identifying risk factors for mortality may help identify the high‐risk group and plan policy management of such patients. We aimed to determine the factors associated with mortality among Indian children with CF. Methods In this retrospective study, we extracted demography, clinical features, laboratory and outcome data from medical records of children with CF. Bivariate and multivariate analysis was performed to identify variables associated with mortality. Results We enrolled 178 children, and there were 32 (18.0%) deaths. Median (IQR) z‐score for body mass index (BMI) at last follow up was −1.5 (−2.7, −0.2) and −2.5 (−4.0, −1.6), p‐value 0.039, in survived and deceased group respectively. Mean (SD) of % predicted of FEV1/FVC and FEV1 25–75 at the time of diagnosis in survived versus diseased group was 94.7 (24.1) versus 81.5 (19.1), p‐value 0.063 and 56.1 (38.9) versus 45.7 (29.9), p‐value 0.347, respectively. Significant factors associated with mortality included history of neonatal complications; hazard ratio (HR): 8.5 (95% confidence interval [CI]: 3.0–23.9, p < 0.001), low Z‐scores for BMI at the time of diagnosis; HR: 7.1 (95% CI: 2.3–22.0, p < 0.001), FEV1/FVC at the time of diagnosis; HR: 5.1 (95% CI: 1.65–15.4, p < 0.004), and FEV1 25–75; HR: 3.6 (95% CI: 1.1–11.8, p = 0.03). Conclusions Factors associated with increased mortality risk included neonatal complications, low BMI, and lower pulmonary function test results. Low BMI and low PFT indices can be improved upon by timely treatment of respiratory infections, better nutrition, early diagnosis, and treatment. A newborn screening program may help in early diagnosis and identification of the neonatal problem of CF.

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