Fungi are a versatile group of microorganisms which can be freely present in the environment, be a part of the normal flora of human and animals and have the ability to cause mild superficial infections to severe life threatening invasive infections. Invasive fungal infections (IFI's) are those infections where fungi have invaded in to the deep tissues and have established themselves resulting in prolonged illness. IFI's usually are seen in debilitated and immunosuppressed individuals. There are many reports of IFI's even in immunocompetent individuals thus making IFI's a potential threat in the present century. Fungi are saprophytic microorganisms which have evolved mechanisms to survive in the mammalian hosts. Most of the fungal infections have been accidental and systemic fungal infections are a rarity that may result in high mortality. In systemic fungal infections the outcome of the disease depends more on the host factors rather than the fungal virulence. Immune response to fungal infections is a complex subject where in fungi invading goes unrecognised by the immune system and that invasive fungal infections can result in severe inflammatory reactions resulting in morbidity and mortality. From being uncommon during the earlier part of the 20 th century when the world was plagued with bacterial epidemics, fungi have evolved as a major global health problem.

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This position statement aims to minimize inappropriate treatment and optimize palliative care for terminally ill patients in Indian intensive care units by standardizing the process of forgoing life support. It also defines the ethical standards for the physician-patient relationship in the context of critical care practice in India. Evidence: Evidence was gathered through a review of recently published medical literature on the subject, as well as by evaluating the relevant statutes of Indian Law. Available empirical data from critical care practice in India were sparse. Newspaper articles reflecting lay opinion on related issues were also reviewed. The terms for search were: end-of-life care; withdrawal and withholding; intensive care; terminal care; medical futility; ethical issues; palliative care. Method: Proposals from the Chair were debated and recommendations were formulated through a consensus process. The process took into account the guiding ethical principles and clinical practices elsewhere in the world, and incorporated the socio-cultural and legal perspectives unique to this country. Recommendations 1. The physician has a duty to disclose to the capable

Background:The global spread of antimicrobial resistance has acquired greater significance in the public health perspective. Drug resistance has posed a threat for the management of various hospital-acquired infections (HAI). For bacteria producing extended spectrum ß lactamase, carbapenems are the drug of choice. However, treatment failures are still a cause of concern due to carbapenemase producers.Aim:Various phenotypic and genotypic methods are available for the detection of carbapenemase producers. Studies thus far have mostly concentrated on comparing various methods for detection of carbapenemase producers. We used low-cost and the easily performed modified Hodge test (MHT) for detecting the carbapenemase producers in Enterobacteriaceae members isolated from various clinical specimens.Material and Methods:The study included 1072 clinical isolates of Enterobacteriaceae collected in India between April 2008 and February 2010. MHT was performed on all the isolates in accordance with CDC and CLSI guidelines.Results:The carbapenemase activity was detected in 35.9% (385/1072) of the isolates. Klebsiella spp. 28.7% (80/278), Citrobacter spp. 20.4% (25/122), 11.3% (38/334) in E. coli, 20.3% (45/221) in Enterobacter spp., and 16.2% (9/117) in Proteus spp. revealed variable resistance activities against carbapenems.Conclusion:Enterobacteriaceae members are among the most common and easily transferable bacterial species responsible for severe HAI. This study revealed a high percentage of Enterobacteriaceae clinical isolates producing carbapenemases in India. Detection of such bacteria, formulating hospital antibiogram, and monitoring the usage of antimicrobial drugs is recommended.

Appropriate treatment limitations towards the end of life to reduce unwanted burdens require ethical clarity that is supported by appropriate legislation. The lack of knowledge of enabling legal provisions, physicians feel vulnerable to legal misinterpretation of treatment limiting decisions. In India the lack of societal awareness, inadequate exploration of the gray areas of bio-ethics and unambiguous legal position relating to terminal illness have resulted in poor quality end of life care. Much of the perceived vulnerability by the physician is attributable to insufficient knowledge and understanding of existing constitutional and legal position in India. While we await informed legal and legislative opinion, this paper highlights possible legal liabilities arising from treatment limitation decisions with available defense. It is hoped that such clarity would lead to more confident ethical decisions and improved end of life care for patients.