Background: Under five children constitute the most vulnerable segment and their nutritional status and mortality rate is a sensitive indicator of the community’s health and nutrition. Health indices of slum children are worst among all urban groups and are even poorer than rural average.Methods: A community based cross-sectional study was conducted from October 2019 to January 2020 in urban slum area of Gwalior city. Data were collected from 550 mothers of children aged 6-60 months using pre-tested semi structured questionnaires and measuring weight, height and mid upper arm circumference of the children.Results: 68.36% of 550 children were having under nutrition in the form of underweight (53.09%), wasting (22.18%) and stunting (59.45%). Maximum number of underweight children belongs to age group 24-60 months (64.54%) followed by <24 months age groups. Stepwise regression showed that the risk of underweight and stunting was significantly (p<0.001) higher among children of illiterate mothers and children from lowest and middle households wealth index.Conclusions: Malnutrition is widely prevalent among study population more than the state and national prevalence. With increasing age cumulative increase in prevalence of malnutrition is seen perhaps due to persistence and addition of causative factors. Maternal education and faulty feeding practice are contributory factor of this high prevalence of disease.

Background and Purpose: The predominant cause of candidiasis was Candida albicans which has recently changed to non-Candida albicans Candida (NCAC) (i.e., Candida spp. other than the C. albicans). The NCAC spp., earlier considered non-pathogenic or minimally virulent, are now considered a primary cause of morbidity and mortality in immunocompromised individuals. Given the NCAC spp.has become more common in clinical cases, this study aimed to determine the prevalence of NCAC spp. in different clinical specimens and assess a few of their virulence factors. Materials and Methods: Routine samples for bacterial culture and sensitivity that showed colony characteristics, like Candida on Blood Agar and microscopic features resembling Candida spp., were processed further. Candida isolates underwent tests for chlamydospore formation and biochemical tests, including sugar fermentation and sugar assimilation tests. These were grown at 42oC, and their colony color was identified using HiCrome™ Candida Differential Agar (HiMedia Laboratories Pvt. Ltd., Mumbai,India), HiCandidaTM Identification Kit (HiMedia Laboratories Pvt. Ltd., Mumbai, India),and VITEK-2® Compact (Biomérieux, France). Virulence factors, such as adherence to buccal epithelial cells (ABEC), biofilm formation, hemolytic activity, and production of coagulase enzyme were also tested. Results: Mean age of the patients was 38.46 years with a male-female ratio of 1.36:1. In total, 137 Candida isolates were recovered; 45.3%, 19.7%, and 13.9% of the isolates were isolated from urine, vaginal swabs, and oropharyngeal swabs, respectively. Moreover, 55(40.1%) isolates were those of C. albicans and 82 (59.9%) isolates belonged to NCAC spp.,with C. tropicalis (23.4%) contributing highest among NCAC species. Furthermore, C. albicans (3; 50%) was the most common spp. in cases of candidemia. Haemolysin production (85.5%) and ABEC (78.2%) were the major virulence factors in C. albicans. C.tropicalis (59.4%) and C. dubliniensis (50%) showed maximum ABEC. Biofilm forming capacity was higher in C. tropicalis (78.1%) than C. albicans (67%). Conclusion: Results of this study suggest varied prevalence and virulence based on geographical locations, even within a subcontinent. It clearly indicates the emergence of the NCAC spp. and their predominance in different body fluids. Identification of Candida to the spp. level should become a routine in all laboratories.

With rising incidences of fungal infections leading to Invasive Fungal Infections (IFIs), Antifungal Susceptibility Testing (AFST) has become the need of the hour and its availability at all the tertiary care settings is a prerequisite for better diagnostics and thus, improved therapeutic management. Multiple factors are into play rendering this rising incidence, and thus, the potential antifungal resistance in those fungi is imminent. To let it off, cautious and timely measure of availing AFST and identification of fungi to species level has become mandatory and needs to be addressed. Antimicrobial Stewardship may play a major role in this transition.

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