An outbreak of nosocomial fungemia due to the unusual yeast, Pichia anomala occurred in the pediatric wards of our hospital over a period of 23 months (April 1996 to February 1998). A total of 379 neonates and children (4.2% admissions) were infected. The probable index case was admitted to the pediatric emergency ward, with subsequent transmission to the premature nursery, pediatric intensive care units, and other children wards. Carriage on the hands of health care personnel was likely to be responsible for dissemination of the fungus. The outbreak could only be controlled after a health education campaign to improve hand-washing practices was instituted and after nystatin-fluconazole prophylaxis to all premature neonates and high-risk infants was introduced. In a case-control study, we identified a lower gestational age, a very low birth weight (<1,500 g), and a longer duration of hospital stay as significant risk factors associated with P. anomala fungemia in premature neonates. We conducted a culture prevalence survey of 50 consecutive premature neonates and found that 28% were colonized with P. anomala at a skin or mucosal site on the date of delivery and that 20% of these neonates subsequently developed P. anomala fungemia. We performed multilocus enzyme electrophoresis on 40 P. anomala outbreak isolates (including patient and health care workers' hand isolates), and the results suggested that these isolates were identical. Our study highlights the importance of P. anomala as an emerging nosocomial fungal pathogen.Deep-seated fungal infections are important causes of morbidity and mortality in hospitalized patients (1, 2, 5, 13). Disseminated candidiasis is the most common nosocomial fungal infection, and Candida albicans has been reported to account for 50% to more than 70% cases of invasive candidiasis (2,5,6,8). However, recent reports have also suggested the emergence of infections caused by non-C. albicans candidas (3,14,21). In addition, less-common pathogenic yeasts (Malassezia, Trichosporon, Hansenula, and Rhodotorula spp.) have recently been reported, with increased frequency, as causes of nosocomial infections (7).Although a rare clinical isolate, the ascosporogenous yeast, Pichia anomala (formerly Hansenula anomala) has been implicated in causing fungemia in a neonatal intensive care unit (10), interstitial lung disease (19), endocarditis (12), and enteritis (9). In addition, there have been two reports of nosocomial outbreaks due to P. anomala: one in a Neonatal Intensive Care Unit in Liverpool, United Kingdom (10), and the other in an oncology hospital in Brazil (18). We describe here an outbreak of invasive P. anomala infection in the pediatric wards of our medical center that occurred during April 1996 to February 1998, with an attack rate of 4.2%. MATERIALS AND METHODSEpidemiologic investigation. The Nehru Hospital, affiliated with the Postgraduate Institute of Medical Education and Research, Chandigarh, India, is a 1,200-bed tertiary adult and pediatric referral center. The pediatric depa...

significantly shorter disease free interval of 11 months.so adding systemic therapy to adjuvant treatment should be investigated further. Survival for patients with regular follow up was 61.6 months. out of 69 ,in 57 patients symptoms alone were the index diagnostic method. Neither of the methods of recurrence detection have impact on os. Conclusions: This study was undertaken in a developing nation that harbours majority of global burden of cervical cancer. Thorough examination of clinical symptoms could diagnose recurrence early. Also the recurrence detection outcomes were not linked to specific diagnostic procedures. interestingly , There was a trend of better survival period in patients who followed up regularly.

Background: A system comprising of screening for pre-cancerous lesions succeeded by therapeutic interventions can greatly reduce the incidence of cervical cancer. High risk HPV detection in urine has proven itself as a potential primary screening tool. However, only a few studies have showed it’s concordance with matched self-collected vaginal samples while screening for high risk HPV infection in the community. Objective of the study was to determine the concordance between first void urine sample and self-collected vaginal sample for high risk HPV detection using Cobas 4800. The sensitivity and positive predictive value of screening by urine HPV testing for CIN 2+ detection would also be done along with its acceptability and cost analysis in community screening. Methods: This study will include women between 30-60 years with intact cervix and no precancerous lesions. Self-sampling will be provided by participants in the form of urine and vaginal swab collection by the Collipee device and vaginal swab stick respectively. This will be followed by high risk HPV testing using Cobas 4800 technology. The participants will also be asked to fill up a questionnaire about the acceptability of urine sampling for cancer screening. Conclusions: Screening tools can perhaps be diversified in order to suit the needs of low and middle income countries. Research and development of cervical cancer screening tools could hence bring to light feasible alternatives that could further improve compliance of non-attenders. Trial registration: The trial is registered with clinical trials registry (CTRI/2023/01/049322).

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Aim and background: Several myocutaneous flap approaches have been described for repairing large vulvar defects caused by deforming radical cancer procedures in the female perineum. In general, vulvar cancer has a favorable prognosis when adequately treated with multidisciplinary treatment. Case presentation: In this case report, we describe a patient who underwent a radical vulvectomy for locally advanced squamous cell carcinoma of the vulva, and the defect was reconstructed by an anteromedial thigh flap. Conclusion: Anteromedial thigh flap offers many advantages including adequate soft tissue coverage, a shorter route for flap transfer, an unnoticeable scar, quick recovery times, and better functional outcomes. Clinical significance: Large abnormalities are now more easily repaired, and the morbidity linked to such radical procedures in advanced vulvar cancer has decreased due to the reconstruction option with an anteromedial thigh flap.