Candida tropicalis is a leading cause of invasive candidiasis in the Asia-Pacific region with reported crude mortality rates exceeding 50%. The rising prevalence of azole-resistant strains presents a significant clinical challenge. We analyzed 1,016 C. tropicalis clinical isolates collected over nine years from 27 hospitals across North India. Fluconazole resistance was detected in 5.1% (n = 52) of isolates, with cross-resistance observed to voriconazole in 55.7% and itraconazole in 44.2% of isolates. Multilocus sequence typing (MLST) analysis of global 1,630 isolates including 208 Indian and whole-genome sequencing of 716 global isolates (139 Indian) confirmed the clonal emergence and persistence of azole-resistant MLST clade 4 strains in Indian hospitals. Phylogenomic analyses identified that Indian azole-resistant lineage was closely related to azole-resistant isolates from mainland China and Taiwan. The underlying mechanism of resistance involved hotspot mutations (Y132F) in the ERG11 gene along with its duplication, overexpression, and twofold high ergosterol content. Comparative transcriptomics of two clinical isolates exhibiting >512 fold difference in fluconazole susceptibility identified upregulation of virulence-associated genes, ALS7 gene (eightfold), SAP7 and SAP9 (1.6- and 2-fold, respectively) in azole-resistant isolate. Furthermore, azole-resistant isolates showed robust biofilm-associated metabolic activity (twofold), reduced β-glucan exposure, and greater survival in both neutrophil and macrophage killing assays. Notably, azole-resistant lineage exhibits several traits associated with adhesion and immune evasion that could possibly enable its spread in healthcare settings and signals the beginning of a greater spread of this clone. The urgent need for continuous genomic surveillance and antifungal stewardship is warranted to mitigate the spread of multidrug-resistant C. tropicalis.IMPORTANCEInvasive fungal infections affect 6.5 million people annually and are associated with high mortality rates. Despite being the leading cause of invasive yeast infections in the Asia-Pacific, this is the first comprehensive study of Candida tropicalis from India documenting the emergence of azole-resistant clonal lineage (clade 4) in several hospitals in India. Azole resistance is driven by mutations, gene duplication, and overexpression of its target gene ERG11. The Indian azole-resistant isolates showed high genetic relatedness with those from China. Also, resistant isolate showed overexpression of virulence-related genes and robust biofilm formation. Notably, reduced β-glucan exposure in fluconazole-resistant isolates may contribute to their decreased susceptibility to the innate immune system. Importantly, this study provides evidence for the emergence of azole-resistant C. tropicalis lineage in India, which exhibits several traits associated with adhesion and immune evasion that could possibly enable its spread in healthcare settings leading to a public health concern.
Trauma causes significant global burden of disease. Trauma life support training programmes aim to improve early trauma care, but little is known about their effects on patient outcomes. We conducted a systematic review using keywords and medical subject headings (MeSH-terms) related to trauma life support training in seven online databases: Medline, Embase, Cochrane, Web of Science, Global Health, CINAHL and Google Scholar. The reference lists of included articles were also searched for relevant studies. Published studies that compared patient outcomes between providers trained in any trauma life support training programme with those trained in another training programme or those not trained were included. We appraised the quality of the included studies and conducted meta-analyses using random effects models. We screened 9,626 records from which we identified and included 19 eligible studies. There were 92,614 patients cumulatively across the 19 studies and Advanced Trauma Life Support (ATLS) was the most common trauma life support training programme. Seventeen of the studies were included in a meta-analysis with mortality as the outcome. Trauma life support training programmes were associated with reduced mortality at an odds ratio of 0.60 (95
Ventral hernia repair (VHR) is a common general surgical procedure. While robotic VHR (RVHR) has shown advantages in large, complex hernias, comparative evidence with laparoscopic VHR (LVHR) for smaller defects is limited. We conducted a prospective, real-world evidence study across 12 centers in India. Adults aged 18–65 years undergoing primary or incisional VHR with a defect ≤ 5 cm requiring mesh placement were included. Primary outcomes were postoperative pain and analgesic use within 14 days; secondary outcomes included quality of life (QoL), hospital stay, and perioperative complications. A total of 200 patients (101 RVHR, 99 LVHR) were analyzed, with comparable baseline characteristics. Defect size was larger in the RVHR group (p < 0.001). Median operative time was longer in RVHR (p < 0.001), while post-anesthesia care unit stay was shorter (p = 0.0026). RVHR was associated with faster recovery, including earlier return to daily activities (median 5 vs. 7 days, p < 0.001), fewer analgesic doses (2.55 ± 0.97 vs. 3.25 ± 1.55, p < 0.001), and shorter work restrictions (14 vs. 30 days, p = 0.0042). Pain outcomes favored RVHR, with consistently lower Numeric Rating Scale (NRS) scores, greater improvement in PROMIS pain intensity scores at day 14 (p = 0.0072), and more patients reporting low pain intensity (51.5
Obesity is a global health crisis affecting developing nations, including India. The management of obesity continues to evolve with newer drugs, metabolic and bariatric surgery and endoscopic interventions, requiring family physicians and specialists to adapt their clinical practice accordingly. There is an urgent need for a standardized algorithm to diagnose, stage, and treat obesity. The Endocrine Society of India (ESI) and the Obesity Surgeons Society of India (OSSI) appointed a steering committee to develop an evidence-based algorithm for managing patients with obesity in India. This was put to vote by 80 specialists (38 from OSSI and 42 from ESI) in a physical meeting. A proposed stage-wise algorithm based on Edmonton Obesity Staging System, Asian definition of obesity, and resources in India, received 100
INTRODUCTION:This study aimed to examine the impact of metabolic and bariatric surgery (MBS) on key micronutrients in patients with obesity over 10 years. PATIENTS AND METHODS:A retrospective chart review was carried out for individuals who had MBS from February 2013 to May 2022 at 11 centres. The micronutrient (iron, Vitamin B12, Vitamin D3 and calcium) levels were collected before surgery and up to 10 years afterwards. RESULTS:The data from 1675 individuals with a mean age of 43.09 ± 11.93 years were analysed. The study population comprised 34.81% of males and 65.19% of females. There was an increase in the serum iron levels over 1 year (P < 0.01), 3 years (P < 0.01), 5 years (P = 0.2175), 7 years (P < 0.01) and 10 years (P = 0.0998) after surgery. Similar results were observed for Vitamin B12 levels at 1 year (P < 0.01), 3 years (P < 0.01), 5 years (P = 0.3083), 7 years (P = 0.2817) and 10 years (P = 0.2645). Vitamin D3 levels increased at 1 year (P < 0.01), 3 years (P < 0.01), 5 years (P < 0.01), 7 years (P = 0.0069) and 10 years (P = 0.8179). However, calcium levels exhibited a downwards trend at 5 years (P = 0.0008) post-surgery. CONCLUSIONS:A high prevalence of micronutrient deficiency was observed amongst patients preoperatively, which improved following MBS.
