Efficacy of a remote screening model for oral potentially malignant disorders using a free messaging application: A diagnostic test for accuracy study

OBJECTIVE

To assess the feasibility of using a remote sensing model as a free messaging application tool in the preventive screening of oral potentially malignant disorders in a rural area of India.

DESIGN

An observational cross-sectional study.

SETTING

Primary care setting in Udupi District, Karnataka, South India.

PARTICIPANTS

One-hundred and thirty-one individuals with a mean (SD) age of 37.34 (11.31) years, of whom 64.1% and 35.9% were men and women, respectively.

INTERVENTIONS

Clinical oral examination followed by photo capture of five areas of the patients' mouth.

MAIN OUTCOME MEASURES

Reliability measures for the use of a photo messaging service in diagnosing oral potentially malignant disorders, as compared to the clinical examination.

RESULTS

When lesions were categorised as normal and abnormal, the reliability (kappa) between the diagnoses, based on photo messaging and clinical oral examination, was 0.68 and 0.67 for Examiners 1 and 2, respectively. The sensitivity values for Examiners 1 and 2 were 98.5% and 99.04%, respectively, whereas the specificity was 72% and 64%, respectively. When the agreement between photo messaging and clinical oral examination for an exact diagnostic match was assessed, the reliability (kappa) was 0.59 and 0.55 for Examiners 1 and 2, respectively. The sensitivity values for Examiners 1 and 2 were 98.1% and 98.7%, respectively, whereas the specificity was 64% and 52% respectively.

CONCLUSION

There was a substantial agreement between the diagnosis based on clinical examination and WhatsApp image for both the examiners, when the lesions were dichotomised as normal and abnormal, but slightly reduced when assessed for the exact diagnostic match. Screening for oral potentially malignant disorders using photo messaging can serve as an effective adjunct and a potential cost-effective tool in a low-resource setting.

Prevalence, Risk Factors, Treatment and Outcome of multidrug resistance Candida auris Infections in Coronavirus Disease (COVID-19) Patients: A Systematic Review

BACKGROUND

Candida auris is an emerging multidrug-resistant pathogen in intensive care settings (ICU). During the coronavirus disease 19 (COVID-19) pandemic, ICU admissions were overwhelmed, possibly contributing to the C. auris outbreak in COVID-19 patients.

OBJECTIVES

The present systematic review addresses the prevalence, underlying diseases, iatrogenic risk factors, treatment and outcome of C. auris infections in COVID-19 patients.

METHODS

MEDLINE, Scopus, Embase, Web of Science and LitCovid databases were systematically searched with appropriate keywords from 1^st January 2020 to 31^st December 2021.

RESULTS

A total of 97 cases of C. auris were identified in COVID-19 patients. The prevalence of C. auris infections in COVID-19 patients was 14%. The major underlying diseases were diabetes mellitus (42.7%), hypertension (32.9%), and obesity (14.6%), followed by the iatrogenic risk factors such as a central venous catheter (76.8%%) intensive care unit (ICU) stay (75.6%), and broad-spectrum antibiotic usage (74.3%). There were no significant differences in underlying disease and iatrogenic risk factors among C. auris non-candidemia/colonisation and C. auris candidemia cases. The mortality rate of the total cohort is 44.4%, whereas, in C. auris candidemia patients, the mortality was 64.7%.

CONCLUSION

This study shows that the prevalence of C. auris infections remains unchanged in the COVID-19 pandemic. Hospital-acquired risk factors may contribute to the clinical illness. Proper infection control practices and hospital surveillance may stop future hospital outbreaks during the pandemic.

Emergomycosis, an Emerging Thermally Dimorphic Fungal Infection: A Systematic Review

Emergomycosis is an endemic mycosis caused by the Emergomyces species. Infections due to this agent have been reported globally. Hence, the present systematic review on Emergomyces infections was conducted to study the disease epidemiology, underlying diseases and risk factors, causative agents, and treatment and outcome. The MEDLINE, Scopus, Embase, and Web of Science databases were searched systematically with appropriate keywords from January 1990 to October 2022. A total of 77 cases of emergomycosis were included in the analysis. Emergomycosis was most commonly seen in patients with human immunodeficiency virus (HIV) infection (n = 61, 79.2%) and HIV-uninfected patients with or without other comorbidities (n = 16, 20.8%). The underlying disease and risk factors significantly associated with emergomycosis in the HIV-infected patients were CD4+ T-cell counts less than 100 cells/mm3 (n = 55, 90.2%), anaemia (n = 30, 49.2%), and thrombocytopenia (n = 17, 27.9%), whereas in the HIV-uninfected patients, treatment with immunosuppressive drugs (n = 10, 62.5%), renal disease (n = 8, 50%), transplant recipients (n = 6, 37.5%), and diabetes mellitus (n = 4, 25%) were the significant risk factors associated with emergomycosis. Emergomyces africanus (n = 55, 71.4%) is the most common causative agent, followed by E. pasteurianus (n = 9, 11.7%) and E. canadensis (n = 5, 6.5%). E. africanus was most often isolated from HIV-infected patients (n = 54, 98.2%), whereas E. pasteurianus was most common in HIV-uninfected patients (n = 5, 55.6%). The all-cause mortality rate of the total cohort is 42.9%. No significant variation in the mortality rate is observed between the HIV-infected patients (n = 28, 36.4%) and the HIV-uninfected patients (n = 5, 6.5%). In conclusion, with an increase in the immunosuppressed population across the globe in addition to HIV infection, the case burden of emergomycosis may increase in the future. Hence, clinicians and mycologists should be vigilant and clinically suspicious of emergomycosis, which helps in early diagnosis and initiation of antifungal treatment to prevent disease mortality.

Validation of an Indian (Kannada) translation of the Family Impact Scale questionnaire and the impact of malocclusion on the families of adolescent school children

OBJECTIVES

The objectives of this study were to validate an Indian translation of the Family Impact Scale (FIS) questionnaire and assess the impact of malocclusion on the families of adolescent school children between 12 and 15 years old across socio-economic strata (SES).

MATERIALS AND METHODS

The sample consisted of 768 school children aged between 12 and 15 years from randomly selected schools in Udupi district. The FIS and informed consent forms were sent through the children to be completed by their parents. Information was collected on socio-demographic details, past dental visit in the last year, type of school and SES. Clinical examination for malocclusion using the Dental Aesthetic Index was conducted by a single trained and calibrated examiner.

RESULTS

The prevalence of malocclusion was 59.9%. The intra-class correlation for the total FIS score of 0.95 and Cronbach's alpha value of 0.88 demonstrated internal consistency. There was a significant difference in the overall and subscale scores of FIS between parents of children with and without malocclusion (P < 0.001). Parents of children who had malocclusion had significantly higher FIS scores across all SES (P < 0.001). Parents of children with malocclusion had 1.86 (P < 0.001, 95% CI = 1.60-2.17) times higher FIS scores than parents of children without malocclusion after adjusting for age, gender, SES, and past dental visits in the last year.

CONCLUSION

The psychometric properties of the FIS were found satisfactory for assessing the effect of a child's oral condition on his/her family. Malocclusion in children had a significant negative influence on the family impact scores.

Epidemiology of Saccharomyces fungemia: A systematic review

Fungemia due to Saccharomyces species is reported in considerable numbers, and the increase is attributed to using Saccharomyces boulardii probiotics in clinical settings. The present systematic review addresses the underlying diseases and risk factors in Saccharomyces fungemia patients, along with the treatment and outcome of the disease. The MEDLINE, Scopus, Embase, and Web of Science databases were searched systematically with appropriate keywords from June 2005 to March 2022. This review identified 117 Saccharomyces fungemia cases; 108 cases were included in the analysis. Saccharomyces fungemia is commonly seen in patients treated with S. boulardii probiotics (n = 73, 67.6%), and 35 (32.4%) patients did not receive probiotic therapy. The underlying disease and risk factors significantly associated with S. boulardii probiotic-associated fungemia were intensive care unit stay (n = 34, 31.5%), total parenteral nutrition or enteral feeding (n = 32, 29.6%), patients with gastrointestinal symptoms such as diarrhea (n = 23, 21.3%), and diabetes mellitus (n = 14, 13.0%). In patients without probiotic therapy, immunosuppression (n = 14, 13.0%), gastrointestinal surgery (n = 5, 4.6%), and intravenous drug use (n = 5, 4.6%) were the significant risk factors for Saccharomyces fungemia. The all-cause mortality rate of the total cohort is 36.1%. No significant variation in the mortality rate is observed between S. boulardii probiotic treated patients (n = 29, 26.9%) and patients without probiotic therapy (n = 10, 9.3%). In conclusion, S. boulardii probiotic therapy in debilitated critical care patients may have contributed to increased Saccharomyces fungemia cases. Further, clinicians should be vigilant in preventing S. boulardii fungemia in patients with prophylactic probiotic therapy.