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Background: Head-and-neck squamous cell cancers (HNSCC) are common in India. Recurrent and metastatic HNSCC carry a poor prognosis. The chemotherapy options are limited, and the median survival is measured in months. The addition of targeted antibodies and immunotherapy improves overall survival (OS). In resource-limited settings, chemotherapy remains the only option in advanced HNSCC. Objectives: We aimed to assess the efficacy and safety of the combination of paclitaxel and Mycidac-C (heat-killed Mycobacterium w) in the palliative setting for advanced HNSCC. Materials and Methods: This was a retrospective study conducted in the Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India in patients with relapsed/refractory or metastatic HNSCC who received the combination of paclitaxel and Mycidac-C between August 2019 and May 2020. Patients were treated until progression or unacceptable toxicity. The study was approved by the Institutional Ethics Committee, and the requirement for written informed consent was waived. Results: We included 28 patients in the study. Most of the patients (22, 78.6%) had oral cavity cancers and had platinum-refractory disease (25 patients, 96.4%). The median age was 51 years (range, 31-70), 26 (92.9%) patients were male, and 25 (89.3%) had a performance status of 0-1. At least two lines of previous therapies had been administered to 23 (82.1%) patients. The median duration of follow-up was 3.4 months (range, 0.2-18.1). The median numbers of cycles of paclitaxel and Mycidac-C administered were 3 (range, 1-6) and 2.5 (range, 1-6), respectively. The median progression-free survival (PFS) and OS were 2.9 months (95% confidence interval [CI], 2.36-3.48) and 4.9 months (95% CI, 3.78-5.99), respectively. The most common adverse effects were anemia in 26 (93.9%) patients and increased alanine aminotransferase and aspartate aminotransferase levels in five (17.9%) and four (14.3%) patients, respectively. Four (14.3%) patients developed neutropenia, two (7.1%) developed diarrhea, and two (7.1%) developed peripheral neuropathy. Conclusion: In resource-limited settings, the combination of paclitaxel and Mycidac-C can be considered a therapeutic option for patients with advanced relapsed/metastatic HNSCC.

This report describes nosocomial blood stream infection caused by Candida auris in a patient with neurological illness in a tertiary care hospital. Blood culture was performed by Bactec and initial identification and sensitivity by VITEK 2. It was misidentified as Candida haemulonii with sensitivity to Caspofungin, Micafungin and Voricanazole. MALDI-TOF analysis on the isolate confirmed it as Candida auris. However, patient was treated with Caspofungin and showed clinical improvement. Thus, multiple automated methods should be employed to accurately diagnose bugs causing life threatening infections.

Introduction: Candiduria is a common finding in catheterised patients with increasing trend of non albicans Candida species. Biofilm formation on indwelling catheters leads to persistent colonisation ending up in infection in immunocompromised patients. Aim: This study was conducted with the aim of identification of Candida species isolated from urine samples of catheterised patients; comparison of three phenotypic methods for biofilm detection in these Candida isolates and evaluating the role of biofilm in persistent candiduria. Materials and Methods: A prospective study was conducted in Microbiology Department. Total 50 non repeat urine samples were selected from the patient’s sample received in the laboratory routinely. Samples with significant number of pus cells and budding yeast cells in direct microscopy and significant count of Candida species in culture from catheterised patients were subjected to HiChrom agar for species identification and tube method, congo red agar and tissue culture plate method for biofilm detection. Diagnostic test analysis was done for the three biofilm detection methods taking tissue culture plate methods as gold standard. Chi-square analysis was performed for comparison of persistent candiduria with duration of catheterisation and biofilm. Results: Sensitivity and specificity for tube method was 100% and 0% respectively and 26.53% and 100% respectively for Congo red agar. A significant difference was found in persistent candiduria in patients with duration of catheterisation of one week and those with more than one week (χ2 =0.0047 p-value=0.9) and also in proportion of biofilm positive Candida isolates in these two group of patients χ2 =4.56, p-value=0.9). Conclusion: Tube method showed excellent sensitivity while congo red agar had better specificity. This study shows that Candida colonisation and biofilm formation is associated with persistent candiduria.