Background: Candida score has been developed and used for identifying patients at risk for developing Candida infections. However, its usefulness in predicting outcomes of patients with candidemia has not been evaluated. We aimed to determine the risk factors for mortality in patients with candidemia admitted to an Indian medical intensive care unit (ICU). Methods: We conducted a retrospective cohort analysis of 56 patients with candidemia presented in 18 months duration. Baseline patient characteristics, ICU course, and outcome were noted and Candida score was calculated. We conducted an analysis based on the primary outcome measure of ICU mortality. Results: Out of 3,142 ICU admissions, the incidence of candidemia was 17.8/1,000 admissions. The mean interval between ICU admission and candidemia was 12.9 ± 14.4 days. C. tropicalis was the commonest species isolated from 28.6% isolates, followed by Candida albicans (21.4%) and C. glabrata (12.5%). The mean length of ICU stay was 22.9 ± 28 days and hospital stay was 30.1 ± 30.2 days. Crude ICU mortality was 33.93%. There was no statistically significant difference between mortality of patients with albicans and non-albicans candidemia (p=0.732). On multivariate analysis, only two factors, previous antifungal therapy (p=0.004, OR=101.4, 95% CI=4.52-227.7) and Candida score >3 (p=0.028, OR=13.2, 95% CI=1.3-125) were found to be independently predicting mortality. Conclusion: Candida infection is generally late-onset and is associated with a prolonged ICU and hospital stay, and high mortality. Candida non-albicans infection was more common but there was no difference in mortality among patients with C. albicans and non-albicans infection. Previous antifungal therapy and Candida score were found to be independently predicting mortality.

Background: Vitamin C is increasingly being used for treating myriad clinical conditions. Even high doses of vitamin C are considered safe, but complications including hemolysis have been reported. Methods: We performed a systematic search, from PubMed, Science Direct, and Google Scholar databases, from January 1975 till 31st July 2021. The search terms used were “Vitamin C” OR “ascorbic acid” AND “hemolysis” OR “hemolytic anemia” and data regarding patient’s demographics, dose, duration, and form of vitamin C therapy and the patient outcomes were extracted. Results: A total of 14 case reports matched the selected criteria. The age of the patients ranged from 3 weeks to 75 years with 78.6% being males. 71.4% were diagnosed to have Glucose-6-phosphate dehydrogenase (G6PD) deficiency but the previous history of hemolysis was reported in only two patients. 57.1% were prescribed vitamin C for nutritional supplementation. The dose ranged from 1 to 200 gm/day with 57.1% receiving intravenous formulations. Half of these patients also developed other complications including acute kidney injury (AKI), disseminated intravascular coagulation, oxalosis and methemoglobinemia. A great majority (78.6%) developed complications within 3 days of starting vitamin C and only 1 death (7%) was reported. Conclusions: Vitamin C is generally a safe drug but like any other drug it should be prescribed with caution and only when clinically indicated. Physicians should be aware of potential complications like severe hemolysis and AKI which may be precipitated when using high dose vitamin C, especially in a patient with G6PD deficiency.