Antimicrobial utilization pattern in Systemic Inflammatory Response Syndrome positive septicemia: a prospective study in an apex hospital in South Delhi

Background: Despite significant advances in critical care, mortality and morbidity in severe sepsis and septic shock remain high, this may be explained by the fact that in sepsis bacterial infection triggers the innate immune response, setting in motion a cascade of pro-inflammatory and anti-inflammatory cytokines leading to what we recognize as the systemic inflammatory response syndrome (SIRS). It has been thought that this self-propagating cascade drives the progression to severe sepsis and septic shock with increasing degrees of cellular injury and end-organ dysfunction, therefor early initiation of empirical antimicrobial agent is crucial and life-saving atleast in high risk patient. This study aimed to see the outcome (recover or mortality) of patients diagnosed by using SIRS criteria.Methods: Total of 105 patients of suspected sepsis fulfilling SIRS criteria (SIRS ?2), were included in study. Study population were administered appropriate empirical antimicrobial depending on the source of infection and followed till the final outcome (complete recovery or death).Results: Out of 105 patients included in study based on SIRS criteria, 87 (82.85%) were confirmed to be having septicemia on further evaluation. In majority of patient primary source of infection were respiratory tract (44.76%) and most commonly employed and effective empirical antimicrobial were a combination piperacillin with tazobactum and amikacin (40%). 92.39% patients recovered with empirical antimicrobial, with total in-hospital mortality rate of 7.61%.Conclusions: Early initiation of appropriate antimicrobial by using SIRS as an indicator for the early diagnosis of septicemia is crucial in the management of septicemia and prevention of development of severe sepsis, septic shock.

Prevalence of associated psychosomatic symptoms in patients of irritable bowel syndrome

Background: Irritable bowel syndrome (IBS) is a functional disorder of gastrointestinal tract with unclear aetiology and no reliable biomarkers like other chronic and functional disorders. Majority of the patients of IBS suffer from various forms of psychosomatic disorders as comorbidity that further exaggerate the complexity of diagnosis and management of IBS. The aim of the present study was to find the prevalence of commonly associated psychosomatic symptoms associated with IBS in the patients of lower socioeconomic strata.Methods: This is a prospective observational study carried out over a period of 10years from November-2007 till October-2017, in HAHC hospital attached to Hamdard Institute of Medical Sciences and Research. A structured questionnaire comprising of a total of 36 closed ended questions was designed. Eleven questions were about the demographic characteristics and twenty-five were pertaining to IBS symptoms according to Manning and Rome III criteria with some necessary modifications. Various psychosomatic illnesses were recorded separately after ruling out the organic cause with appropriate investigations.Results: In the present study out of 4000 patients with IBS symptoms, 70.8% were having some form of psychosomatic symptoms, Patients with psychosomatic disorders were significantly more often young in age and females (53.28%), showing highest number of patients belonging to the age group 26-35years (51.44%). 34% patient had two or more psychosomatic illnesses. Headache (62.26%) and insomnia (63.03%) were the commonest followed by chest pain (36.54%). Chest pain (77.68%), headache (62.26%) and insomnia (56.07%) was more common in male whereas palpitation (60.58%) and breathlessness (57.68%) was more common in female.Conclusions: There is significantly high prevalence of psychosomatic illness in the patients of IBS in the low socio-economic strata. The young patients (productive age group) are more affected which may be responsible for further deteriorating their social and economic condition.

Antimicrobial stewardship: need of the hour

Efforts to tackle the global threat of Antimicrobial Resistance (AMR) have recently taken shape in a number of potentially far-reaching collaborative initiatives. When microbes become resistant to medicines, the options for treating the diseases they cause are reduced. This resistance to antimicrobial medicines is happening in all parts of the world for a broad range of microorganisms with an increasing prevalence that threatens human and animal health. The direct consequences of infection with resistant microorganisms can be severe, including longer illnesses, increased mortality, prolonged hospital stay, loss of protection for patients undergoing operations and other medical procedures, and increased costs. Antimicrobial resistance affects all areas of health, involves many sectors and has an impact on the whole of society. To overcome the threat of antimicrobial resistance, a three-pillar approach has been advocated i.e. Optimize the use of existing antimicrobial agents, prevent the transmission of drug-resistant organisms through infection control and Improve environmental decontamination. Antimicrobial stewardship [AMSP] is one of the key strategies to overcome resistance. It is an inter-professional effort, across the continuum of care, involves timely and optimal selection, dose and duration of an antimicrobial for the best clinical outcome for the treatment or prevention of infection with minimal toxicity to the patient and minimal impact on resistance and other ecological adverse events.

Immobilization of cellulase on TiO2 nanoparticles by physical and covalent methods: A comparative study.

Immobilization of cellulase from Aspergillus niger on TiO2 nanoparticles was studied by two different approaches — physical adsorption and covalent coupling. A. niger was selected, as it is generally non-pathogenic, is found in nature in the broad range of habitats and produces cellulase extracellulary. For covalent method, TiO2 nanoparticles were modified with aminopropyltriethoxysilane (APTS). The adsorbed and covalently immobilized enzymes showed 76% and 93% activity, respectively, as compared to the free enzyme. The catalytic efficiency Vmax/Km increased from 0.4 to 4.0 after covalent attachment, whereas in adsorption method, it increased slightly from 0.4 to 1.2. The covalently-immobilized and adsorbed cellulase lost only 25% and 50% of their activity, respectively after 60 min of incubation at 75°C. The reusability and operational stability data also showed that covalent coupling increased the stability of the enzyme. The presence of enzyme on TiO2 nanoparticles was confirmed by Fourier-transform infrared spectroscopy. The high-resolution transmission electron microscopy (HR-TEM) and atomic force microscopy (AFM) studies indicated aggregation of enzyme when adsorbed on TiO2 surface and a monolayer of enzyme in covalent attachment. In conclusion, covalently attached cellulase retained good activity and thermal stability, as compared to physically adsorbed enzyme. The lower amount of enzyme activity and thermal stability in case of physically adsorbed immobilized enzyme was due to aggregation of the enzyme after adsorption on TiO2 nanoparticles, as revealed by HR-TEM and AFM. Thus, TiO2 nanoparticles could be suitable candidates for immobilization of cellulase for industrial applications like paper, textile, detergent and food industries.

The microbiological quality of water from dental unit waterlines in Malaysian Armed Forces dental centres

Water quality in the dental unit waterlines (DUWLs) is important to the patients and dental health care personnel as they are at risk of being infected with opportunistic pathogens such as Pseudomonas or Legionella species. In this study, a total of 86 samples were collected from DUWLs of 19 dental units in 11 Malaysian Armed Forces dental centres (MAFDC). 350 ml water sample was collected in sterile thiosulphite bags from the outlets of 3–way syringe, high speed handpiece, scaler, cup filler, independent water reservoir or the tap of the same surgery respectively. Samples were transported to the laboratory within 24 hours and kept in the refrigerator at 40C. 100ml of each sample was filtered through a 0.45 μm polycarbonate membrane filter. The filter was then inoculated onto plate count agar and incubated at 370 C for 24 hours, after which the formed colonies were enumerated. Another separate 100ml of water sample was poured onto buffered charcoal yeast extract agar and cetrimide agar to culture Legionnella and Pseudomonas respectively. Identification of these bacteria were confirmed by polymerase chain reaction and sequencing. Pseudomonas aeruginosa was detected in 9.5% of the samples but Legionnella was not detected in any of the samples. 77% of the samples met American Dental Association (ADA) recommendation of less than 200 cfu/ml. The result of this study showed that it is difficult if not impossible to eliminate biofilm from the DUWLs. Regular monitor of water quality from DUWL is required to maximise the health of the dental patients and dental health care personnel.