Proangiogenic Hypoxia-Mimicking Agents Attenuate Osteogenic Potential of Adipose Stem/Stromal Cells

BACKGROUND@#Insufficient vascularization hampers bone tissue engineering strategies for reconstructing large bonedefects. Delivery of prolyl-hydroxylase inhibitors (PHIs) is an interesting approach to upregulate vascular endothelialgrowth factor (VEGF) by mimicking hypoxic stabilization of hypoxia-inducible factor-1alpha (HIF-1a). This studyassessed two PHIs: dimethyloxalylglycine (DMOG) and baicalein for their effects on human adipose tissue-derivedmesenchymal stem/stromal cells (AT-MSCs). @*METHODS@#Isolated AT-MSCs were characterized and treated with PHIs to assess the cellular proliferation response.Immunostaining and western-blots served to verify the HIF-1a stabilization response. The optimized concentrations forlong-term treatment were tested for their effects on the cell cycle, apoptosis, cytokine secretion, and osteogenic differentiationof AT-MSCs. Gene expression levels were evaluated for alkaline phosphatase (ALPL), bone morphogeneticprotein 2 (BMP2), runt-related transcription factor 2 (RUNX2), vascular endothelial growth factor A (VEGFA), secretedphosphoprotein 1 (SPP1), and collagen type I alpha 1 (COL1A1). In addition, stemness-related genes Kruppel-like factor 4(KLF4), Nanog homeobox (NANOG), and octamer-binding transcription factor 4 (OCT4) were assessed. @*RESULTS@#PHIs stabilized HIF-1a in a dose-dependent manner and showed evident dose- and time dependent antiproliferativeeffects. With doses maintaining proliferation, DMOG and baicalein diminished the effect of osteogenic inductionon the expression of RUNX2, ALPL, and COL1A1, and suppressed the formation of mineralized matrix. Suppressedosteogenic response of AT-MSCs was accompanied by an upregulation of stemness-related genes. @*CONCLUSION@#PHIs significantly reduced the osteogenic differentiation of AT-MSCs and rather upregulated stemnessrelatedgenes. PHIs proangiogenic potential should be weighed against their longterm direct inhibitory effects on theosteogenic differentiation of AT-MSCs.

Proangiogenic Hypoxia-Mimicking Agents Attenuate Osteogenic Potential of Adipose Stem/Stromal Cells

BACKGROUND@#Insufficient vascularization hampers bone tissue engineering strategies for reconstructing large bonedefects. Delivery of prolyl-hydroxylase inhibitors (PHIs) is an interesting approach to upregulate vascular endothelialgrowth factor (VEGF) by mimicking hypoxic stabilization of hypoxia-inducible factor-1alpha (HIF-1a). This studyassessed two PHIs: dimethyloxalylglycine (DMOG) and baicalein for their effects on human adipose tissue-derivedmesenchymal stem/stromal cells (AT-MSCs). @*METHODS@#Isolated AT-MSCs were characterized and treated with PHIs to assess the cellular proliferation response.Immunostaining and western-blots served to verify the HIF-1a stabilization response. The optimized concentrations forlong-term treatment were tested for their effects on the cell cycle, apoptosis, cytokine secretion, and osteogenic differentiationof AT-MSCs. Gene expression levels were evaluated for alkaline phosphatase (ALPL), bone morphogeneticprotein 2 (BMP2), runt-related transcription factor 2 (RUNX2), vascular endothelial growth factor A (VEGFA), secretedphosphoprotein 1 (SPP1), and collagen type I alpha 1 (COL1A1). In addition, stemness-related genes Kruppel-like factor 4(KLF4), Nanog homeobox (NANOG), and octamer-binding transcription factor 4 (OCT4) were assessed. @*RESULTS@#PHIs stabilized HIF-1a in a dose-dependent manner and showed evident dose- and time dependent antiproliferativeeffects. With doses maintaining proliferation, DMOG and baicalein diminished the effect of osteogenic inductionon the expression of RUNX2, ALPL, and COL1A1, and suppressed the formation of mineralized matrix. Suppressedosteogenic response of AT-MSCs was accompanied by an upregulation of stemness-related genes. @*CONCLUSION@#PHIs significantly reduced the osteogenic differentiation of AT-MSCs and rather upregulated stemnessrelatedgenes. PHIs proangiogenic potential should be weighed against their longterm direct inhibitory effects on theosteogenic differentiation of AT-MSCs.

Awareness of Diabetic Retinopathy among Diabetic Patients in King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

Background: Diabetic retinopathy is a serious complication of DM, it occurs due to poor control of DM and lack of knowledge on the complications of DM. Among many approaches, strong awareness of retinopathy by diabetic patients could help in the early detection, management and prevention of this complication. Aim: this study was conducted to assess the awareness of diabetic retinopathy among diabetics in Saudi Arabia. Methods: A hospital-based, cross sectional study was conducted using a pre-tested questionnaire. All diabetic patients seen at the diabetes clinic in King Abdulaziz University Hospital were recruited. Questionnaire was distributed on all participants. The questionnaire contained questions to determine awareness of retinopathy and its risk factors. Data obtained was analyzed using the statistical package for social sciences (SPSS) 16.0. Results: A total of 357 diabetic patients were involved with a mean age of 50 years. 61% of patients were aware of DR. Only 38% were aware that annual retinal examinations are required and 70% were not aware what the treatment for DR is. And only 50% of all the respondents went for eye checkups. Conclusion: Although a large proportion of diabetics in Saudi Arabia are aware that diabetes can affect their eyes, there is however little or no knowledge of its risk factors and prevention. There is therefore a need for increasing this awareness in order to decrease the number of cases of blindness resulting from DR in Saudi Arabia.

Liposomal Microencapsulation of Rodent-repelling Agents onto Jute Burlaps: Assessment of Cytotoxicity and Rat Behavioral Test.

In Egypt, the world’s biggest wheat importer, about 7 to 10 percent of stored grains are damaged because of poor conditions of storage. Rodent invasion is considered as one of the main reasons that caused wheat grain damage. With respect of food safety, this work aims to treat the grain burlaps (containers) to rodent repellent. The rodent repellent agents was extracted from natural local resources. For the rodent repellent effectiveness, wheat burlaps are treated with rodent repelling agents using eco-friendly components. There are prepared using camphor oil, mint oil, and capsaicinoids (extracted from hot red pepper) as local resources to develop low cost and high-performance final product. The plan of work relies on two main axes; first, the experimental part in which burlap was treated for rodent repellent; second, testing and characterizing the treated samples for cytotoxicity and animal behavior test. The treatment was taking place by conventional pad-dry-cure technique.

Encapsulation of Nicotinamide into Cellulose Based Electrospun Fibers.

Systematic application of topical drugs has been widely prescribed as an effective treatment for skin disorders. However, the widespread use of such topical drugs is also associated with emergence of resistant strains of microorganisms resulting in patients resist for one or more antibiotics. Nicotinamide, a water-soluble amide of nicotinic acid and a common topical drug, is approved as anti-acne drug with anti-inflammatory potentials. Encapsulation of nicotinamide into electrospun water-soluble matrix that chemically crosslinked is the approach to control its release. In this research, biocompatible nano-fibrous mat was developed with hydroxyethyl cellulose (HEC) blended with poly(vinyl alcohol) (PVA) by electro-spinning technique. The concentration of HEC (5% w/v) with PVA (10% w/v) was optimized, blended in different ratios (20–50% HEC concentration) and electro-spun to get smooth nano-fibers. Nicotinamide was successfully encapsulated in the electro-spun fibers. Nicotinamide release was controlled via chemical cross-linking of the produced mat. Selected parameters of spinning solutions (viscosity and conductivity) and process parameters (applied voltage and needle-to-collector distance) were studied. The microstructure, morphology of blended HEC/PVA, nicotinamide -loaded nano-fiber, cross-linked HEC/PVA nano-fibrous scaffolds were characterized by scanning electron microscope (SEM), Fourier transform infrared spectroscopy (FTIR). SEM images showed that the mean diameters of blend nano-fibers were ranged from 80 to 60 nm. The release profile of the nicotinamide was demonstrated. Release profile of the uncrosslinked and crosslinked mats were demonstred. Immortalized human skin fibroblasts cells were used to examine the biocompatibility of the produced HEC/PVA/ nicotinamide electrospun mats.

Effect of intranasal steroids on adenoid hypertrophy in children: a meta-analysis study

Objectives: adenoid hypertrophy [AH] remains the commonest cause of obstructive sleep apnea syndrome in children. Enlarged adenoids may also obstruct the Eustachian tube orifice, which can result in temporary conductive hearing loss. The presence of fluid in the middle ear [otitis media with effusion] is frequently associated with adenoidal hypertrophy and suggests Eustachian tube dysfunction. Surgical treatment is indicated in severe forms. However there are some limitations for surgery as the main route of therapy, e.g. in cleft palate adenoidectomy may lead to velopharyngeal incomptence or in bleeding tendency there is risk of hemorrhage after surgery. In such instances surgical procedure could be replaced by non surgical methods. Intranasal steroids treatment have been proposed to reduce adenoid size and, consequently, to improve the clinical picture of pediatric patients affected by adenoid hypertrophy

Study design: meta-analysis review of literatures

Methods: searching at the pub-med [Medline database] for articles including the following key words: Intranasal steroids in adenoid hypertrophy. Efficacy of Intranasal steroids in treatment of AH. The included articles were 7 articles fulfilled the inclusion criteria

Data collection: the data collected from the chosen 7 articles. Data analysis: data analysis was performed utilizing meta-analytic review manger [RevManS] software

Conclusion: the results show a significant difference between patients receiving Intranasal steroids and patients receiving placebo. Nasal administration of steroids is safe, reproducible, easily performed, and well tolerated by pediatric patients. So, from these findings, it is concluded that Intranasal steroids therapy is effective in treatment of Adenoid Hypertrophy in children

Controlled Release of Drugs from Cellulosic Wound Bandage Using Silica Microsphere as Drug Encapsulator Module.

Controlled-drug-releasing materials show promising applications in medicinal bandages. In addition, one could incorporate drugs to make such bandages more versatile. During this context, silica microparticles were synthesized, during presence of different drugs namely sodium diclofenac, linoleic acid and recienoleic acid. The morphological characterization shows formation of monodispersed, silica microparticles. FT-IR spectroscopy provided the interaction of the drug molecule at its hydroxide (OH) site with oxygen ions on the silica surface. UV–vis spectroscopy showed persistence of the different drugs signature, especially its R group, confirming its antimicrobial activity even after conjugation. Using zone-of-inhibition studies, the antimicrobial studies were done on two microorganisms, namely, Staphylococcus aureus and Escherichia coli. However, the encapsulator module showed controlled release of all drugs for the duration of 48 h. This work demonstrated an effective protocol to prepare antimicrobial patches for controlled drug delivery.

Biomaterials Based on Essential Fatty Acids and Carbohydrates for Chronic Wounds.

Chronic wounds such as decubitus ulcer remain challenging due to their integrated and overlapping phases. The matrix metalloproteinases (MMPs) enzymes, whose main function is to degrade all kinds of extracellular matrix (ECM) proteins, aid cellular migration and extracellular remodeling. MMPs, in the wound bed, allow the lysis of the dead tissues, by which the macrophages task becomes easier to digest the dead cells. MMPs activities should be monitored and inhibited as the healing process proceeds. If MMPs are not inhibited in time, they will break down tissue to attack the ECM itself creating chronic wounds. In the current work, conjugated linoleic acid (CLA) and ricinoleic acid (RA) are extracted from commercial oils as MMPs inhibitors. A pharmaceutical carrier is formulated containing chitosan fine particles, impregnated silver nanoparticles into microcrystalline cellulose, CLA and RA. Carrier and the active ingredients were prepared and characterized by spectral and morphological analysis. The final formulation was examined for antimicrobial, cytotoxicity, and in-vivo wound healing activity. Results showed a strong inhibitory activity against the tested pathogenic microorganisms for the silver contacting samples. The rates of wound closures during wound healing in diabetic male-rats of formulas containing ricinoleic acid was faster than that containing conjugated linoleic acid.

An audit of febrile neutropenia cases from a rural cancer center in India.

BACKGROUND: Data of febrile neutropenia (FN) from rural cancer centers is sparse. We did a audit of outcome of patients with FN in the period of March 2013‑August 2013. The aim was to help us to develop rational antibiotic usage policies. MATERIALS AND METHODS: Retrospective analysis of all consecutive patients presenting with FN. Data regarding demographic profile, tumor type, intent of treatment, chemotherapy regimen, blood culture susceptibility details, use of antibiotics, response to antibiotics and complications of FN were noted. SPSS (Statistical Product and Service Solutions) 16 was used for analysis. RESULTS: 67 patients had FN and there were 91 episodes. The median day of presentation with FN after start of chemotherapy was 10 days. The nadir absolute neutrophil count was 161.5 and nadir platelet count 1,00,000. The median multinational association for supportive care in cancer (MASCC) Score was 24. In accordance with MASCC there were 27 high risk FN and 64 low risk FN episodes. On multivariate analysis using logistic regression MASCC score strata was the only significant variable that predicted failure to 1st line antibiotics (P = 0.03) and mortality (P = 0.01). Nine patients (9.9%) had positive isolates on blood cultures. The blood culture isolates were predominantly Gram negative (66.7%). CONCLUSION: The importance of developing local guidelines for rational antibiotic usage is highlighted.

Laparoscopic Versus Open Appendicectomy: A Comparison of Primary Outcome.

Currently, laparoscopic appendectomy is widely practiced for the management of acute appendicitis. It is not clear whether open or laparoscopic appendectomy is more appropriate. Our aim was to compare the safety and the advantages of laparoscopic versus open appendectomy in a prospective study. 102 patients were participated in this study. The group 1 patients were subjected to laparoscopic appendectomy [LA], whereas the group 2 patients were subjected to open appendectomy [OA]. 46 patients included in LA group and 54 patients in OA group. The mean operative time for LA and OA was 84.4 (45-220) minutes and 59 (30-180) minutes respectively. Although LA was associated with a shorter hospital stay [LA-3.5 days versus OA-5 days] but duration of operation is prolong in LA than OA and the postoperative wound infection is significantly higher in OA than LA. LA is safe and superior to OA in respect to an early discharge, lesser postoperative pain; decreased post operative wound infection, early return to work and a better cosmetic scar.

Awareness of Tadika’s (Kindergarten) Children towards Healthy Lifestyle in Kuala Terengganu, Malaysia.

Health is a common need for every human being. Six point six (6.6) million children under the age of five died in 2012. These child deaths are due to conditions that could be prevented or treated with access to simple and cheap interventions. Leading causes of death in under-five children are pneumonia, preterm birth complications, birth asphyxia, diarrhoea and malaria. School is the primary place of awareness and actually education enlighten people to practice safe-lifestyle. Therefore, World Health Organisation (WHO) launched in 1995 a Global School Health Initiative to incorporate health education in schools for children. Therefore, the current study was conducted with objective is to identify children’s awareness towards healthy lifestyle in the aspects of eating behavior, personal hygiene and physical activities. The specific objectives are: to evaluate the awareness level of children towards healthy lifestyle; to identify the attitude level of children in practicing healthy lifestyle; to document and correlate the level of awareness and attitude of children in practicing healthy lifestyle. Current study is a cross sectional study and conducted among children of a kindergarten named Tadika Nurul Iman As- Siddiq, Malaysia. Present study population was 60 children. All the students are Malay in race and religion is Islam. Sixty-eight percent of kids are familiar with the types of food to stay healthy. They also agreed (78%) that knowledge of healthy food is important. Proper authority should take initiative to conduct prospective research. Therefore necessary measures and interventions can be initiative in very early to have healthier Malaysian national.

Incidence of blaNDM-1 gene in Escherichia coli isolates at a tertiary care referral hospital in Northeast India.

Purpose: Increasing reports on New Delhi metallo-β-lactamase-1 (NDM-1) producing Escherichia coli constitute a serious threat to global health since it is found to be highly resistant to most of the currently available antibiotics including carbapenems. This study has been performed to find out the incidence blaNDM-1 in E. coli isolates recovered from the various clinical samples at a tertiary care referral hospital in Northeast India. Materials and Methods: A total of 270 non-duplicated E. coli isolates were recovered from the various clinical samples at a tertiary care referral hospital in Northeast India. All isolates with reduced susceptibility to meropenem or ertapenem (diameter of zones of inhibition, ≤21 mm) were further phenotypically confirmed for carbapenemase production by modified Hodge test. All screened isolates were also subjected to the polymerase chain reaction detection of blaNDM-1 gene and additional bla genes coding for transmission electron microscopy, SHV, CTX-M, and AmpC. Results: Out of 270 E. coli isolates, 14 were screened for carbapenemase production on the basis of their reduced susceptibility to meropenem or ertapenem. All screened isolates were found to be positive for blaNDM-1 . Each of the blaNDM-1 possessing isolate was also positive for two or more additional bla genes, such as blaTEM , blaCTX-M and blaAmpC . Phylogenetic analysis showed very less variation in blaNDM-1 gene with respect to blaNDM-1 possessing E. coli isolates from other parts of India and abroad. Conclusions: Our findings highlight the incidence of blaNDM-1 in E. coli isolates with a reduced susceptibility to meropenem or ertapenem.

On some generalized discrete logistic maps

Recently, conventional logistic maps have been used in different vital applications like modeling and security. However, unfortunately the conventional logistic maps can tolerate only one changeable parameter. In this paper, three different generalized logistic maps are introduced with arbitrary powers which can be reduced to the conventional logistic map. The added parameter [arbitrary power] increases the degree of freedom of each map and gives us a versatile response that can fit many applications. Therefore, the conventional logistic map is considered only a special case from each proposed map. This new parameter increases the flexibility of the system, and illustrates the performance of the conventional system within any required neighborhood. Many cases will be illustrated showing the effect of the arbitrary power and the equation parameter on the number of equilibrium points, their locations, stability conditions, and bifurcation diagrams up to the chaotic behavior

Effect of intravenous dexmedetomidine infusion on some proinflammatory cytokines, stress hormones and recovery profile in major abdominal surgery

This study was designed to evaluate the effect of intravenous dexmedetomidine infusion in patients undergoing major abdominal surgery on stress response markers as plasma interleukin-6, cortisol and blood glucose level. It also assessed its effect on recovery profile and postoperative pain. Thirty adult ASA I-III patients admitted to the surgery department of the Alexandria Main University Hospital scheduled for elective major abdominal surgery under general anaesthesia were included. They were randomly classified into two equal groups of 15 patients each, dexmedetomidine group [Group D] received intravenous dexmedetomidine infusion and placebo group [Group P] received intravenous infusion of normal saline. Haemodynamic parameters were recorded intra- and postoperatively. Interleukin-6, cortisol and blood glucose levels were measured. Recovery profile, postoperative pain score and analgesic requirement postoperatively were assessed. Heart rate and mean arterial pressure were significantly lower in group D relative to group P during most of the intra- and postoperative periods. Postoperatively, the levels of interleukin-6, cortisol and blood glucose were significantly lower in group D relative to group P. Recovery time was longer in group D than group P but with no significant difference. Postoperative pain score was significantly less in group D relative to group P during the early postoperative period with smaller amount of analgesic requirements in group D. Dexmedetomidine is safe and effective in blunting the postoperative rise of the proinflammatory cytokine interleukin-6 and resulted in lower levels of markers of stress response to surgery as cortisol and blood glucose. Dexmedetomidine also reduces the postoperative pain score without delaying recovery from anaesthesia

The Prevalence of Multi-Drug Resistance-1 Gene of Plasmodium Falciparum Malaria in Gezira State-Central Sudan

Abstract:Malaria parasite resistance to chloroquine poses a severe and increasing health problem in tropical countries. Implementing molecular markers for monitoring the drug resistance may be essential to overcome the problem. The aim of the present study is to investigate the prevalence of multi-drug resistance of p. falciparum parasite in malaria patients. Blood samples for DNA extraction were collected from the positive malaria patients. The prevalence of mutations in P. falciparum multi-drug resistant gene-1 (pfmdr-1) was detected by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) methods. Approximately; 74.1 of study populations are adults and 25.9 are children. Regression analysis shows a decrease in malaria incidence with increasing age. The prevalence of malaria is higher in males (58.6) compared to females (41.4). There were no statistical differences between malaria incidence and the socioeconomic level within the study population. The frequency of homozygous N/86 and Y/86 alleles were 51.7 and 37.9; respectively; and the heterozygous N/Y86 allele was 10.3.In conclusion the frequency of Pfmdr-1 N/Y86 allele among P. falciparum multi-drug resistant isolates support the hypothesis that Pfmdr-1 N/Y86 allele could be used as predictive marker to monitor multi-drug susceptibility in epidemiological surveys

Childhood's acute toxicity pattern at the poisoning treatment unit, zagazig university hospitals, from January 2009 to august 2010 a retrospective study

Acute poisoning represents one of the most common medical emergencies in childhood. Poisoning patterns change according to age group, type of exposure and the nature and dose of the poison. This study's objective is to understand the pattern of childhood poisoning in the poisoning treatment unit, Zagazig University Hospitals and to compare these results with those of other countries. retrospective descriptive study. Poisoning treatment Unit, Faculty of Medicine, Zagazig University Hospitals during the period from January 2009 to August 2010. All children 12 years old and below. 304 poisoned children were enrolled in this study. 1.6% of the cases involved children below 1 year old. 81% of the cases were between 1-6 years. Children between 7-12 years composed 17.4% of the cases. In all age groups more male cases [57%] were found as compared to female cases [43%]. 32% of the poisoned cases were living in Zagazig city while 68% were living in the suburban. In 90.5% of the cases, the accident happened at home while in 9.5% of cases, the accident occurred outside the home. 99.4% of the cases were accidental. The oral route was involved in 72% of the cases. The presenting symptoms were classic in 70% of the cases. 10.2% of the cases were admitted to the Intensive Care Unit. 3.6% were discharged against medical advice. In 86.2% of the cases, observation with or without supportive measures together with decontamination and antidotal therapy whenever needed were sufficient. Pesticide poisoning constituted 28.6% of the total cases. Petroleum products were implicated in 13.15% of the cases. Cleaning and disinfectant agents were the culprits in 17.1% of the cases. Therapeutic drugs constituted 22.9% of the causes of poisoning. Carbon monoxide poisoning was detected in 1.64% of the cases. Natural poisoning was detected in 7.89% of the cases. Conclusion: Our study showed that a relatively large proportion of the visits to the poisoning treatment unit were done by children between 1 and 6 years and that pesticide especially organophosphorus insecticide were the most incriminated agents. Good supportive care is the cornerstone of management for childhood poisoning. We need to reorganize the data collection and use modern techniques of information technology. Public health authorities can adopt the results as the basis for designing prevention measures for different age groups in the population

Effect of benzene extract of Ocimum sanctum leaves on cauda epididymal spermatozoa of rats

Recent studies have shown that benzene extract of Ocimum sanctum [O. sanctum] leaves induces the ultrastructural changes in the epithelial cells of the cauda epididymis, its subsequent recovery in the seminiferous epithelium and fertility of male albino rats. Our aim was to investigate the effect of benzene extract of O.sanctum leaves on the cauda epididymal sperm parameters, morphology and their organelles at the ultrastructural level in albino rats. Wistar male rats [n=20] were allocated into two groups of control [n=10] and test group [n=10]. The test group received benzene extract of O.sanctum leaves [250mg/kg/day] for 48 consequence days. Five animals from each group were used for fertility test. Twenty-four hours after the last dose, the rest of the control [n=5] and treated [n=5] animals were sacrificed by cervical dislocation and then the cauda epididymal plasma was used for sperm analysis, scanning electron microscopy [SEM] and transmission electron microscopic [TEM] studies. Sperm analysis of test group exhibited significant [p

Prevalence and risk factors for colonisation with extended spectrum β-lactamase producing enterobacteriacae vis-à-vis usage of antimicrobials.

Purpose: A point prevalence study was carried out in a teaching hospital in Assam to determine the prevalence, sensitivity profile and risk factors for acquisition of extended spectrum β-lactamase (ESBL) producing enterobacteriacae vis-ΰ-vis amount and pattern of antibiotic use. Materials and Methods: ESBL was detected by double disc synergy method. Defined daily dose and bed-days were calculated. Result: Colonisation rate of ESBL producing enterobacteriacae ranged from 14% (n=73) in medicine to the highest 41% (n=29) in orthopaedic with an intermediate 23% (n=80) in surgery. Presence of ESBL was found to be strongly associated with resistance to specific classes of antimicrobials. Exposure to cefotaxime and gentamicin, and surgery were risk factors for acquiring ESBL producing enterobacteriacae. Non-ESBL producing community isolates were found to be considerably more sensitive to different antibiotics with no resistance detected to trimethoprim, co-trimoxazole, ciprofloxacin and aminoglycosides. Conclusion: The study confirms the role of certain 'high risk' antimicrobials in acquisition of ESBL producing Enterobacteriaceae and shows that periodic cohort studies could be an effective strategy in surveillance of antimicrobial resistance in hospitals of resource poor countries to inform antibiotic policy and treatment guidelines.

Characterisation of methicillin resistant S. aureus strains and risk factors for acquisition in a teaching hospital in northeast India.

Purpose: A point prevalence study was carried out in a teaching hospital in Assam to characterise S. aureus strains, establish the rate of colonisation of methicillin resistant S. aureus (MRSA) and associated risk factors for its acquisition. Materials and Methods: Antibiogram-Resistogram profile was done by BSAC standardized disc sensitivity method; Phage and RFLP typing were carried out by the PHLS, London. Results: Single MRSA strain resistant to multiple classes of anti-staphylococcal antibiotics dominated the hospital. The MRSA colonisation rate was found to be 34% (n=29) and 18% (n=80) in orthopaedics and surgery, respectively and only ~1% (n=73) in the medical units. Exposure to ciprofloxacin and surgery were risk factors but duration of hospital stay was not. In contrast, meticillin sensitive S. aureus (MSSA) strains were usually distinct strains and sensitive to most of the anti-staphylococcal antibiotics including 18% to penicillin. Conclusions: The MRSA strain prevalent in the hospital phenotypically resembles the predominant Asian strain viz., Brazilian/Hungarian strains (CC8-MRSA-III). Duration was not a risk factor, which suggests that in absence of exposure to specific antimicrobials, even in a hospital with no or little infection control intervention, a vast majority remain free from MRSA. This underlines the importance of rational prescribing empirical antibiotics.