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Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.
ABSTRACT
Background :Low End diastolic velocity of common carotid artery is potential hemodynamic marker of intracranial resistance and associated with ischemic stroke.Abstracts:Aim:Assessment of Common carotid artery end diastolic velocity , a hemodynamic parameter, with the future risk for development of Cerebrovascular stroke .In order to assess common carotid artery end diastolic velocity , we have evaluated age, BMI, W/H , blood pressure , lipid profile and HbA1c in CV Stroke and control subjects.Material method: The present study was conducted on 30 CV Stroke patients(GroupA) and 30 non stroke hypertensiveand diabeticpatients (Group B) . CCA End diastolic velocity was assessed in each group by Doppler ultrasound machine. BMI and W/H was measured according to WHO protocol. Blood pressure was measured by sphygmomanometer.Lipid profile and HbA1cwas done by autoanalyser machine . Result :CCA End diastolic velocity in Group A and group B was found to be10.49±6.02&17.70±4.18 and12.59±3.47 &21.47±5.21in right and left side respectively. The data was highly significant (p<0.0001).Age in Group Aand B was found to be 62.8±9.11 and 53.87±10.06respectively (p=0.0007). BMI in Group A and Group B was found to be 27.93±3.24 and 28.52±3.87 respectively (p=0.5245).W/H in Group A and Group B was 0.88±0.042 and 0.89±0.04 respectively (p=0.3489). Systolic and diastolic blood pressure in both the groups was found to be 148.02±14.77& 138.93±7.04and 88.33±5.97 & 84.53 ±5.75which was statisticallysignificant with p value 0.003and 0.014 respectively. The difference between mean of two groups for HbA1c ,HDL , LDL ,triglycerideand total cholesterolin both the groups were8.61±0.84& 7.47±0.56, 38.7±5.42 & 49.91±8.333, 143.37±6.25 &113.63±17.42, 136.63±12.11&201.9±55.26 ,226.37±8.006 &202.4±22.08respectivelywhich was statistically very significant(p<0.0001). Conclusion: Carotid hemodynamic alterations expressed in Common Carotid Artery End diastolic velocity should be screened for future riskfor development of CV stroke in hypertensiveand diabetic patients with advance age. These findings need to be confirmed by a prospective study.
ABSTRACT
Papanicolaou (Pap) staining procedure has achieved worldwide acceptance in cytology practice due to its crisp cytological details. There are many centres or private laboratories in our country which cannot fulfill the economic requirement of Pap staining and hence employ comparatively cheaper haematoxylin and eosin (H & E) stain. Although routine H & E cannot replace Pap, this study is an attempt to modify H & E staining that would offer comparable diagnostic results. The present study is restricted to FNAC material from palpable lesions i.e.breast and lymph nodes. For this purpose 50 lymph nodes ( LN) and 18 breasts were aspirated. Out of two fixed smears, 1 was stained by Pap technique for routine reporting and other by modified H & E method which was examined and reported by other pathologist, Dr.Sangeeta B.Desai ( SBD) The diagnosis of both the techniques were compared. Emphasis was also given on cytomorphological characteristics. Out of fifty lymph node aspirates from various sites, no diagnostic discrepancy was observed in 46 cases. Three out of 4 had sampling errors whereas, poor nuclear staining was noticed in a single case. Out of eighteen breast aspirates concordant diagnosis was achieved in 16 cases. Out of two discrepant diagnosis 1 was due to sampling error, and the other was an interpretative error. All the cases were confirmed histologically. In conclusion, modified H & E staining is useful for common sites of aspirations of superficial lesions.