Assessment of core capacities for antimicrobial stewardship practices in indian hospitals: Report from a multicentric initiative of global health security agenda

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.

Conjunctivo-limbal Autograft for Climatic Droplet Keratopathy with Ulcerative Keratitis: A Case Report.

Climatic droplet keratopathy (CDK) is one of the most frequent degenerative corneal diseases with high prevalence rates, especially in equatorial and polar regions. Th e profound hypoesthesia observed in some cases with advanced CDK may contribute to the occurrence of trophic-corneal ulceration, rapid bacterial over infection, diffi culty of healing and relentless evolution to perforation. Superfi cial keratectomy, lamellar or penetrating keratoplasty and excimer laser phototherapeutic keratectomy are various surgical options that have been tried in the management of CDK involving the visual axis, impairing the vision. We attempted conjunctivo-limbal autograft (CLAG) in a patient of advanced CDK with corneal ulceration and studied the outcome at the end of 6 weeks and found a better corneal epithelial regeneration post CLAG.

Effect of indoor air pollution during cooking on peak expiratory flow rate and its association with exposure index in rural women.

Routine exposure to domestic cooking fuels is an important source of indoor air pollution causing deterioration of lung function. We conducted a community based cross-sectional study in 760 non-smoking rural women involved in household cooking with four types of cooking fuels i.e. Biomass, Kerosene stove, Liquid Petroleum Gas (LPG) and Mixed (combination of two and more cooking fuels). Peak Expiratory Flow Rate (PEFR) less than 80% of the predicted was considered as abnormal PEFR. The overall prevalence of abnormal PEFR was found to be 29.1% with greater predominance among biomass fuel users (43.3%) with high risk ratio (1.86) as compared to kerosene (0.63), LPG (0.75) and mixed (0.66) fuel users. However the pair wise comparison of different groups of cooking fuels by Marascuilo procedure reported significant differences within different groups except kerosene - mixed group. The study also demonstrated a negative correlation between observed PEFR and exposure indices in different cooking fuels (r=–0.51). Our results indicate that prolonged exposure to cooking fuels particularly biomass fuels as a source of cooking adversely affects PEFR in nonsmoking rural women.

Evaluation and comparison of interleukin-8 (IL-8) level in gingival crevicular fluid in health and severity of periodontal disease: A clinico-biochemical study.

Background: Cytokines play an important role in the pathology associated with chronic inflammatory diseases. Because of pro-inflammatory and neutrophil chemotactic properties, the cytokines like interleukins (IL) may play a significant role in the pathogenesis of periodontitis. The biological effects of IL-8 are relevant in this regard. Aim: This study was done to compare the level of this molecule in gingival crevicular fluid (GCF) from patients with adult periodontitis (experimental group) and from individuals with clinically healthy gingival (control group). Materials and Methods: GCF was collected from patients with adult periodontitis and clinically healthy gingival for 30 s using a Periopaper strip and the volume of the sample determined. Following elution of the fluid, assays for IL-8 were carried out by enzyme-linked immunosorbent assay (ELISA). The concentration of IL-8 was calculated in the original volume of GCF on each strip. Results: The level of IL-8 in the experimental group was significantly higher than in the control group ( P < 0.01). The clinical parameters were positively correlated to IL-8, suggesting that the GCF IL-8 exhibited dynamic changes upon severity of periodontal disease ( P < 0.05). Conclusion: These data suggest that level of IL-8 is associated with periodontal status. The level of IL-8 in GCF is valuable in detecting the inflammation of periodontal tissue.

Amaranthus roxburghianus root extract in combination with piperine as a potential treatment of ulcerative colitis in mice / 中西医结合学报

<p><b>OBJECTIVE</b>The present work was undertaken to determine the effects of Amaranthus roxburghianus Nevski. (Amaranthaceae) root alone and in combination with piperine in treating ulcerative colitis (UC) in mice.</p><p><b>METHODS</b>Swiss albino mice were divided into seven groups (n = 6). Standard group received prednisolone (5 mg/kg, intraperitoneally). Treatment groups received hydroalcoholic extract of roots of A. roxburghianus (50 and 100 mg/kg, per oral) and a combination of hydroalcoholic extract of roots of A. roxburghianus (50 and 100 mg/kg, per oral) and piperine (5 mg/kg, per oral). Ulcer index, colitis severity, myeloperoxidase (MPO), malondialdehyde and glutathione were estimated from blood and tissue. Column chromatography of the extract was done and purified fractions were analyzed by gas chromatography-mass spectroscopy (GC-MS).</p><p><b>RESULTS</b>Treatment with the combination of hydroalcoholic extract of A. roxburghianus and piperine showed minimal ulceration, hemorrhage, necrosis and leucocyte infiltration by histopathological observation. Acetic acid increased MPO levels in blood and colon tissue to 355 U/mL and 385 U/mg, respectively. The combination of hydroalcoholic extract of A. roxburghianus (100 mg/kg) and piperine (5 mg/kg) significantly decreased MPO in blood and tissue to 182 U/mL and 193 U/mg, respectively (P < 0.05). Similarly, this combination significantly reduced malondialdehyde levels and increased glutathione levels in blood and tissue. Various phytoconstituents were detected by GC-MS.</p><p><b>CONCLUSION</b>The combination of hydroalcoholic extract of A. roxburghianus and piperine is effective in the treatment of UC and the effects are comparable with the standard drug prednisolone. 4H-pyran-4-one, 2,3-dihydro-3,5-dihydroxy-6-methyl, eugenol and benzene, and 1-(1,5-dimethyl-4-hexenyl)-4-methyl are reported having analgesic, anti-inflammatory, and antioxidant properties; they may play a role in the biological activity of A. roxburghianus root.</p>

Formulation and evaluation of telmisartan microspheres by emulsion solvent evaporation technique.

Microspheres are multi-component system provide constant and prolonged drug release. Furthermore their floating abilities increase gastric residence time. These properties reduce the gastrointestinal toxic effects and dosing frequency and thereby improve the patient compliance. The present study aimed to formulate and evaluate telmisartan microspheres. Emulsion solvent evaporation (ESE) technique was employed for microsphere preparation using different ratios of ethyl cellulose polymer and drug. Prepared microspheres were evaluated for drug entrapment efficiency, micromeritic characters, floating behaviour and in vitro drug release. This revealed polymer drug ratio has influence on drug release.

Phytopharmacological properties of coriander sativum as a potential medicinal tree: an overview.

Coriandrum Sativum family Umbelliferae is highly reputed ayurvedic medicinal tree commonly known as the Dhanyaka. It is small sized tree growing throughout India, Italy. Netherlands, Central and Eastern Europe, China and Bangladesh. The different parts of this plant contain monoterpenes, α-pinene, limpnene, γ-terpinene, p-cymene, borneol, citronellol, camphor, geraniol, coriandrin, dihydrocoriandrin, coriandronsA-E, flavonoids and essential oils. Various parts of this plant such as seed, leaves, flower and fruit, possess Diuretic, Antioxidant Activity, Ant-diabetic Anti-convulsant activity, Sedative Hypnotic Activity, Anti-microbial Activity, Anti mutagenic, Anthelmintic activity. Various phytopharmacological evaluations have been reported in this literature for the important potential of the Coriandrum sativum.

Experimental modeling of anxiety.

Anxiety has much impact on human as well as animal behaviors. For evaluation of anxiolytic drug require both clinical and biological aspect of anxiety. We review the existing experimental models of anxiety like elevated plus maze apparatus, light dark model, open field apparatus, holeborad apparatus in order to promote further understanding of neurobiological aspects of anxiety.

Evaluation of wound healing effect of petroleum ether and methanolic extract of Abelmoschus manihot (L.) Medik., Malvaceae, and Wrightia tinctoria R. Br., Apocynaceae, in rats / Avaliação do efeito de cicatrização dos extratos de éter de petróleo e metanol de Abelmoschus manihot (L.) Medik., Malvaceae, e Wrightia tinctoria R. Br., Apocynaceae, em ratos

In recent years, oxidative stress and free radicals have been implicated in impaired wound healing. Abelmoschus manihot (L.) Medik., Malvaceae, and Wrightia tinctoria R. Br., Apocynaceae, plants widely used in Ayurveda, possesses anti-inflammatory and antimicrobial properties. The present study was undertaken to assess the potential of petroleum ether and methanolic extracts in wound healing in Wistar albino rats. The rats were divided into six groups of six animals each. Group 1 is normal wounded control, group 2 received standard drug and the other four groups were treated with two different doses each of petroleum ether and methanolic extract of A. manihot and W. tinctoria. The wound healing parameters were evaluated by using incision wounds in extract-treated rats, standard and controls. Both the doses of petroleum ether and methanolic extract significantly increased wound breaking strength when compared with the control group.

Nos últimos anos, o estresse oxidativo e radicais livres têm sido implicados na cicatrização. Abelmoschus manihot (L.) Medik., Malvaceae e Wrightia tinctoria R. Br., Apocynaceae, plantas utilizadas na medicina Ayurveda, possuem propriedades antiinflamatórias e antimicrobianas. O presente estudo foi realizado para avaliar o potencial dos extratos de éter de petróleo e metanólico na cicatrização de feridas em ratos Wistar. Os ratos foram divididos em seis grupos com seis animais cada. O grupo 1 foi utilizado como controle, o grupo 2 recebeu a droga padrão e os outros quatro grupos foram tratados com duas doses diferentes de cada um dos extratos de A. manihot e W. tinctoria. Os parâmetros de cicatrização foram avaliados através da incisão feridas em ratos tratados com extrato, padrões e controles. Ambas as doses dos extratos de éter de petróleo e metanólico aumentaram significativamente força de ruptura da ferida quando comparados ao grupo controle.

Antihyperglycemic, antistress and nootropic activity of roots of Rubia cordifolia Linn.

Effect of alcoholic extract of roots of Rubia cordifolia was studied on elevated blood glucose level in alloxan treated animals. The extract reduced the blood sugar level raised by alloxan. Effect of alcoholic extract was also investigated on cold restraint induced stress and on scopolamine-induced memory impairment. Alcoholic extract enhanced brain gamma-amino-n-butyric acid (GABA) levels and decreased brain dopamine and plasma corticosterone levels. Acidity and ulcers caused due to cold restraint stress were inhibited by alcoholic extract. Animals treated with alcoholic extract spent more time in open arm in elevated plus maze model. It also antagonized scopolamine induced learning and memory impairment. Baclofen induced catatonia was potentiated by alcoholic extract.

Ecofriendly approach of urban solid waste management: a case study of Jalgaon city, Maharashtra.

In India, the traditional methods are used for urban solid waste management. These practices are associated with degradation of the urban environment Hence, an environmentally sound garbage management system is required for the urban waste management. The concept of waste minimization needs to be adopted in such systems. It is possible to implement certain corrective measures at collection, storage, transport and disposal of urban solid waste to minimize the adverse impacts on the environment The present investigations are emphasized on generation, characterzation and ecofriendly disposal of solid waste generated in Jalgaon city, Maharashtra. In the present study the waste generation at source was studied in the various income groups of the city. The per capita waste generation was studied by sampling the waste directly from the source of generation. The study reveals that the waste generation is large in the high-income group followed by middle and low-income group public. Further the physicochemical characterization of the waste was also studied. The data generated will help to develop environmentally sound and economically feasible solid waste management system for Ihe city.

Review article limb salvage surgery in bone tumours.

Wide resection of bone tumour has become an accepted treatment in the limb salvage surgery. The reconstruction of the residual defect following wide resection is a major problem. The motions of involved joint after resection of the large tumour can be restored by using either the osteoarticular allograft or endoprosthesis. Osteoarticular graft is suitable for proximal tibial reconstruction and endoprosthesis for distal femoral reconstruction. Resection arthrodesis can be done with autograft, cement or autoclaved tumour bone. Autograft is rarely used to reconstruct the large residual defect. Cement can reconstruct the larger defect, but it is not a suitable procedure on long term basis. The reimplantation of resected autoclaved tumour bone graft is technically a simple and financially a cost saving solution for this difficult problem. It is the most suitable method of reconstruction for the developing and poor countries where the resources for other methods are not available due to financial technical or socio-cultural reasons.