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Background : Measuring antimicrobial consumption is necessary to understand the volume and patterns of use, to design appropriate interventions to reduce and rationalize its use. Materials and Methods : The antimicrobial consumption in Neurology ICU and IPD were measured over a 5-year period using WHO Defined Daily Dose (DDD) methodology. Results : There was an increasing trend in Antimicrobial Consumption (AMC) from 125.7 to 155.5 DDDs/100 days over 5 years with highest consumption in 2017-2018 (190.7 DDDs). The consumption of Watch group of antibiotics was higher than access group antibiotics both in ICU and IPD and constituted more than 75% of total antibiotic consumption. Conclusions : The initiation of empiric therapy though may be necessary depending on the patients condition, however, duration of antibiotic therapy and reducing usage of prophylactic antibiotics for aspiration pneumonia and reducing consumption of Watch group of antibiotics were identified as stewardship opportunities. Feedback on AMC data and persuasive educational interventions to rationalize and reduce antimicrobial use are required.
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Antimicrobial resistance (AMR) is a burgeoning challenge of global priority, warranting immediate action to prevent the explosion of multidrug-resistant (MDR) pathogens. Indiscriminate antimicrobial use is the most important driver for AMR. AMR has led to depletion of the antibiotic pipeline and developing new antibiotics is extremely challenging due to technical and financial issues and also resistance emerges as soon any new antibiotic is introduced. At present, preserving the power of existing antibiotics by prudent use and curtailing spread of pathogens by infection prevention and control (biosecurity) in both humans and animals are the best available options to defer AMR crisis. Meanwhile, to reduce dependence on antibiotics, other alternatives such as vaccines, antibodies, pattern recognition receptors, probiotics, bacteriophages, peptides, phytochemicals, metals, and antimicrobial enzymes are being explored. This review provides an overview of various promising, potential and under investigative strategies as alternatives to antibiotics.
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Background: Anaemia in pregnancy is a universal health problem that may cause a number of obstetrical and neonatal complications. This prospective observational study aims to evaluate and compare maternal and neonatal outcomes in different grades of anaemia severity.Methods: A total of 400 pregnant women with anaemia in third trimester were classified into three groups according to haemoglobin (Hb) levels-group I with Hb:10-10.9 g/dl, group II with Hb:7-9.9g/dl and group III with Hb<7 g/dl. Maternal and neonatal outcomes of women with different severity of anaemia were analyzed and compared. Two groups means were compared by Student’s t-independent test and more than two groups means by one way analysis of variance test followed by post-hoc pairwise comparison using Bonferroni test.Results: The prevalence of anaemia in the study population was 35.2%. Mild, moderate and severe anaemia were found in 58% (n=232), 29.0% (n=116) and 13% (n=52) women respectively. A statistically significant difference in maternal outcomes such as Preterm labor (p=0.001), Prelabor premature rupture of membranes (p=0.044), Intrauterine growth restriction (p=0.002) and postpartum hemorrhage (p=0.001) was observed amongst the three groups. Cardiac failure occurred in 26.9% (n=14) and mortality in 13.4% (n=7) women with severe anaemia. Amongst the neonatal morbidities, the rate of low birth weight, preterm birth, respiratory distress syndrome, septicaemia, pneumonitis and jaundice revealed an increasing trend with rising severity of anaemia which was statistically significant.Conclusions: Targeted interventions addressing early detection and appropriate treatment in early pregnancy can prevent and avoid dismal maternal and neonatal consequences.
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Brenner tumors are rare ovarian tumors, which are a subgroup of transitional cell tumors of ovary. Most of these tumors are benign presenting as incidental unilateral masses in postmenopausal age group. Only 5-7% cases are bilateral. These tumors are mostly small, solid and asymptomatic, seen commonly in association with mucinous cystadenomas of ovary. In such cases they may attain a massive size. Specific diagnosis of Brenner tumor is difficult using imaging studies and can be definitely diagnosed only on pathological examination. Surgical removal is usually curative for benign tumors. We present a rare case of bilateral Brenner tumor of ovary with associated unilateral mucinous cystadenoma in which bilateral Brenner tumor was a rare incidental finding on pathological examinatio
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AIM: To evaluate and compare subjective and objectively, the course of surgically induced dry eye following both phacoemulsification ( PKE ) and manual-small incision cataract surgery ( SlCS) procedure, and to analyze the result in terms of causative factors. ●METHODS:This single centre prospective study included 100 eyes of 100 patients randomly divided into two groups (Group 1, SlCS-50 patients; Group 2, PKE-50 patients), who underwent cataract surgery with intraocular lens ( lOL)-implantation from Jun. 2013 to Dec. 2014 for a period of one and half year by single surgeon. Ln all patients post operative course of dry eye were tabulated and assessed at 1, 4, 12wk, subjectively and objectively, and thereafter analyzed in terms of possible causative factors. Statistical data were calculated using SPSS 23. 0 Windows software. RESULTS: There was no significant preoperative intergroup difference in subjective and objective dry eye test (DET) values (P>0. 05). Both the groups showed similar trend of persistently declining objective DET -values till at the end 12wk, as compared to their respective preoperative values (P0. 05). PKE seems to have better subjective DET-value at the end of 12wk. ●CONCLUSlON:Dry eye disease is inevitable following cataract surgery. Both PKE and SlCS, can affect the dry eye test values in almost similar manner post operatively till up to 12wk. Randomized multicentre trial with larger cohort and longer follow-up is warranted to substantiate our findings.
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Aims: To evaluate GenoType® MTBDRplus line probe assay as a diagnostic tool for detection of Mycobacterium tuberculosis and drug susceptibility testing from cerebrospinal fluid of probable tuberculous meningitis patients. Study Design: A prospective, double blind study. Place and Duration of study: Dept. of Microbiology and Neurology, Institute of Human Behavior and Allied sciences, Delhi, India between February 2014 to October 2014. Methodology: Cerebrospinal fluid collected from 107 probable meningitis patients with diagnostic score >10 were subjected to smear microscopy, automated liquid culture (BACTEC MGIT 960) and Polymerase chain reaction (IS6110). All the samples were also subjected to GenoType® MTBDRplus line probe assay for detecting M. tuberculosis and drug susceptibility. Drug susceptibility testing of all the M. tuberculosis isolates was done by BACTEC MGIT 960 and GenoType® MTBDRplus line probe assay. Results: The sensitivity, specificity of the assay for M. tuberculosis detection was 49.5%, 100% against clinical diagnosis as reference standard and 68.9%, 100% against definitive diagnosis as reference standard. A diagnostic accuracy of 56.8% (kappa 0.22), 75% (kappa 0.46), were seen in patients with probable and confirmed diagnosis respectively. The drug susceptibility results for Isoniazid and Rifampicin could be delineated in only 39.2% of patients. Conclusion: This assay proved to have better sensitivity, diagnostic accuracy than smear microscopy and automated liquid culture for early detection of M. tuberculosis from probable tuberculous meningitis patients and has comparable sensitivity to culture (39.2%) for detection of drug susceptibility (though on different isolates). Rapid turnaround time and user friendliness makes it an acceptable assay for simultaneous early detection of M. tuberculosis and its drug susceptibility for better patient management.
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Fetal Kidney Length (FKL) is most accurate single parameter for estimating GA than other biometric indices in late 2nd and 3rd trimester and could be easily incorporated into the models for estimating GA. We evaluated role of FKL in estimation of gestational age (GA) in late 2nd & 3rd trimester. A total of 98 pregnant women with singleton pregnancy underwent serial biometric & FKL measurements ultrasonographically at 24, 28, 32, 36 and 38 weeks of gestation. These measurements were used to date the pregnancies relative to dating by last menstrual period. Linear regression models for estimation of GA were derived from the biometric indices and FKL. New models were constructed by combining different biometric indices and kidney length in various combinations. Comparison of accuracy in prediction of GA was made between individual parameters and these models to obtain best individual parameter and the best model in prediction of gestational age. Left FKL was slightly, but significantly longer than right FKL at each gestational period observed in the study. Standard error of prediction of GA was least for FKL (±8.56 days), closely followed by femur length (±8.9 days) and maximum for abdominal circumference (±11.72 days). The best model in estimating GA included all the five variables (femur length, FKL, biparietal diameter, head and abdominal circumference) with a standard error of ±7.41 days. FKL is the most accurate single parameter for estimating GA than other biometric indices in late 2nd and 3rd trimester and could be easily incorporated into the models for estimating GA.
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Background & objectives: Emergence of multi-drug resistant (MDR) and extensively-drug resistant (XDR) strains of Mycobacterium tuberculosis has further complicated the problem of tuberculosis (TB) control. Medicinal plants offer a hope for developing alternate medicines for the treatment of TB. The present study was done to evaluate in vitro anti-tubercular activity of five medicinal plants viz., Acalypha indica, Adhatoda vasica, Allium cepa, Allium sativum and Aloe vera. Methods: Aqueous extracts of leaves of A. indica, A. vasica, bulbs of A. cepa, cloves of A. sativum and pure gel of A. vera leaves, were tested in vitro for their activity against two MDR isolates (DKU-156 and JAL-1236), reference susceptible strain M. tuberculosis H37Rv as well as rapid grower mycobacterial pathogen M. fortuitum (TMC-1529) using Lowenstein Jensen (L-J) medium and colorimetric BacT/ALERT 3D system. Activity in L-J medium was evaluated by percentage inhibition which was calculated by mean reduction in number of colonies on extract containing as compared to extract free controls. Results: Extracts of all the five plants A. indica, A. vasica, A. cepa, A. sativum and A. vera exhibited anti-tuberculosis activity in L-J medium, the proportion of inhibition of these plants extract in respect mentioned above is 95, 32, 37, 72, 32 per cent, respectively for MDR isolate DKU-156 and 68, 86, 79, 72, 85 per cent, respectively for another MDR isolate JAL-1236, while for sensitive M. tuberculosis H37Rv, inhibition was found to be 68, 70, 35, 63 and 41 per cent, at 4 per cent v/v concentration in L-J medium. There was no inhibition against rapid grower M. fortuitum (TMC-1529). In BacT/ALERT also, extracts of these plants showed significant inhibition against M. tuberculosis. Interpretation & conclusions: Our findings showed that all these plants exhibited activity against MDR isolates of M. tuberculosis. While the anti-TB activity of A. vera, A. vasica and A. sativum against MDR isolates confirm earlier results, activity of the extracts of A. indica and A. cepa is reported for the first time. Further studies aimed at isolation and identification of active substances from the extracts which exhibited promising activities, need to be carried out.
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Género Justicia/química , Aloe/química , Antituberculosos/uso terapéutico , Tuberculosis Extensivamente Resistente a Drogas/tratamiento farmacológico , Ajo/química , Humanos , Pruebas de Sensibilidad Microbiana , Cebollas/química , Extractos Vegetales/uso terapéutico , Plantas Medicinales/química , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológicoRESUMEN
Mullerian Duct abnormalities cause various congenital malformations in the female genital tract. These abnormalities have variable effects on pregnancy and its out come. Uterus didelphys and uterus pseudodidelphys are two extreme forms of these abnormalities which are rarely encountered in obstetrical practice. A young primigravida reported in labour and because of duplication of genital tract there was difficulty in the determination of stage of labour as well as diagnosis of labour. There was also problem associated with progress of labour and operative delivery. Same patient on a subsequent pregnancy reported with complications associated with presentation of foetus as well as preterm labour. This poses a diagnostic dialemma during labour. The insight into such an event can make us alert in diagnosis during such rare obstetrical encounters.
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We report a 38 week old female fetus affected by Meckel-Gruber syndrome. Polycystic dysplastic kidneys, oligohydroamnios, symmetrical IUGR, hydrocephalus with Dandy-Walker cyst was observed on ultrasonographic (USG) examination. Small occipital encephalocele with polydactly was noted after delivery of child.