Bactericidal Effect of Selenium Nanoparticles Combined with Povidone-iodine on Pathogenic Bacteria in Surgical Site Infection / 中山大学学报(医学科学版)

ObjectiveTo investigate the bactericidal effect of loaded multifunctional povidoneiodine-nanometer selenium （PVP-I@Se） disinfectant on Staphylococcus aureus （SA） and methicillin-resistant Staphylococcus aureus （MRSA）， and to provide an experimental basis for the reduction of surgical site infection （SSI）. MethodsThe control group was the povidone iodine （PVP-I） group with different concentrations of iodine （50， 75， 100， 200 and 400 μg/mL）. The PVP-I@Se group （experimental group） was the PVP-I group further supplemented with 2 μg/mL Selenium nanoparticles （SeNPs）. Then we compared the bactericidal effect of the two groups of disinfectant solutions on SA and MRSA by examining the minimum inhibitory concentration （MIC）， minimum bactericidal concentration （MBC）， the shortest sterilization time at a concentration of 50 μg/mL iodine and the inhibition zone diameters at concentrations of 200 μg/mL and 400 μg/mL iodine. ResultsMIC values of PVP-I against SA and MRSA were both 79.17 μg/mL， and those of PVP-I@Se were 54.17 and 70.83 μg/mL， respectively. MBC values of PVP-I against SA and MRSA were 129.17 and 150.00 μg/mL， respectively， and those of PVP-I@Se were 70.83 and 87.50 μg/mL， respectively. At a concentration of 50 μg/mL iodine， the shortest sterilization time of PVP-I for SA and MRSA was 130 s and 140 s， respectively， and that of PVP-I@Se was 65 s and 75 s， respectively. At a concentration of 200 μg/ml iodine， the inhibition zone diameters of PVP-I for SA and MRSA were 7.67 mm and 8.33 mm， and those of PVP-I@Se were both 9.50 mm. At a concentration of 400 μg/mL iodine， the inhibition zone diameters of PVP-I for SA and MRSA were 9.00 mm and 9.33 mm， and those of PVP-I@Se were 11.67 mm and 12.00 mm， respectively. ConclusionsPVP-I with different concentrations of 50， 75， 100， 200 and 400 μg/mL iodine supplemented with 2 μg/mL SeNPs have better and faster bactericidal effect on SA and MRSA. When combined with SeNPs， PVP-I can enhance the bactericidal activity against SA and MRSA， but with better sensitizing effect on SA than MRSA and higher demand of iodine concentration （400 μg/mL） for sensitizing effect on MRSA. This study provides a theoretical basis for selecting optimal concentration and action time of the disinfectant， thus reducing SSI.

An Observational Study of the Knowledge, Attitude and Practice of ADR Reporting among the Junior Doctors of Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal.

One of the health problems which is associated during the management of a patient with series of drugs is ADR/ADE. Therefore, the aim of the present study was to find out the activities for improving the reporting of ADRs/ADEs. The data on the KAP is collected on a pre-tested questionnaire.METHODSThis is a non-interventional cross-sectional study. The questionnaire was prepared after referring the questionnaires of previous studies. Out of 120 questionnaires distributed, only 100 questionnaires were received back. Descriptive statistics is used for analysing the data.RESULTSThe response on the questionnaire is 83.3%. Seventy-nine (79) participants knew the definition of ADR/ADE. Eighty-eight (88) participants want to report the ADRs of the marketed drugs irrespective of new or old. Seventy-five (75) participants know about PvPI. Ninety (90) participants do not consider all the OTC and Herbal drugs are safe. Seventy-two (72) participants do not know the establishment of a Pharmacovigilance centre at the Department of Pharmacology, JNIMS. Only 55.6% of the participants oblige to report the ADRs as a professional health care provider. 58% of the participants opine to conduct a regular CME program on ADR/Pharmacovigilance. 63.2% participants state that maximum ADRs are seen among dermatological, paediatric and elderly patients. 58.2% of the participants express their opinion about the occurrence of ADRs/ADEs with irrational prescription, polypharmacy, foods, drinks etc. 44% participants have the attitude of reporting ADRs/ADEs but only 10% participants perform the actual reporting with careful observations on patients’ behaviour. Most of the ADRs/ADEs are avoidable if there is good communication and reporting.CONCLUSIONSA regular awareness programme on ADR/ADE along with CME program and also online reporting facilities is necessary for promotion of reporting of the ADR/ADE. Therefore, the drug should be prescribed rationally, and polypharmacy should be avoided as much as possible.

A study on pattern of adverse drug reaction in an adverse drug reaction monitoring centre of a tertiary care hospital in South Kerala, India

Background: Adverse drug reactions (ADR) are rated as fifth leading cause of death and accounts for approximately 5% of all hospital admissions. Under reporting of ADR from healthcare professional is considered as the contributing factor for increased morbidity and mortality. India has taken well appreciated step to launch Pharmacovigilance Programme of India (PvPI) to safeguard heath care of Indian population. This study looks into the detailed analysis of ADR reported to adverse drug reaction monitoring centre (AMC), Government Medical College, Trivandrum to assess its pattern, causality, severity and seriousness of ADR. Primary objectives of this study are the pattern of adverse drug reactions reported to ADR monitoring centre (AMC) and secondary objective is to assess causality, severity.Methods: A record based descriptive study was conducted in the ADR monitoring centre of government medical college, Trivandrum, Kerala from September 1st 2016 to February 2017(6 months). The data were collected from the all reported case records/ ADR report form of CDSCO. The details of the various adverse drug reactions were identified and analysed to find the pattern of adverse drug reactions including distribution of age, gender, causal drug group, system organ class. Also, an attempt is made to do causality assessment using WHO UMC scale and severity by using Heart wig Seigel Scale.Results: Out of 320 ADR cases, majority of reports were due to cutaneous manifestations. Most common ADRs were erythema, induration, and rash, itching. Females were 56% and males were 44%. Majority cases were of adult age group. Causality 91.88% were probably related, 75.6% were mild reaction. 25% of cases were serious. 77.5% were recovered. Antibacterial implicated 25(7.8%) followed by anti-epileptics 24 (7.5%) ADR.Conclusions: The pattern of adverse drug reactions reported to this AMC is comparable to the studies done in other parts of country. A strong need for streamlining of ADR monitoring system and reporting reemphasized by this study, which will promote the ADR reporting in healthcare professionals.

Evaluation of trigger tool method for adverse drug reaction reporting by nursing staff at a tertiary care teaching hospital

Background: To sensitize nurses about Trigger Tool Method (TTM) and to evaluate the impact of TTM on adverse drug event (ADE) reporting by nurses at a tertiary care teaching hospital in India.Methods: This was prospective, interventional, single center study conducted among nursing health professionals of Civil Hospital Ahmedabad (CHA) posted in Medicine Department. They were sensitized about ADE reporting, pharmacovigilance, methods of ADRs reporting and details about TTM. Also, a list of 17 triggers was prepared by the investigator and given to nurses. They were educated to report ADEs using TTM. At the initiation and end of study, questionnaires were given to evaluate knowledge, attitude and practice of ADR reporting among participant nurses. All triggers and ADEs reported were analyzed in terms of association between them, effectiveness of trigger in detecting an ADR and in terms of Positive Predictive Value (PPV). Reported ADRs were also assessed for causality, severity and preventability.Results: A total 758 patients were admitted during the study period in the respective medicine department. List of 17 triggers consists of 9 drug triggers (DT), 1 laboratory trigger (LT) and 7 patient triggers (PT). Of these 17 triggers, 14 triggers were identified by nurses. These 14 triggers were noticed 130 times. These included DT (100 times), LT (0 times) and PT (30 times). Of the various triggers observed, 7 DT and 4 PT were related to ADRs. Hence, 11 triggers (64.70%) were positive (related to ADRs), out of 17 total triggers under evaluation. 21 ADRs were observed using TTM by nurses.Conclusions: The TTM helps to detect and report ADRs by nurses. Educational interventions about TTM help in better detection and reporting of ADRs.

Comparison of impact of undergraduate teaching program to assess the knowledge and attitude towards pharmacovigilance and adverse drug reporting among undergraduate medical students at a teaching medical institute in South India

Background: Pharmacovigilance has become an important tool to ensure the safety of patient in recent years. To ensure right practice of pharmacovigilance, proper understanding is very essential and the medical colleges with the undergraduate teaching program become a vital platform to educate and train the medical students towards pharmacovigilance. This study compares the impact of teaching program of the undergraduate curriculum in assessing the knowledge and attitude of the undergraduate medical students towards pharmacovigilance.Methods: The study includes 158 undergraduate medical students of second year being trained in pharmacology at Mysore Medical College. A validated and standardized questionnaire was distributed to all the students twice, once during their 3rd term (pre-sensitization) and the second time during their 5th term (post sensitization). Willingness to answer and complete the questionnaire was considered as consent.Results: The pre and post sensitization questionnaires were analyzed individually. A decrease from 114 to 90 students (15.19 % decrease) willing to complete the questionnaire was seen. The mean total knowledge score was 6.37±1.90 during the pre-test as compared to 6.35±1.78 in the post test analysis. An overall increase was seen with the knowledge of ADRs and pharmacovigilance. Only 18.4% knew of the presence of an ADR monitoring center in the institute pre-test which increased to 64.4% post sensitization. 81.6% answered rightly the type of ADRs that needs to be reported as compared to the 67.3% pre-sensitization. The overall attitude towards ADR reporting was seen to be in the right direction, with 71% saying that pharmacovigilance covered adequately in the curriculum. Voluntary reporting attitude increased from 74.6% to 88%. 70% of the students feel ADR reporting as a professional obligation, while only 54% felt so pre-sensitization.Conclusions: Pharmacovigilance should be included in the curriculum with more hours dedicated to teaching. Various interesting methods should be implemented to train and made aware of its importance to ensure patient safety on a global scale.

Efeitos do banho prévio, da tricotomia e da antissepsia na redução da contaminação do sítio cirúrgico em cadelas submetidas à OSH eletiva / Effects of the previous bath, trichotomy and antisepsis in reducing contamination of the surgical site in bitches undergoing elective OSH

O objetivo deste estudo foi analisar a influencia do banho 24 horas antes do procedimento cirúrgico e da tricotomia pré-operatória na redução da contagem microbiana da pele do campo operatório, bem como a eficiência antisséptica do gluconato de clorexidina 0,5% e da polivinilpirrolidona iodada 10% para antissepsia do sítio cirúrgico, verificando sua ação 4 minutos e 2 horas após aplicação. Utilizaram-se 20 cadelas hígidas, alocadas ao acaso em 2 grupos de 10 animais: os animais do Grupo I foram submetidos ao banho 24 horas antes do procedimento cirúrgico, enquanto os do Grupo II não passaram por este procedimento. Foram isolados diversos gêneros bacterianos antes e após o uso dos antissépticos. Significância estatística foi verificada entre os grupos quanto ao efeito do banho prévio à cirurgia, apenas 2 horas após a aplicação de clorexidina. A tricotomia reduziu 26,48% da carga microbiana nos animais do Grupo I e elevou a carga microbiana em 41,19% nos animais do Grupo II, revelando diferença estatística. Após o uso dos antissépticos, não foi observada diferença estatística entre os grupos em nenhum momento. Do mesmo modo, a comparação da eficiência dos antissépticos com ou sem banho, não revelou significância estatística. A polivinilpirrolidona iodada causou reação alérgica em 15% dos animais e não foi observada irritação cutânea causada pela clorexidina. Conclui-se que o banho prévio tem efeito na redução da carga bacteriana apenas após 2 horas de antissepsia com clorexidina; a tricotomia é mais eficaz na redução microbiana quando o animal é submetido ao banho e os dois antissépticos são igualmente eficazes na antissepsia cirúrgica por até 2 horas quer o animal tome banho ou não previamente à cirurgia.(AU)

The objective of this study was to analyze the influence of bath 24 hours before surgery and preoperative shaving in reducing microbial count of the operating field skin and antiseptic efficiency of 0.5% chlorhexidine gluconate and 10% iodine polyvinylpyrrolidone for antisepsis of the surgical site, by checking its action 4 minutes and 2 hours after application. We used 20 healthy bitches, randomly allocated into 2 groups of 10 animals: Group I underwent bath 24 hours before surgery, whereas Group II did not undergo this procedure. Many bacterial genera have been isolated before and after use of antiseptics. Statistical significance was observed between the groups regarding the effect of bath prior to surgery, just two hours after application of chlorhexidine. Shaving reduced 26.48% of the microbial load in Group I and increased the microbial load in 41.19% in Group II, showing statistical difference. After the use of antiseptics, there was no statistical difference between the groups at any time. Similarly, comparison of the efficiency of the bath with or without antiseptic showed no statistical significance. The iodine polyvinylpyrrolidone caused allergic reaction in 15% of animals and was not observed skin irritation caused by chlorhexidine. We conclude that the prior bath is effective in reducing bacterial load just after 2 hours of antisepsis with chlorhexidine; shaving is more effective in reducing microbial when the animal is subjected to the bath and the two antiseptic agents are equally effective in surgical antisepsis or for up to 2 hours the animal did not take a bath or prior to surgery.(AU)

Knowledge and perception towards pharmacovigilance and adverse drug reactions reporting among medical students at a teaching hospital in South India

Background: Pharmacovigilance and adverse drug reactions monitoring has become an integral part to ensure patient safety. Targeting the younger doctors for sensitization towards pharmacovigilance is the key to ensure practice of ADR reporting in clinical practice. The objective of the study is to understand and assess the knowledge and perception of students towards pharmacovigilance and adverse drug reactions reporting.Methods: The study included undergraduate medical students of second, pre-final and final years of Mysore Medical College. A validated and standardized KAP based questionnaire was distributed to all students. Willingness to answer and complete the questionnaire was considered as consent.Results: The questions were statistically analysed individually and compared. Q1-Q10 compared knowledge towards pharmacovigilance, Q11-Q20 on the attitude and Q21-Q23 on the practice of ADR reporting. 325 questionnaires were distributed of which only 280 consented (second year - 114, pre-final - 98, final - 68). 112(49.1%), 137(69.9%) and 79(58.1%) of the three groups respectively knew what pharmacovigilance and ADR is. 79.8%, 76.5% and 75% knew who can report ADRs while 18.4%, 32.7% and 33.8% did not know what ADRs to report. 73(64.1%); 93(81.6%), 18(18.4%); 69(70.4%), 13(19.1%); 37(54.4%) knew the existence of AMC in the institute and the PvPI respectively. More than 92% agreed that ADR reporting is necessary. Majority (>90%) agreed that PV and ADR reporting should be taught to all health care students while 28%, 30% and 54% said that it was not well covered in their curriculum.73(64%), 51(52%) and 63(93%) were not familiar with the ADR reporting form.Conclusions: Pharmacovigilance and ADR reporting needs to be made compulsory, have better, interesting ways to learn and understand it, so that the students can practice it with confidence in their clinical practice.

Cross sectional study to assess the awareness of pharmacovigilance among post graduate residents of tertiary care medical college hospital of central India

Background: Pharmacovigilance knowledge and awareness in post graduate student doctors is key factor for proper implementation of PvPI. This study was planned to evaluate the knowledge &awareness of pharmacovigilance in post graduate students in tertiary care centre in Indore.Methods: It was a single point cross sectional questionnaire-based study conducted in a tertiary care Institute MGM Medical College & M.Y. Hospital in the state of Madhya Pradesh at Indore. It was conducted among post graduate student doctors from various clinical departments. Total of 150 questionnaires were distributed, 115 of them were returned back and were analysed.Results: Overall knowledge level was satisfactory. 91.30% knew about ADR while 95% were aware about PVPI. 13% knew about local AMC at Indore while only 4.34% knew global centre for Pharmacovigilance is at Sweden Uppsala. 86.95% thought Med watch as global database for ADR against only 13% knew its Vigibase. 96.50% thought ADR reporting is necessary. 97.40% thought it should be included in UG curriculum. 95.65% had not reported any ADR till date while 86.95% had not seen an ADR form.Conclusions: Post graduate doctors are the prime candidates to impart the importance of pharmacovigilance. The study strongly suggested that there was a great need to create awareness among the post graduate doctors to improve the reporting of ADRs.

Transpulmonary thermodilution for evaluating respiratory function in swine after severe acute dichlorvos poisoning / 中华急诊医学杂志

Objective In order to extrapolate the respiratory dysfunction of patients in early stage of acute organophosphorus pesticide poisoning (AOPP),transpulmonary thermodilution technique was used in swine models of severe acute dichlorvos poisoning (SADP) to evaluate respiratory function.Methods Twenty healthy female swine were randomly divided into dichlorvos ( n =7 ),atropine ( n =7 ) and control (n =6) groups.In the dichlorvos group,the swine were administered with 80％ emulsified dichlorvos (100mg/kg) via the gastric tube toinduce SADP.In the atropine group,swinewere administered with dichlorvos,and 0.5h later,atropine was injected to obtain and maintain atropinization.The swine of control group were administered with saline solution instead.Arterial and venous blood samples were collected 0,0.5,1,2,4 and 6 hours after modeling for blood gas analysis and detecting acetylcholinesterase levels.Both extravascular lung water index (EVLWI) and pulmonary vascular permeability index ( PVPI ) were measured by using PiCCO (pulse indicator continuous cardiac output ). At the termination of the experiment,the animals were sacrificed and the lung wet/dry weight ratio was determined and histopathological changes of lung tissue were also observed under microscope.Results In the dichlorvos group,EVLWI and PVPI were substantially increased from 0.5 h to 6 h after modeling but PaO2/FiO2 decreased from 0-6 h after modeling.In the atropine group,EVLWI and PVPI increased initially,but then they decreased 1 h afterwards and PaO2/FiO2 was also gradually decreased from 0-1 h.In both dichlorvos group and atropine group,the EVLWI was negatively correlated with PO2/FiO2 and positively correlated with PVPI.Compared with the control group,the lung wet/dry weight ratio increased markedly in the dichlorvos group and mildly increased in the atropine group.Meanwhile,the histopathological changes of lung tissue were obvious in the dichlorvos group and mild in the atropine group.Conclusions SADP swine experienced substantial changes in respiratory function. EVLWI was a reliable and valuable indicator for evaluating respiratory function in the early stage of AOPP.

Preparation of Anhydrous Hand-cleaning Agents / 中国药房

OBJECTIVE:To prepare anhydrous iodine-containing or iodine-free hand-cleaning agents for use at field or water-deficient area.METHODS:An adhesive paste was made with PVA as vehicle and PVP-I as disinfector.Iodine value was taken as parameter of quality control.The adhesive-eliminating test was carried out on Escherichia coli and HBV elimi?nating and skin irritation tests were performed in rabbits.RESULTS:This preparation could eliminate bacteria by its adhesive action and had considerable disinfective action because of the ingredient iodine,however it could not eliminate HBV.No irrita?tion to skin was found.CONCLUSION:The preparation can effectively remove the dust,bacteria and viruses from the hands and is suitable for cleaning hands in conditions of wartime,training and water-deficient area.

Preparation and Quality Control of PVP-I Film / 中国药房

OBJECTIVE: To prepare PVP-I film agent of high water solubility and to establish a method for its quality control. METHODS: The film was prepared by mixing PVP-I,glycerol, distilled water and PVA05-88. The content of povidone iodine was determined with electric titration. The stability of the preparation stored in brown glass and colorless glass was investigated.RESULTS:The prepared film was integrated, clear and even in color and size. The average recovery was 99.03%(RSD=0.75%).The film stored in brown glass showed no evident changes in appearance and content within 60d, while that in colorless glass was found to have a decrease in content and yellowish appearance. CONCLUSION: The preparation technology is simple and method of quality control is accurate and reliable.