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The emergence of superbugs and highly resistant organisms like methicillin-resistant staphylococci, vancomycin-resistant enterococci, carbapenem-resistant enterobacteriaceae demands the monitoring of antibiotic prescription and usage in various domains. The impact of antibiotic resistance is huge that it increases mortality, morbidity, and economic costs. The issue has to be addressed at various levels and that is why regulatory bodies implement antibiotic stewardship programs. These programs give a list of guidelines like infection control, tracking antibiotic use, prescription auditing, and involvement of health professionals like pharmacists, nurses, etc., A comparison of the list of guidelines given by the Centre for Disease Control and Prevention and Indian Council of Medical Research gives an idea about the measures to be taken at various levels to reduce the burden of antibiotic resistance. Prescription auditing is one of the major components of antibiotic stewardship. The auditing can be done either prospectively or retrospectively using WHO core prescribing indicators and antibiotic-specific indicators. An AWaRe assessment tool was also used to evaluate antibiotic consumption in countries and hospitals. The antibiotics are classified into access, watch and reserve categories. The aim of implementing the AWaRe tool is to increase the rational use of access antibiotic and reduce the consumption of watch and reserve antibiotics. This review focuses on the importance of prescription auditing, AWaRe tool and antibiotic stewardship in decreasing the threat of antibiotic resistance.
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Mucormycosis, a rare fungal disease has emerged as a new epidemic in India, during the CoronaVirus Disease 2019 (COVID-19) pandemic. Mucormycosis is caused by the mucormycetes group of molds. Immunocompromised states such as diabetes, chronic steroid use, and patients receiving immunosuppressant drugs are the risk factors for mucormycosis. The second wave of the COVID-19 pandemic has also invited the notorious mucormycosis in the current scenario. India has announced mucormycosis as a notifiable disease in May 2021, as the number of COVID-19-associated mucormycosis cases has increased swiftly. There are different opinions and evidence for the emergence of mucormycosis or the so-called 'black fungus'. It is proposed that the use of steroids, monoclonal antibodies, and prolonged hospitalization in the treatment of COVID-19 has substantially decreased the immunity in COVID-19-affected patients and maybe the reason for the emergence of fungal infections. The other hypothesis is that improper disinfection procedures such as using non-sterile water for humidification of oxygen can be the reason. Or, the COVID-19 infection itself produces an immunocompromised and diabetic-like state is again a question. This review mainly focuses on the discussion and identification of the most common risk factor for mucormycosis, investigations, and management of mucormycosis.
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Context: Rational drug use has a great role of influence in health care. The fact sheet given by the World Health Organization (WHO) shows that around 50% of the drugs are prescribed, dispensed, and sold inappropriately. One of the major consequences of irrational drug use in infections is antibiotic resistance. Aim: The present study aims to assess the antibiotic-prescribing pattern by auditing the prescriptions in a teaching hospital. Settings and Design: A prospective cross-sectional study was conducted in the pharmacy of a teaching hospital to evaluate the prescriptions of the outpatient department. Materials and Methods: The prescriptions used to treat symptoms suggestive of infections were taken into consideration. A total of 1,000 prescriptions were analyzed. Data Analysis: The data was analysed using Microsoft Excel. Results: A total of 2,536 drugs were prescribed. The average number of drugs per prescription was 2.5. The percentage of encounters with antibiotics prescribed was 17.5%. The percentage of encounters prescribed with a generic name and with drugs from the essential drug list was 87.5% and 65%, respectively. There were no injections prescribed. Amoxicillin and ciprofloxacin were the most common antibiotics prescribed. The duration of the treatment was mentioned in all the prescriptions. Conclusions: Our study shows that the percentage of antibiotic usage is within the WHO standard value. The average number of drugs per prescription was slightly higher than the WHO value. Steps should be taken to improve the generic prescribing by the physicians.
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Several factors contribute to the development of coronary artery disease (CAD). Adenosine diphosphate (ADP) activated P2Y12 receptor also plays a key role in platelet activation and aggregation. It has been found that common variation in the P2Y12 gene was associated with increased platelet aggregation resulting in adverse cardiovascular outcomes. Thus, polymorphisms in the ADP receptor P2Y12 may contribute to the development of CAD. This study aims to determine the frequency distribution of platelet receptor polymorphism P2Y12 (i744T>C) in Tamilian population and to predict its possible role in CAD. Three hundred seventy-one subjects were recruited comprising of 221 healthy volunteers and 150 patients with CAD belonging to either sex, aged 18-60 years of Tamilian origin. Genomic DNA was extracted using phenol-chloroform method. Genotyping was done by PCR-RFLP (Polymerase chain reaction-restriction fragment length polymorphism). The C allele frequency of P2Y12 polymorphism in controls and cases was 8.4% and 17.7%, respectively. The TT, TC, and CC genotype frequencies in controls and cases were 83.7%, 15.8%, 0.5% and 66.7%, 31.3%, 2%, respectively. The genotype frequencies were in Hardy-Weinberg equilibrium. There was a significant association (p < 0.05) between the mutant genotypes of P2Y12 (i744T>C) polymorphism and risk of CAD. The odds ratio was found to be 2.6. The variant allele frequency of P2Y12-i744T>C was significantly different from other populations. There was a significant association between the mutant genotypes of P2Y12 (i744T>C) polymorphism and risk of developing CAD. Thus, the present study will emphasize on the relevance of pharmacogenetic testing of P2Y12 (i744T>C) receptor gene polymorphism in CAD patients.
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Hypertension was induced in male Sprague Dawley rats with twice weekly administration of deoxycorticosterone acetate (DOCA) salt (20 mg/kg s.c) for 4 weeks. They were divided into eight groups of six animals each viz., hypertensive control, standard (prazosin 1 mg/kg), cleistanthin A 12.5, 25, 50 mg/kg and cleistanthin B 12.5, 25 mg/kg, and 50 mg/kg. One more group served as normal control. The hypertension was induced in 4 weeks, and the animals were given assigned treatment in 5(th) week. The alteration in blood pressure (BP) was recorded weekly using a rodent noninvasive blood pressure system. At the end of the experiment alpha-adrenergic receptor response of drugs like adrenaline, nor adrenaline, dopamine (doses 1 µg and 2 µg) was recorded invasively. Two-way repeated measures ANOVA followed by Bonferroni post-hoc test was used to analyze the data. The systolic BP and diastolic BP of test groups rose to a higher level after DOCA administration and fell to the normal range (P < 0.05) following the administration of cleistanthins A and B. There were no differences in the weekly heart rate among the groups. In the test group animals pretreated with prazosin and cleistanthins, adrenaline, noradrenaline and dopamine failed to raise the mean arterial pressure and the end-diastolic pressure from baseline (P > 0.05) cleistanthins A and B exert a significant antihypertensive effect through alpha-adrenergic receptor blockade similar to prazosin.
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BACKGROUND: The antiplatelet activity of clopidogrel is variable among patients suffering from ischemic heart disease. Variation in the cytochrome P450 2C19 (CYP2C19) gene coding for the CYP2C19 enzyme is one of the major determinants of this variable response to clopidogrel. The activity of the CYP2C19 enzyme, which plays a role in the conversion of the prodrug clopidogrel to its active metabolite, is genetically influenced by polymorphisms in its gene. The aim of our study was to evaluate the association of CYP2C19 polymorphisms and the antiplatelet effect of clopidogrel in the South Indian Tamilian population. MATERIALS AND METHODS: Genotyping and platelet aggregation results of 149 ischemic heart disease patients on clopidogrel maintenance therapy (75 mg daily dose) were analyzed in this study. CYP2C19 polymorphisms were genotyped by the PCR-restriction fragment length polymorphism method. We measured residual platelet activities in these patients on clopidogrel therapy in terms of impedance (expressed as ohms). The study subjects were divided into two metabolizer phenotype groups [group 1: poor/intermediate metabolizers (PM/IM); group 2: extensive/ultra-rapid metabolizers (EM/URM)] based on CYP2C19 genotype, and the residual platelet activities were compared. Higher values of impedance denote increased residual platelet activity. RESULTS: Poor/intermediate metabolizers had significantly higher impedance values than EM/URM [(median; range) 4.0; 0-13 vs. 2.0; 0-11, respectively; p = 0.04]. These higher impedance values denote higher residual platelet activities among the carriers of loss-of-function alleles (CYP2C19*2,*3) than among non-carriers. However, residual platelet activities were lower among the carriers of the gain-of-function allele (CYP2C19*17) than among non-carriers, although this difference was not significant. CONCLUSION: Patients with CYP2C19 (*2 or *3) genetic polymorphisms had higher residual platelet activities and were associated with a reduced antiplatelet response to clopidogrel. As the South Indian Tamilian population is characterized with higher frequencies of these genetic polymorphisms, our findings mandate further studies aimed at initiating genome-based personalized antiplatelet therapy.
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Hidrocarburo de Aril Hidroxilasas/genética , Isquemia Miocárdica/tratamiento farmacológico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Agregación Plaquetaria/efectos de los fármacos , Polimorfismo Genético , Ticlopidina/análogos & derivados , Adulto , Anciano , Distribución de Chi-Cuadrado , Clopidogrel , Citocromo P-450 CYP2C19 , Femenino , Frecuencia de los Genes , Genotipo , Humanos , India/epidemiología , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Isquemia Miocárdica/etnología , Farmacogenética , Fenotipo , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/metabolismo , Reacción en Cadena de la Polimerasa , Medicina de Precisión , Factores de Riesgo , Ticlopidina/efectos adversos , Ticlopidina/metabolismo , Ticlopidina/uso terapéutico , Resultado del TratamientoRESUMEN
AIM: To study the adverse drug reaction (ADR) pattern in a pediatric population in a tertiary care hospital. MATERIALS AND METHODS: An observational study was done in the department of pediatrics in a tertiary care hospital. The ADRs occurring in the inpatient wards and outpatient department of pediatrics were actively monitored. The collected reports were analyzed for ADR pattern, drug groups, demographic profile, causality, severity, and preventability of the ADR. RESULTS: A total of 30 ADRs were documented during the mid period of 2009 among pediatric patients. Most of the ADRs (60%) occurred below the age of 1 year. Antibiotics comprised the major group of drugs causing ADRs (67%). Rashes and urticaria were the most common type of ADR (37%) followed by fever, anaphylactic shock, vomiting, chills, and rigors. A single case of death had been reported in the study period. There were more occurrences of ADRs with multiple drugs compared to single drug therapy. About 80% of the ADRs were of probable causality and 87% were of probable preventability. There were no mild reactions, with 77% of reactions being moderate and 23% of reactions being severe in the severity scale. CONCLUSIONS: ADRs occur more among infants and antibiotics were more commonly implicated. Most of the reactions were of moderate severity. This indicates the need for a rigid ADR monitoring among pediatric patients to ensure safety of drug therapy.
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CONTEXT: Critical care units provide a favourable environment for the antimicrobial resistant organisms to disseminate. There is recent increase in number of extended spectrum beta lactamase (ESBL) producers because of the emergence of CTX M Beta lactamases produced by Enterobacteriaceae. They colonize the intestinal flora and spread with greater intensity in the community and hospital. Usage of Carbapenems becomes mandatory as the ESBL inhibitor combination antibiotics (Amoxicillin/Clavulanate) are not effective especially against CTX M ESBLs. AIM: The aim of this study is to detect ESBL producing bla CTX M gene in Enterobacteriaceae from infections in Critical care patients and to stress on the intensity of the problem and to make interventions to curb the emergence and dissemination of CTX M ESBLs. MATERIALS AND METHODS: A total of 118 Enterobacteriaceae isolates from Critical care unit patients were recovered from a variety of clinical specimens. Antimicrobial susceptibility test was done and isolates with resistance or with reduced susceptibility to any of the third generation Cephalosporins were selected for the study. Phenotypic confirmation of ESBL production was done by Double Disc Synergy Test and confirmed by minimum inhibitory concentration. Multiplex polymerase chain reaction was performed to screen the four groups of CTX-M ESBLs. RESULTS: Among the 118 isolates of Enterobacteriaceae 54 isolates were positive for CTX-M group I ESBL which constitutes 45.7 %. CONCLUSIONS: Early detection of CTX M producing Enterobacteriaceae by continuous surveillance and thereby reducing their spread and restricted use of third generation Cephalosporins (3GC) antibiotics could be the possible routes to prevent the emergence and spread of CTX M ESBL producing organisms.
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Buffalo (Bubalus bubalis) is known for its weak/silent estrous behaviour, lower conception rate and longer inter-calving interval as compared to cattle. Understanding the kinetics and functional properties of luteal cells may be helpful to improve reproductive efficiency in the buffalo. Hence the present study was designed to assess the size and distribution of steroidogenic luteal cells along with biochemical properties during different phases of corpus luteum (CL) in the buffalo. The ovaries collected from the local abattoir were classified into three phases, early, mid and late, based on the morphological appearance of the CL as well as the follicles in the ovary. The proportion (%) of the luteal cells (>10microm diameter) increased (P<0.01) from early (30.7+/-1.3) to mid (36.30+/-1.6), and then decreased (P<0.01) in late luteal (31.46+/-1.8) phases. Percentage of small luteal cells (10-20microm diameter) was higher (P<0.05) in early (58.47+/-0.61) and mid (61.29+/-0.67) than late luteal (37.18+/-1.50) phases of CL. However, the percentage of large luteal cells (20-50microm diameter) was higher (P<0.05) only in late (62.82+/-1.50) than early (41.53+/-0.61) and mid (38.71+/-0.67) phases of CL. The average size (microm) of the large luteal cells increased (P<0.05) from early (25.46+/-0.62) to mid (27.15+/-0.5) and late (28.86+/-0.47) luteal phases. The percentage of luteal cells expressing in situ DNA fragmentation was significantly (P<0.05) higher in the late luteal (41.17+/-5.8) than mid-luteal (21.15+/-4.9) phase of the CL. In the early stage, half of the steroidogenic luteal cells had significantly (P<0.05) less 3beta-HSD activity than the other two phases. In the mid stage, the steroidogenic luteal cells had significantly higher (P<0.05) intense 3beta-HSD activity than the other two phases. Further in the late phase, a significant (P<0.05) reduction in intense 3beta-HSD activity was observed in the large luteal cells. The lipid peroxidation (micromol/g of CL) levels were significantly (P<0.05) higher in late luteal (3.46+/-0.2) than the mid-luteal (1.43+/-0.16) phases. The superoxide dismutase and catalase enzyme levels (U/mg of protein) were also significantly (P<0.05) higher in late luteal (0.9+/-0.015 and 3.37+/-0.45, respectively) than the mid-luteal (0.1+/-0.01 and 2.34+/-0.3, respectively) phases. In contrast, the GPx activity (U/mg of protein) decreased significantly (P<0.05) from mid-luteal (1.85+/-0.4) to late luteal (1.22+/-0.2) phases. The present study suggests that (i) the decrease in progesterone levels in late CL may be associated with loss of 3beta-HSD activity in large luteal cells and (ii) demise of the buffalo CL may be mediated by apoptosis despite the high levels of luteal antioxidant enzymes.
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Antioxidantes/metabolismo , Apoptosis , Búfalos , Cuerpo Lúteo/metabolismo , Peroxidación de Lípido/fisiología , Células Lúteas/metabolismo , Animales , Antioxidantes/análisis , Apoptosis/fisiología , Búfalos/metabolismo , Búfalos/fisiología , Catalasa/metabolismo , Bovinos , Células Cultivadas , Cuerpo Lúteo/citología , Cuerpo Lúteo/fisiología , Enzimas/metabolismo , Femenino , Glutatión Peroxidasa/metabolismo , Células Lúteas/citología , Células Lúteas/fisiología , Superóxido Dismutasa/metabolismo , Distribución TisularRESUMEN
Beta-hemolytic Enterococcus faecalis was isolated from the pericardial fluid obtained from a patient with pyopericardium. The patient was immunocompetent and had mild pleural effusion. He was treated with parenteral co-amoxiclav and amikacin, had underwent pericardiectomy with repeated pericardial aspiration, and recovered completely. To our knowledge, this is the first report of pyopericardium due to E. faecalis .