Antibiotics dispensing for URTIs by community pharmacists and general medical practitioners in Penang, Malaysia: A comparative study using simulated patients

Background: In Malaysia, doctors in private clinics (often called dispensing doctors) are permitted to dispense medicines. This potentially may compromise rational dispensing of medicines in general and antibiotics in particular. Aim: This study explored, assessed and compared dispensing of antibiotics between Community Pharmacist (CP) and General Practitioners (GPs) regarding symptomatic diagnosis, antibiotic categories, adherence to therapeutic doses and promotion of generic antibiotics. Method: The study used trained Simulated Patients (SPs), who used a scenario of common cold symptoms at GP private clinics and community pharmacies to observe and explore the practice of antibiotics dispensing. The study was conducted within the period of May to September 2011 in Penang, Malaysia. The data was analysed using descriptive statistics, Chi-square and Fisher’s Exact Tests at alpha level of 0.05. Results: GPs dispensed more antibiotics than CPs (p= 0.001) for common cold symptoms. They dispensed more Amoxicillin (n = 14, 35%) than CPs (n = 11, 11%) (p < 0.001) and more Tetracycline (n = 3, 7.5%) while no CP dispensed this category (p = 0.022). On the other hand, CPs (n = 11, 11%) suggested brand antibiotics where as GPs dispensed only generic antibiotics (p < 0.001). Generally GPs comply better with the symptomatic diagnosis standard e.g. when asking SPs about the symptoms they had, all GPs (n = 40, 100%) complied better with this standard. Despite that, they dispensed more antibiotics (n = 26, 65%) than CPs (n = 29, 29%) (p = 0.001). GPs (n = 22, 55%) also are better than CPs (n = 16, 16%) in adherence to therapeutic doses (p< 0.001). Conclusion: Findings showed poor adherence to rational dispensing of antibiotics by both providers. Although, GPs adhere better to symptomatic diagnosis and therapeutic dosing of antibiotics than CPs, they unnecessarily prescribe and dispense more antibiotics for Upper respiratory tract infection (URTI) symptoms. Establishing prescription guidance and regulatory actions, especially for URTIs treatment, and separating of medication dispensing are seemed to be crucial steps for the reform.Scopu

ISOLATION, IDENTIFICATION AND BIOCONTROL OF SALMONELLA TYPHIMURIUM IN KARIESH CHEESE BY BACTEIOPHAGE

The study aims to assess the possibility of biological control on one of the most serious pathogenic microbes that found to infect Kariesh cheese, namely Salmonella typhimurium.  To achieve this object, firstly a total of 20 Kariesh cheese samples were collected randomly from various markets located at Cairo and exposed to microbiological isolation and identification of S. typhimurium. The obtained results revealed that, S. typhimurium was detected in 30% of surveyed market Kariesh cheese according to the strain identified by polymerase chain reaction (PCR) technique. Secondary, five sewage water samples were obtained from Fac. of Agric., Ain Shams Univ., and Shoubra EL-Kheima station of drinking and sewage water for specific bacteriophage isolation and morphology particles of Salmonella bacteriophage was examined by transmission electron microscope. Third, pasteurized skimmed buffalo’s milk was converted into experimental Kariesh cheese at 40oC by milk inoculation with 2% of freshly activated yoghurt bacterial starter culture and then milk was divided into 5 equal portions. The 1st portion considered as control. The 2nd, 3rd, 4th and 5th portions were contaminated with equal level (1%) of S. typhimurium suspension containing 105 colony forming units (CFU)/mL, previously isolated from foregoing surveyed Kariesh cheese samples, followed by adding phage suspension,  from which isolated from sewage water, containing 108 plaque forming units (PFU)/mL at the levels of nil, 1, 2 and 3% respectively. All portions were separately incubated at the same temperature up to curdling. The curds were cut and individually filled into stainless steel moulds lined with cheese cloth and consolidated by a slight pressure for 24 h. The blocks of curd were then cut, dry salted using 2% NaCl (w/w) and packaged into plastic containers.  Experimentally, there were proportional reductions in lactic acid bacteria (LAB) population as the level of phage spiked into cheese milk increased, as which the reduction rate of LAB count during cold storage period (CSP) prolonging was however declined.    In terms of health safety, although the number of pathogen microbe added was gradually reduced due to the acid developed by prolonging the Cold Storage Period in the absence of phage, but it stilled present until the end of experimental period. While, the pathogen was completely eliminated within 7 days of cheese age when the phage suspension (108 PFU/mL) has been spiked at the level of 1% at least.  The contamination of experimental Kariesh cheese with S. typhimurium led to weaken the ability of cheese curd to drain whey as explained from the dry matter (DM) content which decreased due to the presence of pathogen and increased by the pathogen elimination with bacteriophage, which resulted also to increase the protein /DM content. The ash content reduced by both reasons, namely the contamination with S. typhimurium and/or the spiking level of phage suspension. The presence of S. typhimurium slowed the LAB population and acid production by them. Finally, as a conclusion, the spiking of Kariesh cheese milk with 1% Salmonella typhimurium phage suspension (108 PFU/mL) is quite enough to eliminate this microorganism when it present at the level of 1% suspension containing  105 CFU /mL

Efficacy of different bioagents in suppressing Meloidogyne incognita, and evaluation of some physio-biochemical changes in Phaseolus vulgaris L.

Plant parasitic nematodes cause severe damage, reducing plant production. The ability of four various biocontrol agents was surveyed for effectiveness in inhibiting J2 of Meloidogyne incognita in vitro. The study aims to explore the impact of different bio-agents (Bacillus cereus 54-1, Streptomyces erythrogriesus sub sp. 2, Pleurotus ostreatus, and Spirulina platensis) on the root-knot-nematode, M. incognita reproduction, and their influence on plant growth as well as physiological and biochemical parameters in Phaseolus vulgaris L. plants under greenhouse conditions. Effective inoculation of four bio-control agents on growth and physio-biochemical parameters of bean plants infected with root-knot-nematode was also investigated. After 48 hours of exposure to bioagents, mortality was caused by M. incognita J2s. Mortality ranged between 67.3 and 89%. Under experimental conditions, further validating the relative efficacy of different bioagents in control M. incognita on common bean in two successive seasons. All pageants were efficient in preventing nematode reproduction, but with varying efficacy. Oxamyl (Nematicide) was an extremely effective treatment for suppressing total nematode populations. Nevertheless, the second most effective treatment for reducing M. incognita in roots and soil was B. cereus. All treatments significantly enhanced growth as compared to the control. Treatments with four bioagents significantly reduced H2O2 and malondialdehyde levels. While it significantly raised the activity of peroxidase, polyphenol-oxidase, and superoxide dismutase, in addition to raising the content of phenolics and flavonoids in the infected common bean. The tested bioagents were efficient in preventing nematode reproduction, but at various levels of efficacy. In addition, all treatments significantly enhanced common bean growth parameters and reduced the levels of both H2O2 and MDA. While it raised the activity of POD, PPO, SOD, and contents of phenolics and flavonoids in the infected common bean. These results highlight the value of bioagents as a promising biocontrol technique to manage root-knot-nematodes in common beans

Tracking development assistance for health and for COVID-19 : a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050

Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached$8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total,$40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this,$13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and$1.4 billion was repurposed from existing health projects. $3.1 billion (22.4$2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7$1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods: We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings: Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation: Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding: Bill & Melinda Gates Foundation

Performance of reconstruction and identification of τ leptons decaying to hadrons and vτ in pp collisions at √s=13 TeV

The algorithm developed by the CMS Collaboration to reconstruct and identify τ leptons produced in proton-proton collisions at √s=7 and 8 TeV, via their decays to hadrons and a neutrino, has been significantly improved. The changes include a revised reconstruction of π⁰ candidates, and improvements in multivariate discriminants to separate τ leptons from jets and electrons. The algorithm is extended to reconstruct τ leptons in highly Lorentz-boosted pair production, and in the high-level trigger. The performance of the algorithm is studied using proton-proton collisions recorded during 2016 at √s=13 TeV, corresponding to an integrated luminosity of 35.9 fb¯¹. The performance is evaluated in terms of the efficiency for a genuine τ lepton to pass the identification criteria and of the probabilities for jets, electrons, and muons to be misidentified as τ leptons. The results are found to be very close to those expected from Monte Carlo simulation