Is nalidixic acid screening still valid for the detection of reduced susceptibility of fluoroquinolone with salmonella typhi?

Introduction: Considering the limitations of screening with nalidixic acid to detect reduced susceptibility to fluoroquinolones of Salmonella enterica serovar Typhi (S.Typhi) strains, we evaluated the use of a 30 µg nalidixic acid disc screening method in Pakistan. Methodology: Non duplicate nalidixic acid susceptible S. Typhi isolates (246) from 2003-2008 were retrieved from the Salmonella strain bank. Minimum inhibitory concentrations of ciprofloxacin for all strains were determined by agar dilution and further rechecked by ciprofloxacin E-tests.E. coli ATCC 25922 was used as the control strain. The MIC data for ciprofloxacin were compared with nalidixic acid disk (30µg) zone diameters. Results: Repeat testing of all S. Typhi isolates with a nalidixic acid (30µg) disk showed 100% susceptibility with an average zone diameter of 26 mm. Agar dilution testing revealed reduced susceptibility to ciprofloxacin, with MICs of 0.125 µg /ml for three (1.2%) isolates only. Zone sizes of strains with higher MICs were significantly lower than the strains with lower MICs (20 versus 26 mm) (p value \u3c 0.001). Conclusion: Estimation of fluoroquinolone MICs on every nalidixic acid susceptible S. Typhi strain is not cost effective in our setting; the proportion of strains with high fluoroquinolone MICs was found to be very low. We recommend periodic fluoroquinolone MIC determination to include all isolates with a nalidixic acid borderline zone (size 20-22 mm)

Prevalence of Self-Medication of Psychoactive Stimulants and Antidepressants among Undergraduate Pharmacy Students in Twelve Pakistani Cities

Purpose: To evaluate the prevalence of self-medication of psychoactive stimulants and antidepressants among pharmacy students of Pakistan.Methods: A cross-sectional survey on self-medication of psychoactive stimulants and antidepressants among pharmacy students was conducted with a structured and validated questionnaire distributed to a total of 2981 final year undergraduate pharmacy students in 12 major Pakistani cities (Karachi, Lahore, Islamabad, Rawalpindi, Sargodha, Dera Ismail Khan, Abbottabad, Bahawalpur, Hyderabad, Faisalabad, Multan and Peshawar) of Pakistan. Out of this, 2516 (718 male and 1798 female) students completed and returned the questionnaire.Results: Prevalence of self-medication of psychoactive stimulants was 1.31 (1.13 – 1.75 for 95% CI) and antidepressants was 8.34 (8.03 – 8.85 for 95% CI). A majority of the students (63 %) identified academic competition as a driving force for indulging in self-medication of psychoactive stimulants while nearly all the students (96 %)admitted using antidepressants to obtain relief from the pressure of studies (p < 0.05).Conclusion: Pakistani pharmacy students, despite being aware of the hazards of psychoactive stimulants, indulge in self-medication. Prevalence of self-medication with antidepressants is very high among the students due to the pressure of studies. Primarily, academic competition is the major driving force for the use of psychoactive stimulants.Keywords: Self-medication, Psychoactive stimulants, Antidepressants, Pharmacy students, Academicpressur

CMS physics technical design report : Addendum on high density QCD with heavy ions

Peer reviewe

Efficacy and safety of baricitinib or ravulizumab in adult patients with severe COVID-19 (TACTIC-R): a randomised, parallel-arm, open-label, phase 4 trial

Background From early in the COVID-19 pandemic, evidence suggested a role for cytokine dysregulation and complement activation in severe disease. In the TACTIC-R trial, we evaluated the efficacy and safety of baricitinib, an inhibitor of Janus kinase 1 (JAK1) and JAK2, and ravulizumab, a monoclonal inhibitor of complement C5 activation, as an adjunct to standard of care for the treatment of adult patients hospitalised with COVID-19. Methods TACTIC-R was a phase 4, randomised, parallel-arm, open-label platform trial that was undertaken in the UK with urgent public health designation to assess the potential of repurposing immunosuppressants for the treatment of severe COVID-19, stratified by a risk score. Adult participants (aged ≥18 years) were enrolled from 22 hospitals across the UK. Patients with a risk score indicating a 40% risk of admission to an intensive care unit or death were randomly assigned 1:1:1 to standard of care alone, standard of care with baricitinib, or standard of care with ravulizumab. The composite primary outcome was the time from randomisation to incidence (up to and including day 14) of the first event of death, invasive mechanical ventilation, extracorporeal membrane oxygenation, cardiovascular organ support, or renal failure. The primary interim analysis was triggered when 125 patient datasets were available up to day 14 in each study group and we included in the analysis all participants who were randomly assigned. The trial was registered on ClinicalTrials.gov (NCT04390464). Findings Between May 8, 2020, and May 7, 2021, 417 participants were recruited and randomly assigned to standard of care alone (145 patients), baricitinib (137 patients), or ravulizumab (135 patients). Only 54 (39%) of 137 patients in the baricitinib group received the maximum 14-day course, whereas 132 (98%) of 135 patients in the ravulizumab group received the intended dose. The trial was stopped after the primary interim analysis on grounds of futility. The estimated hazard ratio (HR) for reaching the composite primary endpoint was 1·11 (95% CI 0·62–1·99) for patients on baricitinib compared with standard of care alone, and 1·53 (0·88–2·67) for ravulizumab compared with standard of care alone. 45 serious adverse events (21 deaths) were reported in the standard-of-care group, 57 (24 deaths) in the baricitinib group, and 60 (18 deaths) in the ravulizumab group. Interpretation Neither baricitinib nor ravulizumab, as administered in this study, was effective in reducing disease severity in patients selected for severe COVID-19. Safety was similar between treatments and standard of care. The short period of dosing with baricitinib might explain the discrepancy between our findings and those of other trials. The therapeutic potential of targeting complement C5 activation product C5a, rather than the cleavage of C5, warrants further evaluation

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

In Vitro and In Vivo Evaluation of a Nano-Tool Appended Oilmix (Clove and Tea Tree Oil) Thermosensitive Gel for Vaginal Candidiasis

The main objective of the proposed work was the development of a thermosensitive gel (containing clove and tea tree oil) for the management of vaginal candidiasis. Both oils have been recommended to be used separately in a topical formulation for vaginal candidiasis. Incorporating two natural ingredients (clove and tea tree oil) into a product give it a broad antimicrobial spectrum and analgesic properties. The two oils were mixed together at a 3:1 ratio and converted into o/w nanoemulsion using the aqueous titration method and plotting pseudo ternary phase diagrams. Further transformations resulted in a gel with thermosensitive properties. To determine the final formulation’s potential for further clinical investigation, in vitro analyses (viscosity measurement, MTT assay, mucoadhesion, ex vivo permeation) and in vivo studies (fungal clearance kinetics in an animal model) were conducted. The current effort leveraged the potential of tea tree and clove oils as formulation ingredients and natural therapeutic agents for vaginal infections. Its synergy generated a stable and effective thermosensitive gel that can be utilized for recurrent candidiasis and other infections

Evaluation of Dental Caries and Periodontal Health Status in Children with Autism: a Case Control Study

Background: Dental problems are common in autistic children due to poor oral hygiene. During the dental treatment, main challenge is reduced ability of autistic kids to communicate. The objective of this study was to investigate about the oral health status of autistic children and to compare the risk of dental caries and periodontal disease between children with autism and healthy controls. Methodology: This case-control study was conducted at the Milestone Charitable Trust and Defense Housing Authority (DHA), Sheikh Khalifa Bin Zayed School, for the duration of 04 months (1st Dec 2019 – 30th March 2020). Among cases, 67 autistic children and among controls,67 healthy children, of age 7 to 17 years, of either gender, were included. All the participants were examined and assessed for presence or absence of any carious lesions, and periodontal health. Data analysis was done using SPSS version 23. Results: The overall mean age of included children was 12.51±2.99 years. Of 134 children, 53.7% were males and 46.3% females. The odds of periodontal disease were 5.52 times higher in autistic children as compared to healthy children (p < .001). The odds of dental caries were 3.43 times higher in autistic children as compared to healthy children (p < .001). In both age groups (<=10 years and >10 years), the risk of periodontal disease and dental caries was higher among autistic children as compared to normal children. While, according to gender, the risk of dental caries was higher among male autistic children as compared to normal children. Conclusion: The odds of dental caries and periodontal disease were higher among autistic children as compared to healthy controls. Keywords: Autism Spectrum Disorder, Dental caries, Periodontiti

Chemical composition of essential oil of Thymus vulgaris collected from Saudi Arabian market

Objective: To focus on the analysis of chemical constituents of the Thymus vulgaris L. (locally known as “Zaitra” or “Za'atar”; Family: Lamiaceae) which is available in the market of Saudi Arabia. Methods: The Zaitra oil was analyzed by gas chromatography-mass spectrometry. The mass spectra were compared with the standard spectra available in National Institute Standard and Technique library. Results: The results indicated that the Thymus oil is composed of many chemical compounds including α pinene, thymol and caryophyllene which are biologically active and also used in various diseases. Conclusions: It can be concluded that the Thymus vulgaris due to presence of many bioactive compounds can be used as a new potential source of medicine for the treatment of various types of illness