Necrotising myometrial granulomas leading to postpartal hemorrhage: an extremely unusual presentation

Granulomas exclusively involving the myometrium are rare pathological finding and those presenting with atonic post-partum hemorrhage have never been reported. Here we present a case of myometrial granulomas presenting with atonic postpartum hemorrhage (PPH) with no evidence of granulomatous inflammation elsewhere in the body. There was also no history of instrumentation or biopsy of the uterine cavity in the past

Prevalencija i analiza molekulske heterogenosti vrsta Campylobacter jejuni i Campylobacter coli izdvojenih iz ljudi, peradi i goveda u Pantnagaru u Indiji.

Thermophilic campylobacters are the leading cause of food -borne bacterial gastroenteritis worldwide. Reports regarding the prevalence of campylobacters in India are very few and no report on the use of molecular typing tools is available for this important pathogen. In the present study, a total of 612 stool/fecal samples collected from humans (n = 260), poultry (n = 239) and cattle (n = 113) were examined for the presence of thermophilic campylobacters by direct plating on modified charcoal cefoperazone deoxycholate agar plates, and employing conventional morphological and biochemical tests. Of these, only 43 samples showed positive Campylobacter colonies. Further, genus and species level identification and confirmation by multiplex PCR revealed the isolates from human (4) and cattle (1) to be Campylobacter jejuni, whereas, out of 38 isolates from poultry, 29 (76.32%) and 9 (23.68%) were C. coli and C. jejuni, respectively. The genetic diversity of the isolates studied by flaA-RFLP typing, using DdeI restriction enzyme, revealed the presence of 11 and 7 flatypes among the 14 C. jejuni and 29 C. coli isolates, respectively. Dendrogram analysis showed that one of the C. jejuni isolates from poultry shared 100% genetic similarity with the human isolate. The prevalence rate in human, poultry and cattle was estimated to be 1.54, 15.89 and 0.88%, respectively, with a comparatively high prevalence of C. coli in poultry. This study appears to be the first of its kind from India, on the application of multiplex PCR and flaA-RFLP typing of Campylobacter isolates obtained from a variety of sources.Termofilni kampilobakteri vodeći su uzrok bakterijskog gastroenteritisa diljem svijeta koji se prenose hranom. Izvješća o njihovoj prevalenciji u Indiji su rijetka, a potpuno nedostaju izvješća o upotrebi molekularnih metoda za njihovu tipizaciju. U ovom je istraživanju bilo pretraženo ukupno 612 uzoraka i to 260 uzoraka stolice ljudi, 239 uzoraka izmeta peradi te 113 uzoraka izmeta goveda na prisutnost termofilnih kampilobaktera izravnim nasađivanjem na preinačen cefoperazon deoksikolatni agar s drvenim ugljenom. Uzročnik je bio identificiran uobičajenim testovima za određivanje morfologije i biokemijskih osobina. Kolonije kampilobaktera dokazane su samo u 43 pretražena uzorka. Daljnjim postupkom identifikacije na razini roda i vrste te potvrde višestrukom lančanom reakcijom polimerazom dokazano je da su četiri izolata iz ljudi i jedan iz goveda pripadali vrsti Campylobacter jejuni, dok je od 38 izolata iz peradi njih 29 (76,32 %) pripadalo vrsti C. coli, a 9 (23,68 %) vrsti C. jejuni. Istraživanjem genetske raznolikosti izolata na osnovi polimorfizma dužine restrikcijskog fragmenta gena flaA uporabom restrikcijskog enzima DdeI dokazano je 11 fla tipova među 14 izolata vrste C. jejuni i sedam fla tipova među 29 izolata C. coli. Analiza dendrograma je pokazala da je jedan izolat C. jejuni iz peradi bio identičan izolatu iz ljudi. Procijenjena prevalencija u ljudi iznosila je 1,54, u peradi 15,89, a u goveda 0,88 %, s relativno velikom prevalencijom vrste C. coli u peradi. Ovo je prvo istraživanje takve vrste u Indiji

The Global Alliance for Infections in Surgery : defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p <0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Peer reviewe

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Biosorption of copper from aqueous solution using algal biomass

813-816Sorption experiments using the dead biomass of Spirogyra species, for copper removal were carried out to study the influence and optimization of the biosorption of Cu (II). The effect of pH (1.0 - 10.0), initial metal ion concentration (1 - 100ppm), different contact periods (30 - 180 min), varying temperature (25 – 50 ºC) and varying biomass quantities (0.5,1.0,1.5 and 2.0 g) were also examined. It was observed that Spirogyra species possessed better specific uptake capacities for Cu (II), showing approximate uptake of 34.94mg/g of biomass. Spirogyra species has shown much better sorption in the pH between 6.0 - 7.0 and at contact time of 30 min

Clinical, radiological and histopathological profile of sinonasal masses: An observational study at a tertiary care centre in Uttarakhand

Introduction: Sinonasal masses are commonly encountered in clinical practice of Otorhinolaryngology. These masses are sometimes difficult to be differentiated from each other due to their similar clinical presentation and their radiological features also create confusion. Histopathology plays a key role in differentiating these masses from each other. The aim of present study was to study the clinical presentation, radiological characteristics and histopathological findings of some commonly occurring sinonasal masses. Materials and methods: This observational cross sectional study comprising of 60 patients was done in Government Medical College, Haldwani and associated Dr Susheela Tiwari Government Hospital between the periods of January 2019 to September 2020.All patients (18 years and above) presenting with complaints suggestive of sinonasal masses were included in this study after taking due consent. These cases were subjected to thorough history taking and clinical examination, routine hematological and biochemical evaluation, nasal endoscopy, CT scan of nose and paranasal sinuses/ MRI(where required) and biopsy. Final diagnosis was made after histopathological examination. Observations and results: 60 cases were studied out of which 40(66.66%) cases were males and 20(33.33%) were females with a male to female ratio of 2:1. Maximum cases was recorded in the third decade of life with 17(28.33%) patients. Nasal obstruction was the most common complaint.( 54patients (90%) In 49 (81.66%) cases radiology indicated involvement of more than one region of the sinonasal tract. Histopathology proved (70%) of the total cases ie.42 to be non neoplastic and rest (18 (30%) neoplastic. Benign neoplastic masses were 14(23.33%) and malignant masses were 4(6.66%) of the total cases. Inflammatory nasal polyps were the most common non neoplastic lesions. In case of neoplastic variety, inverted papilloma and capillary hemangioma were the most common benign lesions. Squamous cell carcinoma was the most common malignant lesion. Conclusion: Histopathological examination is mandatory for final diagnosis in patients with sinonasal masses. Combined clinical, radiological and histopathological evaluation is necessary to determine the true nature of the sinonasal mass and further management

A review study on benefits of calcium supplementation on adolescent bone mineral density

Because of the new distribution of two epidemiological investigations and one meta-examination of randomized controlled clinical preliminaries, the relationship between calcium supplementation and antagonistic cardiovascular occasions has as of late turned into a subject of discussion. The reports demonstrate that there is a critical expansion in antagonistic cardiovascular occasions following supplementation with calcium; notwithstanding, various specialists have raised various issues with these reports, for example, irregularities in endeavors to duplicate the discoveries in different populaces and questions concerning the legitimacy of the information because of low consistence, predispositions on the off chance that ascertainment, and additionally an absence of change. The reports demonstrate that there is a huge expansion in antagonistic cardiovascular occasions following supplementation with calcium; notwithstanding, these reports have been reprimanded for furthermore, the Women's Health Initiative, the Auckland Calcium Study, and a significant number of different investigations that were remembered for the meta-examination acquired information from subjects who had calcium levels that were inside the ordinary reach. Along these lines, it is indistinct whether a similar gamble profile would be seen in populaces that had low calcium admissions. Furthermore, the skeletal advantages of calcium supplementation are more noteworthy in subjects with low calcium admissions.&nbsp

A review study on benefits of calcium supplementation on adolescent Bone mineral density

Because of the new distribution of two epidemiological investigations and one meta-examination of randomized controlled clinical preliminaries, the relationship between calcium supplementation and antagonistic cardiovascular occasions has as of late turned into a subject of discussion. The reports demonstrate that there is a critical expansion in antagonistic cardiovascular occasions following supplementation with calcium; notwithstanding, various specialists have raised various issues with these reports, for example, irregularities in endeavors to duplicate the discoveries in different populaces and questions concerning the legitimacy of the information because of low consistence, predispositions on the off chance that ascertainment, and additionally an absence of change. The reports demonstrate that there is a huge expansion in antagonistic cardiovascular occasions following supplementation with calcium; notwithstanding, these reports have been reprimanded for furthermore, the Women's Health Initiative, the Auckland Calcium Study, and a significant number of different investigations that were remembered for the meta-examination acquired information from subjects who had calcium levels that were inside the ordinary reach. Along these lines, it is indistinct whether a similar gamble profile would be seen in populaces that had low calcium admissions.&nbsp