Trends Of Antibiotic Susceptibility Of Salmonella Enterica Serovar Typhi And Paratyphi In An Urban Hospital Of Dhaka City Over 6 Years Period

The antibiotic resistance pattern of salmonella is ever changing over time. The present study is a retrospective analysis of rate of isolation of Salmonella Typhi and Paratyphi and their antibiotic resistance pattern over 6 years period in an urban hospital of Dhaka city. Blood culture submitted in BIRDEM hospital from 2004-2009 were analyzed. Isolated Salmonella sp were identified and antimicrobial susceptibility testing was carried out by a standard disc diffusion method. Among 385 isolated Salmonella sp 304 (79%) were Salmonella enterica serovar Typhi and 81 (21%) were Salmonella enterica serover Paratyphi A. The rate of isolation of S. Paratyphi A has increased over 6 the year period from 14% to 24%. Resistance to individual first line anti-salmonella drugs has increased from 2004 to 2006 (42 to 63%) but has decreased thereafter. Similar pattern was found when simultaneous resistance to three first line antibiotics namely ampicillin, chloramphenicol and co-trimoxazole were considered. Out of total 304 S. Typhi, 117 (38%) were simultaneously resistant to all three first line drugs compared to only 1.8% S. Paratyphi A. Analysis showed that 80 to 90% of isolated S. Typhi was nalidixic acid resistant (NARST) with reduced susceptibility to ciprofloxacin while the rate for S. Paratyphi A was 71-94%. All S. Typhi and Paratyphi A were sensitive to ceftriaxone. The study showed that there was a gradual decline of resistance of S. Typhi to first line antibiotics but very high prevalence of nalidixic acid resistant S. Typhi and S. Paratyphi in Bangladesh. DOI: http://dx.doi.org/10.3329/imcj.v5i2.10097 IMCJ 2011; 5(2): 42-45</jats:p

Disruptive supply chain technology assessment for sustainability journey: A framework of probabilistic group decision making

The fourth industrial revolution, commonly recognized as Industry 4.0, has been ushered by modern and innovative intelligence and communication technologies. Concerns about disruptive technologies (DTs) are beginning to grow in developing countries, despite the fact that the trade-offs between implementation difficulties and realistic effects are still unknown. Hence, prioritization and promotion of such technologies should be considered when investing in them to ensure sustainability. The study aims to provide new critical insights into what DTs are and how to identify the significant DTs for sustainable supply chain (SSC). Understanding the DTs’ potential for achieving holistic sustainability through effective technology adoption and diffusion is critical. To achieve the goal, an integrated approach combining the Bayesian method and the Best Worst Method (BWM) is utilized in this study to evaluate DTs in emerging economies' supply chain (SC). The systematic literature review yielded a total of 10 DTs for SSC, which were then evaluated using the Bayesian-BWM to explore the most critical DTs for a well-known example of the readymade garment (RMG) industry of Bangladesh. The results show that the three most essential DTs for SSC are “Internet of things (IoT)”, “Cloud manufacturing”, and “Artificial intelligence (AI)”. The research insights will facilitate policymakers and practitioners in determining where to concentrate efforts during the technology adoption and diffusion stage in order to improve sustainable production through managing SC operations in an uncertain business environment

Current utilization patterns for long-acting insulin analogues including biosimilars among selected Asian countries and the implications for the future

Introduction: Prevalence rates for diabetes mellitus continue to rise, which, coupled with increasing costs of complications, has appreciably increased expenditure in recent years. Poor glycaemic control including hypoglycaemia enhances complication rates and associated morbidity, mortality and costs. Consequently, this needs to be addressed. Whilst the majority of patients with diabetes have type-2 diabetes, a considerable number of patients with diabetes require insulin to help control their diabetes. Long-acting insulin analogues were developed to reduce hypoglycaemia associated with insulin and help improve adherence, which can be a concern. However, their considerably higher costs have impacted on their funding and use, especially in countries with affordability issues. Biosimilars can help reduce the costs of long-acting insulin analogues thereby increasing available choices. However, the availability and use of long-acting insulin analogues can be affected by limited price reductions versus originators and limited demand-side initiatives to encourage their use. Consequently, we wanted to assess current utilisation rates for long-acting insulin analogues, especially biosimilars, and the rationale for patterns seen, across multiple Asian countries ranging from Japan (high-income) to Pakistan (lower-income) to inform future strategies. Methodology: Multiple approaches including assessing utilization and prices of insulins including biosimilars among six Asian countries and comparing the findings especially with other middle-income countries. Results: Typically, there was increasing use of long-acting insulin analogues among the selected Asian countries. This was especially the case enhanced by biosimilars in Bangladesh, India, and Malaysia reflecting their perceived benefits. However, there was limited use in Pakistan due to issues of affordability similar to a number of African countries. The high use of biosimilars in Bangladesh, India and Malaysia was helped by issues of affordability and local production. The limited use of biosimilars in Japan and Korea reflects limited price reductions and demand-side initiatives similar to a number of European countries. Conclusions: Increasing use of long-acting insulin analogues across countries is welcomed, adding to the range of insulins available, which increasingly includes biosimilars. A number of activities are needed to enhance the use of long-acting insulin analogue biosimilars in Japan, Korea and Pakistan

The current situation regarding long-acting insulin analogues including biosimilars among african, Asian, European, and South American countries : findings and implications for the future

Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers. Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders. Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries. Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production. Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities