A cross sectional study to assess knowledge, attitude and practice of rational antibiotic prescription among resident doctors

Background: Irrational prescription is a major contributor to the antimicrobial resistance. Resident doctors are the major focus of interventional programs aimed at rational prescription of antibiotics. So, their knowledge, attitude and practice regarding rational antibiotic prescription need to be assessed to plan future strategies.Methods: A questionnaire based cross sectional study among interns and resident doctors of a Government Medical College was conducted. Questionnaire consisted of questions to assess knowledge, attitude and practice of resident doctors in rational antibiotic prescriptions and multiple-choice questions to assess practice of hospital antibiotic policy.Results: 80 participants were enrolled in the study. All participants responded to yes or no questions and 47 answered multiple choice questions. 40% were aware of the current hospital antibiotic policy and 29% knew the term antibiotic stewardship. Only 15% were confident in their knowledge on antimicrobial resistance. 87.5% think there is no use in prescribing an antibiotic in common cold. 36.3% overprescribes antibiotics in their daily practice. Only 32.5% practiced de-escalation. 90% were educating patients regarding correct use of antibiotics. 90% send samples for culture and sensitivity but only 22.2% waited for results to start antibiotics.Conclusions: There is a need for approaches that includes implementation of antibiotic policy and to plan for effective teaching programs regarding antibiotic resistance and importance of rational prescription of antibiotics which can improve the quality of antibiotic prescription and minimize antibiotic resistance

Pattern of management of febrile neutropenia among breast cancer patients treated with different chemotherapeutic regimens

Background: Breast cancer is one of the common malignancies in females. Chemotherapy with Adriamycin and Cyclophosphamide (AC) followed by the Docetaxel (AC-T, Regimen-I), AC followed by Docetaxel and Carboplatin (AC-T+Cr, Regimen-II) and AC followed by Docetaxel and Trastuzumab (AC-T+Tr, Regimen-III) are commonly given for treatment. These cause myelosuppression and febrile neutropenia and need necessary interventions.Methods: This is a prospective open labelled observational comparative study to evaluate the antibiotic usage needed to treat sepsis following febrile neutropenia among breast cancer patients undergoing chemotherapy with regimen I, II and III. All patients received prophylactic Pegfilgrastim / Filgrastim. Antibiotics used and days in intensive care unit (ICU) in all the 8 cycles of chemotherapy were recorded. 38 patients in Regimen I, 40 patients in Regimen II and 46 patients in Regimen III completed the study and were included in the statistical analysis.Results: In regimen II, following cycle 2 of chemotherapy, none of the patients needed antibiotic therapy. Antibiotic use was maximum, following cycle 1of chemotherapy in regimen I and III, maximum number of antibiotics prescribed were 7. Number of days of ICU care needed for regimen II patients following 3rd cycle of chemotherapy was 3.5±3.5 days. No ICU care was needed for regimen III patients, following cycles 2, 3 and for regimen II following cycle 7.Conclusions: Febrile neutropenia produced by chemotherapy were effectively treated with intravenous antibiotics in ICU for an average of 2-3 days. No mortality was associated with febrile neutropenia and all patients were recovered

A case of valproate induced non-hepatic hyperammonemic encephalopathy

Sodium valproate is a broad spectrum anticonvulsant. Valproate induced hyperammonemic encephalopathy with normal liver function is a serious, but less common entity

Preclinical modeling of myelodysplastic syndromes

Myelodysplastic syndromes (MDS) represent a heterogeneous group of hematological clonal disorders. Here, we have tested the bone marrow (BM) cells from 38 MDS patients covering all risk groups in two immunodeficient mouse models: NSG and NSG-S. Our data show comparable level of engraftment in both models. The level of engraftment was patient specific with no correlation to any specific MDS risk group. Furthermore, the co-injection of mesenchymal stromal cells (MSCs) did not improve the level of engraftment. Finally, we have developed an in vitro two-dimensional co-culture system as an alternative tool to in vivo. Using our in vitro system, we have been able to co-culture CD34+cells from MDS patient BM on auto- and/or allogeneic MSCs over 4 weeks with a fold expansion of up to 600 times. More importantly, these expanded cells conserved their MDS clonal architecture as well as genomic integrity

Quantification of lentiviral vector copy numbers in individual hematopoietic colony-forming cells shows vector dose-dependent effects on the frequency and level of transduction

Lentiviral vectors are effective tools for gene transfer and integrate variable numbers of proviral DNA copies in variable proportions of cells. The levels of transduction of a cellular population may therefore depend upon experimental parameters affecting the frequency and/or the distribution of vector integration events in this population. Such analysis would require measuring vector copy numbers (VCN) in individual cells. To evaluate the transduction of hematopoietic progenitor cells at the single-cell level, we measured VCN in individual colony-forming cell (CFC) units, using an adapted quantitative PCR (Q-PCR) method. The feasibility, reproducibility and sensitivity of this approach were tested with characterized cell lines carrying known numbers of vector integration. The method was validated by correlating data in CFC with gene expression or with calculated values, and was found to slightly underestimate VCN. In spite of this, such Q-PCR on CFC was useful to compare transduction levels with different infection protocols and different vectors. Increasing the vector concentration and re-iterating the infection were two different strategies that improved transduction by increasing the frequency of transduced progenitor cells. Repeated infection also augmented the number of integrated copies and the magnitude of this effect seemed to depend on the vector preparation. Thus, the distribution of VCN in hematopoietic colonies may depend upon experimental conditions including features of vectors. This should be carefully evaluated in the context of ex vivo hematopoietic gene therapy studies

A functional assay for microRNA target identification and validation

MicroRNAs (miRNA) are a class of small RNA molecules that regulate numerous critical cellular processes and bind to partially complementary sequences resulting in down-regulation of their target genes. Due to the incomplete homology of the miRNA to its target site identification of miRNA target genes is difficult and currently based on computational algorithms predicting large numbers of potential targets for a given miRNA. To enable the identification of biologically relevant miRNA targets, we describe a novel functional assay based on a 3′-UTR-enriched library and a positive/negative selection strategy. As proof of principle we have used mir-130a and its validated target MAFB to test this strategy. Identification of MAFB and five additional targets and their subsequent confirmation as mir-130a targets by western blot analysis and knockdown experiments validates this strategy for the functional identification of miRNA targets

Catalytic conversion of methane at low temperatures: a critical review

The current study reviews the recent development in the direct conversion of methane into syngas, methanol, light olefins, and aromatic compounds. For syngas production, nickel-based catalysts are considered as a good choice. Methane conversion (84%) is achieved with nearly no coke formation when the 7% Ni-1%Au/Al2O3 catalyst is used in the steam reforming of methane (SRM), whereas for dry reforming of methane (DRM), a methane conversion of 17.9% and CO2 conversion of 23.1% are found for 10%Ni/ZrOxMnOx/SiO2 operated at 500oC. The progress of direct conversion of methane to methanol is also summarized with an insight into its selectivity and/or conversion, which shows that in liquid-phase heterogeneous systems, high selectivity (>80%) can be achieved at 50oC, but the conversion is low. The latest development of nonoxidative coupling of methane (NOCM) and oxidative coupling of methane (OCM) for the production of olefins is also reviewed. The Mn2O3–TiO2–Na2WO4/SiO2 catalyst is reported to show the high C2 yield (22%) and a high selectivity toward C2 (62%) during the OCM at 650oC. For NOCM, 98% selectivity of ethane can be achieved when a tantalum hydride catalyst supported on silica is used. In addition, the Mo-based catalysts are the most suitable for the preparation of aromatic compounds from methane

Estuarine circulation, mixing, and residence times in the Salish Sea

A realistic numerical model is used to study the circulation and mixing of the Salish Sea, a large, complex estuarine system on the United States and Canadian west coast. The Salish Sea is biologically productive and supports many important fisheries but is threatened by recurrent hypoxia and ocean acidification, so a clear understanding of its circulation patterns and residence times is of value. The estuarine exchange flow is quantified at 39 sections over 3 years (2017–2019) using the Total Exchange Flow method. Vertical mixing in the 37 segments between sections is quantified as opposing vertical transports: the efflux and reflux. Efflux refers to the rate at which deep, landward-flowing water is mixed up to become part of the shallow, seaward-flowing layer. Similarly, reflux refers to the rate at which upper layer water is mixed down to form part of the landward inflow. These horizontal and vertical transports are used to create a box model to explore residence times in a number of different sub-volumes, seasons, and years. Residence times from the box model are generally found to be longer than those based on simpler calculations of flushing time. The longer residence times are partly due to reflux, and partly due to incomplete tracer homogenization in sub-volumes. The methods presented here are broadly applicable to other estuaries