Development of decadal (1985–1995–2005) land use and land cover database for India

India has experienced significant Land-Use and Land-Cover Change (LULCC) over the past few decades. In this context, careful observation and mapping of LULCC using satellite data of high to medium spatial resolution is crucial for understanding the long-term usage patterns of natural resources and facilitating sustainable management to plan, monitor and evaluate development. The present study utilizes the satellite images to generate national level LULC maps at decadal intervals for 1985, 1995 and 2005 using onscreen visual interpretation techniques with minimum mapping unit of 2.5 hectares. These maps follow the classification scheme of the International Geosphere Biosphere Programme (IGBP) to ensure compatibility with other global/regional LULC datasets for comparison and integration. Our LULC maps with more than 90% overall accuracy highlight the changes prominent at regional level, i.e., loss of forest cover in central and northeast India, increase of cropland area in Western India, growth of peri-urban area, and relative increase in plantations. We also found spatial correlation between the cropping area and precipitation, which in turn confirms the monsoon dependent agriculture system in the country. On comparison with the existing global LULC products (GlobCover and MODIS), it can be concluded that our dataset has captured the maximum cumulative patch diversity frequency indicating the detailed representation that can be attributed to the on-screen visual interpretation technique. Comparisons with global LULC products (GlobCover and MODIS) show that our dataset captures maximum landscape diversity, which is partly attributable to the on-screen visual interpretation techniques. We advocate the utility of this database for national and regional studies on land dynamics and climate change research. The database would be updated to 2015 as a continuing effort of this study

Cost and usage patterns of antibiotics in a tertiary care neurosurgical unit

Objectives: The routine use of prophylactic antibiotics in neurosurgery has been shown to significantly reduce surgical site infection rates. The documentation of non-surgical site, nosocomial infections in neurosurgical patients remains limited, despite this being a stimulus for prolific antibiotic usage. The actual quantum of antibiotic use in neurosurgery and its role in infection control remain both undocumented and controversial. The authors address this issue with a cost-effectiveness study using historical controls. Materials and Methods: Bacteriologically positive body fluid samples were used to quantify infection rates in the year 2006 and compared with those in the year 1997. Itemized drug lists obtained from dedicated neurosurgical intensive care units and wards were used to quantify antibiotic usage and calculate their costs. Results were compared using both historical and internal controls. The monetary conversion factor used was INR 40=US$1. Results: A total of 3114 consecutive elective and emergency neurosurgical procedures were performed during the study period. 329 patients (10.6$359,455.7). On an average, an operated patient received 32.2 units of antibiotics valued at Rs. 4,617 ($115.4). The crude infection rates were recorded to have reduced significantly in comparison to 1997, but did not differ between mirror intra-departmental units with significantly different antibiotic usage. Conclusions: Antibiotics accounted for 31% of the per capita cost of consumables for performing a craniotomy in the year 2006. This estimate should be factored into projecting future package costs

Effect of risk-stratified, protocol-based perioperative chemoprophylaxis on nosocomial infection rates in a series of 31 927 consecutive neurosurgical procedures (1994-2006)

Although the use of prophylactic antibiotics has been shown to significantly decrease the incidence of meningitis after neurosurgery, its effect on extra-neurosurgical-site infections has not been documented. The authors explore the effect of risk-stratified, protocol-based perioperative antibiotic prophylaxis on nosocomial infections in an audit of 31 927 consecutive routine and emergency neurosurgical procedures. Infection rates were objectively quantified by bacteriological positivity on culture of cerebrospinal fluid (CSF), blood, urine, wound swab, and tracheal aspirate samples derived from patients with clinicoradiological features of sepsis. Infections were recorded as pulmonary, wound, blood, CSF, and urinary. The total numbers of hospital-acquired infections and the number of patients infected were also recorded. A protocol of perioperative antibiotic prophylaxis of variable duration stratified by patient risk factors was introduced in 2000, which was chosen as the historical turning point. The chi test was used to compare infection rates. A P value of <0.05 was considered significant. A total of 31 927 procedures were performed during the study period 1994-2006; 5171 culture-proven hospital-acquired infections (16.2%) developed in 3686 patients (11.6%). The most common infections were pulmonary (4.4%), followed by bloodstream (3.5%), urinary (3.0%), CSF (2.9%), and wound (2.5%). The incidence of positive tracheal, CSF, blood, wound, and urine cultures decreased significantly after 2000. Chemoprophylaxis, however, altered the prevalent bacterial flora and may have led to the emergence of methicillin-resistant Staphylococcus aureus. A risk-stratified protocol of perioperative antibiotic prophylaxis may help to significantly decrease not only neurosurgical, but also extra-neurosurgical-site body fluid bacteriological culture positivity

Cushing's Disease: results of treatment and factors affecting outcome

Objective: To analyze the therapeutic results of intervention and the factors affecting the outcome of patients with Cushing’s Disease (CD) cared for at the All Indian Institute of Medical Science (AIIMS), New Delhi. Design: Patients with Cushing’s Disease treated at a teritiary care centre from January 2000 to December 2009 were prospectively studied. Results: Ninety-seven patients received treatment for CD during this period. Mean duration of follow-up was 3.4 &#177; 2.2 (mean&#177;SD) years. Eighty-one patients (83.5%) underwent Transsphenoidal Surgery (TSS) as the primary treatment modality. Fifty-four patients (66.7%) went into remission after initial TSS; ten (18.5%) of them relapsed after a mean follow-up period of 2.9&#177;2.1 (mean&#177;SD) years. Histopathologic examination of resected tissue showed corticotroph adenoma in 48 of the 54 (88.9%) who went into remission and 17 of the 27 (63.0%) who did not go into remission after the initial TSS. Sixteen patients with severe hypercortisolism underwent Bilateral Adrenalectomy (BA) as a life-saving measure which was followed by pituitary surgery 6 to 12 months later. Five patients including one with a large macroadenoma required three or more procedures to achieve eucortisolism. Conclusion: Fifty-four out of 81 (66.7%) of our patients with CD had remission following initial TSS, ten of whom relapsed later on. Sixteen patients unerwent BA as a life-saving procedure. Factors affecting outcome were, age, gender, low dose dexamethasone suppression test cortisol value and histologic confirmation of corticotroph adenom

Development of Decadal (1985–1995–2005) Land Use and Land Cover Database for India

India has experienced significant Land-Use and Land-Cover Change (LULCC) over the past few decades. In this context, careful observation and mapping of LULCC using satellite data of high to medium spatial resolution is crucial for understanding the long-term usage patterns of natural resources and facilitating sustainable management to plan, monitor and evaluate development. The present study utilizes the satellite images to generate national level LULC maps at decadal intervals for 1985, 1995 and 2005 using onscreen visual interpretation techniques with minimum mapping unit of 2.5 hectares. These maps follow the classification scheme of the International Geosphere Biosphere Programme (IGBP) to ensure compatibility with other global/regional LULC datasets for comparison and integration. Our LULC maps with more than 90% overall accuracy highlight the changes prominent at regional level, i.e., loss of forest cover in central and northeast India, increase of cropland area in Western India, growth of peri-urban area, and relative increase in plantations. We also found spatial correlation between the cropping area and precipitation, which in turn confirms the monsoon dependent agriculture system in the country. On comparison with the existing global LULC products (GlobCover and MODIS), it can be concluded that our dataset has captured the maximum cumulative patch diversity frequency indicating the detailed representation that can be attributed to the on-screen visual interpretation technique. Comparisons with global LULC products (GlobCover and MODIS) show that our dataset captures maximum landscape diversity, which is partly attributable to the on-screen visual interpretation techniques. We advocate the utility of this database for national and regional studies on land dynamics and climate change research. The database would be updated to 2015 as a continuing effort of this study