THE THERAPEUTIC AND TOXICOLOGICAL EFFECT OF KUPILU (STRYCHNOS NUX-VOMICA L.)- A REVIEW

Kupilu (Strychnos nux-vomica L., family-Loganiaceae) is a poisonous herbal plant, also known as Kuchla in Ayurvedic samhitas and has been commonly used in Ayurvedic pharmacopoeia. It is also described in Surasadi gana of Sushruta and Amradi phala varga of Bhavprakasa. It is a deciduous tree which is widely distributed in India and found throughout tropical areas of India, Sri Lanka, Vietnam, Thailand, Cambodia and Malaysia. In this review, an endeavor has been made to explore the therapeutic utilities of Strychnos nux vomica and its poisoning effect as mentioned in Ayurveda. It is observed that seeds of Strychnos nux-vomica are used as an ingredient of compound formulations of Ayurvedic medicine, indicated for nervous debility, paralysis and weakness of limbs, sexual weakness, dyspepsia, dysentery and chronic rheumatism. Additionally, it is employed in the treatment of anemia, asthma, bronchitis, colic, intermittent fever, hysteria, etc in a specific therapeutic dose. In higher doses, it produces tetanic convulsions ultimately resulting in death. Kupilu has been described as a toxic plant in Ayurveda so certain Shodhan process of the seeds are considered mandatory before its administration

AN OVERVIEW ON PHARMACOVIGILANCE: A KEY FOR DRUG SAFETY AND MONITORING

Pharmacovigilance outlined by the globe Health Organization (WHO) because the science and series of activities about the detection, evaluation, understanding rejection of adverse impact or Associate in Nursing different drug connected problem’ and a clinical test could be an analysis study in human volunteers to answer specific health queries. Fastidiously conducted clinical trials square measure quickest and safest thanks to realizing treatment that employment in individuals and thanks to improving health.  Play a crucial role in guaranteeing that patient to be provided the safe drug. The Pharmacovigilance has been recognizing to play a crucial role in the rational use of the drug by providing data concerning the adverse impact possess by drug normally population. The information of drug Adverse Drug Reaction (ADRs) are often increased by numerous suggests that such information studies, intensive observation, spontaneous reportage and different new method at dictatorial and scientific level square measure being developed with the intention of step-up Pharmacovigilance. As a result of assessment strategies are not entirely void of individual judgments, integrator reliableness is often low. In conclusions, there's still no methodology universally accepted for casualty assessment of ADRs. Keywords: Adverse Drug Reaction, Clinical test, Pharmacovigilance, Treatment

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Microcytic hypochromic anemia: Should high performance liquid chromatography be used routinely for screening anemic and antenatal patients?

Background: Hemoglobinopathies are the most common inherited red cell disorders worldwide. Identification of these disorders is immensely important epidemiologically and for improved management protocols. Aim and Objectives: Our aim was to determine the prevalence of hemoglobinopathies in patients with microcytic hypochromic anemia and to assess the suitability of using high performance liquid chromatography (HPLC) routinely for screening antenatal cases and patients with anemia. Materials and Methods: A total of 4335 cases received from Mar 2007 to Nov 2011 were studied for various hemoglobinopathies and variants on BIO RAD ′VARIANT′ analyzer. Results: Of the 4335 cases studied, 2119 were antenatal cases, 1710 patients with other disorders and 506 family studies. Of these, 688 cases displayed abnormal hemoglobin fractions on HPLC of which 140 were antenatal women. There were 455 cases of β thalassemia trait, 24 β thalassemia major, 20 thalassemia inter-media, 54 sickle cell trait, fivesickle cell disease, 21 double heterozygous β thalassemia-sickle cell trait, nineand 4 Hb D- Punjab heterozygous and homozygous respectively, three Hb D β Thalassemia trait, 20 and 37 Hb E homozygous and heterozygous respectively, three Hb E β Thalassemia trait and four cases of Hb Q India. Twenty nine adults had isolated HbF elevation. Conclusion: Our study found a high prevalence (15.8%) of hemoglobinopathies amongst microcytic hypochromic anemia and antenatal cases. An accurate diagnosis helps in preventing unnecessary iron loading. Screening all antenatal cases with anemia helps in timely antenatal counseling, thus preventing the psychological trauma of bearing a transfusion dependent child for life

Classification of Middle Tropospheric Systems over the Arabian Sea and Western India

The formation of Middle Tropospheric Cyclones (MTCs) that are responsible for a large portion of annual precipitation and extreme rainfall events over western India is studied using an unsupervised machine learning algorithm and cyclone tracking. Both approaches reveal four dominant weather patterns that lead to the genesis of these systems; specifically, re-intensification of westward moving synoptic systems from Bay of Bengal (Type 1, 51%), in-situ formation with a coexisting cyclonic system over the Bay of Bengal that precedes (Type 2a, 31%) or follows (Type 2b, 10%) genesis in the Arabian Sea, and finally in-situ genesis within a northwestward propagating cyclonic anomaly from the south Bay of Bengal (Type 2c, 8%). Thus, a large fraction of rainy middle tropospheric synoptic systems in this region form in association with cyclonic activity in the Bay of Bengal. The four variants identified also show a marked dependence on large-scale environmental features with Type 1 and Type 2a formation primarily occurring in phases 4 and 5, and Type 2b and Type 2c in phases 3 and 4 of the Boreal Summer Intraseasonal Oscillation. Further, while in-situ formation with a Bay of Bengal cyclonic anomaly (Type 2a and 2b) mostly occurs in June, downstream development is more likely in the core of the monsoon season. Out of all categories, Type 2a is associated with the highest rain rate (60 mm/day) and points towards the dynamical interaction between a low pressure system over the Bay of Bengal and the development of MTCs over western India and the northeast Arabian Sea. This classification, identification of precursors, connection with cyclonic activity over the Bay of Bengal and dependence on large-scale environment provides an avenue for better understanding and prediction of rain-bearing MTCs over western India

Optimizing India’s Medical Oxygen Supply Chain for Pandemics

The pandemic situation like COVID-19 worsened the medical situation in India, and the crisis of medical oxygen availability at hospitals in different parts of India has also been a deep concern. In this study, we analyzed the supply chain of medical oxygen from manufacturing units to the needy capital cities of states. A two-mode optimization model has been developed for better planning of transportation and supply of medical oxygen. Various industrial units with a liquid oxygen production facility have been considered as sources while road and rail routes have been considered as modes of transportation. Finally, the oxygen cylinders/tankers are transported by road to hospitals. The mathematical model tries to optimize the route and transport medium, considering various constraints. This paper identifies the challenges in Indian contexts and tries to address them by an optimal, cost-effective, and efficient planning for medical oxygen transportation