Microbiological Antibiotic Assay Validation of Gentamicin Sulfate Using Two-Dose Parallel Line Model (PLM)

Nowadays, microbiological assay is still widely used with several antibiotics that are composed of a mixture of related active compounds. However, obtaining a reasonably valid determination of the potency is dependent on the validity and suitability of the assay design. The present work aimed to validate an assay design for an aminoglycoside antibiotic (Gentamicin Sulfate) using a two-dose Parallel Line Model agar diffusion assay in a large 8×8 rectangular plate. All preparatory procedures were done following the United States Pharmacopeia and the inhibition zones were measured using a digital caliper to the nearest 0.01 mm. Analysis of variance in compendial requirements for regression and parallelism were found to satisfactorily meet the acceptance criteria. Specificity was achieved for the product under investigation with no detectable IZ that could be found for all components except the antibiotic. The validation method showed an acceptable linearity of r2≥0.98. Accuracy and precision parameters showed RSD (%)<2. All relative error value estimates were below 4%. The proposed validation design for 32×32 cm antibiotic plates yielded valid results and can be projected for the routine Quality Control analysis of the antibiotic material, especially that which is incorporated into a finished medicinal dosage form. Doi: 10.28991/HIJ-2021-02-04-04 Full Text: PD

Dendrogram Analysis and Statistical Examination for Total Microbiological Mesophilic Aerobic Count of Municipal Water Distribution Network System

The microbiological quality of water for human consumption is a critical safety aspect that should not be overlooked, especially when considering facilities for healthcare and the treatment of ill populations. Thus, the biological stability of water is crucial for the distribution network that delivers potable water to the final users for consumption and other human activities. The present work aimed to study a municipal distribution network system for city water within a healthcare facility. The implementation of the statistical analysis was conducted over long-term data collection, and the comparative study for the microbiological count of the water samples - from different points-of-use was assessed using the non-parametric analysis of the Kruskal-Wallis test. The comparative study involved a preliminary general one-way Analysis of Variance (ANOVA) followed by ad-hoc pairwise comparison. The statistical study involved a correlation matrix and a dendrogram to elucidate the level of association between different sections in the network. The ports C4 and C13 were at the trough in the microbiological count, in contrast to C13, which showed the highest level of the average microbial density. Despite a low to moderate level of correlation between the datasets of the water network, the tree diagram (dendrogram) analysis showed remarkable clustering. Use points could be grouped into three dense groups based on abrupt cuts in the similarity value. The study was useful in the analysis of the pattern and behavior of the microbial quality in a distribution water network in a specific area of the study. This work in turn would help in investigating the areas of improvement and defect spotting, in addition to assessing the biological stability of the water distribution system. The study could be extended to cover other different processed water networks, such as distilled, deionized, and purified water, as well as Water-For-Injection (WFI). Doi: 10.28991/HIJ-2022-03-01-03 Full Text: PD

Assessment of Sperm Morphometry in Evaluating Male Infertility

Background: Infertility is a complex issue affecting 15% of couples of reproductive age, with men accounting for 40%-50% of infertility cases. Semen analysis comprises various descriptive measures of sperm and seminal fluid to determine semen quality. Transforming qualitative descriptions of sperm deformities and shape changes into quantitative terms can aid in identifying sub-visual abnormalities. This study aimed to evaluate sperm morphometry parameters in both infertile and fertile men. Methods and Results: The study enrolled a total of 101 participants, divided into three groups: Group A included 38 subfertile patients with varicocele, Group B included 33 patients with idiopathic infertility (23 with asthenozoospermia and 10 with oligozoospermia), and Group C (the control group) included 30 healthy fertile men. The mean age of patients was 31.6±5.81, 31.3±6.0, and 29.47±4.27 years in Groups A, B, and C, respectively. Scrotal duplex examinations were performed to identify the presence of varicocele. Semen samples were collected following WHO Manual (2010). Semen dynamic and morphological analyses were conducted using CASA (Computer-Assisted Semen Analysis, MIRALAB, ISO9001, ISO13485). We found that sperm concentration, total sperm count, sperm progressive motility, and sperm progressive+non-progressive motility were significantly lower in Group A and Group B than in Group C (P=0.000 in all cases); however, there were no differences between Group A and Group B regarding these parameters (Table 5). The sperm morphology index was significantly lower in Group A than in Group C (P=0.0024); no differences were found between Group B and Group C and Group B and Group A. The mean value of the sperm deformity index was significantly lower in Group A than in Group C P=0.004). Conclusion: Our study highlights the significant association between sperm morphology and male infertility in varicocele and idiopathic subfertile males

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

COVID-19 KINETICS BASED ON REPORTED DAILY INCIDENCE IN HIGHLY DEVASTATED GEOGRAPHICAL REGION: A UNIQUE ANALYSIS APPROACH OF EPIDEMIC

The recent outbreak of COVID-19 has impacted the whole globe in various facets of life. Most challenges stem from the public health effect with morbidities and mortalities extensively and comprehensively recorded and reported. The present case provides a unique analysis of the database of the observed cases and deaths of the corona virus pandemic. The focus was on one of the most devastating geographical locations in the world. The dataset of the USA was extracted and arranged chronologically over 106 weeks. The kinetics of mortality and morbidity were analyzed using three-dimensional graphs and control charts. Modeling of the cumulative dataset after logarithmic transformation was executed and the model was analyzed for fitting in terms of regression and error. A strong correlation existed between the number of reported cases and deaths over the study period with noticeable signs of six overlapping waves. Logarithmic transformation (to the base ten) showed improvement in data fitting with an appreciable reduction in standard error and residual parameters. The best-fitted model was an exponential association that could be used to evaluate the severity and frequency of the epidemic in terms of cumulative daily cases and deaths. The provided examination highlights the importance of the new statistical techniques for public health assessment and confrontation of the outbreaks by practitioners and professionals for community protection by providing measurable metrics for the evaluation of the health effect of the disease in the community.                          Peer Review History: Received: 1 November 2022; Revised: 7 December; Accepted: 4 January 2023, Available online: 15 January 2023 Academic Editor: Dr. Jennifer Audu-Peter, University of Jos, Nigeria, [email protected] Received file:                             Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, [email protected] Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, [email protected] Similar Articles: COVID-19 PANDEMIC AWARENESS AND ITS IMPACT ON BANGLADESHI PEOPLE: A COMMUNITY BASED SURVEY KNOWLEDGE, CHARACTERISTICS, WORK SITES OF HEALTH PRACTITIONERS FOR CHEST PHYSIOTHERAPY IN PATIENTS WITH COVID-19, IN KHARTOUM, SUDAN COVID-19 IN MEXICO: PREPARING FOR FUTURE PANDEMIC

A New Decision-Making Strategy for Techno-Economic Assessment of Generation and Transmission Expansion Planning for Modern Power Systems

Planning for the intensive use of renewable energy sources (RESs) has attracted wide attention to limit global warming and meet future load growth. Existing studies have shown that installing projects such as transmission lines, energy storage systems (ESSs), fault current limiters, and FACTs facilitate the integration of RESs into power systems. Different generation and transmission network expansion planning models have been developed in the literature; however, a planning model that manages multiple types of projects while maximizing the hosting capacity (HC) is not widely presented. In this paper, a novel planning framework is proposed to enhance and control the HC level of RESs by comparing various kinds of renewables, ESSs, fault current limiters, and FACTs to choose the right one, economically and technically. The proposed problem is formulated as a challenging mixed-integer non-linear optimization problem. To solve it, a solution methodology based on a developed decision-making approach and an improved meta-heuristic algorithm is developed. The decision-making approach aims to keep the number of decision variables as fixed as possible, regardless of the number of projects planned. While an improved war strategy optimizer that relies on the Runge-Kutta learning strategy is applied to strengthen the global search ability. The proposed decision-making approach depends primarily on grouping candidate projects that directly impact the same system state into four separate planning schemes. The first scheme relies on the impedance of devices installed in any path to optimally identify the location and size of the new circuits and the series-type FACTs. The second scheme is based on optimally determining the suitable types of ESSs. On the other hand, the third scheme optimizes the reactive power dispatched from the ESSs and shunt-type FACTs simultaneously. The fourth scheme is concerned with regulating the power dispatched from different types of RESs. All of the simulations, which were carried out on the Garver network and the 118-bus system, demonstrated the ability of the investigated model to select the appropriate projects precisely. Further, the results proved the robustness and effectiveness of the proposed method in obtaining high-quality solutions in fewer runs compared to the conventional method