Rothia prosthetic knee joint infection

Rothia species — Gram-positive pleomorphic bacteria that are part of the normal oral and respiratory flora — are commonly associated with dental cavities and periodontal disease although systemic infections have been described. We describe a 53-year-old female with rheumatoid arthritis complicated by prosthetic knee joint infection due to Rothia species, which was successfully treated by surgical removal of prosthesis and prolonged antimicrobial therapy. The issue of antibiotic prophylaxis before dental procedures among patients with prosthetic joint replacements is discussed

Study of the antibiotic sensitivity pattern of bloodstream infections in gynaecological ICU

Background: Severe sepsis is one of the leading causes of death even in the developed nation, among critically ill patients admitted in intensive care units (ICU). Decreasing antibiotic susceptibility with increasing length of hospital stay increases the burden on the healthcare system.Methods: A total of 75 samples taken from the patients suspected with bloodstream infection in the gynaecological ICU were processed as per standard protocol. Identification of bacteria was carried out with the help of relevant biochemical tests. Antibiotic susceptibility testing was done by Kirby-Bauer Disk diffusion method according to CLSI guidelines.Results: Positive blood culture was seen in 21 (28%) samples. Out of these 13 (61.90%) were gram negative bacteria and 8 (38.09%) was gram positive cocci. Escherichia spp., Klebsiella spp. and Acinetobacter spp. were the predominant isolates in gram negative bacteria. Gentamicin, Piperacillin-Tazobactam, Imipenem and Levofloxacin were the most sensitive antibiotics while Cefazolin, Cefuroxime, Cefepime and Ceftazidime were the most resistant antibiotics.Conclusions: Gram negative bacteria are an emerging cause of sepsis in ICU patients while gram positive bacteria still remain prevalent. The purpose of this study is to identify the bacterial cause of septicaemia in general intensive care unit (GICU) patients

Characteristics of blood infections and phenotypic detection of extended-spectrum β-lactamases in ICU patients in Central India posing a challenge

Background: Bloodstream infection (BSI) is defined by positive blood cultures in a patient with systemic signs of infection and may be either secondary to a documented source or primary, that is, without identified origin. The aim of this study was to improvise blood culture systems for a quicker, optimum diagnosis and prompt treatment. Methods: A prospective study was conducted with total of 309 samples for determining the bacteriological profile and prevalence of ESBL in BSI’s in patients admitted in the ICU’s (surgical/medical/gynaecological) with the suspicion of sepsis. Samples received in department of microbiology were processed as per standard protocol and identification of bacteria was carried out with the help of relevant biochemical tests. AST for both the ICUs was done together by Kirby-Bauer disk diffusion method according to CLSI guidelines. Results: Of the total, 149 (48.22%) samples were positive for growth with the major isolates out of these being gram negative bacilli, 104 (69.79%) and 45 (30.21%) were gram positive cocci. Among the gram negative bacilli, Klebsiella pneumoniae 35 (33.65%) was the most common bacteria while the least frequent organism isolated was Acinetobacter baumanii 10 (9.62%). Imipenem, piperacillin-tazobactam and levofloxacin were the most sensitive antibiotics whereas cefepime, cefuroxime were the most resistant antibiotics. Conclusions: This study highlights the incidence of gram negative bacilli in ICU’s and the emergence of multi-drug resistant organism. Infections with MDR organisms can lead to inadequate or delayed treatment which is associated with adverse patient outcomes

Feto-maternal outcome in human immunodeficiency virus seropositive mothers in co-relation with CD4 count

Background: To study the effect of human immunodeficiency virus (HIV) infection on pregnancy outcomes and new born as mother to child transmission of HIV is a major route on new infections in children and compare it with HIV uninfected pregnancies.Methods: Prospective comparative study conducted on 40 HIV seropositive and 40 HIV seronegative pregnant women attending ANC and delivering in the department of obstetrics and gynecology, S. M. S. Medical College, Jaipur, Rajasthan, India.Results: CD4 count had no effect on birth weight of baby or term of delivery. HIV seropositive pregnancies were more prone to IUD, still birth and preterm birth (p=0.029). Mother to child transmission was 2.7%.Conclusions: HIV infection increases the risk of adverse foetal outcome in terms of intrauterine demise, still birth and preterm labour

EFFECT OF POLYMERS ON THE PHYSICOCHEMICAL AND DRUG RELEASE PROPERTIES OF TRANSDERMAL PATCHES OF ATENOLOL

Objective: The objective of this research work was to develop a transdermal drug delivery system containing atenolol with different ratios of hydrophilic and hydrophobic polymeric combinations, using solvent evaporation technique and to examine the effect of hydrophilicity and hydrophobicity of polymers on the physicochemical and drug release properties of transdermal patches.Methods: Solvent casting method has been used to formulate transdermal patches. Hydroxypropyl methylcellulose (HPMC), Polyvinylpyrrolidone (PVP), Ethylcellulose (EC) in different combination ratios were used as the polymer. Propylene glycol was used as a plasticizer. Permeation enhancers such as span 80 were used to enhance permeation through the skin. In vitro diffusion study was carried out by franz diffusion cell using egg membrane as a semi-permeable membrane for diffusion.Results: Result showed that the thickness of the all batch of patches varied from 0.32 to 0.39 mm with uniformity of thickness in each formulation. Formulations F1 to F3 had high moisture content varied from 2.07±0.09 to 2.56±0.15 and high moisture uptake value varied from 3.21±0.35 to 4.09±0.38, due to a higher concentration of hydrophilic polymers. Drug content of all batches was ranged between 85.92±1.32 to 95.71±1.42. Folding endurance values off all batches were more than 75. Formulation batches F1 to F3 showed higher cumulative drug release varied from 61.34% to 68.11% as compared to formulation batches F4 to F6.Conclusion: Higher proportion of hydrophilic polymer in the formulation of transdermal patches, gives higher percentage drug release from prepared patches. The finding of the study indicates that hydrophilicity and hydrophobicity of polymer effects the physicochemical and drug release properties of transdermal patches and an optimum proportion of hydrophilic and hydrophobic polymer is required for the preparation of effective transdermal patches.Â

Determination of mycophenolic acid in human plasma by ultra performance liquid chromatography tandem mass spectrometry

AbstractA simple, sensitive and high throughput ultra performance liquid chromatography tandem mass spectrometry method has been developed for the determination of mycophenolic acid in human plasma. The method involved simple protein precipitation of MPA along with its deuterated analog as an internal standard (IS) from 50µL of human plasma. The chromatographic analysis was done on Acquity UPLC C18 (100mm×2.1mm, 1.7µm) column under isocratic conditions using acetonitrile and 10mM ammonium formate, pH 3.00 (75:25, v/v) as the mobile phase. A triple quadrupole mass spectrometer operating in the positive ionization mode was used for quantitation. In-source conversion of mycophenolic glucuronide metabolite to the parent drug was selectively controlled by suitable optimization of cone voltage, cone gas flow and desolvation temperature. The method was validated over a wide concentration range of 15–15000ng/mL. The mean extraction recovery for the analyte and IS was >95%. Matrix effect expressed as matrix factors ranged from 0.97 to 1.02. The method was successfully applied to support a bioequivalence study of 500mg mycophenolate mofetil tablet in 72 healthy subjects

Prescribing pattern in patients of asthma visiting outpatient departments of a tertiary care hospital: a cross-sectional, observational study

Background: Objective of the study was to evaluate the prescribing pattern in patients of asthma visiting outpatient departments.Methods: Collected prescriptions were analyzed for demographic variables, proportions of various comorbid conditions, average number of drugs per prescription, average number of anti-asthmatic drugs per prescription, proportion of prescription with antibiotics, fixed dose combinations, and generic/brand names, proportion of formulations utilized, proportion of concomitant medications and possible drug interactions, average cost per prescription, average cost of antiasthmatic drugs per prescription, proportion of irrational prescription and adverse drug reactions.Results: Total 139 prescriptions were evaluated. Deriphyllin was the most commonly prescribed anti-asthmatic drug followed by beta agonist- steroid combination. Majority drugs were prescribed by inhalational route. Deriphyllin, and dexamethasone were prescribed by oral route and salbutamol was by both oral and inhalational route of administration. Antibiotics were prescribed to 24 patients. Possible drug interaction with deriphyllin was found in 15 prescriptions. Average cost per prescription was Rs. 193.4 (95%CI: 171.6-215.3).Conclusions: Prescribing pattern of asthma in our hospital shows more use of anti-asthmatic drugs. Standard treatment guideline should be followed. Role of methylxanthine in long term management of asthma should be justified