Awareness on antibiotic usage among undergraduate medical students in a teaching hospital, Guntur

Background: Antibiotics are the mainstay treatment of most of the infectious diseases. Inappropriate and irrational use of antimicrobial agents has led to increase in the development of antimicrobial resistance. Medical students are a part of health care system and they must be aware of increasing antibiotic resistance as they are the future prescribers. The objectives of the study were to assess the awareness on antibiotic usage and its resistance among medical students and to study the perception on antibiotic medication among medical students.Methods: This was a cross-sectional, semi-structured questionnaire-based study. Questionnaire consists of 4 parts- socio-demographic details, awareness on antibiotics and its resistance, knowledge on specific treatment of a disease, perception levels. Prior IEC approval was taken. The obtained data was statistically analyzed using Microsoft excel sheet.Results: Among 230 participants, majority of the students have awareness on general antibiotic usage and 97.8% were having knowledge about antibiotic resistance. The main source of information on antibiotic resistance is identified as classroom teaching (67.8%). 46.9% and 25.2% students correctly identified the drug of choice for treating enteric fever and community acquired pneumonia respectively.Conclusions: Degrees of awareness on antibiotics and its resistance is found to be good. Antibiotic usage pattern is not on par with knowledge. Knowledge on specific treatment of infectious disease is found to be less. So, antibiotic teaching should be integrated with clinical subjects

Interplay between n-3 and n-6 long-chain polyunsaturated fatty acids and the endocannabinoid system in brain protection and repair.

The brain is enriched in arachidonic acid (ARA) and docosahexaenoic acid (DHA), long-chain polyunsaturated fatty acids (LCPUFA) of the n-6 and n-3 series, respectively. Both are essential for optimal brain development and function. Dietary enrichment with DHA and other long-chain n-3 PUFA, such as eicosapentaenoic acid (EPA) have shown beneficial effects on learning and memory, neuroinflammatory processes and synaptic plasticity and neurogenesis. ARA, DHA and EPA are precursors to a diverse repertoire of bioactive lipid mediators, including endocannabinoids. The endocannabinoid system comprises cannabinoid receptors, their endogenous ligands, the endocannabinoids, and their biosynthetic and degradation enzymes. Anandamide (AEA) and 2-archidonoylglycerol (2-AG) are the most widely studied endocannabinoids, and are both derived from phospholipid-bound ARA. The endocannabinoid system also has well established roles in neuroinflammation, synaptic plasticity and neurogenesis, suggesting an overlap in the neuroprotective effects observed with these different classes of lipids. Indeed, growing evidence suggests a complex interplay between n-3 and n-6 LCPUFA and the endocannabinoid system. For example, long-term DHA and EPA supplementation reduces AEA and 2-AG levels, with reciprocal increases in levels of the analogous endocannabinoid-like DHA and EPA-derived molecules. This review summarises current evidence of this interplay and discusses the therapeutic potential for brain protection and repair

Retrospective review of safety and efficacy of programmed cell death-1 inhibitors in refractory high grade gliomas

Abstract Background Programmed cell death ligand-1 (PD-L1) expression has been reported in up to 61% of high grade gliomas (HGG). The purpose of this study was to describe safety and efficacy of PD-1 inhibition in patients with refractory HGGs. Methods This Institutional Review Board approved single center retrospective study included adult patients with pathologically confirmed HGG who received a PD-1 inhibitor from 9/2014–10/2016 outside of a clinical trial at Memorial Sloan Kettering Cancer Center. Results Twenty five HGG patients received pembrolizumab as part of a compassionate use program. Median age was 50 years (range 30–72); 44% were men; 13 had glioblastoma (52%), 7 anaplastic astrocytoma (28%), 2 anaplastic oligodendroglioma (8%), 2 unspecified HGG (8%), and 1 gliosarcoma (4%). Median prior lines of treatments were 4 (range 1–9). Nineteen (76%) previously failed bevacizumab. Median KPS was 80 (range 50–100). Concurrent treatment included bevacizumab in 17 (68%) or bevacizumab and temozolomide in 2 (8%) patients. Median number of doses administered was 3 (range 1–14). Outcomes were assessed in 24 patients. PD-1 inhibitor related adverse events included LFT elevations, hypothyroidism, diarrhea, myalgias/arthralgias, and rash. Best radiographic response was partial response (n = 2), stable disease (n = 5), and progressive disease (n = 17). Median progression free survival (PFS) was 1.4 months (range 0.2–9.4) and median overall survival (OS) was 4 months (range 0.5–13.8). Three-month PFS was 12% and 6-month OS was 28%. Conclusion While response rates are low, a few patients had a prolonged PFS. Pembrolizumab was tolerated with few serious toxicities, even in patients receiving concomitant therapy

Minimally Invasive Management of Ureteral Distal Strictures: Robotic Ureteroneocystostomy With a Bilateral Boari Flap

Objective: To describe robotic ureteroneocystostomy performed by bilateral Boari flap. Methods: An 82-year-old female with bilateral mid ureteral strictures secondary to uterine cancer treated with radiation was managed with ureteral stenting and bilateral nephrostomy tubes. Nevertheless, patient had severe colic and recurrent urinary tract infections and thus agreed to undergo bilateral robotic ureteral reconstructive surgery. Patient positioning and ports placement were similar to those of robotic prostatectomy. Ureters were divided at the level of the common iliac bifurcation and mobilized proximally. Strictures were excised and ureters were spatulated. After the bladder was dropped from the abdominal wall, a bladder flap was created with a broad base to ensure adequate blood supply. The ureteral anastomosis to the bladder flap was started using 3-0 Vicryl interrupted sutures to secure the posterior ureter to the bladder flap. The flap was then bisected in the midline to create a tension-free anastomosis. The ureteral anastomosis was completed over a double J ureteral stent. The wings of the bisected bladder flap were reapproximated with a 3-0 barbed suture to form a "Y" bladder configuration. Procedures were done bilaterally. The remainder of the cystotomy was closed with barbed suture. The bladder was tested for leakages and a drain was placed. Results: Blood loss was 50 mL. The patient recovered uneventfully and was discharged on postoperative day 4 with nephrostomy tubes and Jackson-Pratt drain removed prior to discharge. Follow-up cystogram revealed no leakage and bilateral reflux in the reconstructed bladder. Ureteral stents were removed 4 weeks postoperatively. Follow-up for these patients is recommended with either a renal scan or CT scan with delayed imaging. For this patient with severe chronic kidney disease, she unfortunately could not receive intravenous contrast and renal scan proved unreliable. Therefore, our follow-up was performed on the basis of her renal function (creatinine) which remained stable without nephrostomies or ureteral stents. Postoperatively, the patient did not complain of de novo lower urinary tract symptoms nor did she require anticholinergics. Conclusion: Robotic bilateral Boari flap is feasible for patients with bilateral distal ureteral strictures. Further studies are needed to assess long-term outcomes. Given the significant degree of bladder reconstruction required for this procedure, we recommend an assessment of bladder capacity preoperatively in the form of a gravity cystogram or video urodynamics