Sharma M.,Rd Gardi Medical College |
Sharma M.,Karolinska Institutet |
Eriksson B.,Nordic School of Public Health |
Marrone G.,Karolinska Institutet |
And 2 more authors.
BMC Infectious Diseases | Year: 2012
Background: The worldwide increase in antibiotic resistant bacteria is of great concern. One of the main causes is antibiotic use which is likely to be high but is poorly described in India. The aim was to analyze and compare antibiotic prescribing for inpatients, in two private sector tertiary care hospitals; one Teaching and one Non-teaching, in Ujjain, India.Methods: A cross-sectional study with manual data collection was carried out in 2008. Antibiotic prescribing was recorded for all inpatients throughout their hospital stay. Demographic profile of inpatients and prescribed antibiotics were compared. WHO Anatomical Therapeutic Chemical (ATC) classifications for antibiotics was used and Defined Daily Doses (DDD) were calculated per patient day.Results: A total of 8385 inpatients were admitted during the study period. In the Teaching hospital (TH) 82% of 3004 and in the Non-teaching hospital (NTH) 79% of 5381 patients were prescribed antibiotics. The most commonly prescribed antibiotic groups were; fluoroquinolones and aminoglycosides in the TH and, 3rd generation cephalosporins and combination of antibiotics in the NTH. Of the prescriptions, 51% in the TH and 87% in the NTH (p<0.001) were for parenteral route administration. Prescribing by trade name was higher in the NTH (96%) compared with the TH (63%, p<0.001).Conclusions: The results from both hospitals show extensive antibiotic prescribing. High use of combinations of antibiotics in the NTH might indicate pressure from pharmaceutical companies. There is a need to formulate and implement; based on local prescribing and resistance data; contextually appropriate antibiotic prescribing guidelines and a local antibiotic stewardship program. © 2012 Sharma et al.; licensee BioMed Central Ltd.
Choudhary A.,Rd Gardi Medical College |
Mishra J.,Jk Nursing Hospital
International Journal of Pharma and Bio Sciences | Year: 2013
Aim:The aim of our study was to evaluate the effects of Yoga intervention in females suffering from premenstrual tension and premenstrual syndrome. Settings and Design 32 recently diagnosed females with premenstrual tension patients were recruited for a randomized controlled trial comparing the effects before and after a Yoga program. Materials and Methods To evaluate the premenstrual symptoms and severity, a simple scoring system given by WHAQ was used. Symptoms were divided in 3 main categories that were Negative effect, Water retention and Impaired concentration, analyzed before and after the yogic intervention techniques. Statistical Analysis Used We used analysis of covariance to compare interventions before and after the Yoga practice. Result 32 females contributed data to the current analysis (n=32). The result suggest a significant decrease in the negative affect category (p=< 0.00001) and in impaired concentration category (p =< 0.0001). There was also a significant lesser decrease (P=< 0.001) in water retention category as compare before and after Yoga practice. Conclusion The result suggest possible benefits for yogic techniques (Asanas, Pranayama and Dhyana) in reducing premenstrual symptoms and preventing suffering from premenstrual tension and syndrome.
Diwan V.,Karolinska Institutet |
Diwan V.,Rd Gardi Medical College |
Stalsby Lundborg C.,Karolinska Institutet |
Tamhankar A.J.,Karolinska Institutet |
Tamhankar A.J.,Rd Gardi Medical College
PLoS ONE | Year: 2013
The presence of antibiotics in the environment and their subsequent impact on resistance development has raised concerns globally. Hospitals are a major source of antibiotics released into the environment. To reduce these residues, research to improve knowledge of the dynamics of antibiotic release from hospitals is essential. Therefore, we undertook a study to estimate seasonal and temporal variation in antibiotic release from two hospitals in India over a period of two years. For this, 6 sampling sessions of 24 hours each were conducted in the three prominent seasons of India, at all wastewater outlets of the two hospitals, using continuous and grab sampling methods. An in-house wastewater sampler was designed for continuous sampling. Eight antibiotics from four major antibiotic groups were selected for the study. To understand the temporal pattern of antibiotic release, each of the 24-hour sessions were divided in three sub-sampling sessions of 8 hours each. Solid phase extraction followed by liquid chromatography/tandem mass spectrometry (LC-MS/MS) was used to determine the antibiotic residues. Six of the eight antibiotics studied were detected in the wastewater samples. Both continuous and grab sampling methods indicated that the highest quantities of fluoroquinolones were released in winter followed by the rainy season and the summer. No temporal pattern in antibiotic release was detected. In general, in a common timeframe, continuous sampling showed less concentration of antibiotics in wastewater as compared to grab sampling. It is suggested that continuous sampling should be the method of choice as grab sampling gives erroneous results, it being indicative of the quantities of antibiotics present in wastewater only at the time of sampling. Based on our studies, calculations indicate that from hospitals in India, an estimated 89, 1 and 25 ng/L/day of fluroquinolones, metronidazole and sulfamethoxazole respectively, might be getting released into the environment per 100 hospital beds. © 2013 Diwan et al.
Jehan K.,International Health Group |
Sidney K.,Karolinska Institutet |
Smith H.,International Health Group |
de Costa A.,RD Gardi Medical College
Reproductive Health Matters | Year: 2012
In Nepal, India, Bangladesh and Pakistan, policy focused on improving access to maternity services has led to measures to reduce cost barriers impeding women's access to care. Specifically, these include cash transfer or voucher schemes designed to stimulate demand for services, including antenatal, delivery and post-partum care. In spite of their popularity, however, little is known about the impact or effectiveness of these schemes. This paper provides an overview of five major interventions: the Aama (Mothers') Programme (cash transfer element) in Nepal; the Janani Suraksha Yojana (Safe Motherhood Scheme) in India; the Chiranjeevi Yojana (Scheme for Long Life) in India; the Maternal Health Voucher Scheme in Bangladesh and the Sehat (Health) Voucher Scheme in Pakistan. It reviews the aims, rationale, implementation challenges, known outcomes, potential and limitations of each scheme based on current available data. Increased use of maternal health services has been reported since the schemes began, though evidence of improvements in maternal health outcomes has not been established due to a lack of controlled studies. Areas for improvement in these schemes, identified in this review, include the need for more efficient operational management, clear guidelines, financial transparency, plans for sustainability, evidence of equity and, above all, proven impact on quality of care and maternal mortality and morbidity. © 2012 Reproductive Health Matters.
Lundborg C.S.,Karolinska Institutet |
Tamhankar A.J.,Karolinska Institutet |
Tamhankar A.J.,Rd Gardi Medical College
Upsala Journal of Medical Sciences | Year: 2014
This paper addresses: 1) Situations where human behaviour is involved in relation to antibiotics, focusing on providers and consumers; 2) Theories about human behaviour and factors influencing behaviour in relation to antibiotics; 3) How behaviour in relation to antibiotics can change; and, 4) Antibiotic mainstreaming as an approach to facilitate changes in human behaviour as regards antibiotics. Influencing human behaviour in relation to antibiotics is a complex process which includes factors like knowledge, attitudes, social norms, socio-economic conditions, peer pressure, experiences, and bio-physical and socio-behavioural environment. Further, key concepts are often perceived in different ways by different individuals. While designing and implementing projects or programmes for behavioural change with respect to antibiotics for professionals or consumers it is helpful to consider theories or models of behaviour change, e.g. the 'stages of change model', including pre-contemplation, contemplation, preparation, action, and maintenance. People in different stages of change are susceptible to different behaviour modification strategies. Application of marketing principles to 'global good', so-called 'social marketing', to improve 'welfare of the individual and society' is gaining increased attention in public health. In conclusion, just providing correct knowledge is not sufficient although it is a pre-requisite for behaviour modification in the desired direction. We can never change the behaviour of any other human, but we can facilitate for others to change their own behaviour. One possibility is to implement 'antibiotic mainstreaming' as a potentially effective way for behaviour modification, i.e. to address consequences for maintaining effective antibiotics in all activities and decisions in society. © 2014 Informa Healthcare.
Pathak A.,Karolinska Institutet |
Pathak A.,Rd Gardi Medical College |
Pathak A.,Uppsala University |
Chandran S.P.,St Johns Research Institute |
And 3 more authors.
BMC Infectious Diseases | Year: 2013
Background: Commensal Escherichia coli are a prominent reservoir of genes coding for antibiotic resistance and also responsible for endogenous infections in pregnant women. We studied the factors in pregnant women associated with carriage of multi-drug resistant (MDR) E. coli and genetic determinants of antibiotic resistance in them.Methods: Women attending to Obstetric and Gynaecology department outpatient clinics for routine antenatal check-up were administered a questionnaire. Peri-anal swabs were collected for culture isolation and identification of E.coil. Antibiotic sensitivity was done using the Kirby-Bauer disc diffusion method as recommended by the CLSI guidelines. MICs for quinolones and third generation cephalosporins were done using the agar dilution method. Genes coding for production of beta lactamses and for the quinolone resistance determinant were screened by polymerase chain reaction. Rep-PCR was done on MDR isolates for detecting possible genetic similarity. Multiple logistic regression models were used to determine the independent factors associated with carriage of MDR isolates.Results: A total of 710 isolates of E. coli from 710 women (mean age 26 years) were included in the study. Resistance to at least one antibiotic tested was detected in 94% of the E. coli isolates. A total of 109 isolates were ESBL producing and 35 isolates were MDR. In the MDR isolates MIC50 and MIC90 for quinolones and third generation cephalosporins were high for those isolates that carried blaTEM gene (26 isolates) and blaCTX-M gene (24 isolates). Both blaTEM and blaCTX-M genes were detected in 19 isolates. The commonest Plasmid Mediated Quinolone Resistance (PMQR) gene identified was aac(6′)-Ib-cr (n = 23/25). All isolates carrying the PMQR genes were also positive for blaCTX-M and blaTEM gene. Mutations in gyr A and par C genes were present in all 35 MDR isolates. The statistically significant risk factors for carriage of MDR E. coli were graduate or post-graduate education, a self-employed status, a family size of more than 10 members, antibiotic usage in last four weeks, and history of hospitalization in the last four weeks.Conclusions: The presence of genes coding for extended spectrum of beta lactamases and plasmid mediated quinolone resistance in commensal E. coli is disconcerting. The study provides strong basis good antibiotic stewardship. © 2013 Pathak et al.; licensee BioMed Central Ltd.
Pathak A.,RD Gardi Medical College
BMJ case reports | Year: 2013
Spinal epidural abscess (SEA) is a rare clinical condition among children. Most patients do not present with classical signs. A 13-year-old boy without any predisposing factors presented with paraparesis, bladder and bowel involvement. MRI spine demonstrated an SEA at the C7 and D1 levels on both sides of the midline with cord oedema at the C2-3 to C6 level with minimal marrow oedema in the C6 vertebral body. We treated the patient with antibiotics (ceftriaxone and vancomycin) alone. The patient showed excellent response with only minimal residual gait disturbance at the end of 6 weeks of antibiotic therapy. This is the first paediatric report of complete recovery of a patient at clinical stage 4 following antibiotic treatment alone from India. However, caution should be exercised to closely monitor the patient's recovery as any progression in the neurological state warrants surgery.
Mahadik K.V.,RD Gardi Medical College
BMJ case reports | Year: 2013
This article addresses issues related to pregnancy anaemia and late referral by a village birth attendant in resource poor setting in a central state of India. A young anaemic woman had labour onset at her village, a birth attendant tried to deliver her but failed. When she came to our hospital, had established septicaemia and absolutely non-reassurable uterine tone leading to intractable atonic postpartum haemorrhage. She died after 5 days because of coagulopathy and multiorgan failure. Huge budgets are being spent for the promotion of institutional deliveries but still the maternal mortality ratio has not reduced. The epidemiology of childbirth, social awareness for safe labour and administrative lethargy towards implementation of government programmes have not changed. The tertiary care-blood and components-multidisciplinary approach could not prevent the death of an anaemic woman. Unless there is a grassroot level change in the healthcare delivery system at the village level, the scenario might not change.
Pathak A.,RD Gardi Medical College
BMJ case reports | Year: 2013
Ecthyma gangrenosum (EG) is a cutaneous manifestation of invasive infection usually caused by pseudomonas, but can be caused by many bacteria, fungal and viral infections. We present the first reported case of EG caused by invasive Escherichia coli in a neonate. A neonate presented with evidence of sepsis and a rapidly evolving 3×3.5 cm(2) well-circumscribed haemorrhagic and necrotic ulcer on the left groin. There was evidence of decreased perfusion of the lower limb owing to pressure effect of the ulcer. The child responded well to anticoagulation and antibiotic therapy. It is crucial to clinically suspect EG and promptly start empiric antibiotic therapy covering pseudomonas to decrease the morbidity and mortality. However, other viruses, fungus and bacteria including E coli should also be considered in the differential diagnosis of EG in a neonate.
Dubey V.,Rd Gardi Medical College
International Journal of Pharma and Bio Sciences | Year: 2014
Hernioplasty is mainstay in treatment of abdominal wall hernias including incisional hernias. But in the developing countries like India everyone can not afford the commercial mesh used for this procedure. So, in this study we used sterilised nylon mosquito net mesh in our patients, efficacy of which has been proved already in the repair of both inguinal and incisional hernias. In this study consecutive patients of incisional hernias, admitted in R.D. Gardi Medical College, Ujjain from March 2008 to March 2014 were included. The included patients were informed and consent was taken for the use of mosquito net mesh. The patients who gave consent for the use of sterilised mesh made the case group in whom mosquito net mesh was used. Those who refused for mosquito net mesh were included in the control group in whom hernia repair was done by conventional non-mesh methods. During the follow up in the post operative period up to six months the main complications in the case group were prolonged discharge (12%), seroma (9.33%), stitch abscesses (8%) and gross infection (5.3%). There was no recurrence noted in the case group. In the control group the gross infection was found in 8 (11.76%) cases followed by prolong infection in 6 (8.82%) cases, seroma and stitch abscess in 5 (7.35%) cases. The recurrence was found in 2(2.94%) cases. Cost of locally purchased and sterilised nylon mosquito net mesh of standard size 10times;15 cm used here was 2 rupees [about 0.0404 US$] as compared to 800 rupees [16.16 US$] for the prolene mesh of same size. On the basis of this study, we can say that properly sterilised mosquito net can be a mesh of the choice in the institutional setups for incisional hernia surgery in the rural areas of the developing countries like India where the population cannot afford the higher cost of surgery with commercially available costly meshes. Also it was found safer to use and can be used in place of conventional methods of primary repairs.