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Objectives To investigate the drivers for infection management and antimicrobial stewardship (AMS) across high infection risk surgical pathways. Methods An qualitative study, ethnographic observation of clinical practices, patient case studies, and face-to-face interviews with healthcare professionals (HCP) and patients was conducted across cardiovascular and thoracic and gastrointestinal surgical pathways in South Africa (SA) and India. Aided by Nvivo 11 software, data were coded and analysed until saturation was reached. The multiple modes of enquiry enabled cross-validation and triangulation of findings. Results Between July 2018–August 2019 data were gathered from 190 hours of non-participant observations (138 India, 72 SA); interviews with HCPs (44 India, 61 SA); patients (6 India, 8 SA), and, case studies (4 India, 2 SA). Across the surgical pathway, multiple barriers impede effective infection management and AMS. The existing, implicit roles of HCPs (including nurses, and senior surgeons) are overlooked as interventions target junior doctors, bypassing the opportunity for integrating infection-related care across the surgical team. Critically, the ownership of decisions remains with the operating surgeons and entrenched hierarchies restrict the inclusion of other HCPs in decision-making. The structural foundations to enable staff to change their behaviours and participate in infection-related surgical care is lacking. Conclusions Identifying the implicit existing HCPs roles in infection management is critical and will facilitate the development of effective and transparent processes across the surgical team for optimised care. Applying a framework approach that includes nurse leadership, empowering pharmacists and engaging surgical leads is essential for integrated AMS and infection-related care. Keywords: antibiotic prescribing, infection control, ethnography, low- and middle-income country, surgery

Effects of Estrogen (E2) is widespread in the human body; still, an unresolved paradox. Neurodegeneration and neuroinflammation are inherently associated with age progression, debilitating by hormone deprivation, especially in female. Senescent cells accumulate with age and promote tissue deterioration in the body system. Neurodegenerative diseases drive a healthy life towards to morbidity and feebleness; despite the different etiology, uncontrolled inflammation is one of the significant causals factors. We here used post-menopausal model (ovariectomized female rat), E2 replenishment therapy reduces the expression of inflammatory mediators, such as complement proteins (C3, C1q, and C3aR) in these animals.E2 therapy could limit the ovariectomy-induced increase of inflammatory events in brain regions such as the hippocampus. Also, the duration of hormone deprivation could be a determinant for the intensity of the anti-inflammatory actions of estrogen. On the whole, considerable evidence, including that from the present study supports the view that complement biosynthesis, which plays a significant role in phagocytosis of cellular debris and synaptic pruning of postnatal neural circuits goes uncontrolled and could be the inducing factor for enhanced neurodegeneration following hormone deprivation.

Pooling together samples and testing the resulting mixture is gaining considerable interest as a potential method to markedly increase the rate of testing for SARS-CoV-2, given the resource limited conditions. Therefore, it has become important to design a user-friendly tool to assist clinicians and policy makers, to determine optimal testing pool and sub-pool sizes for their specific scenarios. We have developed such a tool (riteshsingh.github.io/poolsize). The algorithms employed are described in this paper. The code is open source for review and critique (github.com/RiteshSingh/poolsize​).

Chronic pancreatitis is common in India. However, its risk factors are not clear. There is sparse data on the current prevalence of tropical pancreatitis in India.To undertake a prospective nationwide study of the risk factors and clinical profile of chronic pancreatitis.Thirty-two major centers from different regions of India contributed data on 1,086 patients to a common online website (www.ipans.org).Risk factors, clinical features complications and treatment of chronic pancreatitis.Of the 1,086 subjects, complete data on risk factors were available for 1,033 subjects. Idiopathic pancreatitis was the most common form of pancreatitis (n=622; 60.2%) and alcoholic chronic pancreatitis accounted for about a third of the cases (n=400; 38.7%); the rest (n=11; 1.1%) had rare risk factors. Smoking and cassava intake were documented in 292 (28.3%) and 189 (18.3%) subjects, respectively. Using well-defined criteria, only 39 (3.8%)cases could be labeled as 'tropical pancreatitis'. Pain occurred in 971 patients (94.0%). Four hundred and eighteen (40.5%) subjects had diabetes mellitus. Of alcohol consumers, alcoholism and female gender were independent risk factors for diabetes in subjects with chronic pancreatitis (OR=1.48, P=0.003; and OR=1.75, P0.001, respectively). The most common complications were pseudocysts (15.8%) and biliary obstruction (8.2%). Pancreatic cancer occurred in 42 subjects (4.1%). Ultrasound detected calculi in 69.7%, ductal dilatation in 63.4% and atrophy in 27.3%. The majority of patients were on medical therapy (n=849; 82.2%); endotherapy and surgery accounted for the rest. About 50% percent of the patients with diabetes required insulin (198/418).In this first nationwide prospective survey of chronic pancreatitis in India, idiopathic pancreatitis was the most common form, followed by alcoholic pancreatitis. The classical form of tropical chronic pancreatitis is becoming less common.

A highly sensitive N gene-based PCR-ELISA for the detection of Peste-des-petits-ruminants virus (PPRV) was developed. The RT-PCR yielded a digoxigenin (DIG)-labeled product of 336 bp comprising a sequence from PPRV N gene, which was then detected by ELISA. The assay could detect the viral RNA in PPRV-infected tissue culture fluids with a titer as low as 0.1 TCID(50)/ml. The assay is 10,000 times more sensitive than a classical RT-PCR combined with agarose gel electrophoresis. The assay could detect the virus in the clinical samples, which were negative by conventional sandwich ELISA (S-ELISA). The percentage positivity of the assay in detecting the virus in clinical samples was 66.2% compared to 48.6% for S-ELISA. The assay was more sensitive than S-ELISA also in detecting the virus in early as well as late phases of the disease. In addition, the assay could also be used for differential diagnosis of PPRV and Rinderpest virus (RPV).