Search

During the covid 19 pandemic, management of nursing resource which forms the crux of patient care emerged as one of the major challenges amongst many. The strategies for staff mobilization, redeployment and recruitment, along with laying down standard operating procedures evolved as the pandemic progressed. The safety of the staff has to be a major focus area. Guidelines for covid duty exemption, orientation and training of staff must be drafted, reviewed and revised as required. Issues related to accommodation, psychosocial support and wellbeing have to be addressed. It is very important to adapt to the ever changing needs for nursing resource and be vigilant for emerging issues for an effective response to the pandemic.

Antifungal stewardship is a less explored component of antimicrobial stewardship programmes, especially in developing countries.We aimed to determine antifungal prescription practices in a tertiary centre of a developing country to identify the challenges for antifungal stewardship programmes.Four single-day point prevalent surveys were performed in inpatient units and data were collected from medical records. Antifungal use was recorded in terms of consumption, therapeutic strategies and appropriateness.We found a 2.42%-point prevalence of antifungal prescriptions. Antifungal use was higher in children than adults (4.1% vs. 2.03%), medical than surgical units (3.7% vs. 1.24%) and ICUs than general wards (5.8% vs. 1.9%). The highest antifungal use was observed in the haematology-oncology units (29.3%) followed by emergency (16.2%) and gastroenterology units (11.6%). Among 215 prescriptions, amphotericin B was the most commonly prescribed (50.2%) followed by fluconazole (31.6%). The targeted antifungal therapy was practised more commonly (31.5%) than empiric (29.1%), pre-emptive (22.6%) and prophylactic (16.8%) therapy. Amphotericin B was commonly used for pre-emptive (p = .001) and targeted (p = .049) therapy, while fluconazole (p = .001) and voriconazole (p = .011) for prophylaxis. The prescriptions were inappropriate in 25.1% due to the wrong choice of antifungal (44.4%), indication (27.7%) and dosage (24%). The overall mean antifungal consumption was 2.71 DDD/1000 PD and 8.96 DOT/1000 PD.We report here the low prevalence of antifungal use at a tertiary care centre in a developing country. Though training for antifungal use would be important for antifungal stewardship, the challenge would remain with the affordability of antifungals.

This study aims to assess the perception and attitude of health care personnel regarding integration of nursing education and nursing services. Using purposive and stratified random sampling technique, 92 medical faculty, 32 nursing faculty and 346 nursing officers were enrolled. A three-point Likert scale consisting of 15 items and six open ended questions was used to collect the data. Overall, the concept of integration of nursing education and nursing services at their institute was welcomed by 74.4% of health care personnel. Medical faculty (47.8%), nursing faculty (37.5%) and nursing officers (57.5%) scored the concept of integration as very good.

Objective: To evaluate the impact of interventional “educational module” on knowledge and attitude regarding organ donation amongst resident doctors and nurses in the Institute of National Importance. Study Design: Interventional and prospective. Methods: We devised an interactive educational module covering various aspects of organ donation through a series of audiovisual lectures and information booklets. Resident doctors and nurses posted in those areas of the 1948-bedded Postgraduate Institute of Medical Education and Research (PGIMER), where head injury patients were treated and were subject to intervention using this module. The pre and postinterventional scores of their knowledge and attitude regarding organ donation were compared to find out impact of the intervention. Results: A total of 242 nurses and 87 resident doctors participated in this research. Higher knowledge score was observed preintervention amongst doctors as compared to nurses. Significant improvement was seen in total knowledge scores of both groups postintervention. Doctors had better scores for the “concept of organ donation,” while nurses were more familiar with “procedures and protocols.” Both had low knowledge about “clinical criteria for brain death” and “legal issues” preintervention which improved significantly postintervention. The positive impact of intervention was also observed on attitude in both categories. A significant impact of intervention was observed on overall propensity of doctors and nurses to promote organ donation, for pledging their own organs and for counseling of the patient/attendants on this cause. Conclusion: Scientifically designed educational modules have a promising role in improving awareness and attitude of health care professionals regarding organ donation and their propensity to be prospective donors, effective counselors, and advocates of organ donation.

Cognitive dysfunction is an important complication observed in type 2 diabetes mellitus (T2DM) patients. Tetramethylpyrazine (TMP) is known to exhibit anti-diabetic and neuroprotective properties. Therefore, the present study aimed to investigate the possible therapeutic effects of TMP against type 2 diabetes-associated cognitive impairment in rats. High-fat diet (HFD) followed by a low dose of streptozotocin (35 mg/kg) was used to induce diabetes in Sprague-Dawley rats. TMP (20, 40, and 80 mg/kg) and Pioglitazone (10 mg/kg) were administered for 4 weeks. The Morris water maze (MWM) and novel objective recognition task (NOR) tests were used to assess memory function. Fasting blood glucose (FBG), lipid profile, HOMA-IR, glycosylated hemoglobin (HbA1c), and glucose tolerance were measured. Acetylcholinesterase (AChE) and choline acetytransferase (ChAT) activity, acetylcholine (ACh) levels, oxidative stress, apoptotic (Bcl-2, Bax, caspase-3), and inflammatory markers (TNF-α, IL-1β, and NF-kβ) were assessed. BDNF, p-AKT, and p-CREB levels were also measured. In the present work, we observed that treatment of diabetic rats with TMP alleviated learning and memory deficits, improved insulin sensitivity, and attenuated hyperglycemia and dyslipidemia. Furthermore, treatment with TMP increased BDNF, p-Akt, and p-CREB levels, normalized cholinergic dysfunction, and suppressed oxidative, inflammatory, and apoptotic markers in the hippocampus. Collectively, our results suggest that the TMP may be an effective neuroprotective agent in alleviating type 2 diabetes-associated cognitive deficits.

Introduction: An operating theatre (OT) is a very complex setup, which presents numerous challenges for both patients and health care providers. A safe OT environment decreases the susceptibility of patients to postoperative infections. Therefore, a study was conducted to determine microbiological air quality for establishing baseline values and to assess concurrently the effect of environment and behavioural factors in 46 OTs of a tertiary care hospital. Materials & Methods: The OTs were divided into two groups based on the type of air flow: laminar diffuser (Group I) or conventional diffuser (Group II). Two hundred and thirty-eight samples were collected with an active technique using a sieve impactor, sampling at 100 L/minute. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) Version 20 (IBM Corp., Armonk, NY). Results: In Group I OTs with the laminar diffuser, bacterial and fungal values during the lean period for environmental and behavioural factors were 47.78 colony forming units (CFM)/m3 and 0.24 CFU/m3, respectively. The bacterial and fungal values during the surgical period were 98.01 CFU/m3 and 0.40 CFU/m3, respectively. The same values for Group II OTs with the conventional diffuser were 52.83 CFU/m3 and 0.39 CFU/m3 during the lean period, and 80.06 CFU/m3 and 0.40 CFU/m3 during the surgical period. Discussion: Both environmental and behavioural factors – temperature, humidity, percentage of fresh air in circulation, door type, controlled entry, minimal door opening and proper OT attire – were seen to contribute concurrently to maintaining air quality in operating units.

Astaxanthin (ATX), a natural xanthophyll carotenoid, has shown to exert significant protective effects against various diseases via its antioxidant and anti-inflammatory properties. However, its potential role in arthritis is still not reported. Therefore, the aim of the present study was to investigate the potential anti-arthritic properties of ATX against complete Freund’s adjuvant (CFA)-induced arthritis rats. Adjuvant arthritis was induced by single intraplantar injection of complete Freund’s adjuvant (CFA) in the left hind paw of adult female Wistar rats. ATX (25, 50 and 100 mg/kg) and indomethacin (5 mg/kg) were given orally from days 14 to 28. The anti-arthritic activity was evaluated through various nociceptive behavioral tests (mechanical allodynia, mechanical hyperalgesia, cold allodynia, and thermal hyperalgesia), paw edema assessment, and arthritis scores. Serum tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and cyclic citrullinated peptide (CCP) antibody levels were assessed. Moreover, malondialdehyde (MDA), nitrite, glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT) levels were also evaluated. Oral administration of ATX (50 and 100 mg/kg) exhibited significant anti-arthritic activity via enhancing the nociceptive threshold, reducing paw edema and improving arthritis scores. Moreover, ATX treatment also markedly suppressed inflammatory and oxidative mediators in adjuvant-administered rats. Our findings suggest that ATX possesses potential anti-arthritic activity, which could be attributed to its anti-inflammatory and antioxidant properties.

Introduction: Meal services plays a significant role in speedy recovery and increases patient satisfaction. Objective: Present study was done to assess the satisfaction of suspected COVID-19 patients regarding meal services at a tertiary care hospital of north India. Methodology: This cross-sectional study in retrospective design was done to understand the factors affecting the satisfaction of suspected COVID-19 patients with respect to meal services. The data was collected for patients admitted from January 2020-June 2020 with the help of a questionnaire with graded responses i.e Yes, No or Maybe/Not applicable, gathered from participants after discharge from hospital through ‘google forms’. Results: Out of 160 participants, 159 filled up the questionnaire through ‘google form’. Majority of the participants were

The COVID 19 pandemic ravaged the globe with a remarkable ferocity and has not entirely abated till now with cases flaring up at various places at different times. The expected course is for it to become endemic with recurring exacerbations. Over the past two years, we have become wiser to its pathology, diagnosis, and treatment. However, it is imperative for us to regularly and consistently reassess our protocols to assimilate the current and ever-growing knowledge in this direction. Doing so will help us to use our resources judiciously, improve patient care, and enhance the overall benefit to stakeholders. In this article, we aim draw the researchers' attention to few issues which may not be at the forefront at this point in time but important nevertheless. These include the use of personal protective equipment (PPE), universal gloving, isolation criteria, and handling of dead bodies, among others. We hope that a reassessment of the challenges involved in the said procedures will help us to be better prepared to face and tackle potential future waves and the multiple challenges that would potentially ensue post-spikes in infection incidences.

Surgical site infections (SSIs) may be reduced by following SSI prevention measures. We assessed the SSI rate following caesarean section (CS) and gynaecologic surgery after implementing a simple SSI prevention bundle including preoperative bath and hair wash.The study was carried out in two hospitals in North India (Post Graduate Institute of Medical Education and Research [PGIMER] and Civil Hospital CH) from August 2018 to July 2019. The SSI rate during intervention period (9 months) was compared with baseline rate (3 months). Womens' knowledge about SSI was assessed preoperatively and after counselling, postoperatively.The baseline SSI rate after CS (n = 165) was 11.1% at PGIMER and 8.5% at CH. After gynae surgery (n = 172), it was 13% at PGIMER and 11.5% at CH. During intervention, (CS = 585, gynae surgery = 503), SSI rate was reduced significantly at PGIMER (CS: 11.1% to 3.7%,The reduction in SSI at PGIMER was attributed to better compliance to SSI prevention measures listed above. Counselling women about simple SSI prevention method like preoperative bath with scalp hair wash increased their knowledge about these significantly.

Objectives Data from point prevalence surveys (PPSs) in India are scarce. Conducting PPSs is especially challenging in the absence of electronic medical records, a lack of dedicated resources and a high patient load in resource-poor settings. This multicentre survey was conducted to provide background data for planning and strengthening antimicrobial stewardship programmes across the country. Methods This inpatient PPS was conducted over 2 weeks in May 2019 simultaneously across five study centres in India. Data about patient characteristics, indications for antimicrobials use and details of each antimicrobial prescribed including supportive investigation reports were collected in predesigned forms. Results A total of 3473 admitted patients in wards and ICUs were covered across five study centres. Of these, 1747 (50.3%) patients were on antimicrobials, with 46.9% patients being on two or more antimicrobials. Out of the total antimicrobials prescribed, 40.2% of the antimicrobials were prescribed for community-acquired infection requiring hospitalization followed by surgical prophylaxis (32.6%). Third-generation cephalosporins and drugs from the ‘Watch’ category were prescribed most commonly. Only 22.8% of the antimicrobials were based on microbiology reports. Conclusions The survey demonstrated a high use of antimicrobials in admitted patients with a considerable proportion of drugs from the ‘Watch’ category. The targets for interventions that emerged from the survey were: improving surgical prophylaxis, decreasing double anaerobic cover, initiating culture of sending cultures and de-escalation with targeted therapy.

Atypical antipsychotic drugs (AAPDs) such as olanzapine (OLZ) are associated with serious metabolic adverse effects such as weight gain, visceral fat accretion, glucose intolerance, and lipid abnormalities. Compelling evidence suggests that the gut microbiota is known to regulate metabolic homeostasis and therefore microbiota-modulating strategies such as probiotics may serve as an excellent approach for treating metabolic adverse effects associated with atypical antipsychotic drugs (AAPDs). The therapeutic potential of VSL#3 (20 × 10

Atypical antipsychotic drugs (AAPDs) such as olanzapine (OLZ) are associated with serious metabolic adverse effects such as weight gain, visceral fat accretion, glucose intolerance, and lipid abnormalities. Compelling evidence suggests that the gut microbiota is known to regulate metabolic homeostasis and therefore microbiota-modulating strategies such as probiotics may serve as an excellent approach for treating metabolic adverse effects associated with atypical antipsychotic drugs (AAPDs). The therapeutic potential of VSL#3 (20 × 109 CFU/day), in reversing olanzapine-induced metabolic dysfunction, was assessed. VSL#3 administration led to attenuation of OLZ-induced body weight gain, uterine fat deposition, impaired glucose tolerance, and insulin resistance. Moreover olanzapine treatment also decreased inflammatory markers, abolished oxidative stress in the vWAT, and prevented shifts in gut microbiota abundance levels. These results indicate that VSL#3 via its ability to manipulate the gut microbiome confers beneficial metabolic effects and may, therefore, represent a novel therapeutic approach for reversing antipsychotic-induced metabolic dysfunction.

The nuclear factor erythroid 2-related factor (Nrf2) signaling pathway has recently emerged as a novel therapeutic target in treating various diseases. Therefore, the present study aimed to assess the protective role of the Nrf2 activator, dimethyl fumarate (DMF) in the complete Freund's adjuvant (CFA)- induced arthritis model. DMF (25, 50, and 100 mg/kg) and dexamethasone (2 mg/kg) were orally administered for 14 days. Pain-related tests, paw volume, and arthritic scores were measured weekly. Serum TNF-α, IL-1β, cyclic citrullinated peptide (CCP), C-reactive protein (CRP), and rheumatoid factor (RF) levels were estimated. Nitrite, malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione (GSH), catalase (CAT), and myeloperoxidase (MPO) levels were also evaluated. NF-κB, Nrf2, HO-1, and COX-2 levels were estimated in the joint tissue. DMF treatment exerted anti-arthritic activity by enhancing the nociceptive threshold, improving arthritis scores, and reducing paw edema. Also, DMF suppressed changes in oxidative stress markers and inflammatory mediators and enhanced Nrf2 and HO-1 levels in CFA-injected rats. These findings indicate that the anti-arthritic activity of DMF may be mediated by the activation of the Nrf2/HO-1 pathway, which reduced oxidative damage and inflammation.

Background Ferulic acid (FA) is a phenolic phytochemical known to protect against various diabetic complications. However, its role in diabetic neuropathy is still unclear. The present study investigated the potential protective effects of FA alone and its combination with insulin against streptozotocin (STZ)-induced diabetic neuropathy in rats. Methods STZ (55 mg/kg) was injected in adult Sprague-Dawley rats to induce diabetes. Diabetic rats were treated with FA (25, 50, and 100 mg/kg, p.o), insulin (10 IU/kg, s.c.) and the combination of FA (100 mg/kg, p.o.) with insulin (10 IU/kg, s.c.) for four weeks. Body weight, blood glucose, insulin, glycosylated hemoglobin, nerve conduction velocity and pain parameters were measured. Moreover, oxidative stress, inflammatory (TNF-α, IL-1β, COX-2) and apoptotic markers (Bcl-2, Bax, caspase 3) were assessed in the sciatic nerve tissue. Na+–K+–ATPase activity and nerve growth factor (NGF) levels were also determined. Results FA attenuated STZ induced alteration in metabolic parameters, nociceptive threshold, motor nerve conduction velocity, NGF levels and Na+–K+–ATPase activity. In addition, FA boosted anti-oxidant defenses and suppressed oxidative stress, pro-inflammatory mediators and apoptotic markers. Furthermore, diabetic rats treated with insulin–FA (100 mg/kg) combination demonstrated more pronounced beneficial effects as compared to either agent alone. Conclusions Collectively, our results suggest that FA either alone or in combination with insulin therapy could serve as an efficacious agent for treating diabetic neuropathy.

Silicon photomultipliers (SiPMs) are potential solid-state alternatives to traditional photomultiplier tubes (PMTs) for single-photon detection. In this paper, we report on evaluating SensL MicroFC-10035-SMT SiPMs for their suitability as PMT replacements. The devices were successfully operated in a liquid-xenon detector, which demonstrates that SiPMs can be used in noble element time projection chambers as photosensors. The devices were also cooled down to 170 K to observe dark count dependence on temperature. No dependencies on the direction of an applied 3.2 kV/cm electric field were observed with respect to dark-count rate, gain, or photon detection efficiency., This is an author-created, un-copyedited version of an article accepted for publication/published in Journal of Instrumentation. IOP Publishing Ltd is not responsible for any errors or omissions in this version of the manuscript or any version derived from it. The Version of Record is available online at https://doi.org/10.1088/1748-0221/13/03/C03041

Alcohol-based handrub (AHR) consumption is positively correlated with increases in hand hygiene (HH) compliance. In our 2,000-bed hospital in India, multiple awareness drives have been conducted to promote HH. This study aimed to determine the quantitative effect of these campaigns on use of HH products (soap and AHR) in the hospital. Over the last 6 years, bar soap consumption has increased by 389.15%, whereas that of AHR increased by 146.7%. We also evaluated microbial contamination of 99 bar soap and 60 liquid soap samples in our hospital for a year. Of the samples, 61 (61.6%) of the bar soaps and 2 (3.3%) of the liquid soaps were found to be contaminated with various organisms (P .0002). To conclude, the focus should be to increase the right kind of HH product so that hospitals in developing countries procure liquid soaps instead of bar soaps for handwashing purposes.

Tetraphenyl-butadiene (TPB) is a wavelength shifting material that can absorb ultraviolet photons and emit blue photons. It is used in the detection of vacuum ultraviolet (VUV) photons, for which typical photo-sensors, such as most photomultiplier tubes (PMT) and silicon photomultipliers (SiPM), do not have any quantum efficiency. The secondary blue light is emitted isotropically, however, due to scattering within the material, its angular distribution upon exiting the material can not be easily predicted. Here we describe a procedure for estimating the scattering length of blue light in TPB, by measuring and modeling the angular distribution as a function of layer thickness. The experiment consists of shining 254nm light at various thicknesses of TPB deposited on fused silica, and measuring the intensity of blue light using SiPMs on either side of the sample. We simulate light propagation within the sample to estimate the light yield and compare that to the data, which allows us to estimate mean scattering length for photons in TPB to be in the range 2–3 μm, with some preference for a central value of 2.75 μm.

Few hospitals in India perform regular surveillance for healthcare-associated infections (HAIs) and use of indwelling devices and antimicrobials. The aim of this study was to conduct two one-day point prevalence surveys of HAIs and use of indwelling devices and antimicrobials in a large 1800-bed tertiary care hospital in India. The overall prevalence of HAIs was 7%, and surgical site infections were the most common (33%). Indwelling devices were present in 497 (27%) patients, and 915 (50%) patients were receiving antimicrobials. This study helped to generate robust baseline data on the prevalence of HAIs and use of indwelling devices and antimicrobials in the study hospital.

Hand hygiene compliance at our institution was monitored by direct observation before and after a series of 2 hand hygiene awareness campaigns across an18-month time period to analyze the effect of these campaigns. A total of 5,059 opportunities for hand hygiene were observed. Compliance increased from 28.1% (95% confidence interval [CI], 18.7%-43.2%) to 42.5% (95% CI, 30.7%-54.8%) after the 2 campaigns (P.0001) but dropped to 36.4% (95% CI, 30.5%-44.5%) after 2 years (P.001). Three of the 8 intensive care units that showed a significant increase after the campaigns did not maintain the increased compliance at 2 years' follow-up. We conclude that educational programs should be repeatedly conducted to maintain high adherence to hand hygiene standards in health care settings.