Review of antibiotic use and resistance in food animal production in WHO South-East Asia Region.

Antimicrobial resistance is an emerging global threat to public health. The resistant bacteria in food animals can be transferred to humans through the food chain. Limited information on antimicrobial usage and resistance in food animals is available in Southeast Asia due to inadequate monitoring or surveillance systems. A literature review was conducted on antimicrobial use and resistance in food animal production in Southeast Asia for the period 2011-2020, to assess the scope and extent of antibiotic use and resistance. The countries included in the study were Bangladesh, Bhutan, Democratic People's Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. The information was categorised by country, production type and findings regarding antibiotic use and resistance. A total of 108 publications were included in the review. Results showed widespread use of critically and highly important antibiotics in livestock, poultry and aquacultured fish and their products. To curb the growing threat of antibiotic resistance, Southeast Asian countries need to strengthen surveillance and regulatory controls of antimicrobial use in food animal production through "One Health" approach.

Disparities in Deceased Donor Kidney Offer Acceptance: A Survey of Canadian Transplant Nephrologists, General Surgeons and Urologists.

Background: Significant variability in organ acceptance thresholds have been demonstrated across the United States, but data regarding the rate and rationale for kidney donor organ decline in Canada are lacking. Objective: To examine decision making regarding deceased kidney donor acceptance and non-acceptance in a population of Canadian transplant professionals. Design: A survey study of theoretical deceased donor kidney cases of increasing complexity. Setting: Canadian transplant nephrologists, urologists, and surgeons making donor call decisions responding to an electronic survey between July 22 and October 4, 2022. Participants: Invitations to participate were distributed to 179 Canadian transplant nephrologists, surgeons, and urologists through e-mail. Participants were identified by contacting each transplant program and requesting a list of physicians who take donor call. Measurements: Survey respondents were asked whether they would accept or decline a given donor, assuming there was a suitable recipient. They were also asked to cite reasons for donor non-acceptance. Methods: Donor scenario-specific acceptance rates (total acceptance divided by total number of respondents for a given scenario and overall) and reasons for decline were determined and presented as a percentage of the total cases declined. Results: In all, 72 respondents from 7 provinces completed at least one question of the survey, with considerable variability between acceptance rates for centers; the most conservative center declined 60.9% of donor cases, whereas the most aggressive center declined only 28.1%, P-value < .001. There was an increased risk of non-acceptance with advancing age, donation after cardiac death, acute kidney injury, chronic kidney disease, and comorbidities. Limitations: As with any survey, there is the potential for participation bias. In addition, this study examines donor characteristics in isolation, however, asks respondent to assume there is a suitable candidate available. In reality, whenever donor quality is considered, it should be considered in the context of the intended recipient. Conclusion: In a survey of increasingly medically complex deceased kidney donor cases, there was significant variability in donor decline among Canadian transplant specialists. Given relatively high rates of donor decline and apparent heterogeneity in acceptance decisions, Canadian transplant specialists may benefit from additional education regarding the benefits achieved from even medically complex kidney donors for appropriate candidates relative to remaining on dialysis on the transplant waitlist.

Contexte: Une importante variabilité a été observée aux États-Unis dans le seuil d'acceptation des organes. Au Canada, on manque de données sur le taux de refus des donneurs de reins et sur les raisons qui expliquent ce refus. Objectifs: Examiner la prise de décision quant à l'acceptation ou non d'un donneur de rein décédé dans une population de professionnels de la transplantation canadiens. Conception: Un sondage exposant des cas théoriques de plus en plus complexes de donneurs de reins décédés. Cadre: Des néphrologues, urologues et chirurgiens canadiens spécialisés en transplantation qui prennent des décisions relatives au don d'organes ont été invités à répondre à un sondage électronique entre le 22 juillet et le 4 octobre 2022. Participants: L'invitation à participer a été distribuée par courriel à 179 néphrologues, chirurgiens et urologues canadiens spécialisés en transplantation. Les participants ont été identifiés en communiquant avec chaque program de transplantation pour obtenir une liste des médecins recevant des offres d'organes. Mesures: Les répondants devaient indiquer s'ils accepteraient ou refuseraient un donneur donné, en supposant qu'un receveur approprié existait. Ils étaient également invités à citer les raisons justifiant le refus d'un donneur. Méthodologie: Les taux d'acceptation par scénario (acceptation totale divisée par le nombre total de répondants pour un scénario donné, et pour l'ensemble) et les raisons du refus ont été déterminés et présentés sous forme de pourcentage du nombre total de cas refusés. Résultats: En tout, 72 professionnels issus de 7 provinces avaient répondu à au moins une question du sondage. On a observé une grande variabilité du taux d'acceptation entre les différents centers; le plus conservateur avait refusé 60,9 % des donneurs présentés alors que le plus entreprenant n'avait refusé que de 28,1 % des cas (p < 0,001). Les donneurs d'âge avancé, ceux décédés d'un problème cardiaque et ceux qui souffraient d'insuffisance rénale aiguë, d'insuffisance rénale chronique et de comorbidités étaient plus susceptibles d'être refusés. Limites: Comme pour toute étude sous forme de sondage, celle-ci comporte un possible biais de participation. Cette étude examine les caractéristiques du donneur de manière isolée, mais demande aux répondants de supposer qu'un candidat approprié existe. Dans la réalité, chaque fois que la qualité d'un donneur est évaluée, elle doit être prise en compte dans le contexte du receveur visé. Conclusion: Dans cette étude présentant des cas théoriques de complexité croissante sur le plan médical de donneurs de reins décédés, une importante variabilité a été observée quant au refus des donneurs par les spécialistes de la transplantation canadiens. Les taux relativement élevés de refus et l'apparente hétérogénéité des décisions liées à l'acceptation justifient plus d'éducation auprès des spécialistes de la transplantation canadiens; notamment sur les avantages pour un candidat approprié de recevoir un organe, même si ce dernier provient d'un cas médicalement complexe, par rapport au fait de rester en dialyze sur la liste d'attente pour une transplantation.

Impact of allogeneic stem cell transplantation on thyroid function.

PURPOSE: Primary hypothyroidism is a main endocrine complication after allogeneic stem cells transplantation (allo-SCT) in children, but in adults data on post-SCT hypothyroidism are limited. The aims of this observational, cross-sectional study were to assess the prevalence of hypothyroidism in adult allo-SCT recipients according to time from transplantation, and to identify risk factors. METHODS: One hundred and eighty-six patients (M 104; F 82; median age 53.4 years) who underwent allo-SCT between January 2010 and December 2017 were enrolled and divided into three groups, according to time from allo-SCT (1-3 years; 3-5 years; > 5 years). Pre-transplant TSH and fT4 levels were available for all patients. After transplantation, TSH, fT4 and anti-thyroperoxidase antibodies (TPO-Ab) were evaluated. RESULTS: After a follow-up of 3.7 years, 34 (18.3%) patients developed hypothyroidism, with higher prevalence in females (p < 0.001) and in patients who received matched unrelated donor grafts (p < 0.05). No difference in prevalence was found at different time points. Patients who developed hypothyroidism showed higher rate of TPO-Ab positivity (p < 0.05) and higher pre-transplant TSH levels (median 2.34 µU/ml) compared to those with preserved thyroid function (median 1.53 µU/ml; p < 0.001). Multivariable analysis identified higher pre-transplant TSH levels as a positive predictor of hypothyroidism (p < 0.005). The ROC curve analysis identified a pre-SCT TSH cutoff of 1.84 µU/ml, which can predict hypothyroidism with sensitivity 74.1% and specificity 67.2%. CONCLUSIONS: About one out of four patients developed hypothyroidism after allo-SCT, with a greater incidence in females. Pre-transplant TSH levels seem to predict the onset of post-SCT hypothyroidism.

Modelling the control of bovine brucellosis in India.

Brucellosis imposes substantial impacts on livestock production and public health worldwide. A stochastic, age-structured model incorporating herd demographics was developed describing within- and between-herd transmission of Brucella abortus in dairy cattle herds. The model was fitted to data from a cross-sectional study conducted in Punjab State of India and used to evaluate the effectiveness of control strategies under consideration. Based on model results, stakeholder acceptance and constraints regarding vaccine supply, vaccination of replacement calves in large farms should be prioritized. Test and removal applied at early stages of the control programme where seroprevalence is high would not constitute an effective or acceptable use of resources because significant numbers of animals would be 'removed' (culled or not used for breeding) based on false positive results. To achieve sustained reductions in brucellosis, policymakers must commit to maintaining vaccination in the long term, which may eventually reduce frequency of infection in the livestock reservoir to a low enough level for elimination to be a realistic objective. This work provides key strategic insights into the control of brucellosis in India, which has the largest cattle population globally, and a general modelling framework for evaluating control strategies in endemic settings.

Exploring smart phone based colorimetric technology for on-site quantitative determination of adulterant (neutralizer) in milk.

There is a great concern regarding the safety of milk not only for human health but also for its economic consequences. The portable sensing devices, which can collect and analyze data within food supply chains at critical control points are lacking. Smart phones have now emerged as an integral part of each home, lab, farm and factory. It is having a provision of digital camera and computation; with widespread applicability including food analysis. The use of soda as a milk neutralizer is a usual practice but has a detrimental human health impact. This investigation explored an easy, economic, fast, repeatable, and field applicable Smartphone-based sensing technology, which was standardized and in-house validated for the quantitative determination of neutralizer in milk samples. The method had simple steps of spot-test response and digital image evaluation with the Red Green Blue process. The linearity of the method was shown by analytical curves ranging from 0.125% (1250 ppm) to 1% (10,000 ppm) that were characterized by R2 > 0.99. The limit of detection of 0.11% demonstrated the sensitivity of the method which was found better than the existing wet chemical spot test. Comparison with the existing spectroscopic method revealed no statistically significant difference between the observations using paired t-test at a confidence level of 95%.

Diffusely abnormal white matter in clinically isolated syndrome is associated with parenchymal loss and elevated neurofilament levels.

We characterized the frequency of diffusely abnormal white matter (DAWM) across a broad spectrum of multiple sclerosis (MS) participants. 35% of clinically isolated syndrome (CIS), 57% of relapsing remitting and 64% of secondary progressive MS participants demonstrated DAWM. CIS with DAWM had decreased cortical thickness, higher lesion load and a higher concentration of serum neurofilament light chain compared to CIS without DAWM. DAWM may be useful in identifying CIS patients with greater injury to their brains. Larger and longitudinal studies are warranted.

Seroprevalence and risk factor investigation for the exposure of Toxoplasma gondii among veterinary personnel in Punjab, India.

Toxoplasma gondii, a globally important food borne zoonotic parasite, infects most of the warm-blooded animals as well as people. Veterinarians and para vets are considered at risk of T. gondii exposure. We determined the seroprevalence of T. gondii in veterinary personnel and investigated the associated risk factors in Punjab, India. Two hundred and five blood samples collected from veterinary personnel were tested for the presence of Toxoplasma IgG and IgM antibodies using ELISA. The apparent and true seroprevalence of T. gondii with 95% confidence interval (CI) were estimated. Information about participant demographics, and possible routes of exposure was collected using a self-completed questionnaire at the time of blood collection. For risk factor investigation, a veterinary person was considered Toxoplasma seropositive using a combination of tests in parallel, i.e. if it was positive in either IgG or IgM ELISA. A mixed effects logistic regression model was constructed to evaluate the association of demography, occupational and non-occupational factors with Toxoplasma seropositive status. The apparent and estimated true seroprevalence of T. gondii antibodies using Toxoplasma IgG ELISA was 8.78% (95% CI 5.63-13.45%) and 7.36% (95% CI 4.04-12.29%), respectively. The apparent and estimated true seroprevalence using Toxoplasma IgM ELISA was 0.49% (95% CI inestimable - 2.71%) and 0.51% (95% CI inestimable - 2.83%), respectively. After adjusting other variables in the final model, consuming mutton and owning a cat were associated with large odds of being Toxoplasma seropositive. In this study occupational exposure does not seem to play an important role for the exposure of T. gondii in veterinary personnel in Punjab state of India. The seroprevalence of toxoplasmosis in veterinary personnel is comparatively low in occupationally exposed veterinary personnel in Punjab, India.

Managing acute abdominal pain in the emergency centre: Lessons from a patient's experience.

Pain is one of the most common reasons people present to the emergency centre with 7-10% of presentations being due to acute abdominal pain. However, pain is also often neglected by clinicians in emergency centres. The well validated South African Triage Score (SATS) incorporates pain assessment in the prioritising of patients with the aim of guiding clinicians. Based on the SATS, severe pain (a score of ≥8 out of 10) should prompt the clinician to initiate treatment within 10 min of presentation, as unmanaged pain has multiple negative consequences, including poor outcomes of the acute incident with delayed healing and increased risk of developing chronic pain. In this commentary, we present a patient's experience when attending an emergency centre for acute abdominal pain, describe relevant pain mechanisms and highlight the stages where clinical management could have been optimised.

The effect of rapidly discharging psychiatric inpatients from Mental Health Act section during COVID-19: a cohort study.

AIMS: In March 2020, the UK government ordered mental health services to free up bed space to help manage the COVID-19 pandemic. This meant service users detained under the Mental Health Act were discharged at a higher rate than normal. We analysed whether this decision compromised the safety of this vulnerable group of service users. METHODS: We utilised a cohort study design and allocated service users to either the pre-rapid discharge, rapid discharge or post-rapid discharge group. We conducted a recurrent event analysis to assess group differences in the risk of experiencing negative outcomes during the 61 days post-discharge. We defined negative outcomes as crisis service use, re-admission to a psychiatric ward, community incidents of violence or self-harm and death by suicide. RESULTS: The pre-rapid discharge cohort included 258 service users, the rapid discharge cohort 127 and the post-rapid discharge cohort 76. We found no statistical association between being in the rapid discharge cohort and the risk of experiencing negative outcomes (HR: 1.14, 95% CI: 0.72-1.8, p = 0.58) but a trend towards statistical significance for service users in the post-rapid discharge cohort (HR: 1.61, 95% CI: 0.91-2.83, p = 0.1). CONCLUSIONS: We did not find evidence that service users rapidly discharged from section experienced poorer outcomes. This raises the possibility that the Mental Health Act is applied in an overly restrictive manner, meaning that sections for some formally detained service users could be ended earlier without compromising safety.

Paternal effects in the initiation of migratory behaviour in birds.

What determines why some birds migrate and others do not? This question is fundamental to understanding how migratory systems are responding to environmental changes, but the causes of individual migratory behaviours have proven difficult to isolate. We show that, in a partially migratory population of Eurasian oystercatchers (Haematopus ostralegus), the migratory behaviour of progeny follows paternal but not maternal behaviour, and is unrelated to timing of hatching or fledging. These findings highlight the key role of social interactions in shaping the migratory behaviour of new generations, and thus the spatio-temporal distribution of migratory populations.

Gut microbiota profiling in hematopoietic stem cell transplant recipients: Towards personalized medicine.

BACKGROUND: Antibiotic resistance in bacteria is a cause for concern, especially in hematopoietic stem cell transplant (HSCT) patients. Endogenous bowel microflora in HSCT patients get replaced by hospital multidrug resistant flora and pose risk of serious bacterial infection during the pre-engraftment stage. For decades, many methods to reduce the translocation of gut microbiota in HSCT patients have been attempted. Despite the logic, of using prophylactic antibiotics, there is no consensus on standard regimen. Personalized antibiotic prophylaxis-based on gut microbiota and clinical profile has been suggested by researchers. In this study, gut microbiota in HSCT recipients has been studied with antimicrobial susceptibility testing and detection of various antibiotic resistance phenotypes. METHODS: Seventy-six HSCT patients (2016-2018) were included. Stool surveillance cultures and antibiotic susceptibility testing were performed. Bacterial isolates were classified into various antibiotic resistance phenotypes. RESULTS: This study revealed that 73.75% HSCT recipients had gut colonized with antibiotic resistance microbiota which included extended-spectrum ß-lactamase-, multidrug- and extensively drug-resistant phenotypes. CONCLUSION: This study reiterates the importance of individual profiling of gut microbiota in HSCT patients.

Comparative analysis of Methicillin-Resistant Staphylococcus aureus (MRSA) and Borderline Oxacillin Resistant Staphylococcus aureus (BORSA) in community and food of animal origin.

The aim of this study was to illustrate the relative pervasiveness of Borderline Oxacillin Resistant Staphylococcus aureus (BORSA) and Methicillin-Resistant Staphylococcus aureus (MRSA) in community and food of animal origin and their relationship with other genetic determinants. Staphylococcus aureus isolates were subjected to E-test using the antibiotics: oxacillin, ceftriaxone, cotrimoxazole, vancomycin, genotypic tests for the genes mecA, vanA, blaZ, pvl gene and SCCmec typing. The prevalence of S. aureus (MRSA) in the food of animal origin and community settings was 21% (1.8% MRSA) and 21.9% (7.4% MRSA), respectively. SCCmec type V was prevalent among the food of animal origin, while SCCmec type IVa among the community isolates. The likelihood of MRSA presence among community isolates was three times more than in isolates from chicken and milk samples. Likewise, the likelihood of detecting pvl positive MRSA (pvl+MRSA) isolates was 4-fold higher in the community setting than in the food of animal origin. The mecA negative BORSA (mecA-BORSA) was a frequently observed phenotype among S. aureus isolates. Also, co-detection of pvl and cotrimoxazol resistance was reported in this study although there was no noteworthy correlation of cotrimoxazol resistance with the type of sample. Isolates from milk and community settings exhibit higher minimum inhibitory concentration to vancomycin (Vancomycin MIC creep, 2-4 µg/mL). SIGNIFICANCE: Current study provides the information on the statistical relationship between the genetic determinants of S. aureus with respect to sample type, and additionally the correlation that exists between the pvl and MRSA, pvl and cotrimoxazol resistance, vancomycin MIC and MRSA/Methicillin-Susceptible S. aureus (MSSA).

The Extent and Structure of Peri-urban Smallholder Dairy Farming in Five Cities in India.

Livestock keeping is common in many cities in India, driven by the demand for animal-source foods, particularly perishable milk. We selected five cities from different regions of the country and conducted a census in 34 randomly selected peri-urban villages to identify and describe all smallholder dairy farms. In total 1,690 smallholder dairy farms were identified, keeping on average 2.2 milking cows and 0.7 milking buffaloes. In Bhubaneswar, the proportion of cows milking was only 50%, but in other cities it was 63-73%. In two of the five cities, more than 90% of the farmers stated that dairy production was their main source of income, while <50% in the other cities reported this. In one of the cities, only 36% of the households kept milk for themselves. Market channels varied considerably; in one city about 90% of farms sold milk to traders, in another, 90% sold to the dairy cooperative, and in another around 90% sold directly to consumers. In conclusion, peri-urban dairy systems in India are important but also varying between different cities, with only one city, Bengaluru, having a well-developed cooperative system, and the northeastern poorer region being more dependent on traders. Further studies may be needed to elucidate the importance and to design appropriate developmental interventions.

Blueprinting of summative theory assessment of undergraduate medical students in microbiology.

BACKGROUND: Assessment drives learning. Written assessment of many universities lacks uniformity and validation. Subjectivity influences assessment. Blueprinting has been used as content validity tools. METHODS: In this study, last 5-year's Maharashtra University of Health Sciences (MUHS) second year MBBS papers in Microbiology were evaluated for its content validity. Desired weightage to all the topics in microbiology was given by the faculty of Department of the Microbiology. University papers were also evaluated for level of cognitive domain tested. Closed ended feedback from faculty was taken and was statistically evaluated. RESULT: Study revealed both overrepresentation and underrepresentation of many topics across all the last 5-year university papers in subject of microbiology. The cognitive dimension tested in question papers as per revised Bloom's taxonomy was merely 8% from Bloom's level 1, 20% from level 2, and 8% from level 3, whereas 64% of the questions were ambiguous. Faculty feedback revealed significant impact (P < 0.05) from blueprinting in microbiology. CONCLUSION: Assessment should be aligned to learning objectives, and blueprinting improves content validity.

Pesticide Residues in Peri-Urban Bovine Milk from India and Risk Assessment: A Multicenter Study.

Pesticides residue poses serious concerns to human health. The present study was carried out to determine the pesticide residues of peri-urban bovine milk (n = 1183) from five different sites (Bangalore, Bhubaneswar, Guwahati, Ludhiana and Udaipur) in India and dietary exposure risk assessment to adults and children. Pesticide residues were estimated using gas chromatography with flame thermionic and electron capture detectors followed by confirmation on gas chromatography-mass spectrometer. The results noticed the contamination of milk with hexachlorocyclohexane (HCH), dichloro-diphenyl trichloroethane (DDT), endosulfan, cypermethrin, cyhalothrin, permethrin, chlorpyrifos, ethion and profenophos pesticides. The residue levels in some of the milk samples were observed to be higher than the respective maximum residue limits (MRLs) for pesticide. Milk samples contamination was found highest in Bhubaneswar (11.2%) followed by Bangalore (9.3%), Ludhiana (6.9%), Udaipur (6.4%) and Guwahati (6.3%). The dietary risk assessment of pesticides under two scenarios i.e. lower-bound scenario (LB) and upper-bound (UB) revealed that daily intake of pesticides was substantially below the prescribed acceptable daily intake except for fipronil in children at UB. The non-cancer risk by estimation of hazard index (HI) was found to be below the target value of one in adults at all five sites in India. However, for children at the UB level, the HI for lindane, DDT and ethion exceeded the value of one in Ludhiana and Udaipur. Cancer risk for adults was found to be in the recommended range of United States environment protection agency (USEPA), while it exceeded the USEPA values for children.