Economic evaluation of antimicrobial usage surveillance in livestock.

There is increased pressure by governments and industry to develop national surveillance programmes to evaluate antimicrobial usage (AMU) in animals. This article presents a methodological approach to cost-effectiveness analysis of such programmes. Seven objectives are proposed for AMU surveillance in animals: quantifying use, finding trends, detecting hotspots, identifying risk factors, encouraging research, evaluating the impact of policies and diseases, and demonstrating compliance with regulations. Achieving these objectives would assist in making decisions about potential interventions, help to generate trust, incentivise the reduction of AMU and decrease the risk of antimicrobial resistance. The cost-effectiveness of each objective can be found by dividing the cost of the programme by the performance indicators of the surveillance required to meet the objective concerned. The precision and accuracy of surveillance outputs are suggested here as useful performance indicators. Precision depends on the level of surveillance coverage (SC) and surveillance representativeness (SR). Accuracy is influenced by the quality of farm records and SR. The authors argue that there is an increase in marginal cost for each unit increase of SC, SR and data quality. This is caused by the increasing difficulty of recruiting farmers due to potential barriers such as staff capacity, capital availability, computing literacy and availability, and geographical differences, among other factors. A simulation model was conducted to test the approach, using the quantification of AMU as the primary objective, and to provide evidence of the application of the law of diminishing returns. Cost-effectiveness analysis can be used to support decisions on the level of coverage, representativeness and data quality required in such AMU programmes.

Les gouvernements tout comme le secteur de l'élevage exercent une pression croissante pour que des programmes nationaux de surveillance soient élaborés afin d'évaluer l'utilisation d'agents antimicrobiens (UAM) chez les animaux. Cet article présente une approche méthodologique permettant de réaliser l'analyse coût-efficacité de ces programmes. Sept objectifs sont proposés pour la surveillance de l'UAM chez les animaux : quantifier cette utilisation, relever les tendances, détecter les situations d'utilisation intensive, déceler les facteurs de risque, encourager la recherche, évaluer l'impact des politiques et des maladies et démontrer la conformité avec les réglementations. La réalisation de ces objectifs de surveillance permettra de prendre des décisions éclairées sur les interventions à mener, contribuera à mettre en place un climat de confiance, encouragera à réduire l'UAM et atténuera le risque d'apparition d'antibiorésistances. Le ratio coût-efficacité de chaque objectif peut être déterminé en divisant le coût du programme par les indicateurs de performance de la surveillance requise pour chacun des objectifs examinés. Les auteurs considèrent que la précision et l'exactitude des résultats de la surveillance sont des indicateurs de performance utiles à cet effet. La précision dépend du niveau de couverture de la surveillance (CS) et de sa représentativité (RS). L'exactitude est fonction de la qualité des registres d'élevage et de la RS. D'après les auteurs, chaque accroissement unitaire de la CS, de la RS et de la qualité des données donne lieu à une augmentation du coût marginal. Celle-ci s'explique par la difficulté croissante de recruter des éleveurs pour cette activité, en raison d'obstacles tels que le manque d'effectifs, la disponibilité de capitaux, le manque de compétences et d'équipements informatiques et les différences géographiques, entre autres facteurs potentiels. Un modèle de simulation a été mis en oeuvre pour tester cette approche à partir de l'objectif principal (la quantification de l'UAM), et pour apporter des éléments démontrant l'application de la loi des rendements décroissants dans ce domaine. L'analyse coût-efficacité peut être utilisée pour étayer les décisions concernant la couverture, la représentativité et la qualité des données requises pour les programmes de surveillance de l'UAM.

Los gobiernos y la industria vienen presionando cada vez más para la implantación de programas nacionales de vigilancia destinados a evaluar el uso de agentes antimicrobianos (UAM) en los animales. Los autores presentan una solución metodológica para analizar la relación costo-eficacia de tales programas. En primer lugar proponen un conjunto de siete objetivos que deben cumplirse al vigilar el UAM en los animales: cuantificar el uso, detectar tendencias, localizar áreas de "gran intensidad" de uso, determinar los factores de riesgo, alentar la investigación, evaluar la repercusión de las políticas y las enfermedades y comprobar la observancia de los reglamentos. El logro de estos objetivos ayudaría a decidir sobre posibles intervenciones y a generar confianza, supondría un incentivo para reducir el UAM y atenuaría el riesgo de que surgieran resistencias a estos productos. Para cada objetivo es posible determinar la relación costo-eficacia dividiendo el costo del programa por los indicadores de desempeño de la vigilancia requerida para cumplir el objetivo en cuestión. Los autores proponen utilizar la precisión y exactitud de los resultados de la vigilancia como útiles indicadores de desempeño. La precisión depende del nivel de cobertura y de representatividad de la vigilancia. En la exactitud, por su parte, influyen la calidad de los archivos de las explotaciones pecuarias y la representatividad de la vigilancia. Los autores postulan que cada aumento unitario de la cobertura y la representatividad de la vigilancia y de la calidad de los datos se acompaña de un aumento correspondiente del costo marginal. Ello se explica por la creciente dificultad que presenta la participación de ganaderos en el proceso, debida a su vez a posibles barreras en aspectos como la dotación de personal, el capital disponible, los conocimientos en informática y el acceso a ordenadores o las diferencias geográficas, entre otros factores. Para ensayar el método y probar que se aplica el principio de los rendimientos decrecientes, los autores emplearon un modelo de simulación, utilizando como principal objetivo la cuantificación del UAM. El análisis de la relación costo-eficacia puede ser utilizado como herramienta auxiliar para tomar decisiones sobre el nivel de cobertura, representatividad y calidad de los datos que se necesita en este tipo de programas de vigilancia del UAM.

Relationship of anemia with COVID-19 deaths: A retrospective cross-sectional study.

Background and Aims: With the second wave of COVID-19, India lost close to three lakh people within the span of a few months. In this study, we aimed to investigate the impact of anemia on the severity of COVID-19 based on the hemoglobin (Hb) concentration of the patients noted at the time of admission to the intensive care unit (ICU), to mark Hb as a prognostic marker of disease severity for the future. Material and Methods: Retrospective data was collected from 784 patients admitted to the COVID adult ICU between March and June 2021. Patients were identified as anemic and non-anemic based on the World Health Organization (WHO) guidelines. Chi-squared test was applied to see the relationship of anemia with the patient deaths. Results: Among the 784 patients, 507 succumbed to COVID-19. Of these, 49.3% had varying degrees of anemia. Significant correlation of anemia with death due to COVID-19 was found in males and females (P = 0.002106 and P = 0.033071, respectively) and in patients without any other comorbidities except anemia (P = 0.002020). This suggests that anemia is independently an important parameter that plays a role in severity of COVID-19. Conclusion: Upon observing a significant correlation between anemia and COVID-19 severity, it can be stated that anemia should be considered as an independent prognostic risk factor for COVID-19 and that hemoglobin can be used for risk stratification in patients under home or hospital care.

Exit site infection and peritonitis due to Serratia species in patients receiving peritoneal dialysis: Epidemiology and clinical outcomes.

AIM: To study the epidemiology and clinical outcomes of catheter-related infections of Serratia species in peritoneal dialysis (PD) patients. METHODS: We retrospectively reviewed the patient characteristics, antibiotics susceptibility/resistance patterns and treatment outcomes of exit site infection (ESI) and peritonitis due to Serratia in PD patients during the period of 2004 to 2017. RESULTS: One hundred and sixty-one patients had Serratia ESI, of which 10 (6.2%) progressed to tunnel tract involvement and 11 (6.8%) developed PD peritonitis. Nineteen (11.8%) patients with Serratia ESI failed to respond to medical treatment and required catheter removal. Fifty-six (34.8%) patients had repeat Serratia ESI, which occurred at 12.9 ± 13.6 months after the previous episode. Twenty-two patients had Serratia peritonitis, which accounted for 1% of peritonitis during the study period. Ten (45.5%) patients responded to medical treatment while 12 (54.5%) patients required catheter removal. Nine patients (36.4%) failed to resume PD and were converted to long-term haemodialysis. Two patients had repeat peritonitis at 2 months and 3 years, respectively, after the initial episode. Serratia species in PD patients showed high rates of resistance to ampicillin, and first- and second-generation cephalosporins, but were generally susceptible to aminoglycosides, carboxy-/ureido-penicillins and carbapenems. CONCLUSION: Our results suggest that Serratia ESI show low risk of progression to peritonitis and favourable response to medical therapy, while Serratia peritonitis was associated with high rates of catheter removal and peritoneal failure.

Comparison of Esmolol and Dexmedetomidine for Suppression of Hemodynamic Response to Laryngoscopy and Endotracheal Intubation in Adult Patients Undergoing Elective General Surgery: A Prospective, Randomized Controlled Double-blinded Study.

CONTEXT: Laryngoscopy and endotracheal intubation lead to strong sympathetic response which may precipitate arrhythmias, myocardial ischemia and cerebrovascular accidents in patients with preexisting cardiovascular disease. AIMS: This study was aimed to compare the effect of dexmedetomidine and esmolol on hemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing elective surgery under general anesthesia. SETTINGS AND DESIGN: This was a prospective, randomized controlled double-blinded study. MATERIALS AND METHODS: A total of ninety patients were selected and randomized into three groups of thirty patients each: Group C received infusion of 20 mL 0.9% normal saline (NS) over 10 min, Group D received infusion of dexmedetomidine 1 µg/kg diluted in 20 mL NS over 10 min, and Group E received infusion of esmolol 1.5 mg/kg diluted in 20 mL NS over 10 min. Three minutes after the completion of infusion, patients were induced with general anesthesia. Baseline parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and rate pressure product (RPP) were recorded before administration of study drugs and at 1, 3, 5, 7, and 10 min after intubation. STATISTICAL ANALYSIS USED: One-way ANOVA was used for comparison among the groups and unpaired t-test was used for comparison within the groups along with Tukey's test for post test analysis. RESULTS: Mean HR, SBP, DBP, MAP, and RPP values remained significantly lower in Group D than that of Group C and Group E at all time intervals up to 10 min after intubation. CONCLUSIONS: Both dexmedetomidine and esmolol suppressed the hemodynamic response to intubation when compared to control group, but dexmedetomidine is more effective than esmolol in maintaining hemodynamic stability following laryngoscopy and intubation.

Morphine as a drug for stress ulcer prevention and healing in the stomach.

Morphine pretreatment protects against stress-induced gastric ulceration, however, the exact mechanism is still undefined. Interestingly, the effect of morphine on ulcer healing has not been investigated. In this report, we would like to study these effects in a defined stress ulcer model and to delineate a new implication for morphine to promote stress ulcer healing in rats. Our study showed that cold-restraint stress for 3 h induced hemorrhagic lesions and increased myeloperoxidase activity in the gastric mucosa. Stress also reduced the dimension of layer of periodic acid-Schiff reagent-stained cells in the gastric mucosa by about 50%. Morphine pretreatment (2 or 8 mg/kg, given intraperitoneally) at the time of stress dose-dependently reversed stress-induced gastric ulceration, increase of myeloperoxidase activity and reduction of thickness of mucus-stained cells in the gastric mucosa. Morphine treatment after stress (given at the end of a 3-h stress and also at 3 h thereafter) increased ulcer healing by reducing the ulcer size measured 24 h later. Such action was blocked by naloxone (8 mg/kg) given intraperitoneally 15 min before morphine treatment. Morphine also increased the number of cell proliferation and dimension of layer of cells stained for mucus but not the number of microvessels in the gastric mucosa. Moreover, the number of apoptotic cells was less evidenced in the morphine-treated rats. This study reports for the first time that morphine not only prevents stress ulceration but also promotes healing of stress ulcer through a defined mechanism.

Micronuclei and other nuclear anomalies in normal human buccal mucosa cells of oral cancer patients undergoing radiotherapy: a field effect.

We evaluated micronuclei and other nuclear anomalies in exfoliated epithelial cells of the oral cavity on the side opposite the lesion targeted by radiotherapy and correlated them with radiation doses. Buccal smears were obtained from oral cancer patients undergoing radiotherapy with a cumulative dose of at least 1000 rad for 3 weeks and from controls matched for age, gender and habits. The exfoliated cells from the mucosa were collected using a cytobrush; smears were prepared, fixed in 80% methanol and stained using the Feulgen plus fast green method. The mean number of micronuclei and other nuclear anomalies/1000 cells was significantly greater in patients undergoing radiotherapy treatment, but the differences were not significant compared to radiation doses. It appears that radiotherapy has a potent clastogenic effect on buccal mucosal cells of oral cancer patients.

Hemodynamic, ventilator, and ECG changes in pediatric patients undergoing extraction.

BACKGROUND: Dental treatment induces pain anxiety and fear. This study was conducted to assess the changes in hemodynamic, ventilator, and electrocardiograph changes during extraction procedure among 12-15-year-old children and compare these changes with anxiety, fear, and pain. MATERIALS AND METHODS: A purposive sample of 60 patients selected based on inclusion and exclusion criteria underwent study procedure in the dental OPD of a medical college and hospital. The anxiety, fear, and pain were recorded by dental anxiety scale, dental fear scale, and visual analogue scale, respectively, before the start of the procedure. The systolic blood pressure, diastolic blood pressure, heart rate, oxygen saturation, and electrocardiogram changes were monitored during the extraction procedure. The recording was taken four times (preinjection phase, injection, extraction, and postextraction) and was analyzed. RESULTS: At the preinjection phase the mean vales were systolic blood pressure (128 ± 11.2), diastolic blood pressure (85.7 ± 6.3), heart rate (79.7 ± 9.3), and oxygen saturation (97.9 ± 5.8). These values increased in injection phases and decreased in extraction phase and the least values were found after 10 min of procedure and this relation was significant for all parameters except oxygen saturation (P = 0.48, NS). ECG abnormalities were seen among 22 patients and were significant before and after injection of Local anesthetic (P = 0.0001, S). CONCLUSIONS: Anxiety, fear, and pain have an effect on hemodynamic, ventilator, and cardiovascular parameters during the extraction procedure and hence behavioral management has to be emphasized among children in dental clinics.

Assessment of periodontal status and treatment needs among 12 and 15 years old school children in Udaipur, India.

AIM: To assess and compare the periodontal status and treatment needs among school children aged 12 and 15 years in public and private schools of Udaipur, India and to provide baseline data for planning and evaluation of oral health care promotion programmes. STUDY DESIGN: A cross-sectional descriptive survey. METHODS: A survey was conducted on 900 school children aged 12 and 15 years in Udaipur. The data were collected by means of clinical examination using the CPITN index. STATISTICS: Data was analysed using Pearson's Chi-square and student's t-test. RESULTS: Children aged 15 years had higher scores of healthy gingiva compared with 12 years old. Gender difference of females having better gingival health than males was seen in both age groups. Amongst the schools, children in private schools had good periodontal status in comparison to public schools. A statistically significant association between frequency of tooth brushing and CPITN scores was found among children of the 15 year old group. CONCLUSION: There is a need for a long term school oral health promotion program to sustain the healthy tissues of this growing Indian population.