Sensing and Automation Technologies for Ornamental Nursery Crop Production: Current Status and Future Prospects.

The ornamental crop industry is an important contributor to the economy in the United States. The industry has been facing challenges due to continuously increasing labor and agricultural input costs. Sensing and automation technologies have been introduced to reduce labor requirements and to ensure efficient management operations. This article reviews current sensing and automation technologies used for ornamental nursery crop production and highlights prospective technologies that can be applied for future applications. Applications of sensors, computer vision, artificial intelligence (AI), machine learning (ML), Internet-of-Things (IoT), and robotic technologies are reviewed. Some advanced technologies, including 3D cameras, enhanced deep learning models, edge computing, radio-frequency identification (RFID), and integrated robotics used for other cropping systems, are also discussed as potential prospects. This review concludes that advanced sensing, AI and robotic technologies are critically needed for the nursery crop industry. Adapting these current and future innovative technologies will benefit growers working towards sustainable ornamental nursery crop production.

Evaluation of multifrequency SAR data for estimating tropical above-ground biomass by employing radiative transfer modeling.

The retrieval of the biophysical parameters and subsequent estimation of the above-ground biomass (AGB) of vegetation stands are made possible by the simulation of the extinction and scattering components from the canopy layer using vector radiative transfer (VRT) theory-based scattering models. With the use of such a model, this study aims to evaluate and compare the potential of dual-pol, multi-frequency SAR data for estimating above-ground biomass. The data selected for this work are L-band dual polarized (HH/HV) ALOS-2 data, S-band dual polarized (HH/HV) NovaSAR data, and C-band dual polarized (VV/VH) Sentinel-1 data. The two key biophysical parameters, tree height, and trunk radius are retrieved using the proposed methodology, applying the frequencies independently. A general allometric equation with vegetation-specific coefficients is used to estimate the AGB from the retrieved biophysical parameters. The retrieval results are validated using ground truth measurements collected from the study area. The L-band, with the coefficient of determination ([Formula: see text]) of 0.73 and the root mean square error (RMSE) of 35.90 t/ha, has the best correlation between the modeled and field AGBs, followed by the S-band with an [Formula: see text] of 0.37 and an RMSE of 63.37 t/ha, and the C-band with an [Formula: see text] of 0.25 and an RMSE of 72.32 t/ha. The L-band has yielded improved estimates of AGB in regression analysis as well, with an [Formula: see text] of 0.48 and an RMSE of 50.02 t/ha, compared to the S- and C-bands, which have the [Formula: see text] of 0.12 and 0.03 and the RMSE of 70.98 t/ha and 80.84 t/ha, respectively.

Assessment of mangrove cover dynamics and its health status in the Gulf of Khambhat, Western India, using high-resolution multi-temporal satellite data and Google Earth Engine.

Anthropogenic activity is a major driving factor of greenhouse gas emission, leading to climate change worldwide. So, the best natural approach to lowering the carbon from the atmosphere is mangroves which have more potential to sequestrate carbon. But mangroves are under threat due to land use land cover change. This research has been carried out on the mangroves of Gulf of Khambhat, Gujarat, India, where anthropic activity is affecting the mangrove forest cover with spatiotemporal heterogeneity. In the present study, multi-temporal high-resolution satellite data AVNIR-2 (Advanced Visible and Near Infrared Radiometer type-2) and LISS-4 (Linear Imaging Self-Scanning Sensors-4) were used for the demarcation of various land use/land cover class (LULC), and change analysis and assessment of mangroves health for the years 2009, 2014, and 2019. The impact of saltpan/aquaculture on mangroves growth and its health status has been calculated by various MODIS (Moderate Resolution Imaging Spectroradiometer) satellite data products such as gross primary productivity (GPP), enhanced vegetation index (EVI), and leaf area index (LAI) in Google Earth Engine (GEE), and field-based method was also considered. This study suggests that there is a marginal increase (17.11 km2) in mangrove cover during the assessment period 2009-2019; on other side, 65.42 km2 was degraded also. However, increase in saltpan/aquaculture is imposing an adverse effect on mangroves' basal area, plant density, and productivity. Change analysis also suggests a reduction in healthy mangrove area (from 25.20 to 2.84 km2), which will have an impact on ecosystem services.

Integration of C-band SAR and high-resolution optical images for delineating palaeo-channels in Nagaur and Barmer districts, western Rajasthan, India.

Identifying hitherto unknown palaeo-channels, especially in the arid regions of the Thar Desert, is crucial since these channels may form excellent aquifers, and are also associated with valuable ore deposits of many precious minerals. This study employed integrated C-band Synthetic Aperture Radar (SAR) of Sentinel-1A and high-resolution multispectral Sentinel-2A data of pre- and post-monsoon seasons (June and November) to delineate playas and palaeo-channels. This approach is the first of its kind for this area. The palaeo-channels were delineated through a detailed visual inspection of colour composite (CC) images of Sentinel-2A data, SAR backscatter (VH) images and fused SAR and optical images. Then, we studied the topographic profiles generated from the Shuttle Radar Topography Mission - Digital Elevation Model (SRTM-DEM) across the identified palaeo-channels, Normalized Difference Vegetation Index (NDVI) and Normalized Difference Water Index (NDWI) to further confirm the existence of a palaeo-channel's course and playas. As a result, several playas and palaeo-channels in the area were successfully identified, some of which were previously unmapped and undetected. The results indicate that the post-monsoon datasets are more useful for the precise delineation of palaeo-channels due to the presence of relatively higher moisture along the palaeo-channels' courses.

Determinants of minimum acceptable diet feeding among children aged 6-23 months in Odisha, India.

OBJECTIVE: To assess the level, pattern and determinants of minimum acceptable diet (MAD) feeding in Odisha, India. DESIGN: Utilising cross-sectional data, the MAD was estimated through a dietary assessment method wherein the child's mother was asked to recall all the food intake of the youngest child the previous day and night of the surveyed date. SETTING: National Family Health Survey 2015-2016. PARTICIPANTS: Children aged 6-23 months, living with mother and for whom complete information on MAD was available (n 3073). RESULTS: Only 8·4 % of the children aged 6-23 months were fed MAD, and the MAD feeding varies considerably by socio-demographic characteristics. Children aged 12-17 months had two times (OR: 2·51, 95 % CI (1·48, 4·26)) and those aged 18-23 months had three times (OR: 3·77, 95 % CI (2·25, 6·30)) higher odds of having a MAD than their counterparts aged 6-8 months. Children whose mother was exposed to any mass media had a higher chance of MAD feeding (OR: 1·46, 95 % CI (1·01, 2·11)). CONCLUSIONS: The children of higher age, second or higher-order births, with mother exposed to mass media are significantly more likely to be fed with a MAD. At the same time, children from scheduled caste (SC) households have a lower probability of MAD feeding. The lower MAD feeding among the SC households suggests strengthening the ongoing programmes with a higher emphasis on the inclusion of this disadvantaged and marginalised group. Findings from the current study would assist policymakers, and public health managers improve MAD feeding practices in Odisha, India, in a targeted manner.

Cell-free mitochondrial DNA copy number variation in head and neck squamous cell carcinoma: A study of non-invasive biomarker from Northeast India.

Head and neck squamous cell carcinoma is the most commonly diagnosed cancer worldwide. The lifestyle, food habits, and customary practices manifest the Northeast Indian population toward higher susceptibility to develop head and neck squamous cell carcinoma. Here, we have investigated the association of smoke and smokeless tobacco, and alcohol with copy number variation of cell-free mitochondrial DNA and cell-free nuclear DNA in cases and controls. Cell-free DNA from plasma was isolated from 50 head and neck squamous cell carcinoma cases and 50 controls with informed written consent using QIAamp Circulating Nucleic Acid Kit. Real-time polymerase chain reaction was done for copy number variation in cell-free mitochondrial DNA and cell-free nuclear DNA. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic application between the two study groups using clinicopathological parameters. The levels of cell-free nuclear DNA and cell-free mitochondrial DNA of cases in association with smoke and smokeless tobacco, alcohol with smoking (p < 0.05) were significantly higher (p < 0.01 and p < 0.001, respectively) than controls. Using receiver operating characteristic curve analysis between head and neck squamous cell carcinoma cases and controls, we distinguished cell-free mitochondrial DNA (cutoff: 19.84 raw Ct; sensitivity: 84%; specificity: 100%; p < 0.001) and cell-free nuclear DNA (cutoff: 463,282 genomic equivalent/mL; sensitivity: 53%; specificity: 87%; p < 0.001). The copy number variation in cases (cell-free nuclear DNA: 5451.66 genomic equivalent/mL and cell-free mitochondrial DNA: 29,103,476.15 genomic equivalent/mL) and controls (cell-free nuclear DNA: 1650.9 genomic equivalent/mL and cell-free mitochondrial DNA: 9,189,312.54 genomic equivalent/mL), respectively. Our result indicates that the cell-free mitochondrial DNA content is highly associated with smoke and smokeless tobacco, betel quid chewing, and alcohol which shows greater promises, holding the key characteristics of diagnostic biomarkers, that is, minimal invasiveness, high specificity, and sensitivity.

A brief understanding of process optimisation in microwave-assisted extraction of botanical materials: options and opportunities with chemometric tools.

INTRODUCTION: Extraction forms the very basic step in research on natural products for drug discovery. A poorly optimised and planned extraction methodology can jeopardise the entire mission. OBJECTIVE: To provide a vivid picture of different chemometric tools and planning for process optimisation and method development in extraction of botanical material, with emphasis on microwave-assisted extraction (MAE) of botanical material. METHODS: A review of studies involving the application of chemometric tools in combination with MAE of botanical materials was undertaken in order to discover what the significant extraction factors were. Optimising a response by fine-tuning those factors, experimental design or statistical design of experiment (DoE), which is a core area of study in chemometrics, was then used for statistical analysis and interpretations. RESULTS: In this review a brief explanation of the different aspects and methodologies related to MAE of botanical materials that were subjected to experimental design, along with some general chemometric tools and the steps involved in the practice of MAE, are presented. A detailed study on various factors and responses involved in the optimisation is also presented. CONCLUSION: This article will assist in obtaining a better insight into the chemometric strategies of process optimisation and method development, which will in turn improve the decision-making process in selecting influential extraction parameters.

"A rare case of bladder myiasis mimicking radiation cystitis-A first case report".

Patients diagnosed with cancer post-treatment are prone to have recurrent disease. Regular follow-up of these patients enables early recognition and treatment. A tissue diagnosis before starting treatment is imperative to avoid misdiagnosis and management. Given their immunosuppression, maintaining good nutrition, body hygiene, and clean surroundings is essential to prevent the most common urinary tract infection to rare urinary myiasis infection. Cochliomyia hominivorax, Chrysomya bezziana, and Wohlfahrtia magnifica are the most prevalent flies causing myiasis in human beings. Risk factors for urinary myiasis are open or untreated wounds and debris around the genital area. Specific flies, ticks, and mosquitoes are responsible for myiasis in tropical or subtropical countries, when it is usually not transmitted from human to human. Flies lay their eggs near the urethra, and the larvae hatch and migrate to the bladder. Increased urinary frequency, haematuria, and lower abdominal pain are the most commonly found presenting symptoms. Simple preventive measures can avoid these complications. So, prevention is better than cure.

Design of experiment approach for the process optimisation of microwave assisted extraction of lupeol from Ficus racemosa leaves using response surface methodology.

INTRODUCTION: Triterpenoids are a group of important phytocomponents from Ficus racemosa (syn. Ficus glomerata Roxb.) that are known to possess diverse pharmacological activities and which have prompted the development of various extraction techniques and strategies for its better utilisation. OBJECTIVE: To develop an effective, rapid and ecofriendly microwave-assisted extraction (MAE) strategy to optimise the extraction of a potent bioactive triterpenoid compound, lupeol, from young leaves of Ficus racemosa using response surface methodology (RSM) for industrial scale-up. MATERIAL AND METHOD: Initially a Plackett-Burman design matrix was applied to identify the most significant extraction variables amongst microwave power, irradiation time, particle size, solvent:sample ratio loading, varying solvent strength and pre-leaching time on lupeol extraction. Among the six variables tested, microwave power, irradiation time and solvent-sample/loading ratio were found to have a significant effect (P < 0.05) on lupeol extraction and were fitted to a Box-Behnken-design-generated quadratic polynomial equation to predict optimal extraction conditions as well as to locate operability regions with maximum yield. RESULTS: The optimal conditions were microwave power of 65.67% of 700 W, extraction time of 4.27 min and solvent-sample ratio loading of 21.33 mL/g. Confirmation trials under the optimal conditions gave an experimental yield (18.52 µg/g of dry leaves) close to the RSM predicted value of 18.71 µg/g. CONCLUSION: Under the optimal conditions the mathematical model was found to be well fitted with the experimental data. The MAE was found to be a more rapid, convenient and appropriate extraction method, with a higher yield and lower solvent consumption when compared with conventional extraction techniques.

Evaluation of crop research institutes under data and resource constraints: An alternative approach.

The evaluation of crop research institutes in the developing world under limited data availability has not been assessed in the past due to resource constraints. The paper assesses the social benefits of rice research taking the case of a research institute from India following a new approach. The area coverage of the varieties was estimated to be 3.4 million ha and the gain in production was 6.2 million tonnes per year in India. The additional return obtained due to the adoption of these varieties was about ₹ 14,621 million (US$ 232 million) per year at constant 2014-5 prices. The return per rupee investment in the institute's research and extension was ₹ 17. This approach is recommended for the impact evaluation of other crop research institutes in India and the developing world under resource constraints.

Comparative assessment of CNN architectures for classification of breast FNAC images.

Fine needle aspiration cytology (FNAC) entails using a narrow gauge (25-22 G) needle to collect a sample of a lesion for microscopic examination. It allows a minimally invasive, rapid diagnosis of tissue but does not preserve its histological architecture. FNAC is commonly used for diagnosis of breast cancer, with traditional practice being based on the subjective visual assessment of the breast cytopathology cell samples under a microscope to evaluate the state of various cytological features. Therefore, there are many challenges in maintaining consistency and reproducibility of findings. However, the advent of digital imaging and computational aid in diagnosis can improve the diagnostic accuracy and reduce the effective workload of pathologists. This paper presents a comparison of various deep convolutional neural network (CNN) based fine-tuned transfer learned classification approach for the diagnosis of the cell samples. The proposed approach has been tested using VGG16, VGG19, ResNet-50 and GoogLeNet-V3 (aka Inception V3) architectures of CNN on an image dataset of 212 images (99 benign and 113 malignant), later augmented and cleansed to 2120 images (990 benign and 1130 malignant), where the network was trained using images of 80% cell samples and tested on the rest. This paper presents a comparative assessment of the models giving a new dimension to FNAC study where GoogLeNet-V3 (fine-tuned) achieved an accuracy of 96.25% which is highly satisfactory.

Molecular mechanism of diabetic neuropathy and its pharmacotherapeutic targets.

Diabetic neuropathy is regarded as one of the most debilitating outcomes of diabetes mellitus and may cause pain, decreased motility, and even amputation. Diabetic neuropathy includes multiple forms, ranging from discomfort to death. Prognosis of diabetic neuropathy is an uphill task as it remains silent for several years after the onset of diabetes. Hyperglycemia, apart from inducing oxidative stress in neurons, also leads to activation of multiple biochemical pathways which constitute the major source of damage and are potential therapeutic targets in diabetic neuropathy. A vast array of molecular pathways, including polyol pathway, hexosamine pathway, PKCs signaling, oxidative stress, AGEs pathway, PARP pathway, MAPK pathway, NF-κB signaling, hedgehog pathways, TNF-α signaling, cyclooxygenase pathway, interleukins, lipoxygenase pathway, nerve growth factor, Wnt pathway, autophagy, and GSK3 signaling may be accounted for the pathogenesis and progression of diabetic neuropathy. Although symptomatic treatment is available for diabetic neuropathy, few treatment options are available to eliminate the root cause. The immense physical, psychological, and economic burden of diabetic neuropathy highlights the need for cost effective and targeted therapies. The main aim of this review is to highlight the putative role of various mechanisms and pathways involved in the development of diabetic neuropathy and to impart an in-depth insight on new therapeutic approaches aimed at delaying or reversing various modalities of diabetic neuropathy.

Polypharmacy and comorbidity status in the treatment of type 2 diabetic patients attending a tertiary care hospital: An observational and questionnaire-based study.

PURPOSE/AIM: Diabetes mellitus is associated with several comorbid conditions. Thus, often, diabetic patients are prescribed multiple drugs. Although multiple drugs help to combat various diseases, they also increase the propensity of drug interactions and adverse drug reactions. The present study thus tried to evaluate the comorbid conditions and concurrent medications associated with type 2 diabetic patients. It also aimed to address patient compliance for the medications provided to them. MATERIALS AND METHODS: This was a cross-sectional observational study conducted for 2 months - January-February 2017. Data were collected from prescriptions of the patients and also by interviewing the willing patients, attending the Diabetic Clinic of R. G. Kar Medical College, Kolkata, India. RESULTS: During the study period, 150 patients were interviewed and their prescriptions were studied. Out of 150 patients, 69 (46%) were males and 81 (54%) were females. The mean age of the study population was 51.5 (±0.78) years. The present study evaluated that 83.3% (125) of the study population suffered from at least one comorbid conditions, the most common being hyperlipidemia (70.7%) and hypertension (47.3%). The average number of drugs prescribed is 4.72 (±0.11) per prescription. Metformin was prescribed to 96% of the patients. The concurrent medications recommended included hypolipidemics (72%), antihypertensives (68%), drugs for peptic ulcer (34.7%), and antiplatelets (10.7%). CONCLUSION: The present study thus concluded that diabetic patients suffer from a number of comorbid conditions, most commonly, cardiovascular problems. The comorbidity increased with the age. The level of polypharmacy was also high, thereby increasing the pill burden for the patients.

Malignant non-functional paraganglioma of the bladder presenting with azotemia.

Paragangliomas of the urinary bladder are rare tumors representing less than 1% of bladder tumors and are usually benign. Malignant paragangliomas are uncommon and are defined by their clinical behavior rather than the histologic features. We describe a patient with recurrent nonfunctioning paraganglioma of bladder presenting with hematuria and obstructive uropathy due to involvement of ureteroileal anastomoses. Treatment consisted of excision of recurrent lesion involving both lower ureters with the revision of ureteroileal anastomoses. Histology confirmed the presence of nests of tumor cells with abundant eosinophilic cytoplasm. Immunohistochemically the tumor cells were strongly positive for chromogranin A.

Automated classification of Pap smear images to detect cervical dysplasia.

BACKGROUND AND OBJECTIVES: The present study proposes an intelligent system for automatic categorization of Pap smear images to detect cervical dysplasia, which has been an open problem ongoing for last five decades. METHODS: The classification technique is based on shape, texture and color features. It classifies the cervical dysplasia into two-level (normal and abnormal) and three-level (Negative for Intraepithelial Lesion or Malignancy, Low-grade Squamous Intraepithelial Lesion and High-grade Squamous Intraepithelial Lesion) classes reflecting the established Bethesda system of classification used for diagnosis of cancerous or precancerous lesion of cervix. The system is evaluated on two generated databases obtained from two diagnostic centers, one containing 1610 single cervical cells and the other 1320 complete smear level images. The main objective of this database generation is to categorize the images according to the Bethesda system of classification both of which require lots of training and expertise. The system is also trained and tested on the benchmark Herlev University database which is publicly available. In this contribution a new segmentation technique has also been proposed for extracting shape features. Ripplet Type I transform, Histogram first order statistics and Gray Level Co-occurrence Matrix have been used for color and texture features respectively. To improve classification results, ensemble method is used, which integrates the decision of three classifiers. Assessments are performed using 5 fold cross validation. RESULTS: Extended experiments reveal that the proposed system can successfully classify Pap smear images performing significantly better when compared with other existing methods. CONCLUSION: This type of automated cancer classifier will be of particular help in early detection of cancer.

Familial pigmented purpuric dermatoses.

Pigmented purpuric dermatoses (PPD) are chronic, asymptomatic dermatoses characterized by petechiae, pigmentation and rarely telangiectasias. Familial occurrence of PPD is very rare. We report four individuals in a family over three generations. The inheritance is suggestive of an autosomal dominant pattern.

Gap analysis between provisional diagnosis and final diagnosis in government and private teaching hospitals: A record-linked comparative study.

AIMS: 1. To identify the extent of clinical gaps at the context of knowledge, practice and systems. 2. To formulate necessary intervention measures towards bridging the gaps. SETTINGS AND DESIGN: Comparative, cross-sectional and non-interventional study. METHODS AND MATERIAL: It is retrospective, record-based study conducted upon inpatients (n = 200) of major disciplines of two teaching hospitals. Major outcome variables were to observe the matching and un-matching of final and provisional diagnosis by using ICD-10 criteria. STATISTICAL ANALYSIS USED: Comparative analysis of specific and selective gaps were estimated in terms of percentage (%). RESULTS: Pilot observation showed the existence of gaps between provisional and final diagnosis in both private and government institution. Both knowledge and skill gaps were evident in caregivers and gap in documentation was existent in medical records. CONCLUSIONS: The pilot data is may be an eye-opener to public and private governance systems for understanding and revising the process service planning and service delivery. Necessary intervention measures may be contemplated towards enhancing diagnostic skill of doctors for quality hospital care.

Antidiabetic and antioxidant activity of Rhizophora mucronata leaves (Indian sundarban mangrove): An in vitro and in vivo study.

BACKGROUND: Rhizophora mucronata is a salt-tolerant true mangrove which is widely distributed in Indian mangrove forest and traditionally used to treat diabetes and other health ailments. AIM: The aim of this study is to elucidate the role of Indian variety of R. mucronata leaves on glucose impairing metabolism during diabetes by in vitro and in vivo methods. MATERIALS AND METHODS: The ethanolic fraction of R. mucronata leaves extract (RHE) was assessed for DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging and in vitro anti-diabetic action through α-amylase and α-glucosidase activity assessment. Oral glucose tolerance test (OGTT) and insulin sensitivity test (IST) were assessed and their counteraction with RHE (100 and 200 mg/kg, p.o) and glibenclamide (10 mg/kg, p.o) in streptozotocin (STZ) (50 mg/kg, intravenous) induced hyperglycemic rats were also monitored for 28 days. The data were analyzed statistically using t-test. RESULTS: RHE dose-dependently inhibited α-amylase and α-glucosidase enzymes and lowered the area under the curve (AUC) for glucose on both OGTT and IST. RHE also significantly (p < 0.01) controlled glycemic index and thereby reducing diabetic complications as assessed by lipid profiles, atherogenic index, and coronary index in STZ rats. CONCLUSION: RHE at doses of 100 and 200 mg/kg/day for 28 days provided a significant decrease in diabetes complications and metabolic impairment.

Fine-needle aspiration cytology of glycogen-rich carcinoma of breast: report of a case and review of literature.

Glycogen-rich carcinoma (GRC) of the breast is a rare histological subtype of breast cancer having a poor prognosis. There are very few case reports describing the cytological features of GRC on fine-needle aspiration cytology (FNAC). In this report we present the case of a 34-yr-old woman who underwent FNAC of a clinically palpable breast lump. The aspirate was cellular showing tumor cells in groups, clusters and lying singly. The tumor cells had abundant eosinophilic, finely granular to vacuolated cytoplasm with moderate to marked nuclear pleomorphism. With a cytological diagnosis of carcinoma, a wide local excision was performed. On histology a diagnosis of GRC was made with the tumor cells showing abundant glycogen. The presence of cells with abundant granular to finely vacuolated cytoplasm in a case of breast carcinoma, should point toward the possibility of GRC and other clear cell tumors of the breast. Demonstration of glycogen is required to make a definite diagnosis on cytology.

A questionnaire-based survey to ascertain the views of clinicians regarding rational use of antibiotics in teaching hospitals of Kolkata.

OBJECTIVES: The objective was to assess the views of clinicians in teaching hospitals of Kolkata regarding the use of antibiotics in their own hospitals, focusing on perceived misuse, reasons behind such misuse and feasible remedial measures. MATERIALS AND METHODS: A total of 200 clinicians from core clinical disciplines was approached in six teaching hospitals of Kolkata through purposive sampling. A structured, validated questionnaire adopted from published studies and modified to suit the responding population was completed by consenting respondents through face-to-face interaction with a single interviewer. Respondents were free to leave out questions they did not wish to answer. RESULTS: Among 130 participating clinicians (65% of approached), all felt that antibiotic misuse occurs in various hospital settings; 72 (55.4% of the respondents) felt it was a frequent occurrence and needed major rectification. Cough and cold (78.5%), fever (65.4%), and diarrhea (62.3%) were perceived to be the commonest conditions of antibiotic misuse. About half (50.76%) felt that oral preparations were more misused compared to injectable or topical ones. Among oral antibiotics, co-amoxiclav (66.9%) and cefpodoxime (63.07%) whereas among parenteral ones, ceftriaxone and other third generation cephalosporins (74.6%) followed by piperacillin-tazobactam (61.5%) were selected as the most misused ones. Deficient training in rational use of medicines (70.7%) and absence of institutional antibiotic policy (67.7%) were listed as the two most important predisposing factors. Training of medical students and interns in rational antibiotic use (78.5%), implementation of antibiotic policy (76.9%), improvement in microbiology support (70.7%), and regular surveillance on this issue (64.6%) were cited as the principal remedial measures. CONCLUSIONS: Clinicians acknowledge that the misuse of antibiotics is an important problem in their hospitals. A system of clinical audit of antibiotic usage, improved microbiology support and implementation of antibiotic policy can help to promote rational use of antimicrobial agents.