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Objective: To study whether introduction of an antimicrobial justification form deters clinicians from prescribing restricted antimicrobials and results in de-escalation of these antimicrobials., Methods: Clinicians were asked to fill a justification form if prescribing an antimicrobial from the pre-identified restricted group. Antimicrobial usage pattern over next year was compared with that in the one year preceding the introduction of justification form., Results: Significant overall decrease in antimicrobial usage (40.5% vs 34.6%) was noted in the post-intervention group along with a significant increase in the de-escalation of antibiotics., Conclusion: Introduction of a justification form before prescribing antimicrobials or at the time of deferring de-escalation can be useful in restricting usage of antimicrobials.

Development of a multifunctional drug delivering system without side effects and compromising its therapeutic efficacy is a major concern in anticancer research. Recently, we have developed and demonstrated doxorubicin conjugated gold nanorod (DOX@PSS-GNR) as a sustained drug delivery vehicle. Here, we investigate the biodistribution, antitumor and photothermal efficacy of DOX@PSS-GNR along with its potential impact on cardiotoxicity in in vivo. The studies revealed that the accumulation of Free DOX in myocardium was 4-fold reduced in DOX@PSS-GNR animals, which further minimizes its cardiotoxicity by decreasing cardiac injury via preservation of cardiac markers. Further, DOX@PSS-GNR exhibits effective antitumor efficacy against Dalton lymphoma ascites (DLA) as evidenced by cell cycle analysis, apoptotic signals and reduced tumor volume and weight. In addition, DOX@PSS-GNR exhibits higher photothermal response and dominates DLA growth upon 0.1 W/cm(2) laser irradiation. In conclusion, multifunctional DOX@PSS-GNR with improved therapeutic index and reduced cardiotoxicity represents a promising candidate for cancer treatment., From the Clinical Editor: Doxorubicin is a widely used agent for cancer therapy. However, the side effects are still significant, despite the development of liposomal formulation. In this study, the authors investigated the use of doxorubicin conjugated gold nanorods (DOX@PSS-GNR) in terms of biodistribution, antitumor activity and systemic side effects. The much reduced cardiotoxicity of the new delivery system should provide an improved agent for future clinical use., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To observe the safety and efficacy of Colistimethate sodium in children infected with gram-negative bacteria, susceptible only to colistimethate sodium., Methods: This prospective observational study done over 2 years observed children who received colistin for >48 h, for renal failure as defined by p-RIFLE criteria., Results: Out of 68 children, 52 (76.5%) survived. There were three children with evidence of acute kidney injury and none had neurotoxicity. Serum creatinine significantly decreased at 48 h and at end of treatment, from that at beginning of therapy (P=0.007)., Conclusions: Colistimethate sodium is effective against carbapenem-resistant Gram-negative bacteria, and is safe in children.

'The Big four' are the most poisonous snakes in India, and especially in Kerala. These include the cobra, the viper, the krait and the sea snake. Most of the poisonous snakebites in India occur in Kerala. We believe there are only a few reports of myocardial infarction after snakebites and most of these are viper bites. We believe this is the second case of primary angioplasty for a snakebite. There are at least a few potential issues in performing a primary angioplasty in a snakebite case, namely (1) Is it a thrombus or a spasm? (2) Are the bleeding parameters deranged? Will the patient tolerate tirofiban and other glycoprotein (GB) 2b3a inhibitors? Will he develop dangerous bleeding due to the high dose of heparin needed? Further, would we save the patient from myocardial infarction only to lose him to renal failure, both due to the nephrotoxicity of the venom, the kidney being further damaged by the contrast media used for the angioplasty? We discuss all these issues as they crossed our mind, and hope it will help further treatment in others. We would like to review the available literature on these points and describe a recent case of ours., (2014 BMJ Publishing Group Ltd.)

Background: Surfactant protein abnormalities are rare causes of respiratory distress syndrome., Case Characteristics: A late preterm (36 wks) who presented with respiratory distress syndrome., Observation: He was found to be a homozygous for a G to T transversion at the first base in intron 24, of ABCA3 gene which is necessary for lamellar body formation and surfactant production., Outcome: He died of severe respiratory failure even after multiple doses of surfactants and ventilation., Message: Surfactant deficiency with ABCA3 gene mutation needs to be suspected in late preterms who present with respiratory distress syndrome.

Theranostic nanoparticles with multifunctional ability have been emerging as a new platform for biomedical applications such as imaging, sensing and drug delivery. Despite gold nanorods (Au NRs) being an excellent nanosource with multifunctional versatility, they have certain limitations in biomedical applications, which include surfactant toxicity, biological stability and controlled drug release kinetics. Herein, we have developed Au NR-doxorubicin conjugates (DOX@PSS-Au NR) with improved drug loading efficiency (55 ± 6%) and minimum CTAB toxicity, by employing Au NRs (4.4 ± 0.5 aspect ratio) coated with poly(sodium 4-styrenesulfonate) (PSS). DOX@PSS-Au NR conjugates exhibited higher biological stability with sustained drug release kinetics at pH 5. The binding events of DOX molecules onto the PSS coated gold nanorods (PSS-Au NRs) were monitored through fluorescence quenching and the longitudinal surface plasmon resonance signals. Furthermore the anti-cancer potential and apoptosis inducing efficiency of DOX@PSS-Au NR conjugates in MCF-7 cells revealed higher therapeutic efficiency than free DOX, as corroborated through morphological assessment and in vitro cytotoxicity assay. In addition, DOX@PSS-Au NR conjugates showed efficient cellular entry and uniform intracellular distribution, suggesting the augmenting effect of chemotherapeutic drugs by Au NRs. Thus DOX@PSS-Au NR conjugates demonstrate significant therapeutic potential, suggesting their potential in anticancer therapy.

The aim was to study the efficacy of rescue High Frequency Oscillatory Ventilation (HFOV) in improving the oxygenation and ventilation in neonates with acute respiratory failure after failing Conventional Mechanical Ventilation (CMV). Primary outcome was short term oxygenation, lung recruitment, and ventilation and secondary outcome studied was survival. 675 babies were ventilated and 97 of them received HFOV. HFOV significantly improved oxygenation index, alveolar-arterial oxygen gradient, pH, PCO2, PO2 and caused better lung recruitment within 2 hours. Fifty seven babies (58.77%) survived and the mortality was more in <28 weeks, babies with pulmonary hemorrhage, sepsis and CDH.

Objectives: To study the natural history of medically treated patients with endomyocardial fibrosis (EMF) and to see whether the usage of common drugs affected survival., Design: A real-world all-comers analysis with follow-up., Setting: A teaching hospital., Analysis: Cox proportional hazards multiple regression and Kaplan-Meier curves for survival with both univariate and multivariate analysis., Results: The mean age of this population was 40.5±5 years at first symptom. The mortality was also less than previous reports at 10.38%. The dominant type of EMF was dominant left ventricular EMF in 49, right ventricular EMF in 52 and biventricular EMF in 53. On univariate analysis by Kaplan-Meier curves and log-rank test patients on warfarin had a better survival (at 5, 10 and 15 years-97.3, 87.54% and 87.54%, respectively) compared with no warfarin at 5, 10 and 15 years (91.37%, 88.9% and 66.68%), log rank test NS. On multivariate analysis when sex, the presence of complications, use of ACE inhibitors, use of aldactone, use of digoxin, frusemide and warfarin and age (age at entering the study) were entered into the analysis, the following results were obtained-men had a shorter time to death. Furthermore, when patients taking aldactone and those not taking aldactone were examined it was found that those on aldactone had a higher mortality and shorter time to death., Conclusion: On analysis of the usage of warfarin, those not on it had a shorter time to death; likewise did older patients.