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Background The present study was conducted to study the prevalence of HAIs in a newly established MICU, common microorganisms causing HAIs and their antibiotic-sensitivity profile, and antimicrobial utilization and mortality rate.Methods The present retrospective cohort study was carried out at AIIMS, Bhopal (2015–2019). The prevalence of HAIs was determined; sites of HAIs and common causative microorganisms were identified, and their antibiotic-sensitivity profiles were studied. The group of patients with HAIs was matched with a control group drawn from the pool of patients without HAIs; this matching was done with respect to age, gender, and clinical diagnosis. Antimicrobial utilization, Period of ICU stay, comorbidities and patient mortality rates in the two groups were analyzed. The clinical criteria by the CDC- National Nosocomial Infections Surveillance to diagnose HAIs.Results A total of 281 ICU patients’ records were analyzed. The mean age was 47.21 ± 19.07 years. Of these 89 were found to have developed ICU-acquired HAIs (Prevalance:32%). Bloodstream infections (33%) and respiratory tract infections (30.68%), catheter-associated urinary tract infections (25.56%), and surgical site infections (6.76%) were the commonest. The most frequently isolated microorganism causing HAIs was K. pneumonia (18%), A. baumannii (14%) and E. coli(12%), 31% isolates of which were multidrug resistant. The average length of ICU stay was high in patients with HAIs (13.85 vs 8.2 days). The most common co-morbidity was type 2 diabetes mellitus (42.86%). Prolonged ICU stays [OR 1.13, (95% CI; 0.04–0.10)] and the presence of HAIs [OR 1.18(95%CI; (0.03–0.15)] were associated with an increased risk of mortalityConclusions An increased prevalence of HAIs essentially bloodstream infections and respiratory infections with MDR organisms to antimicrobials in the watch group is highly considerable. Acquisition of HAIs with MDR organisms and increased length of hospital stay are considerable risk factors for increased mortality in ICU-admitted patients. Regular antimicrobial stewardship activities and revising existing hospital infection control policies accordingly may reduce HAIs.

Cutting emissions from the pharmaceutical industry is essential to curtailing the carbon footprint of healthcare globally. It is high time that the industry owned up to its carbon emission and took measures to curb back. In this study, we show how many of the leading global pharmaceutical firms have been able to reduce their carbon footprint while being profitable, indicating that modifications to reduce emissions would not pose a financial burden. We have come up with a ‘modified emission intensity’ index and a new term ‘carbovigilance’ in an attempt to bring this aspect of the pharmaceutical companies to light, while also encouraging them to work towards making positive contributions to a greener and healthier earth.

Evidence on comparative effectiveness and safety of prasugrel and ticagrelor post-percutaneous transluminal coronary angioplasty is scarce in Indian population. In a 1:1 propensity score-matched cohort with 71 individuals in each group, the incidence of a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or coronary revascularization was not significantly different in prasugrel and ticagrelor group (7.04% vs 9.86%; absolute difference, 2.8%; HR, 0.65; 95% CI, 0.21–2.1; p = 0.49). There was no significant difference in bleeding (5.63% vs 9.86%; absolute difference, −4.20%; 95% CI, −13.0%–4.5%) and dyspnea (7.04% vs 12.7%; absolute difference, −5.60%; 95% CI, −15.4%–4.1%).

Introduction: Remdesivir, an experimental antiviral drug has shown to inhibit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), both in vitroand in vivo. The present systematic review and meta-analysis were performed to quantify the safety and tolerability of remdesivir, based on safety outcome findings from randomized controlled trials, observational studies and case reports of remdesivir in coronavirus disease 2019 (COVID-19) patients.Methods: We have performed a systematic search in the PubMed, Google Scholar and Cochrane Library using specific keywords such as ‘COVID-19’ OR ‘SARS CoV-2’ AND ‘Remdesivir’. The study endpoints include total adverse events (AEs), serious adverse events (SAEs), grade 3 and grade 4 AEs, mortality and drug tolerability. Statistical analysis was carried out by using Revman 5.4 software.Results: Total 15 studies were included for systematic review, but only 5 randomized clinical trials (RCTs) (n= 13,622) were included for meta-analysis. Visual inspection of the forest plots for remdesivir 10-day versusplacebo and remdesivir 10-day versus5-day groups revealed that there is a significant difference in SAEs [10-day remdesivir versuscontrol (odds ratio [OR] = 0.55, 0.40–0.74) p= 0.0001; I2= 0%; 10-day remdesivir versus5-day remdesivir (OR = 0.56, 0.38–0.84) p= 0.005; I2= 13%]. In grade 4 AEs, there is a significant difference in 10-day remdesivir versuscontrol (OR = 0.32, 0.19–0.54) p= 0.0001; I2= 0%, but not in comparison to 5-day remdesivir (OR = 0.95, 0.59–1.54) p= 0.85; I2= 0%. But there is no significant difference in grade 3 AEs [remdesivir 10 day versuscontrol (OR = 0.81, 0.59–1.11) p= 0.19; I2= 0%; 10-day remdesivir versus5-day remdesivir (OR = 1.24, 0.86–1.80) p= 0.25; I2= 0%], in total AEs [remdesivir 10 day versuscontrol (OR = 1.07, 0.66–1.75) p= 0.77; I2= 79%; remdesivir 10 day versus5 day (OR = 1.08, 0.70–1.68) p= 0.73; I2= 54%)], in mortality [10-day remdesivir versuscontrol (OR = 0.93, 0.80–1.08) p= 0.32; I2= 0%; 10-day remdesivir versus5-day remdesivir (OR = 1.39, 0.73–2.62) p= 0.32; I2= 0%)] and tolerability [remdesivir 10 day versuscontrol (OR = 1.05, 0.51–2.18) p= 0.89; I2= 65%, 10-day remdesivir versus5-day remdesivir (OR = 0.86, 0.18–4.01) p= 0.85; I2= 78%].Discussion & Conclusion: Ten-day remdesivir was a safe antiviral agent but not tolerable over control in the hospitalized COVID-19 patients with a need of administration cautiousness for grade 3 AEs. There was no added benefit of 10- or 5-day remdesivir in reducing mortality over placebo. To avoid SAEs, we suggest for prior monitoring of liver function tests (LFT), renal function tests (RFT), complete blood count (CBC) and serum electrolytes for those with preexisting hepatic and renal impairments and patients receiving concomitant hepatotoxic or nephrotoxic drugs. Furthermore, a number of RCTs of remdesivir in COVID-19 patients are suggested.Plain Language Summary

Background. Ticagrelor has been accepted as a class I antiplatelet agent in patients undergoing percutaneous coronary angioplasty (PTCA). There have been cases reported on ticagrelor being associated with various cardiac conduction defects. But there is no evidence of QTc prolongation associated with the drug as of yet. Case Presentation. A 64-year-old male who underwent PTCA was given ticagrelor. A baseline electrocardiogram (ECG) showed a QTc of 402 ms. He returned after 1.5 months with complaints of shortness of breath. An ECG revealed a prolonged QTc of 468 ms. Ticagrelor was discontinued in view of ticagrelor-induced dyspnea and the patient was started on clopidogrel. The other medications were kept unchanged. The patient returned after a month without any complaints. A follow-up ECG showed a reduced QTc of 425 ms. Conclusion. We present a case of ticagrelor-induced QTc prolongation. To our knowledge, this is the first case to be reported on the same. The Naranjo algorithm for causality assessment gave a total score of 6 indicating that the adverse drug reaction falls under the probable category.