Urological complications of inguinal hernia surgery

BACKGROUND AND AIMS

A systematic review of the literature is presented with regard to urological complications resulting from inguinal hernia surgery. Considering the amount of inguinal hernia operations performed, the resulting complications, which may be urological in presentation, have potential late irreversible and medico-legal implications.

METHODS AND RESULTS

A Pubmed search of 'urological' 'complications' and 'inguinal hernia surgery' was carried out and clinical practice was also taken into consideration.

DISCUSSION

Approximately 75% of hernias occur in the groin; two-third of these are indirect and about one-third direct. Most of these repairs are carried out by the general surgeons and any complication, including urological, are often initially managed by the operating general surgeon. Often a urological opinion is sought late for conditions which may be reversible. We present potential urological complications, their presenting features and management.

CONCLUSION

Recognition, timely referral and appropriate treatment of urological complications after hernia surgery are necessary to avoid potential consequences and long-term morbidity.

Chromium (VI) induced acute toxicity and genotoxicity in freshwater stinging catfish, Heteropneustes fossilis

Acute toxicity and genotoxicity of Chromium(VI) as K2Cr2O7 were evaluated in freshwater stinging catfish, Heteropneustes fossilis. Fish showed behavioral alterations after K2Cr2O7 exposure and 96h-LC50 was 35.724mg/L in semi-static bioassay. Fish were exposed to three sub-lethal concentrations (concentration I=1/4th of 96h-LC50, concentration II=1/10th of 96h-LC50 and concentration III=environmental concentration of Cr reported in the river Buriganga). Blood, liver and gill samples were collected after 48h, 96h and 192h. Micronucleus (MN) assay was conducted in blood erythrocytes and DNA damage was evaluated by comet assay in whole blood, gill and liver tissues. Cr(VI) significantly (p<0.05) induced MN frequency and tail DNA (percent) which increased in a concentration depended manner in all types of tissues. Frequency of MN and tail DNA (percent) increased after 48 and 96h of exposure which decreased after 192h of exposure. The liver was the most sensitive to chromium (VI) exposure among the tissues with highest tail DNA (33.70±0.68 percent) at 9.0mg/L after 96h. This study found MN and comet assays in combination as an adequate approach for ecotoxicological monitoring and Cr(VI) as potential genotoxic agent.

Botulinum toxin-A for the treatment of overactive bladder: UK contributions

Background:

Botulinum toxin-A (BoNT/A) is now established second-line management for refractory overactive bladder (OAB) and recognised in many incontinence guidelines and pathways. For those with neurogenic detrusor overactivity secondary to spinal cord injury or multiple sclerosis, the toxin is currently licensed in certain parts of the world, including the UK. It is an effective treatment in those in whom antimuscarinics and conservative measures have failed who have symptoms of OAB and or detrusor overactivity (DO).

Methods:

Treatment can be given in an outpatient setting and can be administered under local anaesthesia. Its efficacy lasts for between six and 12 months.

Results:

It has an acceptable safety profile with the biggest risk being urinary tract infection and difficulty emptying the bladder, necessitating clean intermittent self-catheterisation (CISC). Medium-term follow-up suggests repeated injections are also safe and efficacious.

Conclusions:

The mechanism of action of the toxin is more complicated than originally thought, and it seems likely that it affects motor and sensory nerves of the bladder. In the last 10 years much of the progress of this treatment from early experimental trials to mainstream clinical use, and a better understanding of how it works in the bladder, are as a result of research conducted in the UK. This review summarises the significant and substantial evidence for BoNT/A to treat refractory OAB from UK centres.

Novel methodology to assess sputum smear microscopy quality in private laboratories

Background

In South Asia, it is estimated that 80% of patients choose to attend a private facility for their healthcare needs. Although patients generally believe that the private-sector provides high quality services, private diagnostic laboratories are largely unregulated and little is known about the accuracy of results provided. This study assesses the accuracy of sputum smear microscopy for pulmonary tuberculosis diagnosis in private laboratories operating in Karachi, Pakistan. A novel evaluation methodology was designed in which patient-actors submitted sputum specimens spiked with cultured Mycobacterium tuberculosis (Mtb) for testing such that laboratories were not aware that they were being assessed.

Methods

Smear-negative sputum specimens from Indus Hospital TB Program patients were collected and combined with an attenuated, cultured Mtb strain to create Mtb-spiked samples; for negative standards, no Mtb was added to the smear-negative sputum specimens. Seven of the largest private laboratories across Karachi were chosen for evaluation and were sent six Mtb-spiked and one Mtb-negative sputum specimens. Patient-actors pretending to be laboratory customers submitted these specimens to each laboratory for testing over a three day period.

Results

Only three laboratories accurately classified all the Mtb-spiked specimens which were submitted. A further three misclassified all the Mtb-spiked specimens as smear-negative, thus providing the ‘patients’ with false negative results.

Conclusions

TB sputum smear microscopy services are highly variable across private laboratories and are often of extremely poor quality. Engagement, capacity building and rigorous monitoring of standards at private laboratories are of vital importance for the control of TB. Our findings, while specific for TB diagnostic tests, could be symptomatic of other tests performed in private laboratories and warrant further investigation.

Size-dependent antimicrobial properties of CuO nanoparticles against Gram-positive and -negative bacterial strains

Background

CuO is one of the most important transition metal oxides due to its captivating properties. It is used in various technological applications such as high critical temperature superconductors, gas sensors, in photoconductive applications, and so on. Recently, it has been used as an antimicrobial agent against various bacterial species. Here we synthesized different sized CuO nanoparticles and explored the size-dependent antibacterial activity of each CuO nanoparticles preparation.

Methods

CuO nanoparticles were synthesized using a gel combustion method. In this approach, cupric nitrate trihydrate and citric acid were dissolved in distilled water with a molar ratio of 1:1. The resulting solution was stirred at 100°C, until gel was formed. The gel was allowed to burn at 200°C to obtain amorphous powder, which was further annealed at different temperatures to obtain different size CuO nanoparticles. We then tested the antibacterial properties using well diffusion, minimum inhibitory concentration, and minimum bactericidal concentration methods.

Results

XRD spectra confirmed the formation of single phase CuO nanoparticles. Crystallite size was found to increase with an increase in annealing temperature due to atomic diffusion. A minimum crystallite size of 20 nm was observed in the case of CuO nanoparticles annealed at 400°C. Transmission electron microscopy results corroborate well with XRD results. All CuO nanoparticles exhibited inhibitory effects against both Gram-positive and -negative bacteria. The size of the particles was correlated with its antibacterial activity.

Conclusion

The antibacterial activity of CuO nanoparticles was found to be size-dependent. In addition, the highly stable minimum-sized monodispersed copper oxide nanoparticles synthesized during this study demonstrated a significant increase in antibacterial activities against both Gram-positive and -negative bacterial strains.

A dual-centre, cohort comparison of open, laparoscopic and robotic-assisted radical cystectomy

INTRODUCTION

The role of minimally invasive radical cystectomy as opposed to open surgery for bladder cancer is not yet established. We present comparative outcomes of open, laparoscopic and robotic-assisted radical cystectomy

MATERIAL AND METHODS

Prospective cohort comparison of 158 patients from 2003-2008 undergoing open radical cystectomy (ORC) (n = 52), laparoscopic radical cystectomy (LRC) (n =58) or robotic-assisted radical cystectomy (RARC) (n = 48) performed by a team of three surgeons at two hospitals. Peri-operative data, complication rates, length of hospital stay, oncological outcome (including lymph node status) and survival were recorded. Statistical analyses were adjusted to account for potential confounding factors such as ASA grade, gender, age, diversion type and final histology.

RESULTS

RARC took longer than LRC and ORC. Patients were about 30 times more likely to have a transfusion if they had ORC than if they had RARC (p < 0.0001) and about eight times more likely to have a transfusion if they had LRC compared with RARC (p < 0.006). Patients were four times more likely to have a transfusion if they had ORC as compared with LRC (p < 0.007). Patients were four times more likely to have complications if they had ORC than RARC (p = 0.006) and about three times more likely to have complications with LRC than with RARC (p = 0.02). Hospital stay was mean 19 days after ORC, 16 days after LRC and 10 days after RARC.

CONCLUSIONS

Despite study limitations, RARC had the lowest transfusion and complication rates and the shortest length of stay, although taking the longest to perform.

Factors influencing sex differences in numbers of tuberculosis suspects at diagnostic centres in Pakistan

SETTING

DOTS-reporting tuberculosis (TB) diagnostic centres across Pakistan.

OBJECTIVES

To quantitatively investigate the influence of diagnostic centre characteristics on the number of female and male TB suspects registered at diagnostic centres.

DESIGN

Ten districts were selected across the four provinces of Pakistan. Data were collected on male and female TB suspects in all diagnostic centres within each district. A structured questionnaire was used to collect data on characteristics of the diagnostic centres. Multiple linear regression analysis was conducted to evaluate the influence of each characteristic on sex differences in the numbers of suspects.

RESULTS

Two diagnostic centre characteristics were associated with higher numbers of female than male TB suspects: catering to the local catchment area (P = 0.001) and being accessible on foot (P = 0.002). The following characteristics were associated with higher numbers of male than female TB suspects: being open after 2 pm (P = 0.041), having more than five doctors working at the centre (P = 0.019), and having more than 100 suspects registered per quarter (P = 0.008).

CONCLUSIONS

Smaller, local diagnostic centres that are accessible on foot registered more female than male TB suspects. More centralised facilities located further from homes, larger facilities and those with evening opening hours registered more male than female suspects.

Mesenteric vein thrombosis treated successfully with ultrasound augmented thrombolysis

Mesenteric vein thrombosis is a potentially fatal condition that is associated with better outcomes with early diagnosis and intervention. A 32-year-old-man with Down syndrome presented with abdominal pain and was found to have extensive porto-splenomesenteric thrombosis with early bowel ischemia on computed tomography. He was treated successfully with ultrasound augmented thrombolysis. Ultrasound can improve efficiency of thrombolysis, decreasing the time required for thrombolysis by half, decrease thrombolytic dose and monitoring time and thus reduce overall costs and complications seen with long thrombolysis times.

Prevalence of Neospora caninum antibodies in sheep and goats in Pakistan

The purpose of the present study was to obtain seroepidemiological information on the Neospora caninum infection status of sheep and goats in different areas of Punjab Province and Azad Kashmir (Pakistan). A cross-sectional study, with the use of a competitive ELISA, showed an overall 27.7% (35 of 128) (95% confidence interval [CI] ± 7.7%) and 8.6% (13 of 142) (95% CI ± 4.6%) seroprevalence of N. caninum antibodies in sheep and goats, respectively. The difference in seroprevalence between sheep and goat populations was statistically significant (P < 0.05). The highest prevalence (37.4% ± 13.2%) was recorded in the tailless breed of sheep.

An in vivo and in silico approach to elucidate the tocotrienol-mediated fortification against infection and inflammation induced alterations in antioxidant defense system

BACKGROUND

Tocotrienol (Tocomin) are naturally occurring analogues of vitamin E family and has been reported to possess a potent free radical scavenging activity. In the present study we have initially investigated protective role of tocotrienol against infection and inflammation induced alterations in tissues antioxidant defense system, as well as speculated, via in silico docking studies, that tocotrienol can act by directly binding to antioxidant enzymes.

MATERIALS AND METHODS

Syrian hamsters were injected with bacterial lipopolysaccharide (LPS, 200 microg), zymosan (20 mg), or turpentine (0.5 ml) to mimic acute infection, acute systemic inflammation, and acute localized inflammation, respectively, which are responsible for the generation of plenty of free radicals that causes oxidative stress. Tocomin (10 mg) was administered daily for 10 days before and 12 h after lipopolysaccharides (LPS) or 24 h after turpentine or zymosan injection. Molecular docking studies were performed using Autodock 4.0.

RESULTS

Our results show a significant decrease in the activities of antiperoxidative enzymes, glutathione reductase (GR), glutathione peroxidase (GPx), catalase (CAT), superoxide dismutase (SOD), glutathione-s-transferase (GST), as well as reduced glutathione (GSH), in liver and kidney of LPS, turpentine or zymosan stressed hamsters. Feeding of 10 mg Tocomin to stressed hamsters was quite effective in reversing/normalizing the altered levels of enzymatic and nonenzymatic antioxidants in liver and kidney. In order to explore the interaction between tocotrienol and antioxidant enzymes a molecular docking study was performed. The results showed good interaction in term of binding energy and inhibition constant in the following order GR > CAT > SOD > GST > GPx.

CONCLUSION

Our in vivo and in silico results for the first time indicate that tocotrienol significantly alleviate the condition of oxidative stress not only by its potent free radical scavenging properties but also may be by interacting directly and strongly with antioxidant enzymes as proved by molecular docking simulations.

Development and Evaluation of pH-Dependent Micro Beads for Colon Targeting

The purpose of this research was to develop and evaluate multiparticulates of alginate and chitosan hydrogel beads exploiting pH sensitive property for colon-targeted delivery of theophylline. Alginate and chitosan beads were prepared by ionotropic gelation method followed by enteric coating with Eudragit S100. All formulations were evaluated for particle size, encapsulation efficiency, swellability and in vitro drug release.In vitro dissolution studies performed following pH progression method demonstrated that the drug release from coated beads depends on coat weights applied and pH of dissolution media. Mechanism of drug release was found to be swelling and erosion-dependent. The studies showed that formulated alginate and chitosan beads can be used effectively for the delivery of drug to colon and a coat weight of 20% weight gain was sufficient to impart an excellent gastro resistant property to the beads for effective release of drug at higher pH values.

Health-seeking behaviour of women selling sex in Lahore, Pakistan

The aim of this study was to describe the knowledge and health-seeking behaviour related to sexually transmitted infections (STIs) and abortion among women selling sex in Lahore, Pakistan. This was a cross-sectional, community-based, quantitative study. A total of 730 women selling sex were recruited by respondent-driven sampling. A pretested structured questionnaire was administered through face-to-face interviews. The median age of the participants was 30 years. Thirteen percent of the participants said it was common for them to have an abnormal vaginal discharge. Seventy-five percent of the participants recognized STIs as either leucorrhoea or AIDS. Sixty-five percent of the participants complained of having suffered from STI(s) in the six months preceding the survey, of whom 28% sought treatment. Women selling sex who reported consistent condom use were 1.5 times (95% confidence interval [CI]: 1.1–2.2) more likely to seek treatment than women who did not report consistent condom use. The level of knowledge about STIs remains low among women selling sex in Lahore, Pakistan, and health-seeking behaviour for the management of STIs and abortions is influenced by ability to pay and ease of access in the private sector.

Long-term results of treatment of malignant carcinoid syndrome with prolonged release Lanreotide (Somatuline Autogel)

BACKGROUND

Somatostatin analogues are the mainstay of therapy for malignant carcinoid syndrome. There is clear evidence that the once monthly intramuscular formulation, Octreotide LAR, controls symptoms of carcinoid syndrome, and recent data also suggests an antitumour effect. There is limited data on prolonged release Lanreotide (Somatuline Autogel, Ipsen Pharma Biotech, Signes, France) and no long-term data to date.

AIM

To present long-term results of prolonged release Lanreotide in a large cohort of patients with malignant carcinoid syndrome, assessing clinical and objective response and tolerance.

METHODS

Seventy six patients with metastatic midgut neuroendocrine tumours and carcinoid syndrome were included in this 9-year retrospective study. Clinical response was based on symptom score with radiological assessment based on RECIST (Response Evaluation Criteria In Solid Tumours).

RESULTS

Data were available in 69 patients. Ninety four percent achieved symptomatic response at first follow-up visit. Forty six percent had loss of symptomatic response, but 44% of these achieved control with an increase in dose of prolonged release Lanreotide. Overall, symptoms were well controlled throughout the study period with prolonged release Lanreotide alone in 74% of patients. Twenty six percent required additional treatment despite good initial response. Only 30% demonstrated radiological progression. Eleven patients who were switched from Octreotide LAR had return of symptomatic control. No significant adverse effects were experienced.

CONCLUSIONS

Prolonged release Lanreotide provides good symptomatic control of diarrhoea and flushing as well as tumour stability in patients with malignant carcinoid syndrome.

The safety and efficacy of botulinum toxin-A in the management of bladder oversensitivity: a randomised double-blind placebo-controlled trial

OBJECTIVE

To assess the safety and efficacy of botulinum toxin-A (botn-A) in the management of patients with bladder oversensitivity (BO).

PATIENTS AND METHODS

Twenty-three consecutive patients with a diagnosis of BO refractory to anticholinergics were enrolled in this randomised, double blind, placebo-controlled trial. Patients were randomly allocated to receive intradetrusor injections of either botn-A (100 U Botox) or saline (placebo) via a flexible cystoscopic approach. The study was designed to have 90% power to detect a change in the maximum cystometric capacity (MCC) of 30%. It was calculated that a total cohort of 58 patients would be required. Urodynamic assessment (UDS), voiding diaries (VD) and quality of life (QoL) were assessed at baseline and at 4 and 12 weeks following intervention.

RESULTS

An interim analysis was performed and the trial halted after recruitment of 23 patients as a result of poorly perceived patient benefit. Data were analysed for 21 patients (10 botn-A; 11 placebo). In the treatment arm, there was a significant increase in MCC (mean rise 105 ml; p = 0.009). However, storage symptoms remained statistically unchanged following botn-A. Three patients in the treatment arm were required to perform clean intermittent self-catheterisation with no clinical improvement. The limitations of this trial include the small sample size and the unplanned interim analysis.

CONCLUSIONS

This is the first randomised, double blind, placebo-controlled trial examining the effects of botn-A exclusively in patients with BO. A significant increase in MCC was observed but this did not translate to clinical benefit with no change observed in the symptoms and quality of life for the majority of patients.

[Effect of curcumin on nitric oxide induced structural and functional modifications of high molecular weight cystatin from the goat brain]

Cystatins are thiol proteinase inhibitors ubiquitously present in the mammalian body. In brain, they prevent unwanted proteolysis and are involved in several neurodegenerative diseases. Under physiological conditions nitric oxide can be found in almost all the tissues, but under pathological conditions NO has damaging effects. Its increased concentration, under various neural diseases leads to cell damage through formation of highly reactive peroxynitrite. Our present study was designed to investigate the protective effect of curcumin against NO induced damage of HM-GBC. NO caused intensive structural and functional damage of HM-GBC, resulting in 89% loss of its antiproteolytic activity after 2 h of incubation. Structural damage occurs in the form of protein degradation. Curcumin significantly protected HM-GBC against this damage. This suggests that curcumin has a significant potential in the treatment of diseases caused by nitrogen free radicals and this potential must be further explored for the development of novel drugs.

Millennium development goals and the water target: details, definitions and debate

One of the primary targets of MDG 7, dealing with issues of environmental sustainability, is to halve by 2015 (from 1990 levels) the proportion of the population without sustainable access to safe drinking water and basic sanitation. It is undoubtedly difficult to summarise a complex target such as access to water or safety of water source in a single quantifiable indicator. However, in our opinion, the indicators used to estimate how much of the population has 'access' to 'safe' drinking water leave out some important elements that should be taken into account when determining whether the goals have been met. In addition, the authors propose a modification to Bradley's classification of water-related illness to include a category for waterborne diseases of a non-infectious aetiology.

Management of open tibial fractures - a regional experience

INTRODUCTION

The treatment of soft-tissue injuries associated with tibial diaphyseal fractures presents a clinical challenge that is best managed by a combined plastic and orthopaedic surgery approach. The current study was undertaken to assess early treatment outcomes and burden of service provision across five regional plastic surgery units in the South-West of England.

SUBJECTS AND METHODS

We conducted a prospective 6-month audit of open tibial diaphyseal fracture management in five plastic surgery units (Bristol, Exeter, Plymouth, Salisbury, Swansea) with a collective catchment of 9.2 million people. Detailed data were collected on patient demographics, injury pattern, surgical management and outcome followed to discharge.

RESULTS

The study group consisted of 55 patients (40 male, 15 female). Twenty-two patients presented directly to the emergency department at the specialist hospital (primary group), 33 patients were initially managed at a local hospital (tertiary group). The mean time from injury to soft tissue cover was significantly less (P < 0.001) in the primary group (3.6 ± 0.8 days) than the tertiary group (10.8 ± 2.2 days), principally due to a delay in referral in the latter group (5.4 ± 1.7 days). Cover was achieved with 39 flaps (19 free, 20 local), eight split skin grafts. Nine wounds closed directly or by secondary intention. There were 11 early complications (20%) including one flap failure and four infections. The overall mean length of stay was 17.5 ± 2.8 days.

CONCLUSIONS

Multidisciplinary management of severe open tibial diaphyseal may not be feasible at presentation of injury depending on local hospital specialist services available. Our results highlight the need for robust assessment, triage and senior orthopaedic review in the early post-injury phase. However, broader improvements in the management of lower limb trauma will additionally require further development of combined specialist trauma centres.

Adsorption of fluoride from water by surface-functionalized polyurethane foam

Surface-functionalized polyurethane foam (SPUF) showed an exceptionally high adsorption potential for defluoridation of drinking water. Kinetic experiments of fluoride adsorption on SPUF demonstrated quick adsorption in first 60 min and then achieved maximum adsorption (7.8 mg g⁻¹). The adsorption isotherm was described using Bradley equation. The adsorption capacity of SPUF was significantly influenced by the pH of the solution. The highest adsorption capacity was attained at pH 6.7 and no drastic reduction noticed in the adsorption capacity of SPUF at normal pH range (5.8-8.2). The fluoride adsorption capacity of SPUF was compared with other adsorbents like activated carbon, soil, alumina and carbon nanotubes. The added advantage of SPUF adsorbent is, it can be easily recharged by altering the pH of the solution using NaOH or Ca(OH)₂. The high adsorption capacity and easy-to-use nature of SPUF in batch mode and continuous system makes the new adsorbent a promising material for defluoridation of drinking water.

Robotic radical cystectomy for bladder cancer

This article will focus on the evolution of robotic-assisted radical cystectomy (RARC) as the treatment for muscle invasive or uncontrolled superficial bladder cancer. Authors describe the current implementation of technology in their patients. The results of published case series and comparative studies on RARC available to date are also reviewed, to identify the surgical, pathological, oncological and quality of life outcomes of RARC.

Management of gastroentero-pancreatic neuroendocrine tumors (GEP-NETs)

Neuroendocrine tumors (NETs) are relatively rare neoplasms that often present as diagnostic dilemmas due to obscure or non-specific symptoms. The ability of carcinoid tumors to cause clinical symptoms by secretion of hormones or biogenic amines is best recognised in the form of the carcinoid syndrome. Although generally slow growing, a significant minority demonstrate aggressive tumor growth. Ten-twenty percent of pancreatic NETs may be associated with hereditary disorders such as multiple endocrine neoplasia-1 (MEN-1) and less frequently, Von Hippel Lindau, which should be considered in the investigation and management of these patients. A small percentage of NETs are associated with co-existing synchronous non-carcinoid neoplasm. The aim of this paper was to review the optimal management in patients with NETs. The therapeutic options which are reviewed, including the use of somatostatin analogues, the role of surgery, the use of chemotherapy, biotherapy using interferon, peptide receptor targeted therapy. In addition, the challenging interventional management of liver metastases is discussed, including the role of hepatic-artery embolization, radiofrequency ablation and the place of orthotoptic liver transplantation in selected patients. Authors have focused on the newest therapeutic modalities, e.g., radionuclide peptide receptor targeted therapy with Yttrium-90 and Lutetium-177, the newest somatostatin analogues such as pasireotide and angiogenic inhibitors. In conclusion, with the increasing number of investigative procedures and therapeutic options available to diagnose and treat carcinoid tumors, it is vital to have a multidisciplinary approach. Furthermore, additional scientific research and controlled clinical trials are needed to determine the efficacy of the many treatment options, which for these rare tumors can only be achieved by collaboration.

Default during TB diagnosis: quantifying the problem

OBJECTIVES

To quantify default during diagnosis in TB suspects and in smear-positive cases; to investigate sex differences in default during diagnosis, in all of Pakistan.

METHODS

Data from laboratory registers were collected on 12 216 suspects in nine districts over the period July-September 2008.

RESULTS

A total of 1573 TB suspects (12.9%, 95% CI = 12.3-13.5) dropped out of the diagnostic process after initial sputum submission. A total of 2058 smear-positive cases were detected, and of these 107 (5.2%, 95% CI = 4.2-6.2) defaulted during diagnosis and therefore could not be started on treatment. Male suspects defaulted slightly more frequently than female suspects (P = 0.0268).

CONCLUSION

Default during diagnosis is a frequent occurrence in Pakistan that should be monitored and addressed by TB control programs.

Plant growth promotion by phosphate solubilizing bacteria

Most agronomic soils contain large reserves of total phosphorus [P], but the fixation and precipitation of P cause P deficiency, and in turn, restrict the growth of crops severely. Phosphorus replenishment, especially in sustainable production systems, remains a major challenge as it is mainly fertilizer-dependent. Though the use of chemical P fertilizers is obviously the best means to circumvent P deficiency in different agro-ecosystems, their use is always limited due to its spiralling cost. A greater interest has, therefore, been generated to find an alternative yet inexpensive technology that could provide sufficient P to plants while reducing the dependence on expensive chemical P fertilizers. Among the heterogeneous and naturally abundant microbes inhabiting the rhizosphere, the phosphate solubilizing microorganisms (PSM) including bacteria have provided an alternative biotechnological solution in sustainable agriculture to meet the P demands of plants. These organisms in addition to providing P to plants also facilitate plant growth by other mechanisms. Despite their different ecological niches and multiple functional properties, P-solubilizing bacteria have yet to fulfil their promise as commercial bio-inoculants. Current developments in our understanding of the functional diversity, rhizosphere colonizing ability, mode of actions and judicious application are likely to facilitate their use as reliable components in the management of sustainable agricultural systems.