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Purpose: Emergency delirium (ED), a common postoperative neurologic complication, causes behavioral disturbances leading to self?traumas and also has long?term adverse effects in children. Our aim was to investigate the efficacy of a single?bolus dose of dexmedetomidine in reducing the incidence of ED. Additionally, pain relief, number of patients who needed rescue analgesia, hemodynamic parameters, and adverse events were assessed. Methods: One hundred and one patients were randomly allocated into two groups: 50 patients received 15 mL of dexmedetomidine 0.4 ?g/kg (group D) and 51 patients received volume?matched normal saline (group C). Hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were monitored regularly throughout the procedure. ED was assessed with Pediatric Anesthesia Emergence Delirium Scale (PAEDS), and pain was measured using the modified Objective Pain Score (MOPS). Results: The incidences of ED and pain were higher in group C than group D (P < 0.0001 and P < 0.0001, respectively). Group D showed significant decrease in MOPS and PAEDS values at 5, 10, 15, and 20 min (P < 0.05), HR at 5 min (P < 0.0243), and SBP at 15 min (P < 0.0127). There was no significant difference in DBP between the two groups at any time point. The mean blood pressure (MBP) at 10 min was significantly less in group D than group C (P < 0.001). Conclusion: Dexmedetomidine 0.4 ?g/kg as a single bolus over 10 min immediately after intubation is effective for the prevention of ED and significantly reduces the need of rescue analgesia without compromising the hemodynamic parameters in children undergoing ophthalmic surgery.
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Purpose: To assess the refractive outcomes and effect on endothelial cell density of refractive implantable lens (RIL) implantation following deep anterior lamellar keratoplasty (DALK). Methods: A retrospective study was conducted on 10 eyes of 10 patients who had undergone DALK and subsequently underwent toric RIL implantation. The patients were followed up over a period of 1 year. The parameters compared were uncorrected and best corrected visual acuity, spherical and cylindrical acceptance, mean refractive spherical equivalent, and endothelial cell counts. Results: There was a significant improvement (P < 0.05) from preoperatively to 1 month postoperatively in the mean log of minimum angle of resolution (logMAR) uncorrected distance visual acuity (UCVA; 1.1 ± 0.1 to 0.3 ± 0.1), spherical refraction (5.4 ± 3.8 to 0.3 ± 0.1 D), cylindrical refraction (5.4 ± 3.2 to 0.8 ± 0.7 D), and MRSE (7.4 ± 3.5 to 0.5 ± 0.4 D). Three patients achieved spectacle independence for distance vision with a residual MRSE less than 1 D in the other cases. A stable refraction was maintained up to 1 year follow?up in all cases. There was a 2.3% mean decline in endothelial cell counts at 1 year of follow?up. No intraoperative or postoperative complications were seen in any case up to 1 year of follow?up. Conclusion: RIL implantation is an effective and safe procedure for the correction of high ametropia post?DALK
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Background : Acute Kidney Injury (AKI) is a common complication Post Cardiac Surgery with reported incidence of 20-70%. Various studies have been conducted worldwide on risk factors contributing to the etiology of AKI in Cardiac surgery patients. We undertook similar study to understand the etiology and risk factors associated with AKI at Goa Medical College hence we undertook this study. Methodology : A retrospective record based observational study was conducted at Goa Medical College; wherein records of 419 patients who underwent Cardiac Surgery during the study period were analyzed for pre-operative, intra-operative and postoperative variables. Kidney Disease Improving Global Outcomes criteria were used to study the incidence of AKI. The Data was entered in Microsoft Excel and analysed using SPSS version 22.0. Chi-square test and Student t test were used as a test of significance. Results : Out of 419 patient records reviewed; 40.3% patients developed AKI after Cardiac Surgery. Age, Sex, h/o previous Cardiac Surgery, CPB duration, Aortic Cross Clamp Time, addition of vasopressor etc. were some of the significant risk factors associated. AKI associated with Cardiac Surgery was associated with a mortality of 8.3%. Mean duration of ventilation 38.48�.27 hrs. and ICU stay 6.12�15 days was comparatively longer than patients without AKI (P<0.001). Conclusion : We concur that AKI is a serious complication in patients undergoing Cardiac Surgery and has significant impact on the outcome of the patients in terms of duration of ICU stay, duration of ventilation and mortality. There is need to identify modifiable risk factors at the earliest and develop approaches to improve the outcome and decrease the AKI associated morbidity and mortality
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Mycobacterium tuberculosis (MTB), the organism causing tuberculosis (TB) remains a major cause of morbidity and mortality. Plant-based drugs have been used worldwide in traditional medicines for the treatment of various diseases including tuberculosis. Medicinal plants are an important source of new antimicrobial agents and remain an attractive alternative strategy. The present study was performed to evaluate anti-MTB activity of two medicinal plants viz., Allium ascalonicum, and Allium sativum. Different concentrations of extracts of these plants were tested for their anti MTB activity against MTBH37Rv strain and the inhibitory activity was expressed as CFU inhibition, % inhibition and IC50. In our study Allium sativum showed higher anti TB activity however this bactericidal property was not signi?cantly different between each groups. The overall anti mycobacterial activity of these extracts might be attributed due to the presence of ?avonoids, saponins, steroids, terpenoids, tannins and other phytoconstituents. The extract of the plant also exhibited promising antitubercular activity.
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Background: The sciatic nerve is one of the very vital nerves of the body, which has importance not only in the field of Anatomy but also in various clinical fields such as Orthopaedics, Anaesthesia, Plastic & Reconstructive Surgery, and Neurosurgery. This study was the first attempt to analyze the different dimensions of the anatomically normal sciatic nerves at different levels, involving Malaysian cadavers.Material & Methods:The study was conducted on 78 adult, both cadaveric and disarticulated lower limb specimens belonging to both genders. The morphometric analysis was done in 64 specimens having anatomically normal sciatic nerves. The dimensions were measured by a digital Vernier caliper, a measuring tape, and thread.Results:The average width, thickness and circumference of the nerve at the lower border of piriformis muscle (PM) were 15.86 mm ± 1.47 (right) & 16.56 mm ± 1.08 (left); 4.22 mm ± 0.29 (right) & 4.10 mm ± 0.20 (left) and 27.70 mm ± 2.02 (right) & 27.72 mm ± 2.39 (left), respectively. Similarly, at the level between ischial tuberosity (IT) and greater trochanter (GT), the mean width was 11.59 mm ± 1.43 (right) & 11.50 mm ± 1.53 (left); thickness was 3.48 mm ± 0.18 (right) & 3.35 mm ± 0.17 (left) and circumference was 27.08 mm ± 2.79 (right) & 27.22 mm ± 2.87 (left). At bifurcation, the mean width was 8.66 mm ± 0.65 (right) & 8.90 mm ± 0.81 (left); thickness was 2.41 mm ± 0.12 (right) & 2.31 mm ± 0.15 (left) and circumference was 19.75 mm ± 1.44 (right) & 19.99 mm ± 1.45 (left). The average distance between IT and GT was 50.37 mm ± 4.47 (right) & 47.73 mm ± 4.24 (left); between lateral border of IT and medial border of sciatic nerve was 15.43 mm ± 1.45 (right) & 14.66 mm ± 1.37 (left); and between medial border of GT and lateral border of the nerve was 27.13 mm ± 1.38 (right) & 25.07 mm ± 1.73 (left). The average length of the nerve was 328.20 ± 26.26 (right) & 332.31 ± 21.89 (left); and that of the thigh was 412.19 ± 24.50 (right) & 407.24 ± 25.82 (left).Conclusion: This knowledge will not only aid future researchers but also will assist surgeons, orthopaedicians, anaesthetists, reconstructive surgeons, and neurosurgeons by preventing iatrogenic nerve injuries.
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Purpose: To compare different endophthalmitis prophylaxis methods adopted in cataract surgery (manual small-incision cataract surgery and phacoemulsification) between the years 2013 and 2021 in the community eye care section of a tertiary eye care hospital in South India and report their outcomes. Methods: All cataract surgeries performed from January 2013 to December 2021 (2,46,874 surgeries) at a single center were included in this retrospective study. The different endophthalmitis rates with each regimen were analyzed and evaluated. Results: 70,081 surgeries were performed from January 2013 to February 2015, where Tobramycin was added to Balanced Salt Solution (BSS) (Group A). From March 2015 to January 2017, 63,245 surgeries were performed when intracameral Moxifloxacin was given (Group B). From February 2017 to December 2021, 1,13,548 surgeries were performed were Amikacin was added to BSS (Group C). In total, 42 cases of postoperative endophthalmitis were reported during the study period (0.02%). There was no significant difference in the endophthalmitis rates between groups A and B (P = 0.4152); however, there was a significant decrease in endophthalmitis rates in group C when compared with group A (P = 0.04) and group B (P = 0.006). Conclusion: There was a significant reduction in the rates of endophthalmitis following the addition of amikacin in irrigating BSS. Nocardia was one of the predominant organisms isolated from these endophthalmitis patients. This is the first single-center study to report a comparative analysis of different endophthalmitis prophylactic measures in a community eye care set up with a high incidence of Nocardia endophthalmitis prevented with amikacin in BSS irrigating solution.
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Prevention and timely management of cardiovascular (CV) complications like myocardial infarction, heart failure (HF), stroke and renal complications, like chronic kidney disease (CKD) and end-stage renal disease, are important to improve the quality of life and survival in people with type 2 diabetes mellitus (T2DM). The multifaceted action of sodium-glucose co-transporter 2 inhibitors (SGLT2i) results in effective glycemic control with benefits on CV and renal risk factors, like body weight, blood pressure, uric acid and albuminuria. Robust CV and renal event reduction is reflected in the outcomes of large CV outcome trials, meta-analyses and real-world studies. Recent evidence has proven cardiac and renal benefits with SGLT2i in subjects with HF and CKD irrespective of their T2DM status. Until recently, SGLT2i was used as a glucose-lowering molecule with pleiotropic benefits, mainly by primary care practitioners and diabetologists. The potential for cardiac and renal protection in people with and without T2DM has shifted an interest in cardiologists and nephrologists to view it as a cardiac and renal molecule, respectively. Thus, the role of SGLT2i in the management of T2DM is undergoing a paradigm shift—straddling the interfaces of diabetology, cardiology, nephrology and primary care—moving away from being considered a pure antidiabetic molecule. We conducted a literature review of SGLT2i in management of T2DM along with their protective effects on CV and renal parameters in patients with or without baseline comorbidities.
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Heme oxygenase-1 (HO-1) is a critical stress-responsive enzyme that has antioxidant and anti-inflammatory functions. HO-1 catalyzes heme degradation, which gives rise to the formation of carbon monoxide (CO), biliverdin, and iron. The upregulation of HO-1 under pathological conditions associated with cellular stress represents an important cytoprotective defense mechanism by virtue of the anti-oxidant properties of the bilirubin and the anti-inflammatory effect of the CO produced. The same mechanism is hijacked by premalignant and cancerous cells. In recent years, however, there has been accumulating evidence supporting that the upregulation of HO-1 promotes cancer progression, independently of its catalytic activity. Such non-canonical functions of HO-1 are associated with its interaction with other proteins, particularly transcription factors. HO-1 also undergoes post-translational modifications that influence its stability, functional activity, cellular translocation, etc. HO-1 is normally present in the endoplasmic reticulum, but distinct subcellular localizations, especially in the nucleus, are observed in multiple cancers. The nuclear HO-1 modulates the activation of various transcription factors, which does not appear to be mediated by carbon monoxide and iron. This commentary summarizes the non-canonical functions of HO-1 in the context of cancer growth and progression and underlying regulatory mechanisms.
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Interstitial granulomatous dermatitis (IGD), a rare dermatological disorder was first described by Ackerman et al, in the year 1993. It is characterized by a heterogeneous clinical spectrum and a specific histopathological pattern. It has been described in association with a number of auto-immune disorders, drugs, fungal infections, and malignancies. It may manifest as papules, patches, plaques, nodules, annular lesions, or less frequently, as described classically, as indurated linear subcutaneous cords. This case is being reported as interstitial granulomatous dermatitis is rare dermatological manifestation of rheumatoid arthritis and presentation as large ulcerated skin lesions is further extremely rare. In this case report we describe a 67-year-old gentleman with Seropositive Rheumatoid arthritis. He presented to our hospital with complaints of multiple well defined skin lesions with pus discharge over lower limbs, trunk and upper limbs. Biopsies from left upper limb and abdomen showed focal necrobiosis with surrounding granulomatous inflammation with rare perivascular granulomas. He was subsequently diagnosed to have interstitial granulomatous dermatitis based on histopathological examination. Interstitial granulomatous dermatitis has been described to be associated with a number of autoimmune conditions and drugs. It is very important for clinicians to have knowledge about this rare skin condition as it may be heralding presentation of a serious underlying condition like lymphoproliferative disorders or solid organ malignancies. There is no specific treatment and causative disease has to be diagnosed and targeted.
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Giant cell tumors are rarely seen in the foot. Only 1-2% cases of GCT occur in the foot. They can cause a significant amount of pain and deformity due to their aggressive and recurrent nature whenever it occurs in foot. We present an unusual case of a giant cell tumor of proximal phalynx of middle toe of left foot. 26 year old male came with complaints of pain and swelling over the middle toe of left foot since 6 months. Clinical and radiological features showed features consistent with GCT. Foot Function Index revealed a) Pain scale: 29 / 50 = 58%, b) Disability scale: 56 / 90 = 62%, c) Activity limitation scale: 8 / 30 = 27%. Authors performed enbloc resection with ray amputation of 3rd toe. Histopathological examination of excised specimen revealed classic findings of mononuclear cells with interspersed fibro-collagenous strands and numerous multinucleated osteoclast-like giant cells which confirmed our diagnosis. Patient was serially followed up and at 6 months followup, there were no signs of recurrence with markedly improved foot function index.
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Tumour calcinosis is a rare clinical and histopathological syndrome characterised by deposition of calcium deposits in different periarticular soft tissue regions of the body. It mainly manifest in childhood/ adolescence as a painless, firm to hard tumour like mass around the joints. Most common regions involved: Shoulder, elbow and hip. An 18 year old male patient presented to the opd with a history of pain and swelling over his left hip since 2 months. On examination, there was a diffuse tender swelling over the left greater trochanter, skin over the swelling was normal with no discharge, no dilated/ engorged veins. Range of motion of left hip was normal, no limb length discrepancies. X-ray: Showed a well define calcified mass over the greater trochanter with no osseous involvement. MRI revealed an encapsulated hypointense mass present posterior to the greater trochanter, mostly in the muscular plane. Lab findings revealed mild hyperphosphetemia. An aspirate from the swelling showed casseousmaterial. En mass removal was done and sent for biopsy. Biopsy showed features suggestive of tumoral calcinosis. Tumoral calcinosis is a distinct clinico-radiopathological entity characterised by soft tissue periarticular calcinosis which mimics a true neoplasm, associated with elevated levels of serum phosphate. It is an extremely rare condition which is seen in the adolescence and requires more studies regarding the surgical and medical management of the same.
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Background: The objective was to study the effect of Aegle marmelos methanolic extracts of leaf (LE) and fruit pulp extract (FE) on learning and memory in albino rats. 40 healthy wistar albino rats of either sex were randomly divided into 10 groups of 4 each (n=4), weighing about 150 to 200 gm were selected for the study. The extracts i.e. 1ml of 1% carboxy methyl cellulose, LE and FE at doses of 100 mg/kg and 200 mg/kg were administered per oral one hour before the experiment.Methods: Learning and memory was assessed by elevated plus maze and Hebb William maze. Latency time and number of entries were assessed by elevated plus maze whereas only latency was assessed by Hebb William maze.Results: Plant extracts of LE and FE at doses 100 mg/kg and 200 mg/kg have shown significant percentage reduction in latency time in elevated plus maze and Hebb William maze (p<0.05) and reduction in the number of entries in elevated plus maze.Conclusions: LE and FE at doses 200 mg/kg have shown significant effect on learning and memory.
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Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus (MRSA) presence in milk is of significant importance as they are often involved in food borne intoxications. Effective surveillance and detection are the most important tools in outbreak investigation and control. Our study was designed to ascertain the occurrence Staphylococcus aureus and Methicillin-Resistant S. aureus (MRSA) from raw milk collected from apparently healthy cattle in Chennai city, Tamil Nadu, India. A total of 89 (89/258; 34.49%) positive isolates of Staphylococcus aureus obtained from 258 raw milk samples screened. Of which 24 (24/258; 9.3%) isolates positive for MRSA. Studying the antimicrobial resistance and its patterns in foods of animal origin will be of immense help to various regulatory agencies and authorities to devise and implement control measures and to note the compliance of our foods with the prescribed standards.
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Purpose: To date, there is no information on the comparison of the effect of 0.5% bupivacaine with 0.75% ropivacaine solution for vitreoretinal surgery. The aim of the study was to compare the efficacy of 0.5% bupivacaine with 0.75% ropivacaine in peribulbar anesthesia for vitreoretinal surgery. This was a prospective randomized double-blinded observational study in a hospital setting. Sixty patients planned for vitreoretinal surgery were randomized into two groups based on the peribulbar injection administered either with 0.5% bupivacaine or 0.75% ropivacaine solution, as Group B (n = 30) and Group R (n = 30), respectively. Time of onset of analgesia, akinesia, and the need for supplemental anesthesia were noted. Student's t-test or Mann-Whitney U test were used for comparing continuous variables and Chi-square or a Fischer exact test were used as appropriate for comparing two proportions. Results: The patients in Group R showed an earlier onset of both, analgesia (1.97 min vs. 2.10 min, P = 0.002) and akinesia (2.77 min vs. 4.20 min, P < 0.001) compared with the patients in Group B. The efficacy of the block attained was Grade 5 (adequate anesthesia and akinesia without supplementation) in about 97% of the patients in Group R while only 90% in Group B. However, the differences between the groups for the efficacy of the block were not statistically significant (P = 0.301) neither for Grades 5 nor for Grade 4 and 3 (P = 1.00 for both). The onset of postoperative pain was similar for both groups (P = 1.00). Conclusion: We concluded that 0.75% ropivacaine is a better choice of local anesthetic solution for patients undergoing primary vitreoretinal surgery compared with 0.5% bupivacaine.
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Aberrant activation of Ras has been implicated in aggressiveness of breast cancer. Among Ras isoforms (H-, K-, and N-), H-Ras has been known to be primarily responsible for invasion and metastasis of breast cancer cells. Phosphorylation of serine (Ser) or threonine (Thr) is a key regulatory mechanism responsible for controlling activities and functions of various proteins involved in intracellular signal transduction. Peptidyl-prolyl Cis-trans isomerase NIMA-interacting 1, Pin1 changes the conformation of a subset of proteins phosphorylated on Ser/Thr that precedes proline (Pro). In this study we have found that Pin1 is highly overexpressed in human breast tumor tissues and H-Ras transformed human mammary epithelial (H-Ras MCF10A) and MDA-MB-231 breast cancer cells. Notably, Pin1 directly bound to the activated form of H-Ras harbouring a Ser/Thr-Pro motif. Pharmacologic inhibition of Pin1 reduced clonogenicity of MDA-MB-231 human breast cancer cells. Paclitaxel accelerates apoptosis in Pin1 silenced H-Ras MCF10A cells. MDR genes (MDR1 and MRP4) were significantly downregulated in MDA-MB-231 cells stably silenced for Pin1. We speculate that Pin1 interacts with GTP-H-Ras, thereby upregulating the expression of drug resistance genes, which confers survival advantage and aggressiveness of breast cancer cells under chemotherapy.
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Aberrant activation of Ras has been implicated in aggressiveness of breast cancer. Among Ras isoforms (H-, K-, and N-), H-Ras has been known to be primarily responsible for invasion and metastasis of breast cancer cells. Phosphorylation of serine (Ser) or threonine (Thr) is a key regulatory mechanism responsible for controlling activities and functions of various proteins involved in intracellular signal transduction. Peptidyl-prolyl Cis-trans isomerase NIMA-interacting 1, Pin1 changes the conformation of a subset of proteins phosphorylated on Ser/Thr that precedes proline (Pro). In this study we have found that Pin1 is highly overexpressed in human breast tumor tissues and H-Ras transformed human mammary epithelial (H-Ras MCF10A) and MDA-MB-231 breast cancer cells. Notably, Pin1 directly bound to the activated form of H-Ras harbouring a Ser/Thr-Pro motif. Pharmacologic inhibition of Pin1 reduced clonogenicity of MDA-MB-231 human breast cancer cells. Paclitaxel accelerates apoptosis in Pin1 silenced H-Ras MCF10A cells. MDR genes (MDR1 and MRP4) were significantly downregulated in MDA-MB-231 cells stably silenced for Pin1. We speculate that Pin1 interacts with GTP-H-Ras, thereby upregulating the expression of drug resistance genes, which confers survival advantage and aggressiveness of breast cancer cells under chemotherapy.
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Biological seed coating is a new technique of seed treatment through which biological agents are coated over the seed surface for effective control of seed and soil-borne pathogens. In this study, pigeonpea seed was biologically coated with Pseudomonas fluorescens, Rhizobium spp. and Phosphorus solubilizing bacteria (PSB) using biofriendly polymer and sugar syrup as adjuvants. The shelf life of bioagents and seed quality parameters was studied during six months of storage period. The colony units of Pseudomonas increased with biofriendly polymer either as individual or in consortia with biofertilizers. Six months after treatment, more colony units of Pseudomonas fluorescens were recorded on the surface of biologically coated seed of pigeonpea with biofriendly polymer as an adjuvant compared to sugar syrup. Seeds coated with Pseudomonas and PSB using biofriendly polymer recorded high seed germination and seedling vigour compared to sugar syrup. The observations reveal that there is a possibility of coating seed with biological agents using biofriendly polymer immediately after processing or before packaging without affecting the shelf life of bioagents and seed quality. Thus, the biologically coated pigeonpea seed in advance of cropping season can go a long way in minimizing risk associated with on farm seed treatment.
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Adult onset still’s disease is a rare systemic inflammatory disorder of unknown aetiology, characterized by clinical triad (high spiking fever, evanescent rash and arthritis) and biological triad with lack of serological markers as a true gold standard makes diagnosis difficulty. Here is a case of 32year old male presented with high grade fever for 2 months, joint pains and swelling for 1month rash for 3 days. O/E: pallor and B/L tender, swollen ankle and knee joints, and P/A: splenomegaly. Investigations showed-Hb%. 8 gms, neutrophilic leucocytosis with thrombocytosis, ESR:72 mm/1h, CRP elevated. ASO-titre, RA factor and Anti CCP antibodies are negative. Adult onset still’s disease is a heterogenous and rare systemic inflammatory disorder of unknown aetiology with lack of serological diagnostic modalities.
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Background: As per GOLD (Global initiative for chronic obstructive lung disease) guidelines bronchodilators are required for symptomatic treatment of chronic obstructive pulmonary disease (COPD) patients. Currently there is no evidence to say about the safety of fixed dose combinations used in COPD patients. Since the drugs are to be taken for longer period, it is essential to know the safety aspects of these drugs. Moreover we don’t have adequate studies and documentation to say that a particular drug combination is better and safer for COPD patients.Methods: Prospective, open labelled, randomized, comparative, interventional clinical study conducted by the Departments of Pharmacology and Pulmonary Medicine of Basaveshwara Medical College and Hospital, Chitradurga in 40 COPD patients.Results: The fixed dose combinations of drugs used in both the treatment groups i.e. salmeterol/fluticasone and tiotropium/formoterol were equally safer and well tolerated. Some side effects noticed during the course of treatment were statistically significant when compared between the 2 groups, however they were milder and predictable adverse drug reactions.Conclusions: Systemic and severe adverse drug reactions were not observed during 8 week treatment period and the local side effects observed were mild in both the treatment groups. Hence the fixed dose combinations of salmeterol or fluticasone and tiotropium or formoterol are found to be safer for maintenance therapy in COPD patients.
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Background: A drug utilization study may be helpful to identify the problems, suggest the remedial measures and promote rational use. Antimicrobials are commonly used to treat infections caused by bacteria, viruses, protozoa and fungi, evidently require huge prescriptions in India.Methods: A prospective, observational study was carried out for a period of four months from February to May 2019 in the Department of ENT (OPD) at NRI Medical College and General Hospital. Prescriptions were collected randomly from around 300 patients attending the ENT outpatient department after obtaining informed consent. The data were collected in the predesigned proforma for analysis.Results: 300 ENT patients were selected for the study, 62% were male and 38% were female. Out of 300 patients 190 ear disorders, 50 nasal, and 60 throat infections. Antimicrobial therapy were most commonly instituted in ear diseases (67.66%), nose (16.95%) and throat (15.37%) respectively. The most commonly used agents were amoxicillin with clavulanic acid- n=295, cefixime- n=1260, gentamicin- n=200, ciprofloxacin- n=157, azithromycin- n=199, nitroimidazoles (metronidazole- n=111).Conclusions: Cefixime and amoxicillin+clavulanic acid combination was the most commonly prescribed antibiotic in our study. Interventions to rectify the use of brand names are necessary to promote rational drug use. An antibiotic policy has to be developed for the doctors in treating infections so that rationality in using the antibiotics will be developed and the occurrence of antibiotic resistance can be reduced.