Estimating antibiotics consumption in a tertiary care hospital in Islamabad using a WHO's defined daily dose methodology.

BACKGROUND: Antibiotics have helped to reduce the incidence of common infectious diseases in all modern healthcare systems, but improper use of antibiotics including their overuse and misuse can change the bacteria so much that antibiotics don't work against them. In case of developing imposable selective pressure with regard to the proportion of hospitalized patients who receive antibiotics, the quantity of antibiotics that are prescribed to them, and the proportion of patients who receive antibiotic treatment is one of the major contributors to the rising global health issue of antimicrobial resistance. Concerning the levels of antibiotic consumption in Pakistani hospitals, there is negligible research data available. AIM: This study aimed to evaluate five-year inpatient antibiotic use in a tertiary care hospital in Islamabad using the World Health Organization (WHO) Recommended Anatomical Therapeutic Chemical (ATC) Classification / Defined Daily Dose (DDD) methodology. METHOD: It was a descriptive study involving a retrospective record review of pharmacy records of antibiotics dispensed (amount in grams) to patients across different specialties of the hospital from January 2017 to December 2021 (i.e., 60 consecutive months). The antibiotic consumption was calculated by using the DDD/100-Bed Days (BDs) formula, and then relative percent change was estimated using Microsoft Excel 2021 edition. RESULT: A total of 148,483 (77%) patients who received antibiotics were included in the study out of 193,436 patients admitted in the hospital. Antibiotic consumption trends showed considerable fluctuations over a five-year period. It kept on declining irregularly from 2017 to 2019, inclined vigorously in 2020, and then suddenly dropped to the lowest DDD/100 BDs value (96.02) in the last year of the study. The overall percentage of encounters in which antibiotics were prescribed at tertiary care hospital was 77% which is very high compared to the WHO standard reference value (< 30%). WATCH group antibiotics were prescribed (76%) and consumed more within inpatient settings than Access (12%) and Reserve (12%) antibiotics. CONCLUSION: The hospital antibiotic consumption data is well maintained across different inpatient specialties but it is largely non-aligned with WHO AWaRe (Access-Watch-Reserve) antibiotics use and optimization during 2017-2021. Compared to the WHO standard reference figure, the overall percentage of antibiotics encountered was higher by about 47%. Antibiotic consumption trends vary with a slight increase in hospital occupancy rate, with positive relative changes being lower in number but higher in proportion than negative changes. Although the hospital antibiotics policy is in place but seems not to be followed with a high degree of adherence.

Insight into a pure spinel Co3O4 and boron, nitrogen, sulphur (BNS) tri-doped Co3O4-rGO nanocomposite for the electrocatalytic oxygen reduction reaction.

The intricate problems concerning energy require innovative solutions. Herein, we propose a smart composite nano system that can be used in a sustainable and dichotomous manner to resolve energy crises. The current study describes a new way to synthesize a pure spinel cobalt oxide (Co3O4) and boron (B), nitrogen (N), and sulfur (S) tri-doped Co3O4-reduced graphite oxide (rGO) nanocomposite (CBNS). A hydrothermal method has been used for the synthesis of these nanomaterials. The synthesized nanocomposite was characterized by UV-visible spectroscopy, X-ray diffraction (XRD), Raman spectroscopy, scanning electron microscopy (SEM), X-ray absorption spectroscopy (XAS), and transmission electron microscopy (TEM). The XRD results showed the formation of Co3O4 and B, N, S doped nanocomposite with high purity and crystallinity. XAS analysis elucidates the formation of spinel Co3O4 with tetrahedral and octahedral arrangement of cobalt ions. The peaks at 2.50 Å and 3.07 Å are due to the Co-Co bonding. The electrocatalytic oxygen reduction (ORR) was successfully implemented using these nanocomposites. The electrochemical study exhibits the better activity of the B, N, and S tri-doped Co3O4-rGO nanocomposite due to the mutual effect of B, N and S. The synthesized catalyst has maximum current density of 9.97 mA cm-2 with onset potential (Eonset) of 0.98 V in alkaline medium.

Hydrothermal synthesis and characterization of transition metal (Mn/Fe/Cu) co-doped cerium oxide-based nano-additives for potential use in the reduction of exhaust emission from spark ignition engines.

The goal of this work was to synthesize new cerium oxide-based nano-additives to minimise emissions from spark ignition (SI) engines fueled with gasoline blends, such as carbon monoxide (CO), unburned hydrocarbons (HC) and oxides of nitrogen (NO x ). To investigate the effect of transition metal dopants on their respective catalytic oxidation activity, nano-sized CeO2 catalysts co-doped with Mn, Fe, Cu and Ag ions were successfully produced by a simple hydrothermal technique. The synthesis of nano-catalysts with cubic fluorite geometry was confirmed by XRD data. The addition of transition metal ions to the CeO2 lattice increased the concentration of structural defects like oxygen vacancies and Ce3+ ions, which are advantageous for the catalytic oxidation reaction, as also supported by XAFS and RAMAN analysis. Further, nano-gasoline fuel emission parameters are measured and compared to straight gasoline fuel. The results demonstrated that harmful exhaust pollutants such as CO, HC and NO x were significantly reduced. The high surface area, better redox characteristics and presence of additional oxygen vacancy sites or Ce3+ ions have been linked to the improved catalytic performance of the synthesized catalyst.

Observation of Potential-Induced Hydration on the Surface of Ceramic Proton Conductors Using In Situ Near-Ambient Pressure X-ray Photoelectron Spectroscopy.

Interactions of ceramic proton conductors with the environment under operating conditions play an essential role on material properties and device performance. It remains unclear how the chemical environment of material, as modulated by the operating condition, affects the proton conductivity. Combining near-ambient pressure X-ray photoelectron spectroscopy and impedance spectroscopy, we investigate the chemical environment changes of oxygen and the conductivity of BaZr0.9Y0.1O3-δ under operating condition. Changes in O 1s core level spectra indicate that adding water vapor pressure increases both hydroxyl groups and active proton sites at undercoordinated oxygen. Applying external potential further promotes this hydration effect, in particular, by increasing the amount of undercoordinated oxygen. The enhanced hydration is accompanied by improved proton conductivity. This work highlights the effects of undercoordinated oxygen for improving the proton conductivity in ceramics.

Diagnostic Accuracy of High-Resolution Computed Tomography of Chest in Diagnosing Sputum Smear Positive and Sputum Smear Negative Pulmonary Tuberculosis.

Introduction Pulmonary tuberculosis (PTB) is caused by species of organisms in the Mycobacterium tuberculosis complex. It is a major public health problem worldwide and is endemic in Pakistan. Various clinical and biochemical markers exist for its diagnosis. Radiology has an important role in the diagnosis of PTB. Initially, a chest radiograph is warranted for PTB evaluation. High-resolution computed tomography (HRCT) also has high sensitivity and specificity for PTB diagnosis. Features of primary TB include consolidation, lymphadenopathy, pleural effusion and miliary nodules whereas post-primary TB include apical consolidation, nodules and cavitation. The aim of this study was to determine the diagnostic accuracy of HRCT chest in diagnosing sputum smear positive and smear negative PTB. Methods A cross-sectional study was conducted at a large tertiary care teaching hospital. A retrospective review of medical records of patients who underwent HRCT chest and sputum acid-fast bacillus (AFB) direct smear and AFB culture for suspicion of PTB was undertaken. All HRCT chest examinations were performed on multislice computed tomography (CT) scanner. On HRCT, PTB was defined as the presence of consolidation, centrilobular nodules, branching nodules with tree in bud appearance with or without lymphadenopathy and pleural effusion. Diagnostic accuracy of HRCT including sensitivity, specificity, positive and negative predictive values was calculated using 2 x 2 table, taking findings of AFB culture as a gold standard. Results A total of 108 patients were included in this study with a mean age of 51.85 ± 16.86 years. Diagnostic accuracy of HRCT in diagnosing PTB was found to be 84.26% with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 89.09%, 79.25%, 81.67%, and 87.50%, respectively. In sputum smear positive patients, HRCT has diagnostic accuracy, sensitivity, specificity, PPV and NPV of 87.50%, 88.57%, 84.62%, 93.94%, and 73.33%, respectively. In sputum smear negative patients, HRCT has diagnostic accuracy, sensitivity, specificity, PPV and NPV of 81.67%, 90.00%, 77.50%, 66.67%, and 93.94%, respectively. Conclusion HRCT has high sensitivity in diagnosing sputum smear positive and sputum smear negative PTB. The specificity of HRCT in diagnosing sputum smear positive PTB was high, whereas it was slightly low in diagnosing sputum smear negative PTB. Overall diagnostic accuracy of HRCT was high in diagnosing PTB.

Diagnostic Accuracy of Maximum Intensity Projection in Diagnosis of Malignant Pulmonary Nodules.

Introduction Pulmonary nodules are frequently encountered during chest imaging, and its evaluation is usually done by chest radiograph and computed tomography (CT) scan of chest. High resolution of multidetector CT (MDCT) has improved the nodule detection. Post processing techniques such as maximum intensity projection (MIP) can further improve the sensitivity of MDCT for nodule detection. Failure to diagnose malignancy in pulmonary nodules can delay the treatment. Therefore, the aim of this study was to determine the diagnostic accuracy of MIP in the diagnosis of malignant pulmonary nodules taking histopathology findings as gold standard. Materials and methods A retrospective cross-sectional study was conducted at Dow Institute of Radiology, Dow University of Health Sciences, from 1 December 2018 till 30 June 2019. Both male and female patients aged 18 years and above who underwent CT scan of chest with suspicion of pulmonary nodules were included. Patients already diagnosed with malignant pulmonary nodules and presenting for follow-up were excluded. Contrast-enhanced CT chest was performed on a multi-slice scanner. MIP reconstruction and evaluation was performed on the workstation. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of MIP were calculated taking histopathology findings as gold standard. Results A total of 202 patients were included in this study. The mean age of the patients was 55.87 ± 13.08 years. A total of 103 patients (51.0%) were males and 99 patients (49.0%) were females. There were 131 (64.9%) nodules with smooth margins and 71 (35.1%) nodules with irregular margins. The mean size of nodule was 3.1 ± 0.7 cm. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of MIP in diagnosing malignant pulmonary nodules were found to be 85.82%, 82.35%, 90.55%, 74.67%, and 84.65%, respectively, taking histopathology findings as gold standard. The nodules >3 cm in size had a higher sensitivity for diagnosing malignant pulmonary nodules. Smooth margin nodule had high sensitivity, specificity, and diagnostic accuracy for diagnosing malignant pulmonary nodules. Conclusion MIP images have high sensitivity, specificity, and diagnostic accuracy in the diagnosis of malignant pulmonary nodules. The utilization of MIP images can aid in the detection of malignant pulmonary nodules and help in formulating early treatment strategies for the patients. Other post processing techniques such as volume rendering and computer-aided detection can help in further improving patient care.

Evaluation of smooth muscle relaxant potential of Bismarckia nobilis (Hildebr. & Wendl.) in diarrhea, hypertension and asthma by ex-vivo and in-vivo method / Evaluación del potencial relajante en músculo liso de Bismarckia nobilis (Hildebr. & Wendl.) en diarrea, hipertensión y asma por métodos ex vivo e in vivo

To explore the mechanistic basis behind smooth muscle relaxant prospective of Bismarckia nobilis in gastrointestinal, respiratory and cardiovascular ailments. The methanolic extract of B. nobilis and sub-fractions have been evaluated in vitro rabbit isolated tissues, in vivo castor oil-induced diarrhea in rats and charcoal meal activity in mice. The B. nobilis extract relaxed spontaneous and K+(80 mM)- induced contractions in rabbit isolated jejunum preparations, CCh (1 µM) and K+ (80 mM)-induced contractions in tracheal and bladder preparations, PE (1 µM) and K+ (80 mM)-induced concentrations in aorta preparations, likewise verapamil. Spasmolytic activity of dichloromethane fraction is stronger as compared to aqueous fraction. In vivo castor oil-induced diarrhea in rats and charcoal meal activity in mice further supported spasmolytic activity. B. nobilis extract possess anti-spasmodic, anti-diarrheal, airway relaxant and vasodilator activities possible mediated through calcium channel blocking mechanism, justifying therapeutic utility of B. nobilis in diarrhea, asthma and hypertension.

El objetivo de trabajo fue explorar el mecanismo de acción relacionado con el efecto relajante del músculo liso inducido por Bismarckia nobilis (B. nobilis) en enfermedades gastrointestinales, respiratorias y cardiovasculares. El extracto metanólico de B. nobilis y subfracciones fue evaluado in vitro en tejidos aislados de conejos. Además se evaluó diarrea in vivo inducida con aceite de ricino en ratas y la actividad de harina de carbón vegetal en ratones. El extracto de B. nobilis relajó tanto las contracciones espontáneas como las inducidas por K+(80 mM) en preparaciones de yeyuno aisladas de conejos, las contracciones inducidas por PE (1 µM) y K+(80 mM) inducidas en preparaciones de aorta; de manera similar a verapamilo. La actividad espasmolítica de la fracción de diclorometano es más potente en comparación con la fracción acuosa. La diarrea inducida in vivo por el aceite de ricino en ratas y la actividad de la harina de carbón vegetal en ratones apoyaron aún más la actividad espasmolítica. El extracto de B. nobilis posee actividades antiespasmódicas, antidiarreicas, relajantes de las vías respiratorias y vasodilatadoras, posibles a través del mecanismo de bloqueo de los canales de calcio, lo que justifica la utilidad terapéutica de B. nobilis en la diarrea, el asma y la hipertensión.

Diagnostic Accuracy of Short Tau Inversion Recovery as a Limited Protocol for Diagnosing Perianal Fistula.

Introduction Perianal fistula refers to abnormal communication between perianal skin and anal canal. Magnetic resonance imaging (MRI) and endoanal ultrasound have been used in the evaluation of perianal fistula. Endoanal ultrasound is a cost-effective but operator-dependent technique. MRI provides accurate details regarding anal canal anatomy and effectively identifies the fistulae. For evidence-based care, a cost-effective and an accurate imaging modality is required in a developing country. Therefore, the aim of this study was to determine the diagnostic accuracy of short tau inversion recovery (STIR) as a limited protocol MRI pelvis in diagnosing perianal fistula taking surgical findings as the gold standard. Materials and methods A retrospective review of MRI pelvis from 1st February 2018 to 1st July 2018 was undertaken. Patients of any age or gender suspected to have perianal fistula were included. One radiologist interpreted the complete MRI pelvis and the other radiologist only viewed axial and coronal STIR sequences as a limited protocol. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of axial and coronal STIR sequence were calculated taking surgical findings as the gold standard. Results In total, 150 patients were included in this study. The mean age of the patients was 43.20 ± 13.75 years. In total, 122 (81.3%) were males and 28 (18.7%) were females. Using STIR as a limited protocol, fistulae were found in 125 (83.3%) patients, whereas on surgery, the fistulae were found in 119 (79.3%) patients. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy of STIR as limited protocol MRI pelvis in diagnosing perianal fistulae was found to be 96.6%, 67.7%, 92.0%, 84.0%, and 90.6%, respectively, taking surgical findings as the gold standard. Conclusion STIR has high sensitivity and diagnostic accuracy in diagnosing in the perianal fistula. Using STIR as a limited protocol in a developing country can help improving patient care by accurately diagnosing perianal fistulae. Moreover, it is recommended that further studies for identifying internal opening on STIR should also be carried out to improve patient care.

Symptoms of Depression and Anxiety among Women attending Primary Health Care in Gilgit-Baltistan (GB), Pakistan.

OBJECTIVE: To assess symptoms of anxiety and depression among women reporting to primary health care (PHC women) in Gilgit Baltistan (GB), Pakistan. METHODS: This was a cross-sectional study conducted on PHC women belonging GB including other three provinces of Pakistan. PHQ-9 and GAD-7 were used to assess anxiety and depression. Descriptive and inferential statistical techniques were applied to analyze the collected data. RESULTS: PHC women from GB reported higher level of depressive symptoms (t=7.58, p=0.00) and lower level of anxiety symptoms (t=8.3, p=0.00) when compared with cut-off score. Insignificant differences were found in depressive (t=1.5, p>.05) and anxiety (t=1.2, p>.05) scores between GB women and women from rest of Pakistan. However, inter-province differences in depressive (F=5.78, p= 00) and anxiety (F=4.5, p=0.00) symptoms were significant. Increasing age and lack of education were found significant risk factors for GB PHC women's depressive and anxiety symptoms. CONCLUSIONS: PHC women from GB have higher level of depressive and lower level of anxiety symptoms like women from other provinces of Pakistan. Their demographics should be considered while addressing their emotional problems.

Molecular Lifting, Twisting, and Curling during Metal-Assisted Polycyclic Hydrocarbon Dehydrogenation.

The atomistic understanding of the dissociation mechanisms for large molecules adsorbed on surfaces is still a challenge in heterogeneous catalysis. This is especially true for polycyclic aromatic hydrocarbons, which represent an important class of organic compounds used to produce novel graphene-based architectures. Here, we show that coronene molecules adsorbed on Ir(111) undergo major conformational changes during dissociation. They first tilt upward with respect to the surface, still keeping their planar configuration, and subsequently experience a rotation, which changes the molecular axis orientation. Upon lifting, the internal C-C strain is initially relieved; as the dehydrogenation proceeds, the molecules experience a progressive increase in the average interatomic distance and gradually settle to form dome-shaped nanographene flakes. Our results provide important insight into the complex mechanism of molecular breakup, which could have implications in the synthesis of new carbon-based nanostructured materials.

Mechanistic studies of water electrolysis and hydrogen electro-oxidation on high temperature ceria-based solid oxide electrochemical cells.

Through the use of ambient pressure X-ray photoelectron spectroscopy (APXPS) and a single-sided solid oxide electrochemical cell (SOC), we have studied the mechanism of electrocatalytic splitting of water (H2O + 2e(-) → H2 + O(2-)) and electro-oxidation of hydrogen (H2 + O(2-) → H2O + 2e(-)) at ∼700 °C in 0.5 Torr of H2/H2O on ceria (CeO2-x) electrodes. The experiments reveal a transient build-up of surface intermediates (OH(-) and Ce(3+)) and show the separation of charge at the gas-solid interface exclusively in the electrochemically active region of the SOC. During water electrolysis on ceria, the increase in surface potentials of the adsorbed OH(-) and incorporated O(2-) differ by 0.25 eV in the active regions. For hydrogen electro-oxidation on ceria, the surface concentrations of OH(-) and O(2-) shift significantly from their equilibrium values. These data suggest that the same charge transfer step (H2O + Ce(3+) <-> Ce(4+) + OH(-) + H(•)) is rate limiting in both the forward (water electrolysis) and reverse (H2 electro-oxidation) reactions. This separation of potentials reflects an induced surface dipole layer on the ceria surface and represents the effective electrochemical double layer at a gas-solid interface. The in situ XPS data and DFT calculations show that the chemical origin of the OH(-)/O(2-) potential separation resides in the reduced polarization of the Ce-OH bond due to the increase of Ce(3+) on the electrode surface. These results provide a graphical illustration of the electrochemically driven surface charge transfer processes under relevant and nonultrahigh vacuum conditions.