Antibiotic consumption at community pharmacies : a multicenter repeated prevalence surveillance using WHO methodology

Background: Antibiotics are losing their effectiveness because of the rapid emergence of resistant bacteria. Unnecessary antimicrobial use increases antimicrobial resistance (AMR). There are currently no published data on antibiotic consumption in Pakistan at the community level. This is a concern given high levels of self-purchasing of antibiotics in Pakistan and variable knowledge regarding antibiotics and AMR among physicians and pharmacists. Objective: The objective of this repeated prevalence survey was to assess the pattern of antibiotic consumption data among different community pharmacies to provide a baseline for developing future pertinent initiatives. Methods: A multicenter repeated prevalence survey conducted among community pharmacies in Lahore, a metropolitan city with a population of approximately 10 million people, from October to December 2017 using the World Health Organization (WHO) methodology for a global program on surveillance of antimicrobial consumption. Results: The total number of defined daily doses (DDDs) dispensed per patient ranged from 0.1 to 50.0. In most cases, two DDDs per patient were dispensed from pharmacies. Co-amoxiclav was the most commonly dispensed antibiotic with a total number of DDDs at 1018.15. Co-amoxiclav was followed by ciprofloxacin with a total number of 486.6 DDDs and azithromycin with a total number of 472.66 DDDs. The least consumed antibiotics were cefadroxil, cefotaxime, amikacin, and ofloxacin, with overall consumption highest in December. Conclusion: The study indicated high antibiotic usage among community pharmacies in Lahore, Pakistan particularly broad-spectrum antibiotics, which were mostly dispensed inappropriately. The National action plan of Pakistan on AMR should be implemented by policymakers including restrictions on the dispensing of antimicrobials

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of Half-Somersault and Brandt-Daroff exercise on dizziness, fear of fall and quality of life in patients with posterior canal benign paroxysmal positional vertigo: a randomised control trial

The aim of this study was to compare the effects of Half-Somersault and Brandt-Daroff exercises on dizziness, fear of fall, and quality of life in patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV). This study was conducted from July 2020 to November 2020. A total of 20 patients were enrolled in the study, through sealed envelope method, and assigned to two groups, A and B (10 in each). Vestibular activity and participation measure and Fall Efficacy Scale (FES) were used. The mean age of the patients was 36.70±11.58 years. There was a significant (p=0.05) difference between the Vestibular activities and participation measure (VAP) score at post intervention and Fall Efficacy Scale (FES) (p<0.05) between the groups. Within group analysis showed significant results (p=0.01). This study concluded that both manoeuvers are significantly effective in the treatment of PC-BPPV, but patients treated with Brandt-Daroff exercises reported more improvement in terms of quality of life and residual dizziness compared to the Half Somersault group. Key words: Benign paroxysmal positional vertigo, dizziness, vestibular rehabilitation

Game Theoretical Demand Response Management and Short-Term Load Forecasting by Knowledge Based Systems on the basis of Priority Index

Demand Response Management (DRM) is considered one of the crucial aspects of the smart grid as it helps to lessen the production cost of electricity and utility bills. DRM becomes a fascinating research area when numerous utility companies are involved and their announced prices reflect consumer&#8217;s behavior. This paper discusses a Stackelberg game plan between consumers and utility companies for efficient energy management. For this purpose, analytical consequences (unique solution) for the Stackelberg equilibrium are derived. Besides this, this paper presents a distributed algorithm which converges for consumers and utilities. Moreover, different power consumption activities on the basis of time series are becoming a basic need for load prediction in smart grid. Load forecasting is taken as the significant concerns in the power systems and energy management with growing technology. The better precision of load forecasting minimizes the operational costs and enhances the scheduling of the power system. The literature has discussed different techniques for demand load forecasting like neural networks, fuzzy methods, Na&#239;ve Bayes, and regression based techniques. This paper presents a novel knowledge based system for short-term load forecasting. The algorithms of Affinity Propagation and Binary Firefly Algorithm are integrated in knowledge based system. Besides, the proposed system has minimum operational time as compared to other techniques used in the paper. Moreover, the precision of the proposed model is improved by a different priority index to select similar days. The similarity in climate and date proximity are considered all together in this index. Furthermore, the whole system is distributed in sub-systems (regions) to measure the consequences of temperature. Additionally, the predicted load of the entire system is evaluated by the combination of all predicted outcomes from all regions. The paper employs the proposed knowledge based system on real time data. The proposed scheme is compared with Deep Belief Network and Fuzzy Local Linear Model Tree in terms of accuracy and operational cost. In addition, the presented system outperforms other techniques used in the paper and also decreases the Mean Absolute Percentage Error (MAPE) on a yearly basis. Furthermore, the novel knowledge based system gives more efficient outcomes for demand load forecasting

Outcome of laparoscopic cholecystectomy with and without drains at Ayub teaching hospital

Introduction: In terms of surgery, cholecystectomy performed using laparoscopy is the current standard of care for Cholelithiasis. This operation is by far the most common type of surgery done today. However, the literature is still divided on whether or not drainage should be performed following an elective laparoscopic cholecystectomy. Objectives: The aim of this study was to examine whether or not patients undergoing laparoscopic cholecystectomy at Ayub Teaching Hospital, Abbottabad were more likely to develop an infection in the wound if a drain was used. Results evaluation: Checks for wound infections were performed for up to a month after surgery to determine the outcome. Study Design: The study used a randomized controlled trial design. Settings: The study lasted for six months, from January 01, 2022, to June 30, 2022, and took place in the Department of General Surgery, Ayub Teaching Hospital, Abbottabad. Subjects: Patients having laparoscopic cholecystectomy for gall bladder disease were used as subjects.&nbsp

Biocontrol of Fruit Rot of Litchi chinensis Using Zinc Oxide Nanoparticles Synthesized in Azadirachta indica

Lychee (Litchi chinensis Sonn.) is a famous fruit species of tropical and subtropical regions of the world and many biotic and abiotic stresses affect its yield. In this study, lychee fruit rot has been observed and its incidence has been controlled by using zinc oxide nanoparticles (ZnO NPs). Diseased lychee fruits were collected and diagnosed to identify disease-causing pathogens. Morphological appearance, microscopic observation, and sequence analysis of the amplified ITS region identified this isolated pathogen as Aspergillus niger. To control this problem, ZnO NPs were prepared in the leaf extract of Azadirachta indica. Before their antifungal activity, ZnO NPs were characterized using sophisticated approaches. FTIR revealed the presence of reducing and stabilizing molecules on ZnO NPs including alcohol, carboxylic acid, alkyl halide, amine, and alkyl halide. Crystalline nature and average size (29.024 nm) of synthesized ZnO NPs were described by X-ray diffraction. EDX analysis depicted the mass percentage of zinc (30.15%) and oxygen (14.90%). SEM analysis displayed the irregular shape of nanoparticles and confirmed the nano-size of ZnO NPs. Maximum mycelial growth inhibition (70.5%) was observed at 1.0 mg/mL concentration of ZnO NPs in vitro. In in-vivo disease-control analysis, maximum control of lychee fruit rot disease was observed at the same concentration. These results reveal the potential use of these ZnO NPs on a larger scale to replace hazardous chemical fungicides

Preservation and Recovery of Metal-Tolerant Fungi from Industrial Soil and Their Application to Improve Germination and Growth of Wheat

Heavy metals contaminate soil and adversely affect plant growth. These soils contain different fungi and bacteria which exhibit metal tolerance and work as bioremediation agents to detoxify polluted soils. In the present study, polluted soil samples were collected to estimate the contamination of copper (Cu) and cadmium (Cd). From this contaminated soil, metal tolerant fungi were isolated and characterized. Copper and cadmium were found in a range of 190.2&ndash;300.4 mg/kg and 46.8&ndash;56.1 mg/kg, respectively. For the isolation of metal tolerant fungi, soil dilutions were made in water and inoculated on potato dextrose agar (PDA) media. Fungal growth was observed on PDA and successive screening resulted in the isolation of four multi-metal tolerant fungal species, including Penicillim oxalicum, Fusarium solani, Aspergillus niger and Trichoderma harzianum. Sequencing of 18S rRNA genes of isolated fungi also efficiently identified them. To reveal minimum inhibitory concentrations (MIC), these fungi were exposed to increasing concentrations of cadmium and copper chlorides (100 to 1000 ppm) and a variable MIC range of 400 ppm to 1000 ppm was estimated. Based on tolerance index analysis, F. solani was found to be resistant at 1 mM copper, while P. oxalicum was the most tolerant species under cadmium stress. F. solani and P. oxalicum demonstrated the highest biosorption capacity of Cu and Cd, respectively. Both metals negatively affected wheat seedlings in a pot experiment, while the treatment of both F. solani and P. oxalicum positively influenced the germination and growth of wheat. Based on these observations, it could be inferred that F. solani and P. oxalicum can be used for the myco-remediation of Cu and Cd, respectively

Preservation and Recovery of Metal-Tolerant Fungi from Industrial Soil and Their Application to Improve Germination and Growth of Wheat

Heavy metals contaminate soil and adversely affect plant growth. These soils contain different fungi and bacteria which exhibit metal tolerance and work as bioremediation agents to detoxify polluted soils. In the present study, polluted soil samples were collected to estimate the contamination of copper (Cu) and cadmium (Cd). From this contaminated soil, metal tolerant fungi were isolated and characterized. Copper and cadmium were found in a range of 190.2–300.4 mg/kg and 46.8–56.1 mg/kg, respectively. For the isolation of metal tolerant fungi, soil dilutions were made in water and inoculated on potato dextrose agar (PDA) media. Fungal growth was observed on PDA and successive screening resulted in the isolation of four multi-metal tolerant fungal species, including Penicillim oxalicum, Fusarium solani, Aspergillus niger and Trichoderma harzianum. Sequencing of 18S rRNA genes of isolated fungi also efficiently identified them. To reveal minimum inhibitory concentrations (MIC), these fungi were exposed to increasing concentrations of cadmium and copper chlorides (100 to 1000 ppm) and a variable MIC range of 400 ppm to 1000 ppm was estimated. Based on tolerance index analysis, F. solani was found to be resistant at 1 mM copper, while P. oxalicum was the most tolerant species under cadmium stress. F. solani and P. oxalicum demonstrated the highest biosorption capacity of Cu and Cd, respectively. Both metals negatively affected wheat seedlings in a pot experiment, while the treatment of both F. solani and P. oxalicum positively influenced the germination and growth of wheat. Based on these observations, it could be inferred that F. solani and P. oxalicum can be used for the myco-remediation of Cu and Cd, respectively