Impact of antibiotic restriction on broad spectrum antibiotic usage in the ICU of a developing country

Objective: To reduce rates of nosocomial pneumonia and cost of antibiotic therapy. Methods: By means of a policy implementation the following broad spectrum antibiotics were restricted to usage in the ICU for 72 hours: Cefepime, Meropenem, Imipenem, Tazocin, Polymixin B and Vancomycin, after an institutional based pharmacy and therapeutic committee approval. The ICU pharmacist would alert the ICU residents or consultants after 48 hours of the computer based antibiotic entry that the order would expire within hours. Telephone approval was obtained followed by a formal consultation if deemed necessary by the ID specialist or primary team. Antibiotic usage was standardized by defined daily doses (DDDs) per 1000/patient-days. Results: A cumulative 34% reduction was seen in the use of all broad spectrum antibiotics in our ICU after the enforcement of the antibiotic restriction policy. The largest reduction was seen in the use of Tazocin (190 DDDs) and Meropenem (60 DDDs). The policy resulted in a reduction by 40% of overall broad spectrum antibiotic pharmacy costs. The number of multidrug resistant organisms has remained static but the ventilator associated pneumonia rates have declined.Conclusion: Streamlining the formulary to control antibiotic choices and the creation of a restriction program using the expertise of infectious disease physicians resulted in significant reductions in the use of and expenditure for broad spectrum antibiotics (JPMA 57:484:2007)

PAKistan Study of prEmature coronary atHerosclerosis in young AdulTs (PAK-SEHAT): A prospective longitudinal study protocol investigating the prevalence, severity and determinants of atherosclerotic cardiovascular disease in the young adult Pakistani population

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity, mortality and health expenditures worldwide. Despite having higher ASCVD in the Pakistani population, data on subclinical coronary atherosclerosis in young Pakistanis remain scarce. The PAKistan Study of prEmature coronary atHerosclerosis in young AdulTs (PAK-SEHAT) aims to assess the prevalence, severity and determinants of subclinical coronary atherosclerosis among Pakistani men (35-60 years) and women (35-65 years) free of clinically symptomatic ASCVD and will assess 5-year rates of ASCVD events.Methods and analysis: PAK-SEHAT is an ongoing prospective cohort study with 2000 participants from all provinces of Pakistan who will be interviewed at the baseline along with phlebotomy, measurement of carotid intima-media thickness (CIMT) and coronary CT angiography (CCTA). Phlebotomy will be repeated at 2.5 years, whereas CIMT and CCTA will be repeated at 5 years. We will report the frequency of maximal coronary stenosis ≥50% and ≥70%, number of coronary vessels with plaque and the number of coronary segments affected per participant on CCTA. We will use Cox proportional hazards regression models to evaluate the association between baseline characteristics and incident ASCVD events during follow-up. These associations will be presented as HRs with 95% CIs.Ethics and dissemination: The study protocol was approved by the Tabba Heart Institute Institutional Review Board (THI/IRB/FQ/22-09-2021/016). All study procedures are consistent with the principles of the Declaration of Helsinki. Findings of the study will be disseminated via peer-reviewed publications and conference presentations.Trial registration number: NCT05156736

Psychiatric rating scales in Urdu: a systematic review

<p>Abstract</p> <p>Background</p> <p>Researchers setting out to conduct research employing questionnaires in non-English speaking populations need instruments that have been validated in the indigenous languages. In this study we have tried to review the literature on the status of cross-cultural and/or criterion validity of all the questionnaires measuring psychiatric symptoms available in Urdu language.</p> <p>Methods</p> <p>A search of Medline, Embase, PsycINFO and <url>http://www.pakmedinet.com</url> was conducted using the search terms; Urdu psychiatric rating scale, and Urdu and Psychiatry. References of retrieved articles were searched. Only studies describing either cross-cultural or criterion validation of a questionnaire in Urdu measuring psychiatric symptoms were included.</p> <p>Results</p> <p>Thirty two studies describing validation of 19 questionnaires were identified. Six of these questionnaires were developed indigenously in Urdu while thirteen had been translated from English. Of the six indigenous questionnaires five had had their criterion validity examined. Of the thirteen translated questionnaires only four had had both their cross-cultural and criterion validity assessed.</p> <p>Conclusion</p> <p>There is a paucity of validated questionnaires assessing psychiatric symptoms in Urdu. The BSI, SRQ and AKUADS are the questionnaires that have been most thoroughly evaluated in Urdu.</p

Electrochemical Behavior of Inductively Sintered Al/TiO2 Nanocomposites Reinforced by Electrospun Ceramic Nanofibers

This study is focuses on the investigation of the effect of using TiO2 short nanofibers as a reinforcement of an Al matrix on the corrosion characteristics of the produced nanocomposites. The TiO2 ceramic nanofibers used were synthesized via electrospinning by sol-gel process, then calcinated at a high temperature to evaporate the residual polymers. The fabricated nanocomposites contain 0, 1, 3 and 5 wt.% of synthesized ceramic nanofibers (TiO2). Powder mixtures were mixed for 1 h via high-energy ball milling in a vacuum atmosphere before being inductively sintered through a high-frequency induction furnace at 560 &deg;C for 6 min. The microstructure of the fabricated samples was studied by optical microscope and field emission scanning electron microscope (FESEM) before and after corrosion studies. Corrosion behavior of the sintered samples was evaluated by both electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization techniques (PPT) in 3.5% NaCl solution for one hour and 24-h immersion times. The results show that even though the percentage of ceramic nanofibers added negatively control corrosion resistance, it is still possible to increase resistance against corrosion for the fabricated nanocomposite by more than 75% in the longer exposure time periods

Gender differences in clinical outcomes after percutaneous coronary intervention-analysis of 15,106 patients from the Cardiac Registry of Pakistan database

There is a scarcity of data on gender differences in outcomes during and after percutaneous coronary intervention (PCI) in the South Asian population. We assessed the gender differences in in-hospital mortality and complications in patients who underwent PCI. We conducted a cross-sectional study of 15,106 patients from the CROP (Cardiac Registry of Pakistan) CathPCI database. Logistic regression was used to determine factors associated with in-hospital mortality (primary outcome), access site hematoma, and bleeding complications. Approximately 19.6% were women. Women were older (mean age = 57.3 vs 54.4 years) and had a higher prevalence of diabetes (49.3% vs 32.6%), hypertension (72.8% vs 56.4%), peripheral arterial disease (1.5% vs 1%), and cerebrovascular accident (1.2% vs 0.8%) than men (

Knowledge, attitude, and practices regarding infection control measures among medical students

Objective: To assess the knowledge, attitude and reported practices of medical students regarding infection control measures.Methods: The cross-sectional, questionnaire-based study was conducted at one public and one private medical university in Karachi from January to February 2016. The students enrolled were in their clinical years of the Bachelor of Medicine, Bachelor of Surgery course and their knowledge, attitude and practice were measured regarding infection control measures. SPSS 19 was used to analyse data.Results: There were 413 medical students with a mean age of 21.78±1.10 years. Overall, 206(49.9%) students were from the private university and 207(50.1%) from the public institution. Students from the private institution had better knowledge compared to those from the public institution regarding hand hygiene (p\u3c0.001), needlestick injuries (p\u3c0.001) and surgical scrubbing (p=0.007), as well as better reported practices regarding hand hygiene (p\u3c0.001) and surgical scrubbing (p=0.001).Conclusions: Knowledge and practices of medical students regarding the method of surgical scrubbing and needlestick injury protocols in particular needed improvement