Prescribing Patterns of Antibiotics in Tertiary Care Hospital of Abbottabad, Khyber Pakhtunkhwa

Background: The antibiotic resistance is on a rise globally due to irrational use. This survey evaluated the prescribing patterns of antibiotics in tertiary care hospital in Abbottabad. Study type,settings& duration: This observational, descriptive, and prospectivestudy was carried outin divisions of Gynecology, General Medicine, Pediatric Surgery,Orthopedicsand Pulmonology, Tertiary Care Hospital, Abbottabad, KPK from 2019to 2020. Methodology:An antibiotic prescribing pattern survey was carried out among the patients of hospital. Medical case sheets of patients and drug charts were used to record in standardized performs. Results:Total 203 patients on antibiotics were included in the study. Antibiotics prescribed in Gynae Department were UTIs 57%, LSCS 35%, NVD 20%, wound infection 16.6%, D&C 10%, SVD 10%, RTIs 6.6%, Extraction 6.6%, Stitch removal 6.6%, Hysterectomy 5%, Ectopic Pregnancy 5% post ovectomy 3.3% Uterine bleeding 3.3%, & most common dosage form:, Tablets: 56.6%,Capsules: 40%, Syrups:3.33% in Pead’s Department URTI 62%, Cold and fever 10%, Eye Infection 8%, LRTI 6% , in dosage form: Syrups: 82%. Drops: 12%, Injection: 4%, Tablet: 2%. In Surgical ward Ceftro:35%,Titan:20%, Grasil:20%,Flagyl:10%, Kefzol:5%, Ampiclox:5%, Bestrix:5%. In General OPD, RTI 48%, Wound Infection 18%, fever 14%, UTIs 8.33%, Pneumonia 1.66% the most prescribed dosage form, Injection :28%, Syrup:12%, Drops:8.0% Tablets: 8.0%, Capsules: 6.0%. In orthopedic ward: Grasil:22.2%, Amikacin:19.3%, Oxidil:18.8%, Titan:11.11%, Cefbactam:11.11%, Kefzol:10%, Sulperazone:5.55%, , Augmentin:5.55%, Gentacin:2.7%, Most prescribed dosage form: Injection :100%,Tablets, Capsules and Syrup 0%. In Pulmonary disease department Respiratory tract infection 55% and in Bronchitis are 35%. Most commonly prescribed dosage form: Injection :50%, Tablets :45%, Capsules :5%, Syrup, and Drops 0%. Mainly Augmentin was prescribed as a combination therapy. Most antibiotics were prescribed for 5-7 days. Conclusion:The survey indicates that the use of antibiotic in tertiary care hospital is very high and is not rational

Association of rs10490924 in ARMS2/HTRA1 with age-related macular degeneration in the Pakistani population

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Variants in the ASB10 Gene Are Associated with Primary Open Angle Glaucoma.

BACKGROUND:Recently nonsynonymous coding variants in the ankyrin repeats and suppressor of cytokine signaling box-containing protein 10 (ASB10) gene were found to be associated with primary open angle glaucoma (POAG) in cohorts from Oregon and Germany, but this finding was not confirmed in an independent cohort from Iowa. The aim of the current study was to assess the role of ASB10 gene variants in Pakistani glaucoma patients. METHODS:Sanger sequencing of the coding exons and splice junctions of the ASB10 gene was performed in 30 probands of multiplex POAG families, 208 sporadic POAG patients and 151 healthy controls from Pakistan. Genotypic associations of individual variants with POAG were analyzed with the Fisher's exact or Chi-square test. RESULTS:In total 24 variants were identified in POAG probands and sporadic patients, including 11 novel variants and 13 known variants. 13 of the variants were nonsynonymous, 6 were synonymous, and 5 were intronic. Three nonsynonymous variants (p.Arg49Cys, p.Arg237Gly, p.Arg453Cys) identified in the probands were not segregating in the respective families. This is not surprising since glaucoma is a multifactorial disease, and multiple factors are likely to be involved in the disease manifestation in these families. However a nonsynonymous variant, p.Arg453Cys (rs3800791), was found in 6 sporadic POAG patients but not in controls, suggesting that it infers increased risk for the disease. In addition, one synonymous variant was found to be associated with sporadic POAG: p.Ala290Ala and the association of the variant with POAG remained significant after correction for multiple testing (uncorrected p-value 0.002, corrected p-value 0.047). The cumulative burden of rare, nonsynonymous variants was significantly higher in sporadic POAG patients compared to control individuals (p-value 0.000006). CONCLUSIONS:Variants in ASB10 were found to be significantly associated with sporadic POAG in the Pakistani population. This supports previous findings that sequence variants in the ASB10 gene may act as a risk factor for glaucoma

Amino acid conservation of amino acids of ASB10 in different species.

<p>Mutated amino acids conserved in humans and other species are shown in blue color.</p

Pedigrees of consanguineous Pakistani glaucoma families, with a probable autosomal dominant inheritance pattern.

<p>Segregation analysis of three nonsynonmous variants: (<b>1A)</b> represents segregation of p.Arg49Cys, <b>(1B)</b> segregation of p.Arg237Gly change, <b>(1C)</b> shows p.Arg453Cys variant segregation, Variant allele is indicated with an “M1(p.Arg49Cys), M2(p.Arg237Gly) and M3(p.Arg453Cys)”, and the wildtype allele indicated with “WT” for the three variations. This demonstrates that the variants do not segregate with the disease in the respective families. The proband is indicated with an arrow.</p

Results of logistic regression analysis for Genotype and allele frequency of SNPs rs11720822 in <i>PDIA5</i> and rs2754511 in <i>BIRC6</i> in POAG, PCAG and PEXG patients and control individuals.

a<p>Age and gender adjusted OR and (95%CI) from multivariate logistic regression analysis; p^bBonferoni corrected p values; ^cOR and (95%CI) from univariate logistic regression analysis; Est., estimates</p

Family MRQ14 homozygous and compound heterozygous variant validation using Sanger sequencing and <i>in silico</i> pathogenecity predictions.

<p>NM, mRNA accession number; PhyloP, Phylogenetic P-values; Polyphen, Polymorphism phenotyping; SIFT, Sorting intolerance from tolerance, Mutation taster (<a href="http://www.mutationtaster.org" target="_blank">http://www.mutationtaster.org</a>).</p><p>Family MRQ14 homozygous and compound heterozygous variant validation using Sanger sequencing and <i>in silico</i> pathogenecity predictions.</p

The sequencing chromatograms of the families MRQ14, MRQ11 and MRQ15.

<p>(<b>A</b>) Shows the panels containing the region with the identified <i>KMT2B</i> mutation in family MRQ14: ancestral (left panel), heterozygous (middle panel) and variant (right panel) (<b>B</b>) shows the region containing the identified <i>ZNF589</i> mutation in family MRQ11: ancestral (left panel), heterozygous (middle panel) and variant (right panel). (<b>C</b>) shows the <i>de novo</i> variant of <i>HHAT</i> in family MRQ15: ancestral (left panel), heterozygous (right panel).</p

Pedigree of families (A) MRQ14, (B) MRQ11 and (C) MRQ15.

<p>The segregation of mutation of <i>KMT2B</i>, <i>ZNF589</i> and <i>HHAT</i> are also in the pedigree. The symbol +/+ represents homozygous ancestral alleles, M/M is for homozygous variant alleles and +/M is for heterozygous carriers. In the panel B, the genotype of the father (III:1) has been deduced.</p