Prescribing Pattern of Antibiotics among Hospitalized Patients with Urinary Tract Infection.

BACKGROUND: Urinary tract infection is one of the most common bacterial infections worldwide. It has become one of the most common cause for the hospitalization and sepsis. It is generally treated with antimicrobial agents and fluids. This study was conducted to study the prescribing pattern of antibiotic among hospitalized patients with urinary tract infection. METHODS: A descriptive cross-sectional study was conducted in Nepal Medical College Teaching Hospital, Attarkhel, Kathmandu from January 2022 to April 2022. Patients aged 18 years or above of both sex, admitted to various departments with the provisional diagnosis of urinary tract infection prescribed with antibiotics were included in the study. RESULTS: Out of 146 patients admitted with a diagnosis of urinary tract infection, the most commonly prescribed antibiotics during hospital stay were cephalosporin in 102 (69.9%) patients followed by combination of penicillin and beta-lactamase inhibitors (31, 21.2%) and fluoroquinolones (15, 10.3%). Ceftriaxone (78, 53.4%) alone was the most commonly prescribed antibiotic as empirical therapy followed by combination of piperacillin and tazobactam (22, 15.1%). One hundred and forty four (78.6%) patients were prescribed antibiotics from the watch group followed by the access group (21, 11.5 %). E. coli was the most common organism isolated in 29 (76.3%) patients. CONCLUSIONS: Cephalosporin was the commonest antibiotic group prescribed in hospitalized patients among which ceftriaxone was commonly prescribed as an empirical therapy. Among AWaRe classification, antibiotics from the watch group were commonly prescribed.

Antibiotics Self-Medication Practice Among Medical Students.

BACKGROUND: Self-medication of antibiotics is common among healthcare students due to their knowledge of pharmacology of antibiotics, which produces a false sense of confidence in self-diagnosis of disease conditions. Hence, this study was conducted to assess the practice of self-medication with antibiotics among medical students. METHODS: This questionnaire based descriptive, cross-sectional study was conducted in Nepal Medical College Teaching Hospital, Attarkhel, Kathmandu from September 2019 to February 2020 on the Bachelor of Medicine and Bachelor of Surgery students. RESULTS: Out of 405 students, 214 (52.8%) students had practiced antibiotics self-medication. The most commonly self-medicated antibiotics were azithromycin 126(58.9%), amoxicillin 67(31.3%), metronidazole 35(16.4%) and ciprofloxacin 14(6.5%) that were most commonly used for sore throat 93(43.5%), fever 82(38.3%), common cold 59(27.6%) and cough 43(20.1%).The common sources for self-medication were previous prescription 66 (30.8%), followed by own pharmacological knowledge 58 (27.1%). The most common reasons for practicing antibiotics self-medication were stated as previous experience of same illness 165 (77.1%), doctor's advice not deemed necessary 21 (9.8%) and save time 14 (6.6%). Large number of students agreed that antibiotics self-medication was not an acceptable practice 308(76.1%) and can lead to antimicrobial resistance 363(89.6%). CONCLUSIONS: More than half of the respondent medical students had practiced antibiotics self-medication. Sore throat was the commonest cause for it while the most commonly self-medicated antibiotic was azithromycin. Self-medication with antibiotics in medical students is concerning because they are future prescribers of antibiotics; who are supposed to promote rational use of antibiotics.

Dicer in Macrophages Prevents Atherosclerosis by Promoting Mitochondrial Oxidative Metabolism.

BACKGROUND: Alternative macrophage activation, which relies on mitochondrial oxidative metabolism, plays a central role in the resolution of inflammation and prevents atherosclerosis. Moreover, macrophages handle large amounts of cholesterol and triglycerides derived from the engulfed modified lipoproteins during atherosclerosis. Although several microRNAs regulate macrophage polarization, the role of the microRNA-generating enzyme Dicer in macrophage activation during atherosclerosis is unknown. METHODS: To evaluate the role of Dicer in atherosclerosis, Apoe-/- mice with or without macrophage-specific Dicer deletion were fed a high-fat diet for 12 weeks. Anti-argonaute 2 RNA immunoprecipitation chip and RNA deep sequencing combined with microRNA functional screening were performed in the Dicer wild-type and knockout bone marrow-derived macrophages to identify the individual microRNAs and the mRNA targets mediating the phenotypic effects of Dicer. The role of the identified individual microRNA and its target in atherosclerosis was determined by tail vein injection of the target site blockers in atherosclerotic Apoe-/- mice. RESULTS: We show that Dicer deletion in macrophages accelerated atherosclerosis in mice, along with enhanced inflammatory response and increased lipid accumulation in lesional macrophages. In vitro, alternative activation was limited whereas lipid-filled foam cell formation was exacerbated in Dicer-deficient macrophages as a result of impaired mitochondrial fatty acid oxidative metabolism. Rescue of microRNA (miR)-10a, let-7b, and miR-195a expression restored the oxidative metabolism in alternatively activated Dicer-deficient macrophages. Suppression of ligand-dependent nuclear receptor corepressor by miR-10a promoted fatty acid oxidation, which mediated the lipolytic and anti-inflammatory effect of Dicer. miR-10a expression was negatively correlated to the progression of atherosclerosis in humans. Blocking the interaction between ligand-dependent nuclear receptor corepressor and miR-10a by target site blockers aggravated atherosclerosis development in mice. CONCLUSIONS: Dicer plays an atheroprotective role by coordinately regulating the inflammatory response and lipid metabolism in macrophages through enhancing fatty acid-fueled mitochondrial respiration, suggesting that promoting Dicer/miR-10a-dependent metabolic reprogramming in macrophages has potential therapeutic implications to prevent atherosclerosis.