Deranged Liver Function Test After COVID 19 Vaccination: A Rare Presentation With Review Of Literature.

Word Health Organization declared COVID 19 infection as pandemic in 2020. Since then different countries had started working on vaccination. After multiple trials different vaccinations got approved. The first vaccine to be received in Pakistan was Sinopharm and was provided to nearly all health care professionals on priority basis. The safety profile of different vaccines were satisfactory and there were very few side effects reported till date. We are reporting the first case in Pakistan where a female health care professional developed vaccination induced deranged liver function test with delayed but complete recovery. Extensive workup was done to rule out all other differentials of deranged liver function test.

Silver nanoparticles stabilized in polymer hydrogels for catalytic degradation of azo dyes.

Fabrication of poly-(N-isopropylmethacrylamide-co-methacrylic acid) [p(NMA)] microgels to be utilized as microreactors to synthesize stable Ag nanoparticles for catalytic reductive degradation of dyes has been addressed in this work. Both p(NMA) microgel and Ag-p(NMA) hybrid microgel systems have been analyzed by Fourier transform infra-red and Dynamic light scattering, Ultraviolet-Visible spectroscopy, X-ray diffraction and Transmission electron microscopy. Catalytic activity of Ag-p(NMA) towards reductive degradation of Congo Red (CR), Methyl Orange (MO) and Alizarin Yellow (AY) was investigated under different operating conditions. Spectrophotometry was employed to check the progress of reaction while the rate constant (kapp) value of degradation reaction was determined under various conditions to optimize reaction parameters for rapid and economical degradation of these dyes. An increase in kapp value was observed by increasing feed content of dye up to a certain value that decreases again by further increment in dye concentration which reflects that catalysis follows Langmuir-Hinshelwood mechanism. A gradual increase in the kapp value was also observed with increasing quantity of hybrid microgel used as a catalyst. By comparing kapp values of degradation of aforementioned dyes, it was found that Ag-p(NMA) hybrid microgel gives better activity for MO dye degradation in comparison to catalytic degradation of CR and AY.

Carbon Nanotube Reinforced High Density Polyethylene Materials for Offshore Sheathing Applications.

Multiwall carbon nanotube (CNT)-filled high density polyethylene (HDPE) nanocomposites were prepared by extrusion and considered for their suitability in the offshore sheathing applications. Transmission electron microscopy was conducted to analyse dispersion after bulk extrusion. Monolithic and nanocomposite samples were subjected to accelerated weathering and photodegradation (carbonyl and vinyl indices) characterisations, which consisted of heat, moisture (seawater) and UV light, intended to imitate the offshore conditions. The effects of accelerated weathering on mechanical properties (tensile strength and elastic modulus) of the nanocomposites were analysed. CNT addition in HDPE produced environmentally resilient nanocomposites with improved mechanical properties. The energy utilised to extrude nanocomposites was also less than the energy used to extrude monolithic HDPE samples. The results support the mass substitution of CNT-filled HDPE nanocomposites in high-end offshore applications.

In-silico determination of pKa and logp values of some isoniazid synthetic analogues using Marvin software.

Among the physicochemical properties, pKa and LogP values help us in studying drug parameters like ADME and could be predicted to some extent. With this view, here we wish to predict these two properties of our previously synthesized biologically active derivatives of isoniazid using on-line available program Marvin, a Java-based chemical software application frequently used for chemical modeling. According to Marvin, pKa values predicted 99.99% unionized states of INH and some derivatives at physiological pH 7.4. Marvin calculated LogP values estimated good oral absorption for all the synthesized compounds. Therefore it can be said that the findings of the study emerged in an ideal region that permits the formulation of these derivatives. Since this was just a theoretical study, it demands more experimentation to determine accurate situation.

Customizable Ceramic Nanocomposites Using Carbon Nanotubes.

A novel tweakable nanocomposite was prepared by spark plasma sintering followed by systematic oxidation of carbon nanotube (CNT) molecules to produce alumina/carbon nanotube nanocomposites with surface porosities. The mechanical properties (flexural strength and fracture toughness), surface area, and electrical conductivities were characterized and compared. The nanocomposites were extensively analyzed by field emission scanning electron microscopy (FE-SEM) for 2D qualitative surface morphological analysis. Adding CNTs in ceramic matrices and then systematically oxidizing them, without substantial reduction in densification, induces significant capability to achieve desirable/application oriented balance between mechanical, electrical, and catalytic properties of these ceramic nanocomposites. This novel strategy, upon further development, opens new level of opportunities for real-world/industrial applications of these relatively novel engineering materials.

In vitro Spectroscopic studies on drug interaction of cefpodoxime proxetil and H2 receptor blockers.

One of the relatively advance 3rd generation cephalosporins, cefpodoxime proxetil, is being used all-around. Generally, these are used for the cure of infections allied to urinary and respiratory tract. These cephalosporins have showed a remarkable in vitro activity against many strains of bacteria which are resistant to other orally used active medicinal substances. It is the first oral 3rd generation cephalosporin to be used in the cure of skin infections. The practice of H2 receptor antagonists, concerning lots of treatments recommended in patients with different types of ulcers and allergic urticarial condition, is raising hazards of unwanted secondary outcomes and drug interactions. Learning of in-vitro interaction between cefpodoxime poxetil and H2 blockers (Ranitidine, Famotidine and Cimetidine) were examined applying UV/Visible spectrophotometry and Infrared spectrometry. In the existence of H2 receptor blockers, the cefpodoxime proxetil availability was found to be decreased in vitro only under specific conditions. Furthermore, complexes of Cefpodoxime proxetil-H2 receptor antagonists were manufactured approving the interaction of these drugs. Finally, the above mentioned spectrophotometric techniques were employed to examine the complexes formed (Cefpodoxime proxetil-cimetidine, cefpodoxime proxetil-famotidine and cefpodoxime proxetil-ranitidine).

Development and validation of RP-HPLC method for simultaneous determination of cefpodoxime proxetil and H2 receptor antagonists in pharmaceutical dosage forms.

A new method on RP-HPLC is devised and validated, as per ICH guidelines, for the synchronous estimation of cefpodoxime proxetil and H2-receptor antagonits that are Cimetidine, Famotidine and Ranitidine. The method is simple, accurate, expeditious, reproducible, robust and precise. Chromatography was done on a C18 (250 x 4.6mm) column with methanol: water as mobile phae in the ratio of 70:30 (v/v), pumped at a flow rate of 1ml/min and pH was maintained using 85% ortho-phosphoric acid at 3. The λ max 240 nm was preferred for UV detection. A good linear relationship was attained, over the concentration ranges of 20-70 µg/ml and 5-30µg/ml, for cefpodoxime proxetil and H2 blockers respectively, with a correlation coefficient of R= 0.9987 to 0.9992. The method was validated and found precised (i.e. intra day and interday analysis) with RSD <2%. LOD and LOQ observations were under 0.4806 to 2.6069µg/ml which proved the method to be sensitive. The method provided satisfactory results of robustness and reproducibility, when validated and applied successfully for analysis of dosage forms.

Cereal Cyst Nematodes: A Complex and Destructive Group of Heterodera Species.

Small grain cereals have served as the basis for staple foods, beverages, and animal feed for thousands of years. Wheat, barley, oats, rye, triticale, rice, and others are rich in calories, proteins, carbohydrates, vitamins, and minerals. These cereals supply 20% of the calories consumed by people worldwide and are therefore a primary source of energy for humans and play a vital role in global food and nutrition security. Global production of small grains increased linearly from 1960 to 2005, and then began to decline. Further decline in production is projected to continue through 2050 while global demand for these grains is projected to increase by 1% per annum. Currently, wheat, barley, and oat production exceeds consumption in developed countries, while in developing countries the consumption rate is higher than production. An increasing demand for meat and livestock products is likely to compound the demand for cereals in developing countries. Current production levels and trends will not be sufficient to fulfill the projected global demand generated by increased populations. For wheat, global production will need to be increased by 60% to fulfill the estimated demand in 2050. Until recently, global wheat production increased mostly in response to development of improved cultivars and farming practices and technologies. Production is now limited by biotic and abiotic constraints, including diseases, nematodes, insect pests, weeds, and climate. Among these constraints, plant-parasitic nematodes alone are estimated to reduce production of all world crops by 10%. Cereal cyst nematodes (CCNs) are among the most important nematode pests that limit production of small grain cereals. Heavily invaded young plants are stunted and their lower leaves are often chlorotic, forming pale green patches in the field. Mature plants are also stunted, have a reduced number of tillers, and the roots are shallow and have a "bushy-knotted" appearance. CCNs comprise a number of closely-related species and are found in most regions where cereals are produced.

Genomes of parasitic nematodes (Meloidogyne hapla, Meloidogyne incognita, Ascaris suum and Brugia malayi) have a reduced complement of small RNA interference pathway genes: knockdown can reduce host infectivity of M. incognita.

The discovery of RNA interference (RNAi) as an endogenous mechanism of gene regulation in a range of eukaryotes has resulted in its extensive use as a tool for functional genomic studies. It is important to study the mechanisms which underlie this phenomenon in different organisms, and in particular to understand details of the effectors that modulate its effectiveness. The aim of this study was to identify and compare genomic sequences encoding genes involved in the RNAi pathway of four parasitic nematodes: the plant parasites Meloidogyne hapla and Meloidogyne incognita and the animal parasites Ascaris suum and Brugia malayi because full genomic sequences were available-in relation to those of the model nematode Caenorhabditis elegans. The data generated was then used to identify some potential targets for control of the root knot nematode, M. incognita. Of the 84 RNAi pathway genes of C. elegans used as model in this study, there was a 42-53 % reduction in the number of effectors in the parasitic nematodes indicating substantial differences in the pathway between species. A gene each from six functional groups of the RNAi pathway of M. incognita was downregulated using in vitro RNAi, and depending on the gene (drh-3, tsn-1, rrf-1, xrn-2, mut-2 and alg-1), subsequent plant infection was reduced by up to 44 % and knockdown of some genes (i.e. drh-3, mut-2) also resulted in abnormal nematode development. The information generated here will contribute to defining targets for more robust nematode control using the RNAi technology.

Problem based learning and its implementation: faculty and student's perception.

BACKGROUND: Problem based learning (PBL) is perhaps the most innovative instructional method implemented in medical education after its introduction. The objective of the study was to evaluate faculty and students' perception about problem based learning and its implementation. METHODS: The Mixed method sequential design was used to conduct this cross sectional study at Lahore Medical and Dental College (LMDC) from April to June 2012. In the first phase a survey was conducted on 25 faculty members and 235 students on the basis of non-probability convenience sampling and then 3 teachers and 5 students were interviewed in depth. The analyses of qualitative and quantitative data were integrated in the final interpretation phase to draw a conclusion. RESULT: Faculty (96%) and students (73.2%) consider PBL more interesting as compared to conventional teaching. Faculty (56%) and students (43.8%) thinks PBL time-consuming as compared to conventional method. 80 % faculty and 73.2% students support introducing PBL at LMDC but 88% faculty and 72% student thought that faculty training is required for its implementation. 56% Faculty were of the view that workload cannot be managed by present faculty but 51.9% student did not agree with the faculty. Almost 50% of participants thought that clinical faculty is sufficiently available for preparing clinical scenario. Both faculty (76%) and students (71.9%) agreed that PBL help in producing better result in examination. Annual intake of student at LMDC is considered adequate by 48% faculty and 41.9% students. CONCLUSION: PBL is popular among students and faculty of medical college. They feel it a better system and can be implemented after proper planning.

Highly efficient aramid fiber supported polypropylene membranes modified with reduced graphene oxide based metallic nanocomposites: antimicrobial and antiviral capabilities.

Polypropylene hybrid polymeric membranes with aramid support have been fabricated using Thermally Induced Phase Separation (TIPS). Different modifying materials, such as metallic nanoparticles and reduced graphene oxide (rGO), improve the properties of these membranes. The nanomaterials and the fabricated membranes have been characterized with FTIR spectrometer, SEM and UV-Vis Spectrophotometer. Following that, the disinfection capabilities of the fabricated hybrid membranes were investigated. The antibacterial capability of the membranes is established through the testing of the membranes against bacterial strains S. aureus and E. coli, whereas the antiviral evaluation of the membranes was made against H9N2 and IBV strains. This research aims to develop advanced hybrid membranes that effectively disinfect water by incorporating novel nanomaterials and optimizing fabrication techniques.

Fabrication of NIPMAM based polymer microgel network assisted rhodium nanoparticles for reductive degradation of toxic azo dyes.

The aim of this study was to prepare poly-N-isopropylmethacrylamide-co-acrylic acid-acrylamide [p-(NIPMAM-co-AA-AAm)] via precipitation polymerization in an aqueous medium. Rhodium nanoparticles were formed in the microgel network by an in-situ reduction technique with the addition of sodium borohydride as a reducing agent. Pure p-(NIPMAM-co-AA-AAm) and hybrid microgels [Rh-(p-NIPMAM-co-AA-AAm)] microgels were examined by using UV-Visible, FTIR (Fourier Transform Infrared), SEM (Scanning Electron Microscopy), TEM (Transmission Electron Microscopy), DLS (Dynamic Light Scattering) and XRD (X-Ray Diffraction) techniques. The catalytic activities of the hybrid microgel [Rh-(p-NIPMAM-co-AA-AAm)] for the degradation of azo dyes such as alizarin yellow (AY), congo red (CR), and methyl orange (MO) were compared and the mechanism of the catalytic action by this system was examined. Various parameters including the catalyst amount and dye concentration influenced the catalytic decomposition of azo dyes. In order to maximize the reaction conditions for the dye's quick and efficient decomposition, the reaction process was monitored by spectroscopic analysis. The rate constants for reductive degradation of azo dyes were measured under various conditions. When kapp values were compared for dyes, it was found that [Rh-(p-NIPMAM-co-AA-AAm)] hybrid microgels showed superior activity for the degradation of MO dyes compared to the reductive degradation of CR and AY.

Efficacy and safety of fezolinetant for vasomotor symptoms in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Vasomotor symptoms (VMS), such as hot flashes and night sweats, are highly prevalent and burdensome for women experiencing menopausal transition. Fezolinetant, a selective neurokinin 3 receptor (NK3R) antagonist, is a potential therapeutic option for mitigating VMS. OBJECTIVES: Our aim is to assess the efficacy and evaluate the safety profile of fezolinetant compared with placebo in post-menopausal women suffering from VMS, by pooling all the relevant data and reflecting the most current evidence. SEARCH STRATEGY/SELECTION CRITERIA: An extensive literature search was performed in the PubMed, Medline and Cochrane Library databases from inception until June 2023 to identify relevant trials. DATA COLLECTION AND ANALYSIS: Mean differences (MDs) and 95% confidence intervals (CIs) were calculated for continuous outcomes. Risk ratios (RRs) were calculated for dichotomous outcomes. All statistical analyses were performed using R Statistical Software. MAIN RESULTS: A total of six randomized controlled trials were added. For the frequency of daily VMS, the combined pooled result favored the fezolinetant group over placebo (MD -2.38, 95% CI -2.64 to -2.12; P < 0.001, I2 = 0%). For the severity of daily VMS, fezolinetant was again found to be superior to the placebo group (MD -0.40, 95% CI -0.51 to -0.29; P < 0.001, I2 = 70%). Fezolinetant (120 mg) consistently demonstrated a significant reduction in the severity of daily moderate/severe VMS compared with other doses at both 4 and 12 weeks. Patient-reported outcomes (PROs) of Greene Climacteric Scale (GCS), PROMIS the Sleep Disturbance Short Form 8b and Menopause-Specific Quality of Life (MENQoL) scores indicated significant improvement with fezolinetant. No significant difference in efficacy of fezolinetant at 4 and 12 weeks were observed in any outcome. As for safety, no significant differences in the treatment emergent adverse events at 12 weeks were found between fezolinetant and placebo. CONCLUSIONS: Our study significantly favors fezolinetant over placebo regarding the primary efficacy outcomes of daily moderate to severe VMS frequency and severity, including PROs, while both the groups are comparable in terms of treatment emergent adverse events. Further studies are needed to confirm these findings.

Reinforcement of single-walled carbon nanotubes on polydimethylsiloxane membranes for CO2, O2, and N2 permeability/selectivity.

In this study, PDMS incorporated with SWCNTs have been fabricated via solution casting method for industrial applications and characterized by the analyses of SEM, FTIR, TGA, AFM, and MST. The modified membranes were further analyzed for CO2, O2, and N2 gas permeability. The strategic membranes have five different weight ratios (0.013, 0.025, 0.038, 0.050, 0.063) compared to neat PDMS membranes. The even distribution of SWCNTs in PDMS provided results that showed improvement in thermal stability. However, mechanical strength has been weakened with increased concentration of nanofiller because of the increase in the number of SWCNTs by increases that imperfections become more severe. The designed polymeric membranes with good thermal stability and adequate mechanical strength can be used for the selectivity and permeability of CO2, O2, and N2 gases. The effect of the PDMS-SWCNTs on gas permeability has been studied. 0.063 wt.% SWCNTs presented the maximum permeability of CO2 gas while maximum O2 and N2 gas permeability have been obtained by 0.013 wt.% SWCNTs. The ideal selectivity of mixed (50:50) gas conditions has been tested. The maximum CO2/N2 ideal selectivity was obtained by 0.050 and 0.063 wt.% SWCNTs while maximum O2/N2 ideal selectivity obtained by 0.050 wt.% SWCNTs. Therefore, the fabrication of this novel SWCNTs-PDMS membrane may lead to separating the industrial exhaust and be used as a potential membrane for environmental remediation in the future.

Multiplex CRISPR-Cas9 Gene-Editing Can Deliver Potato Cultivars with Reduced Browning and Acrylamide.

Storing potato tubers at cold temperatures, either for transport or continuity of supply, is associated with the conversion of sucrose to reducing sugars. When cold-stored cut tubers are processed at high temperatures, with endogenous asparagine, acrylamide is formed. Acrylamide is classified as a carcinogen. Potato processors prefer cultivars which accumulate fewer reducing sugars and thus less acrylamide on processing, and suitable processing cultivars may not be available. We used CRISPR-Cas9 to disrupt the genes encoding vacuolar invertase (VInv) and asparagine synthetase 1 (AS1) of cultivars Atlantic and Desiree to reduce the accumulation of reducing sugars and the production of asparagine after cold storage. Three of the four guide RNAs employed induced mutation frequencies of 17-98%, which resulted in deletions, insertions and substitutions at the targeted gene sites. Eight of ten edited events had mutations in at least one allele of both genes; for two, only the VInv was edited. No wild-type allele was detected in both genes of events DSpco7, DSpFN4 and DSpco12, suggesting full allelic mutations. Tubers of two Atlantic and two Desiree events had reduced fructose and glucose concentrations after cold storage. Crisps from these and four other Desiree events were lighter in colour and included those with 85% less acrylamide. These results demonstrate that multiplex CRISPR-Cas9 technology can generate improved potato cultivars for healthier processed potato products.

Synergistic effect of GO/ZnO loading on the performance of cellulose acetate/chitosan blended reverse osmosis membranes for NOM rejection.

Declining freshwater resources along with their pollution are threatening the life existence on earth. To meet the freshwater demand, one of the most appropriate and possible ways which has been adopted all over the world is to reuse wastewater by removing its impurities. Among many water pollutants, natural organic matter (NOM) is found to be responsible as major precursor for the formation of other pollutants. Removal of NOM from wastewater is being done by using membrane filtration systems incorporated with certain nanofillers to increase membranes efficiency and permeability. In this study, novel nanocomposite reverse osmosis (RO) membranes were prepared using cellulose acetate and chitosan in N,N-Dimethyl formamide. Graphene oxide (GO) nanosheets and zinc oxide (ZnO) in different concentration were loaded to modify the membranes for tuning their RO performance. The confirmation of the functional groups is demonstrated by Fourier transform infrared spectroscopy which revealed the specific peaks indicating the formation of the nano-composite membranes. The surface morphology was studied by scanning electronic microscopy which shows a gradual transformation of the membrane surface from voids-free to macro-voids filled surface up to threshold concentration of GO and ZnO. The thermal properties of GO based membranes were analyzed using thermogravimetric analysis and differential scanning calorimetry. The uniform interaction of the GO and ZnO with polymers induced the remarkable thermal properties of the synthesized membranes. Permeate flux and contact angle measurements were considered to estimate their water content (96%) capacity and NOM rejection (96%) using 0.1 ppm humic acid solution. The permeate flux, NOM rejection and the water content changed directly with GO and inversely with ZnO wt% in the membranes up to GO5 (GO:0.14: ZnO:0.03) whereas the contact angle exhibited the inverse relationship with GO and ZnO concentration in casting solution of the synthesized membranes. Hence it can be concluded that prepared RO membranes are suitable for NOM rejection and recommended for water treatment.

Outcomes of COVID-19 patients with acute kidney injury and longitudinal analysis of laboratory markers during the hospital stay: A multi-center retrospective cohort experience from Pakistan.

The frequency of acute kidney injury (AKI) in COVID-19 patients can be varied and related to worse outcomes in the disease population. AKI is common among hospitalized patients with COVID-19, particularly the ones needing critical care. This study was conducted in order to determine the outcomes of hospitalized patients with prolonged hospital stays who suffered from COVID-19 associated AKI. It was conducted as a multi-centered, retrospective, cohort study, and including all patients who were diagnosed on COVID-19 PCR. End-stage renal disease patients on hemodialysis were excluded. The cohort included 1069 patients, with 68% males, mean age of 56.21 years, and majority within 50 to 75 years age group (60%). Mean disease onset was 14.43 ± 7.44 days and hospital stay was 7.01 ± 5.78 days. About 62% of patients stayed in intensive care and 18% of them were on invasive ventilation. The mortality rate was 27%. Frequency of AKI was 42%, around 14% of them were resolving during hospital stay and other 28% worsened. The mortality rate was significantly higher with AKI (OR: 4.7, P < .001). Alongside AKI, concomitant liver dysfunction was also significantly contributing to mortality (OR: 2.5), apart from ICU stay (OR: 2.9), invasive ventilation (OR: 9.2), and renal replacement therapy (OR: 2.4). Certain laboratory markers were associated with AKI throughout in-hospital stay.

Functional bioinspired nanocomposites for anticancer activity with generation of reactive oxygen species.

Cancer is a debilitating and deadly disease caused by the uncontrolled growth of aberrant cell populations. This disease cannot always be controlled with traditional therapies and medicines. Different medicines are being used for this purpose, however these medicines have their side effects and are harmful to healthy cells. A better way to cure cancer disease is by limiting the agglomeration of cancer cells, minimizing their growth and their population by destroying these harmful cells. This could be achieved by controlling the function of mitochondria and DNA in cancer cells with the use of biocompatible materials with tuneable physical properties. Accordingly, research is ongoing as to the use of nanomaterials and nanotechnology in medicine. Zinc oxide semiconductor nanoparticles have displayed good anticancer behaviour. They have unique properties such as biocompatibility, good stability, and are environmentally friendly. Owing to these characteristics, they are focused on biological applications such as drug delivery and cancer therapy. In the present research work, zinc oxide, titanium dioxide nanoparticles and titanium oxide-zinc oxide nanocomposites were successfully trailed for anti-cancer activity. Pure zinc oxide nanoparticles (ZnO NPs), titanium dioxide nanoparticles (TiO2 NPs) and their nanocomposites (TiO2+ZnO NPs) were prepared by the co-precipitation technique. The structural properties were investigated by X-ray diffraction, which confirmed the Wurtzite structure of pure ZnO NPs. The morphology of the NPs was checked by scanning electron microscopy. For incident light having a higher energy band gap of nanomaterials, the electrons are excited to the conduction band and these electrons generate reactive oxygen species (ROS). The efficacy of these nanomaterials was checked by exposing the NPs to the human liver cancer cell HepG2. The MTT assay describes anticancer activity via cell viability. The cell viability of composites was observed to be greater than pure ZnO NPs. Their results showed that the structure of ZnO NPs remains the same with composites of TiO2 NPs, but the band gap of the composite was intermediate for individual samples. It also showed that the anticancer activity of composites was also less than pure ZnO NPs which is due to the reduction of ROS generation. This is observed that nanocomposites of ZnO and TiO2 could be effective in the development of a treatment of human liver cancer cells.

Point prevalence probing of antimicrobial prescription patterns from a developing country.

BACKGROUND: Irrational use of antibiotics intensifies resistance and jeopardizes advances made in modern medicine. We aimed to conduct a baseline gap analysis survey on antibiotic prescription practices across Pakistan. RESEARCH DESIGN AND METHODS: This multi-centered cross-sectional survey was conducted at six public sector tertiary care hospitals from February 2021 to March 2021. Data related to various variables including hospital infrastructure, policies and practices, monitoring and feedback, and epidemiological, clinical, and antibiotic prescription for surveyed patients was collected using World Health Organization (WHO) Point Prevalence Survey (PPS) methodology. RESULTS: In a survey of 837 inpatients, 78.5% were prescribed antibiotics. Most commonly prescribed antimicrobial was ceftriaxone (21.7%), followed by metronidazole (17.3%), cefoperazone-sulbactam (8.4%), amoxicillin-clavulanate (6.3%), and piperacillin/tazobactam (5.9%). Surgical prophylaxis (36.7%) and community-acquired infections (24.7%) were the main reasons for antibiotic prescriptions. Single antibiotics were given to 46.7% of patients, 39.9% received a combination of two antibiotics, and 12.5% were prescribed three or more antibiotics. Among six hospitals surveyed, two had drug and therapeutic committees, three had infection prevention and control committees, and one had an antibiotic formulary. CONCLUSION: Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasize the importance of expanding antimicrobial stewardship programs among hospitals. Mentoring clinical teams could help rationalize antimicrobial use.

Association of neutrophil-to-lymphocyte ratio with clinical, pathological, radiological, laboratory features and disease outcomes of invasive breast cancer patients: A retrospective observational cohort study.

Inflammatory conditions play part in the progression of malignancies, and markers signifying growth of these factors can indicate prognosis. Neutrophil-to-lymphocyte (NLR) is used as a marker of subclinical inflammation that may become an integral part of workup to indicate prognosis and associated pathology. This study aims to explore the association of NLR ratio with clinical characteristics, radiological assessment and staging, histopathology, and disease outcomes of breast cancer. A retrospective cohort study was conducted in a tertiary care center to include breast cancer patients that were diagnosed between January 2001 and December 2020. Data including tumor size, lymph nodes, metastasis, histological grading, ER/PR/HER2-neu status, molecular subtypes, clinical staging); nodal findings (sentinel and axillary); pathology from frozen section; and disease outcomes were assessed. Multivariable regression and Kaplan-Meier survival curves were employed to indicate the association of NLR with breast cancer features and disease-free survival. A total of 2050 patients had a median age of 50 years, median NLR levels of 2.14, most common pathology ductal followed by lobular, and most common site of metastasis being lungs followed by bones. Disease-free rate was 7.6%, and a recurrence rate of 1.8%, while 1.6% deaths were reported. NLR was found associated with age, treatment outcomes, tumor size, lymph nodes, metastasis and clinical staging. Other positive correlations were with Ki67 proliferation index, molecular subtypes, and tumor size on frozen section (at transverse and craniocaudal dimensions). Negative correlations were seen with estrogen and progesterone receptors. However, NLR was not found predictable of disease-free survival (P = .160). Significant predictors of disease-free survival were histological grading, ER, PR status, molecular subtype, and Ki67 proliferation index. NLR being a readily available marker has shown novel findings in its association with tumor staging, disease outcomes and characteristics of breast malignancy.