Irrational Use Research Articles

Detection of drug resistance in Escherichia coli from calves with diarrhea in the Tongliao region: an analysis of multidrug-resistant strains

IntroductionEscherichia coli is a major pathogen responsible for calf diarrhea, which has been exacerbated by the irrational and unscientific use of antimicrobial drugs, leading to significant drug resistance.MethodsThis study focused on the isolation and identification of E. coli from calf diarrhea samples in the Tongliao area of China. Isolation was conducted using selective media, Gram staining, and 16S rRNA sequencing. The minimum inhibitory concentration (MIC) of E. coli was determined through the microbroth dilution method. Additionally, the presence of antibiotic-resistant genes was detected, and multidrug-resistant strains were selected for whole-genome sequencing (WGS).ResultsThe results revealed that all 40 isolated strains of E. coli exhibited resistance to sulfadiazine sodium, enrofloxacin, and ciprofloxacin, with 90% of the strains being susceptible to polymyxin B. Notably, strains 11, 23, and 24 demonstrated severe resistance. The detection rates of the antibiotic resistance genes TEM-1, TEM-206, strA, strB, qacH, and blaCTX were 100%, indicating a high prevalence of these genes. Moreover, the majority of strains carried antibiotic resistance genes consistent with their resistance phenotypes. WGS of strains 11, 23, and 24 revealed genome sizes of 4,897,185 bp, 4,920,234 bp, and 4,912,320 bp, respectively. These strains carried two, one, and two plasmids, respectively. The prediction of antibiotic resistance genes showed a substantial number of these genes within the genomes, with strain 24 harboring the highest number, totaling 77 subspecies containing 88 antibiotic resistance genes.DiscussionIn conclusion, all 40 isolated strains of E. coli from calf diarrhea in this study were multidrug-resistant, exhibiting a broad distribution of antibiotic resistance genes and mobile components. This poses a significant risk of horizontal gene transfer, highlighting the critical situation of antibiotic resistance in this region.

A possible alternative to antibacterial therapy in the treatment of acute rhinosinusitis

High incidence of acute rhinosinusitis in a population remains one of the topical issues in practical otolaryngology. Statistical data show an increasing trend towards transition of acute rhinosinusitis in patients into chronic rhinosinusitis. According to literary sources, the emergence of bacterial resistance to antibiotics is as a rule the major reason of protracted course of the disease. Unreasonable antibiotics prescription, irrational use and uncontrolled intake result in the rapid development of antibiotic resistance. In this context, the use of herbal medicines having not only antibacterial, but also mucolytic, fungicidal, antioxidant effects in the complex therapy is a modern solution for disease management. Respero Myrtol, a standardized myrtol-based medicine, has taken its rightful place in the therapy. This article is aimed to investigate the possibilities of the effective use of medicine containing standardized myrtol as its main ingredient in the treatment of acute rhinosinusitis (based on the review of literature). Research materials included scientific articles on aspects of acute rhinosinusitis in otorhinolaryngology practice that were published in domestic specialized periodicals of eLIBRARY and scientific databases Scopus, Web of Science, Medline from 2014 to 2024. The published literature was analysed using the cause-and-effect technique. A clinical example was dis-cussed. With regard to the analysis of scientific literature, a brief overview of the epidemiology, etiology, predisposing factors for the development, diagnosis and treatment of acute rhinosinusitis was provided. The article addresses relevant socio-economic issues related to acute rhinosinusitis, the problem of antibiotic resistance. The issues of improving acute rhinosinusitis treatments using a standardized myrtol medicine in complex therapy as an alternative to antibiotic therapy were brought to attention. As a result, the authors concluded that the use of Respero Myrtol contributes to the rapid relief of clinical symptoms of acute rhinosinusitis, improves the patient’s quality of life, and can be advised as an alternative to antibiotic therapy in uncomplicated course of the disease.

The Gasification and Pyrolysis of Biomass Using a Plasma System

This research paper analyzes the use of plasma technology to process biomass in the form of dried, mixed animal manure (dung containing 30% moisture). The irrational use of manure as well as huge quantities of it can negatively impact the environment. In comparison to biomass fermentation, the plasma processing of manure can greatly enhance the production of fuel gas, primarily synthesis gas (CO + H2). The organic part of dung, including the moisture, is represented by carbon, hydrogen, and oxygen with a total concentration of 95.21%, while the mineral part is only 4.79%. A numerical analysis of dung plasma gasification and pyrolysis was conducted using the thermodynamic code TERRA. For 300–3000 K and 0.1 MPa pressure, the dung gasification and pyrolysis were calculated with 100% dung + 25% air and 100% dung + 25% nitrogen, respectively. Calculations were performed to determine the specific energy consumption of the process, the composition of the products of gasification, and the extent of the carbon gasification. At 1500 K, the dung gasification and pyrolysis consumed 1.28 and 1.33 kWh/kg of specific energy, respectively. A direct-current plasma torch with a power rating of 70 kW and a plasma reactor with a dung processing capacity of 50 kg/h were used for the dung processing experiments. The plasma reactor consumed 1.5 and 1.4 kWh/kg when pyrolyzing and gasifying the dung. A maximum temperature of 1887 K was reached in the reactor. The plasma pyrolysis of dung and the plasma–air gasification of dung produced gases with specific heats of combustion of 10,500 and 10,340 kJ/kg, respectively. Calculations and experiments on dung plasma processing showed satisfactory agreement. In this research, exergy analysis was used to quantify the efficiency of the plasma gasification of biomass. One of the research tasks was to develop a methodology and establish standards for the further standardization of monitoring the toxic emissions of dioxins, furans, and Benzo[a]pyrene.

Flemish consensus statement on the prevention, diagnosis and treatment of urinary tract infections in older nursing home residents.

Urinary tract infections (UTIs) are one of the most commonly reported infections in Belgian nursing home residents. In older adults, UTI diagnosis and management is complex, often leading to over-diagnosis and irrational antimicrobial use, stressing the need for a guideline approach. A consensus statement on the prevention, diagnosis and treatment of UTIs in older adults residing in nursing homes was developed in a collaborative effort between the Flemish Hospital Outbreak Support Teams, the Flemish Agency for Care and Health, the Association of the Flemish Coordinating and Advising General Practitioners, the Belgian Association of Urology, the Belgian Society for Gerontology and Geriatrics and PhD researchers based on a combination of clinical expertise, (inter)national guidelines and peer-reviewed studies. Optimizing fluid intake, appropriate toilet behaviour and posture, mobilization and local estrogen therapy in women are of proven value in UTI prevention, whereas the use of cranberry and probiotics is not to be advocated. The importance of avoiding bladder catheterization is stressed. In older nursing home residents, the diagnosis of UTIs remains challenging, mostly due to atypical systemic symptoms. A consensus diagnostic algorithm for UTI among residents with and without a urinary catheter was developed, including the presence of suggestive clinical symptoms and a positive urine culture. Urine dipsticks have a high negative but a low positive predictive value. C-reactive protein point-of-care testing is not recommended. Asymptomatic bacteriuria should not be screened for, in order to avoid unnecessary triggers for treatment. In cystitis, nitrofurantoin is the primary choice for treatment, with fosfomycin as an alternative; in prostatitis and uncomplicated pyelonephritis a fluoroquinolone is the advocated empirical antimicrobial.

Antibiotic Prescribing Practices in a Tertiary Care Teaching Hospital: A Retrospective Cross-Sectional Analysis.

Background Antibiotics are among the most frequently prescribed medications in hospitals, yet a significant portion of their use is inappropriate, contributing to the growing global threat of antimicrobial resistance (AMR). In Pakistan, AMR has reached alarming levels with the rise of multi- and extensively drug-resistant bacteria. This study evaluates antibiotic prescribing practices and the use of culture sensitivity (CS) testing to assess the appropriateness of antibiotic therapy. Methods This cross-sectional retrospective study was conducted in a 500-bed tertiary care teaching hospital in Islamabad, Pakistan, analyzing inpatient records from 2020 to 2022. From over 5000 patient files, 1012 met the inclusion criteria and were reviewed. The study assessed the rationality of antibiotic prescriptions based on the evidence of infection (EoI), clinical parameters, and the presence or absence of CS testing. Statistical analyses, including Chi-square tests, logistic regression, and Cox proportional hazards regression, were applied to determine the association between antibiotic use and patient outcomes. Results Among the 1,012 patients analyzed, 91.8% (n = 929) received one or more antibiotics. However, 30% (n = 274) of these prescriptions were issued without any documented EoI.Only 17.5% of patients underwent CS testing. Patients exposed to five or more antibiotics had a 2.5-fold increased risk of ICU mortality (HR = 2.50, p < 0.001). A positive correlation (r = 0.42, p < 0.001) was found between the number of antibiotics prescribed and the length of hospitalization. Conclusion The findings of this study reveal a high rate of inappropriate antibiotics prescribed without EoI and CS testing. The results emphasize the urgent need for comprehensive Antibiotic Stewardship Programs (ASPs) in hospital settings, particularly focusing on mandatory CStesting protocols. By reducing irrational antibiotic use, these initiatives can significantly mitigate the rise of AMRglobally, especially in resource-limited settings. Implementing ASPs not only optimizes antibiotic use but also aligns with the WHO recommendations, demonstrating the effectiveness of multifaceted interventions in minimizing resistance and improving patient outcomes.

Empowering Thai community pharmacists in combating antimicrobial resistance: Qualitative insight and sentiment analysis

BackgroundAntimicrobial resistance (AMR) is increasing globally and poses a significant public health challenge. Community pharmacists, especially in primary care settings, play a pivotal role in mitigating the irrational use of antibiotics, a key driver of AMR. ObjectivesThis study aims to explore qualitative insights from community pharmacists regarding antibiotic supply and usage, analyze sentiments related to AMR, and highlight the crucial role of community pharmacists in AMR stewardship at the primary care/community level. MethodsThis study engaged community pharmacists in Thailand through semi-structured interviews to obtain in-depth insights into the antibiotic supply and perceptions of AMR. Additionally, sentiment analysis, which evaluates the emotional tone of the pharmacists' responses, was conducted to enrich the findings. ResultsInterviews with 23 community pharmacists highlighted the practices, challenges, and strategies related to antibiotic supply and use. Key findings include the identification of barriers such as patient demand and lack of awareness about antimicrobial resistance (AMR), alongside strategies for improvement such as public education and professional development. Sentiment analysis reveals a cautiously optimistic perspective toward enhancing rational antibiotic use, underscoring the importance of comprehensive approaches that combine education, ethics, and regulatory measures to address the complexities of antibiotic management at community pharmacies. ConclusionThis study underscores the necessity of public awareness, pharmacist–patient relationships, and regulatory reforms for the rational use of antibiotics in community pharmacies. These findings emphasize that pharmacist education and adherence to professional ethics are essential for mitigating antimicrobial resistance and promoting rational antibiotic use.

Cross-sectional assessment of perception and attitude of pharmacy students towards pharmaceutical promotion: a study from developing country, Pakistan

BackgroundThe pharmaceutical promotion is “all informational and persuasive activities by manufacturers and distributors, the effect of which is to induce the prescription, supply, purchase and/or use of medicinal drugs. These promotional activities affect the dispensing behavior of physicians and pharmacists and influence begins from educational institutes.ObjectiveOur study’s main aim was to evaluate opinion and attitude of pharmacy students towards pharmaceutical promotion.Materials and methodsA cross-sectional online survey was conducted among 3rd, 4th and final year pharmacy students of 3 public and 3 private sector universities in Punjab Pakistan. A modified version of pre available questionnaire was used to collect data from students between June 2020 and December 2020. The tool was made available through a Google Form, assessable to students via provided link. We utilized the snowball sampling technique. Descriptive statistics were used to evaluate the demographics, while Chi-square and t-test were used to analyze associations between demographics and items. Data were analyzed using SPSS version 21.0.ResultsA total of 1,195 students participated in the survey with an average age of 22.2 ± 1.2 years. Nearly 2/3rd of the students were males (62.2%) and a significant proportion (87.3%) of pharmacy students had never taken part in any training provided by pharmaceutical company. Among all, 51.9% confirmed that pharmacists who frequently interact with medical representatives tend to dispense more antibiotics. Additionally, 42.1% indicated they may dispense antibiotics under the influence of promotion. Pharmacy students in senior college years and those with lower parental exhibited significantly more perception and attitude scores (p &amp;lt; 0.001).ConclusionA significant number of students concurred with the notion that promotional activities could impact dispensing practices and they also believed that such activities contribute to the growing issue of irrational antibiotic use. This study underscores the necessity for a heightened emphasis on the educational needs of pharmacy students.

Antimicrobial Potential of Scorpion-Venom-Derived Peptides.

The frequent and irrational use of antibiotics by humans has led to the escalating rise of antimicrobial resistance (AMR) with a high rate of morbidity-mortality worldwide, which poses a challenge to the development of effective treatments. A large number of host defense peptides from different organisms have gained interest due to their broad antibacterial spectrum, rapid action, and low target resistance, implying that these natural sources might be a new alternative to antimicrobial drugs. As important effectors of prey capture, defense against other animal attacks, and competitor deterrence, scorpion venoms have been developed as important candidate sources for modern drug development. With the rapid progress of bioanalytical and high throughput sequencing techniques, more and more scorpion-venom-derived peptides, including disulfide-bridged peptides (DBPs) and non-disulfide-bridged peptides (NDBPs), have been recently identified as having massive pharmacological activities in channelopathies, pathogen infections, and cancer treatments. In this review, we summarize the molecular diversity and corresponding structural classification of scorpion venom peptides with antibacterial, antifungal, and/or antiparasitic activity. We also aim to improve the understanding of the underlying mechanisms by which scorpion-venom-derived peptides exert these antimicrobial functions, and finally highlight their key aspects and prospects for antimicrobial therapeutic or pharmaceutical application.

Research trends and hotspots in clinical trials of migraine in the past 20 years: bibliometric analysis.

Migraine is a widespread, recurrent primary headache disorder primarily characterized by severe pulsatile headache, typically on one or both sides. It is often accompanied by nausea, vomiting, and hypersensitivity to sound and light. Despite the availability of multiple drugs for migraine management, the condition often becomes chronic due to untimely or irrational drug use, significantly distressing patients and increasing the burden on families and society. Over the past two decades, numerous clinical studies on migraine have been published. This study aimed to provide a comprehensive summary of the current status and trends of migraine clinical trials through bibliometric analysis. We used visual network tools such as CiteSpace and VOSviewer to perform a knowledge graph analysis of publications related to migraine clinical trials extracted from the WoSCC. This study analyzed 1,129 articles published in 389 journals from 61 countries. The number of publications on migraine clinical trials has steadily increased from 2004 to 2023. The United States and Albert Einstein College of Medicine are the leading countries and institutions in this field, respectively. Richard B. Lipton is the most prolific author, making significant contributions to the research. The journal Headache has the highest number of publications and citations in this area. Keywords such as "efficacy," "RCT," "CGRP," "prophylaxis," "disability," "depression," "questionnaire," and "real-world effectiveness" received significant attention. This study identified reliable research hotspots and provided directions for clinicians. The treatment of migraine continues to be challenging. Future trends may include continued growth in migraine classification, risk factor analysis, and comorbidity studies. Research on CGRP and epigenetics will advance the progress of precision medicine in the migraine field.

Multi-layered factors contribute to irrational use of antibiotics among pediatric patients in Tanzania: ADDO dispensers perspective

BackgroundAntimicrobial resistance (AMR) is a major public health problem affecting both current and future generations. Development of resistance to the commonly available antibiotics has been directly linked to their irrational use. The World Health Organization (WHO) has clearly stated on the Global Strategy on AMR, judicious antibiotic use as well as adequate knowledge and awareness about AMR, as important tools in curbing the existing problem. Therefore, this study aimed to explore the level of knowledge among accredited drug dispensing outlet (ADDO) dispensers on factors contributing to irrational use of antibiotics among Tanzanian pediatric patients.MethodsA qualitative study employing focused group discussions was conducted among 6–10 ADDO dispensers with at least 6 months dispensing experience in 14 regions between July and August 2020. Thematic analysis was used to analyze the data.ResultsFindings from this study indicate that the ADDO dispensers have adequate knowledge on antimicrobial resistance. Participants were aware of the general meaning and the use of antimicrobials. They were aware that antimicrobials are used for treating infections caused by microbes such as bacteria, fungi, and viruses. Participants knew AMR increases health related costs and that the increasing burden of AMR is not an outcome of a specific group of people such as health care providers or patients, rather a contribution of many factors that bring change in microorganism behavior. Despite this knowledge, participants felt that most of the private health care facilities are profit-oriented; they practice polypharmacy to maximize profit rather than focusing on providing quality health services. Participants revealed that dose shortage after symptomatic relief strongly contributes to AMR. Lastly, the ADDO dispensers expressed that continuous medical education and community education to patients is necessary in the efforts to fight against AMR.ConclusionsTo mitigate the increasing AMR burden in our society, integrated interventions must include both communities, ADDOs as first point of contact and other healthcare providers. Periodic refresher training with an emphasis on proper practices is crucial to help the dispensers transform their knowledge into action. Responsible authorities should ensure that ADDOs and other private health care facilities adhere to regulations.

Evaluation of drug use in stroke patients at the inpatient unit of Brebes Hospital, Central Java

Background: Effective stroke treatment is complicated by factors such as polypharmacy, drug interactions, and side effects, leading to drug-related problems (DRPs) that hinder therapeutic outcomes. Evaluating drug use in stroke patients is crucial to ensure rational, safe, effective, and efficient treatment, ultimately improving therapeutic outcomes. Objective: This study aimed to evaluate the drug use patterns in inpatient stroke patients at Brebes Hospital, focusing on the appropriateness of drug selection, dosage, administration, and the impact of patient characteristics on DRPs. Method: A retrospective, descriptive evaluative design was employed, with data collected from medical records of stroke patients hospitalized at Brebes Hospital between May and July 2022. A total of 135 patients (110 ischemic, 25 hemorrhagic stroke) were included through consecutive sampling. Univariate analysis was used to describe patient characteristics and treatment patterns, while bivariate analysis with the chi-square test assessed the relationship between patient characteristics and DRPs. Results: The most common medications included citicoline (88.15%), clopidogrel (68.85%), and amlodipine (40.48%). DRPs were identified, including non-compliance with guidelines (1 case), contraindicated drugs (5 cases), and inappropriate drug selection (1 case). Notably, five cases of contraindicated use of omeprazole with clopidogrel and one case of phenytoin without indication were observed. Patient characteristics such as age and comorbidities did not significantly influence the incidence of DRPs (p &gt; 0.05). Conclusion: The study found irrational drug use in stroke patients, with DRPs posing challenges for treatment optimization. Addressing DRPs through improved prescribing practices and pharmacist intervention is crucial to enhancing therapeutic outcomes in stroke management.

Is human albumin injection the best choice to treat hypoalbuminemia?

Currently, there is an irrational use of drugs in the treatment of hypoproteinemia. This study evaluates the value of 12 injections to provide a basis for drug selection for the treatment of hypoproteinemia. The content of the first restrictive amino acid, the comprehensive quality of the total essential amino acid, and the closeness to the whole egg protein or FAO/WHO model were evaluated to compare their value in the amino acid synthesis of human serum albumin. A comparison was made between the matching degree of HA and therapeutic amino acids with the human plasma amino acid profile. Furthermore, the value and safety of synthetic human serum albumin were compared. The lowest synthetic value of human serum albumin was 18AA-V, and the highest was 18AA-II. The CS values of HA, 18AA-V, 18AA-II, 18AA-Ip, 18AA-IIp, and 19AA-Ip were 0.18, 0.58, 0.78, 0.55, 0.54, and 0.59, respectively. The similarity to egg protein was 0.81, 0.92, 0.94, 1.00, 1.18, and 1.18, respectively. The proximity values to FAO/WHO standards were 0.81, 0.85, 0.90, 1.36, 1.54, and 1.54, respectively. The changes in 3AA and the amino acid profile were matched when liver function was abnormal. When the renal function was abnormal, 9AA was matched. During trauma, 18AA-VII was matched. The amino acid profile of HA did not correspond. Patients with normal liver and kidney function should choose compound balanced amino acid injection, while patients with abnormalities should choose 3AA. Patients with renal dysfunction should choose 9AA. Trauma patients should choose 18AA-VII.

OS RISCOS DO USO DE ANTI-INFLAMATÓRIOS NÃO ESTERÓIDES PELO PACIENTE DIABÉTICO NO BRASIL

Introduction: Diabetes mellitus (DM) is a chronic non-communicable disease characterized by hyperglycemia. The types of diabetes have different symptoms and treatments and can cause various chronic complications. Diabetic nephropathy and cardiovascular diseases stand out in this article. Anti-inflammatories are divided into two classifications: steroids and non-steroids (NSAIDs). NSAIDs can treat inflammation, pain, edema, osteoarthritis, rheumatoid arthritis, and musculoskeletal disorders. Still, they cause side effects, some of which can cause problems in the renal system and cardiovascular systems, systems that may already be at risk of suffering complications in diabetic patients. Despite these effects, some NSAIDs are Over-the-Counter Medications (OTC) and this facilitates self-medication and irrational use of these medications. Objective: To analyze the risks related to the use of NSAIDs by diabetics in Brazil. Methodology: The method was descriptive and quantitative research through a bibliographic review. Conclusion: Due to the prevalence of diabetics in Brazil and the common use of non-prescription NSAIDs, diabetics must avoid self-medication and be made aware and guided by health professionals.

The Bacterial Species Behind the Wound and Their Antibacterial Resistant Pattern: A Three-Year Retrospective Study at St. Dominic Hospital, Akwatia, Ghana.

Wound infections are often underestimated issues that can lead to chronic illnesses, and since the introduction of antibiotics, wound complications have become less common. However, due to the increased and irrational use of these antibiotics, the resistance in the bacterial isolates has become very common. This has led to reduced treatment options, delay in wound healing, and high treatment costs. This study aimed to investigate bacterial wound infections and their antibiotic resistance at St. Dominic Hospital, Ghana. A total of 517 records of wound swab culture and susceptibility testing, and patient demographics from 2020 to 2022 were collected from the microbiology unit of St. Dominic Hospital in the Eastern Region of Ghana. The data were entered into Microsoft Excel 2019, cleaned, and exported into IBM SPSS v26 for the statistical analysis. p < 0.05 was considered statistically significant for all analyses. The overall prevalence of bacteriological agents causing wound infection in individuals who visited the St. Dominic Hospital from 2020 to 2022 was 70.21% (363/517), with S. aureus 79/363 (21.76%) being the most abundant isolate. Out of the 79 S. aureus isolated, 40 (50.63%) and 39 (49.37%) were resistant to ampicillin and cephalexin, respectively. More than 50% of the predominant Gram-negative isolate, K. pneumoniae, were resistant to clindamycin 45/72 (62.50%) but susceptible to levofloxacin 70/72 (97.22%), cefotetan 69/72 (95.83%), and chloramphenicol 67/72 (93.06%). Antibacterial susceptibility patterns revealed significant resistance trends, particularly among Gram-negative isolates, emphasizing the urgent need for prudent antibiotic use and ongoing surveillance to combat resistance.

Detection of antibiogram pattern and prevalence of blaNDM and blaVIM genes among carbapenem resistant Eschericia coli isolates in a tertiary care hospital

Background: Clinical significance of Eschericia coli is due to its capacity to develop resistance against many antibiotics specially carbapenem by producing carbapenemase which limits treatment options. blaNDM and blaVIM genes are responsible for this multi-drug-resistance. This is an alarming condition for society as well as clinician because they are very difficult to treat due to limited options of antibiotics and its high virulence. Aims and Objectives: The study was conducted to detect antibiogram pattern and prevalence of blaNDM and blaVIM genes among carbapenem resistant E. coli isolates in a tertiary care hospital. Our study will also help to identify molecular basis of Carbapenem resistance including treatment guideline. Materials and Methods: Cross-sectional study was performed during January’2021 to June’2022 time period. Identification of E. coli was followed by standard protocol and antibiotic sensitivity was done by Kirby-Bauer disk-diffusion method following CLSI guideline, using VITEK-2D-SYSTEM. Detection of genes was done by polymerase chain reaction (PCR). Results: Out of 1867 samples, 161 isolates were identified as E. coli, among which 90 were resistant to carbapenem. Among those, 50 (31%) were resistant to all three carbapenems. Among those, 100% were resistant to ampicillin, amoxycillin-clavulanic acid, cefuroxime, cefuroxime-axetil, cefoperazone-sulbactam, ceftriaxone, cefepime, piperacillin-tazobactam, nalidixic acid, ciprofloxacin; 52% were resistant to amikacin; 54% were resistant to gentamicin; 86% were resistant to cotrimoxazole; 22% were resistant to nitrofurantoin and 96% were sensitive to tigecycline; 100% were intermediate sensitive to colistin. blaNDM gene is detected in 17 (34%) isolates and blaVIM gene is detected in 2 (4%) isolates by PCR. Conclusion: E. coli leads to common clinical presentations such as urinary tract infection, blood stream infection, pneumonia, and wound infection. High burden of carbapenem resistant E. coli was associated with urinary indoor samples. Rising incidence of multi-drug-resistance occurs due to lack of infection control measures, irrational use of antibiotics. Continuous surveillance will prevent development of multi-drug-resistance and help to improve treatment guideline.

Expectation and Needs of Medical Students Towards the Implementation of Virtual Simulation in Learning Rational Use of Medicine.

The irrational use of medicines remains prevalent globally despite education efforts, leading to decreased treatment quality and increased healthcare costs. With the rise of online learning during the COVID-19 pandemic, virtual simulation offers a promising solution to enhance the teaching of rational medicine use among medical students. This study aimed to investigate medical students' perspectives and needs regarding the implementation of virtual simulation in learning the rational use of medicines. This study, conducted at Universitas Indonesia from August 2022 to September 2023, used a mixed-method approach to assess the needs for developing virtual simulation in education of rational medicine use. A validated questionnaire with 14 closed-ended and 14 open-ended questions was completed by 281 medical students. The quantitative data were analysed descriptively, using SPSS v16, while thematic analysis was applied to open-ended responses. Students perceived virtual simulations to be the most effective tool for distance learning and suggested features like case scenarios, realistic representation, a good user interface, and user-friendly navigation. The majority preferred a 10-20-minute duration for virtual simulations. Additionally, 52.3% had no prior knowledge of the rational use of medicines, but acknowledged its importance. Virtual simulations could be used to explain the concept, management, and implementation of the rational use of medicines. Virtual simulation should be implemented in distance learning on rational medicine use to increase students' motivation, understanding, retention, interactivity, and focus. The findings might be utilized by medical educators to tailor virtual simulation design to meet medical students' needs and expectations.

Natural History and Microbiological Profiles of Patients With Acute Pancreatitis With Suspected Infected Pancreatic Necrosis.

Acute pancreatitis (AP) is a prevalent emergency. The clinical spectrum of the condition is varied, ranging from a mild to a malignant course with higher mortality rates. Infection of pancreatic/peri necrosis, extrapancreatic infections, and organ failure are significant complications in AP. In the recent era, microbiological composition has shifted more towards multi-drug-resistant organisms due to irrational antibiotic use. This study aims to understand the natural history of patients with suspected infected pancreatic necrosis (IPN), the prevalence of multi-drug-resistant organisms (MDROs), and their antibiotic susceptibility patterns. This prospective, observational study was performed on 130 cases of acute necrotizing pancreatitis (ANP) with suspected IPN that were evaluated during their period of admission in the department of gastroenterology, emergency medicine, or surgery ward of thePostgraduate Institute of Medical Education and Research, Chandigarh, India, a tertiary hospital. The details of outcomes were recorded. The organisms in cases with IPN and antibiotic resistance patterns of various organisms were studied. The most prevalent site of necrosis was combined pancreatic and peripancreatic tissues in 111 (85.4%) patients. The computed tomography severity index (CTSI) had a mean of 8.72±1.43. Of all participants, 36 (27.7%) patients had <30% necrosis, 47 (36.2%) had 30%-50% necrosis, and 47 (36.2%) had >50% necrosis. Overall, 80 (61.5%) patients had organ failure, with acute lung injury (ALI) being the most common. Rates of complications were markedly greater in cases with higher pancreatic necrosis and with infected necrosis (p<0.05). The most common organism isolated from necrotic tissue was Escherichia coli (E. coli) in 17 (32.07%) cases, followed by Acinetobacter baumannii (A. baumannii) in 12 (22.64%) cases. The most common extrapancreatic infection site was respiratory tract infections. Pseudomonas aeruginosa (P. aeruginosa) and A. baumannii revealed maximum resistance to most of the drugs. Conclusion: Infected pancreatic necrosis is linked to high rates of morbidity and mortality. Our study suggests that irrational usage of antibiotics increases the incidence of combined infection, especially with higher rates of multi-drug-resistant infections.

The role of pharmaceutical care in the use of rifaximin for the treatment of diarrhea

the management of diarrhea represents a prevalent issue within the realm of healthcare. Rifaximin is recommended to treat traveler's diarrhea and irritable bowel syndrome. At the same time, it is important to rationally use an antimicrobial drug to prevent the development of antimicrobial resistance. Aim: to evaluate the role of pharmaceutical care in using rifaximin to treat diarrhea, based on a questionnaire. A questionnaire survey was done among 55 pharmacy professionals and 42 pharmacy visitors regarding the dispensing and use of rifaximin for diarrhea treatment. The survey of pharmacy visitors revealed that rifaximin was used for the treatment of small intestinal bacterial overgrowth syndrome (32 cases), traveler's diarrhea (7 cases), and irritable bowel syndrome with diarrhea (3 cases). Patients did not undergo stool culture before rifaximin prescription, which could have prevented antimicrobial resistance and ruled out other causes of diarrhea. It was found that 14% of respondents reported improvement the next day, while 83.3% reported improvement within three days. Pharmacists can educate visitors about the importance of completing the treatment course. Five percent of respondents reported nausea as an adverse reaction. Pharmacists dispensed rifaximin for the treatment of diarrhea in adults almost three times more often than in children. The tablet form of the drug was used in 94.5% of cases, while the oral suspension was used in 5.5% of cases. The majority of pharmacy visitors (89.0%) received rifaximin with a doctor's prescription, and 10.9% without a prescription, which emphasizes the importance of pharmaceutical care to prevent irrational use of the drug. The results of the study show that 92.7% of pharmacists provide recommendations on the safety of rifaximin use, and 78.2% recommend abstaining from alcohol during treatment. Only 21.8% of pharmacists warn about the possible staining of urine, which can cause concern for patients. The majority of pharmacists (89.1%) systematically ask women about possible pregnancy, which indicates their awareness of safe pharmacotherapy. Pharmacists also clarify the simultaneous use of rifaximin with other drugs: 32.7% ask about taking oral contraceptives, 7.3% – antiarrhythmic drugs, and 3.6% – warfarin. mailto:https://meshb.nlm.nih.gov/record/ui?ui=D002648Pharmacists can enhance the effectiveness of rifaximin treatment by preventing its uncontrolled use, emphasizing the importance of completing the treatment course and informing about possible adverse reactions. When providing pharmaceutical care to visitors taking rifaximin, pharmacists should educate them about potential changes in urine color. Additionally, pharmaceutical workers advise women taking oral contraceptives to use additional contraceptive methods while taking rifaximin.

«Владельцы песков»: пескоукрепительные работы на землях кочевых народов Юга России (ногайцев, калмыков и туркмен) в XIX – начале XX веков

The publication examines the organization of sand protection works carried out in semi–desert zones of Southern Russia in the XIX - early XX centuries. Despite separate publications on measures to combat desertification in the Russian Empire, sand protection activities that unfolded in the XIX – early XX centuries on the lands of the nomadic peoples of Southern Russia (Nogais, Kalmyks and Turkmens) did not become the subject of separate works, which determines the nov-elty of the study. The peculiarities of the natural, climatic and geographical living conditions of nomads and their irrational use of arid zones as pasture lands for their livestock were factors that caused the rapid growth of sands in the XIX – early XX centuries. Sand protection works in the south and officials of the sand-ravine parties and the corps of foresters of the Forest Department, under the jurisdiction of the Ministry of State Property, carried south-east of Russia out. The ac-tivities of sand protection organizations included experimental measures to combat desertifica-tion, which included husking and grass sowing on the sands, sowing sandy oats, removing sands from the use of their owners, forestry and horticulture in the steppe. The source base of the study was materials extracted from the State Archives of the Stavropol Territory (GASK) funds: 153 «Forester of the Stavropol sandy-ravine district» and 247 «Stavropol Provincial Forest Protection Committee». Historiographical works on the study of the problem include publications by pre–revolutionary, Soviet and modern researchers involved in combating desertification in Southern Russia in the XIX - early XX centuries. The analysis of materials and sources made it possible to trace the peculiarities of the activities of central and regional authorities, local societies (A.D. – owners of sands), and other organizations that participated in sand protection works during the historical period under consideration. The conclusion is formulated that the sand protection activi-ty that unfolded in the South of Russia in the XIX – early XX centuries. It included many forest reclamation works, the purpose of which was to curb the process of desertification of pasture and agricultural lands of Nogais, Kalmyks and Turkmens, which in turn was a measure of protection and guardianship of the life, health and economic and cultural activities of nomadic peoples with-in the Russian Empire.

KAJIAN RASIONALITAS PENGGUNAAN ANTIBIOTIK PADA ANAK DENGAN INFEKSI SALURAN KEMIH DI RSUD Dr. MOEWARDI SURAKARTA

Urinary tract infection (UTI) is the second highest infectious disease among children in Indonesia. Management of UTI requires antibiotic therapy, but the irrational use of antibiotics makes this disease one of the contributors to the high rate of antibiotic resistance. Therefore, there is a need for a study to measure the rationality of antibiotic use in children with UTI. This study is a descriptive observational study with a cross sectional design. Data were collected retrospectively using a purposive sampling technique based on medical record data of pediatric patients at Dr. Moewardi Surakarta Hospital in 2021-2023. The results showed that out of 100 medical records of pediatric patients with UTI, 68.00% were women and 32.00% were men. Based on age, the highest incidence of UTI occurred in the age range of 10-18 years as much as 52.00%. The most common antibiotic use was ampicillin 68.00%. The results of the rationality study showed 69.00% in category 0 (rational use of antibiotics). Irrationality occurred in category IIA (antibiotic use is not the right dose) 17.00%, IIIA (antibiotic use with too long duration) 1.00%, IIIB (antibiotic use with too short duration) 4.00%, IIA &amp; IIIB (antibiotic use is not the right dose &amp; duration is too short) 2.00%, IVA (there are other more effective antibiotic options) 4.00%, IIIB &amp; IVA (antibiotic use is too short duration &amp; there are other more effective antibiotic options) 3.00%. It can be concluded that the rational use of antibiotics needs to be improved.