BackgroundAntimicrobial resistance (AMR) is a global health crisis driven by the inappropriate use of antibiotics. Prescribing practices are often shaped during internship, and studies suggest that intern physicians typically follow attending physicians’ guidance when choosing antibiotics. However, evidence from a low- and middle-income country (LMIC) like Bangladesh remains limited. This study explored antibiotic prescribing practices and systemic drivers among intern physicians in Bangladesh.MethodsWe conducted a cross-sectional survey between May and August 2025 in 13 public tertiary-care hospitals in Bangladesh. A structured, pre-tested questionnaire was administered in person and online to consenting intern physicians. The tool assessed timing of antibiotic initiation, empirical use, clinical triggers, routes of administration and systemic influences. Data were analysed using descriptive statistics.ResultsAmong 393 respondents, 330 (84%) reported prescribing antibiotics independently. A total of 71.2% initiated empirical therapy after clinical diagnosis but before laboratory confirmation, while only 9.7% routinely waited for culture results. Commonly cited reasons for empirical initiation were fear of treatment delays (54%), severe or worsening symptoms (48.1%), guidance from senior staff (28%) and hospital traditions (26.7%). The most frequent clinical symptoms prompting empirical use were fever (12.5%), wound infections (14.8%) and productive cough (8.4%). β-Lactam antibiotics were prescribed by 96.2% of intern physicians, while 27% reported prescribing fluoroquinolones irrespective of symptoms. Regarding administration routes, 80.4% reported prescribing IV, 64.9% orally and 45.3% both IV and orally. Systemic constraints strongly shaped prescribing choices. Pharmacy stock influenced antibiotic selection in 51% of cases. Time constraints due to heavy patient load were reported by 52.4% of interns, and hierarchical influence from senior physicians by 49.1%. Institutional support was limited: 257 interns (65.4%) reported no clear hospital antibiotic guidelines, and only 19.1% found existing guidelines easily accessible. Notably, 44.3% of interns indicated that accessible protocols would improve their practice.ConclusionsIntern physicians in Bangladeshi tertiary hospitals frequently prescribe antibiotics autonomously, often empirically and without microbiological confirmation. Their prescribing decisions are shaped less by evidence than by systemic and institutional pressures, including lack of guidelines, pharmacy shortages, time constraints and hierarchical expectations. The predominant use of broad-spectrum β-lactams further underscores risks for antimicrobial resistance escalation. Enhanced supervision, accessible guidelines, improved diagnostic capacity and pharmacy support are urgently needed to promote rational antibiotic use and strengthen stewardship.

Dispensing of antibiotics without prescription in community drug retail outlets of Bahir Dar City in Northwest Ethiopia: A simulated client visit before and after educational intervention.

Insight on nicotine insecticides in Guizhou Province, China: Residue analysis and risk assessment in different types of agricultural products.

Structure and solubility of pea seed-derived ingredients produced by air classification: Relevance of the seed milling process and endogenous lipid accumulation.

Optimizing parenteral nutrition practices: Impact of a pharmacist-led quality improvement program on prescription patterns and work efficiency.

Community pharmacies play a crucial role as a primary healthcare access point in low- and middle-income countries, including the Lao People's Democratic Republic (Lao PDR). The Good Pharmacy Practice (GPP) guidelines are the basics to establish minimum standards of community pharmacy practice. This study aimed to assess adherence to the GPP standards of community pharmacies in the Lao PDR and investigate factors associated with poor adherence to the GPP standards. Data collection of this cross-sectional study was conducted in 10 provinces from November 2022 to June 2023. The inspection of GPP adherence regarding facility, storage, services, dispensing, and rational use was performed in 180 pharmacies without any prior notification. Data regarding characteristics of the pharmacies (location, class, period since opening, opening hours per day, income per day, number of customers per day, and number of staff members), and interviewed staff (sex, education level, and employment status) were also collected. Descriptive statistics and logistic regression analyses were performed. This study found only 11.7% of the community pharmacies met 80% or higher of total GPP standards. Community pharmacies located outside of the city were 9.29 times more likely to show low GPP adherence than pharmacies in the city. Male pharmacists were 2.38 times more likely to exhibit low GPP adherence than female pharmacists. Our study elucidated that community pharmacies located outside of the city and male pharmacists might be the target of focused administrative inspection, guidance, or support to refine community pharmacy practice in the Lao PDR.

Antimicrobial resistance (AMR) poses a critical global health challenge, particularly within maternal and child health (MCH) settings where inappropriate antibiotic use heightens infection risks, maternal morbidity, and neonatal complications. Strengthening antibiotic stewardship programs (ASPs) in MCH services is therefore essential to preserve antimicrobial effectiveness and improve clinical outcomes. This review examined the multifaceted roles of midwife nurses and nursing students in advancing antimicrobial stewardship, focusing on educational readiness, clinical participation, and policy engagement. Using PRISMA 2020 guidelines, a comprehensive search of PubMed, CINAHL, Scopus, and Web of Science (2013–2025) identified eligible studies. Evidence was screened using PICO criteria and appraised through Joanna Briggs Institute (JBI) and mixed methods appraisal tool (MMAT) frameworks. Forty-two studies, including randomized controlled trials, quasi-experimental designs, cross-sectional surveys, and qualitative analyses, were narratively and thematically synthesized across domains of clinical practice, education, infection prevention, and policy integration. Findings demonstrated improved adherence to stewardship guidelines (25–40%), significant reductions in antibiotic overuse (30–50%), and notable gains in knowledge and IPC competencies (+30–45%) following nurse-led and student-centered interventions. Educational innovations such as simulation-based learning, stewardship modules, and midwife-driven ASP models were particularly effective in promoting rational antibiotic use. Despite strong evidence supporting their contributions, challenges persist, including limited policy recognition, variable training structures, and disparities across low- and middle-income countries. Strengthening AMS education, integrating stewardship into routine MCH practice, and ensuring formal policy inclusion of midwives and nursing students are imperative to advance antimicrobial optimization and safeguard maternal–neonatal health globally.

Objective To investigate the clinical application of histamine H2 receptor antagonists (H2 RAs) in the prevention of chemotherapy-induced nausea and vomiting (CINV), focusing on the rationality of H2 RAs use, the utilization rates and costs of different H2 RAs agents, to provide a reference for the rational use of H2 RAs in this context. Methods Evaluation criteria for the rational use of H2 RAs in CINV prevention were established based on domestic and international drug package inserts, clinical guidelines, and national expert consensus. A retrospective study was conducted, and the rationality of H2 RA use in CINV prevention was analyzed and evaluated using the Attribute Hierarchy Model (AHM) method among 323 patients discharged from the People’s Hospital of Bozhou in April 2024. The clinical application of different H2 RAs was analyzed. Results The significant issues of irrational use of H2 RAs in CINV prevention included inappropriate solvent and incompatibility (71.83%), use without indications (70.59%), inappropriate dosage and administration (45.82%), prolonged duration of therapy (30.65%), lack of laboratory monitoring (24.46%), and unreasonable efficacy evaluation (23.84%). The mean case score was 71.03 ± 11.06, with oncology cases scoring 70.16 ± 11.03 and non-oncology cases scoring 74.81 ± 10.44, indicating a statistically significant difference ( P < 0.01). The mean cost of H2 RAs in CINV prevention was 114.46 ± 132.64 yuan, accounting for 2.72% of the mean total drug expenditure. Specifically, the average price of H2 RAs was 123.09 ± 139.45 yuan in oncology cases and 70.89 ± 84.64 yuan in non-oncology cases, also with a statistically significant difference ( P < 0.01). The clinical application of H2 RAs showed a preference for the higher-priced ranitidine (88.54%). Conclusion H2 RAs remain widely used in the prevention of CINV; however, the majority of cases (98.45%) demonstrated irrational use, particularly prophylactic administration without appropriate indications. The rationality of H2 RAs use in oncology departments was lower than that in non-oncology departments, while the associated drug costs were higher. Strengthened management of H2 RAs application in CINV prevention is needed to improve the rationality of drug use and to ensure safety, efficacy, and cost-effectiveness for patients.

Introduction Antibiotic resistance (ABR) is a growing public health issue in Senegal, driven by interconnected factors across human, animal, and ecosystem health. This study applied a participatory systems approach to map the factors influencing ABR in Senegal and identify possible policy actions from a One Health perspective. Methods A group model building workshop was held in October 2023 in Dakar with 22 stakeholders from diverse professions and sectors, including human and animal health, environment, agriculture, and food safety. Causal loop diagrams were co-developed to map factors driving ABR and identify intervention points. Results The 22 participants identified 55 factors and 88 connections between those factors, that together contribute to the emergence and spread of ABR in Senegal. Four feedback loops were identified: (1) demand for antibiotics; (2) misinformation, public perception and alternative treatments; (3) development of context-appropriate regulations; and (4) enforcement of regulations. Participants proposed 36 actions for ABR mitigation, focusing on: laboratory capacity development; healthcare and infection prevention and control; rational use of antimicrobials in human and animal health; and coordination, communication, and research. Actions considered to have the greatest potential to positively transform the system included: investment in laboratory capacity; enforcement of regulations against the illegal sale of medications; and harmonization of data collection procedures across surveillance systems. Discussion This study highlights the value of participatory systems approaches for mapping key drivers of ABR and identifying potential ABR policy actions. While this work integrates cross-sectoral perspectives and provides some actionable insights for evidence-informed decision making, the findings reflect the perspectives of national-level actors and shows strong alignment with international policy and priorities. ABR policy design should also involve local authorities and populations to ensure effective and context-appropriate action. This study provides new empirical evidence to support the development of ABR policy in Sub-Saharan Africa by highlighting the interrelationships between policy areas and the knock-on effects that sectoral and cross-sectoral interventions can have.

The concept of trained immunity has redefined the understanding of innate immune memory and opened new opportunities for vaccine design. Polysaccharides, as naturally occurring pathogen-associated molecular patterns (PAMPs), can activate pattern recognition receptors (PRRs) and induce durable immunomodulatory effects. This review examines the historical context of microbial immunotherapy, beginning with Coley's toxin, and traces its evolution toward the rational use of polysaccharides as vaccine adjuvants. Their mechanisms of action, ranging from PRR engagement to metabolic and epigenetic reprogramming, are discussed to support both innate training and adaptive immune activation. Emphasis is placed on how these materials interact with biological barriers, influence antigen processing, and enhance lymph node trafficking. By analyzing the immunological functions and material properties of β-glucan, mannan, alginate, hyaluronic acid, chitosan, and others, the potential of polysaccharide-based platforms is highlighted to improve the efficacy and breadth of synthetic vaccines.

Natural bacterial contaminants in boar semen make it necessary to use preservative-level antibiotics in semen extenders to ensure long-term sperm viability and artificial insemination (AI) success. While concerns exist about the role of semen extender antibiotics in antimicrobial resistance (AMR), empirical evidence is lacking. This study examined microbiome and resistome dynamics in fecal samples of gilts from an organic farming operation, where AI is the primary source of antimicrobial exposure. Metagenomics was used to analyze microbial communities and antibiotic resistance genes (ARGs) across quarantine, breeding pen introduction, and post-AI production phases. The fecal microbiome was dominated by Bacillota and Bacteroidota. Microbial shifts were likely due to environmental and dietary adaptation, with no major changes observed post-AI. Among 168 identified ARGs, 89% were linked to drug resistance, primarily targeting tetracyclines, aminoglycosides, and macrolides, lincosamides and streptogramins (MLS). The abundance of most ARGs decreased between arrival at the operation and 10 days after introduction into the breeding pen, with no major resistome changes post-AI. Neither exposure to previously inseminated females nor antibiotics in semen extenders increased fecal ARGs. This study found no evidence that rational antibiotic use in swine semen extender contributes to increased antimicrobial resistance in the swine fecal microbiome.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-25776-w.

To investigate the clinical features of nivolumab-induced isolated adrenocorticotropin deficiency and to provide a reference for the diagnosis, treatment and rational use of nivolumab, clinical reports of nivolumab induced isolated adrenocorticotropin deficiency were collected by searching the database until August 31, 2025. Clinical data were collected and retrospectively analyzed. Seventy-one patients were enrolled, with a median age of 66 years (range: 26-87), and 73.2% of whom were male and 67.6% from Japan. Melanoma (36.6%) was the main indication for nivolumab. The median time from initiation of nivolumab to the onset of isolated adrenocorticotropin deficiency was 24 weeks (range: 3-60) and the median was 8 cycles (range: 2-33). Fatigue (76.1%), anorexia (66.2%) and nausea (23.9%) were the most common symptoms of isolated adrenocorticotropin deficiency. Laboratory tests revealed hyponatremia (50.7%) and eosinophilia (28.2%). Pituitary magnetic resonance imaging showed no abnormality in most patients (71.8%). Thyroid dysfunction (26.8%) often coexists with isolated adrenocorticotropin deficiency. These patients had a good prognosis after receiving a physiological dose of hydrocortisone. Nivolumab-induced isolated adrenocorticotropin deficiency is a rare disorder with possible racial differences. The possibility of isolated adrenocorticotropin deficiency should be considered in patients with fatigue and fatigue during treatment. Serum sodium and eosinophil ratios should also be closely monitored. The prognosis is good after hydrocortisone replacement therapy.

The study is devoted to a comprehensive analysis of preventive diplomacy as a modern and effective mechanism for the prevention and peaceful settlement of international and internal conflicts in a globally changing world. Preventive diplomacy is considered as “modern diplomacy with a feature” – a tool aimed at the most effective and rational use of diplomatic means to reduce tension before it develops into an open military conflict. Unlike traditional approaches that focus on resolving existing crises, preventive diplomacy emphasizes early detection of potential threats and timely diplomatic intervention. The work demonstrates that conflict prevention is significantly cheaper and more effective compared to subsequent costs for military operations, peacekeeping missions and post-conflict reconstruction. In addition to economic feasibility, preventive diplomacy has a deep humanitarian dimension – it allows saving human lives, preventing mass population displacement and humanitarian disasters. The study reveals practical mechanisms and forms of preventive diplomacy: monitoring electoral processes and preventing electoral fraud as a trigger for conflicts; protecting minority rights as a means of preventing discriminatory practices; an early warning system based on big data analysis and monitoring by international organizations; negotiations and mediation at the local and national levels; exchange of factual information and diplomatic consultations between the parties to a potential conflict. The analysis of specific cases illustrates how timely diplomatic intervention by the UN and regional organizations prevented crises from escalating into armed conflicts. Particular attention is paid to refugees as an indicator of instability - a mass outflow of population often signals a critical deterioration of the situation and the need for urgent preventive measures. The study contains a critical analysis of current international practice, which often does not respond sufficiently to early signs of crises, and justifies the need to strengthen the preventive component in global security strategies.

Global and regional knowledge of antibiotic use and resistance among the general public: a systematic review and meta-analysis.

In the article, the problems of construction companies are discussed. Strategic directions to stabilise the activities of construction companies in Ukraine under martial law are outlined. The necessary comprehensive measures to preserve and realise the human resource potential of construction companies are proposed, namely: employment support programmes, interaction between business and education, modernisation of the motivation system, HR branding of construction companies, expansion of subjectivity in building the human resource potential of construction companies while maintaining the balance between supply and demand in the country's labour market as a whole and territorial balance in the distribution of labour resources, intensification of the activities of employment hubs.The focus is on the issues of shifting the emphasis of labour motivation and its key factors during the period of martial law, while maintaining the priority and importance of classic elements of material motivation (wages, bonuses, additional payments). It is noted that motivation has shifted from the financial and career model to the social, moral and security model, in which physical safety, patriotic duty, and emotional support become the most important factors. The expectations of employees have also changed. During martial law, job security, stability, and humane treatment by employers are more highly valued. The functions of labour market participants and state bodies in implementing measures to achieve a balance between supply and demand in the labour market are detailed.The key aspects of labor organization in the construction industry are revealed, considering the challenges of martial law, in terms of implementing modern approaches to personnel management, introducing optimal work and rest regimes, creating modern workplaces, further improvement of working conditions and occupational safety, focusing on the safety of employees in the workplace, rational division and cooperation of labor, introduction of modern technologies in construction, development of effective logistics chains, and rational use of resources.

Dry eye disease (DED) is a common chronic ocular surface disorder that significantly impacts quality of life. Its pathogenesis involves disruption of immune regulatory mechanisms and ocular surface inflammation, which mutually reinforce each other in a vicious cycle. Conventional treatments, such as artificial tears and meibomian gland care, alleviate symptoms but often fail to control underlying inflammation. Anti-inflammatory therapy is therefore crucial. Traditional agents like corticosteroids provide rapid relief but carry risks with long-term use. Cyclosporine A, an immunosuppressant, offers unique advantages by inhibiting T-cell activation, reducing pro-inflammatory cytokines, enhancing tear secretion, and restoring the ocular surface. Clinical and experimental studies have consistently demonstrated its efficacy and safety in improving tear production, relieving symptoms, repairing ocular surface structures, and slowing disease progression. This review summarizes the mechanisms, recent clinical evidence, and future perspectives of topical cyclosporine A in DED treatment, providing a reference for rational clinical use and novel therapeutic development.

Objective: To develop and validate pictograms related to medication use in order to improve understanding and treatment adherence among users of the Brazilian Unified Health System (SUS) in a municipality in Southern Brazil. Methods: This was a descriptive study with both qualitative and quantitative approaches, conducted at a health unit in Formigueiro, Rio Grande do Sul, Brazil. Initially, focus groups were held with health professionals and SUS users to design the pictograms. Subsequently, 5 pictograms were selected and submitted to a legibility test involving 200 participants. A pictogram was considered legible if it was understood by ≥ 85% of respondents, in accordance with ISO 3864-1. Results: Of the 5 pictograms evaluated, 4 met the legibility criterion. The pictogram “Take 1 hour before breakfast or chimarrão” was the least understood (65%). Pictogram comprehension showed a statistically significant association with education level, occupation, and the number of daily medications used (p<0.05). Conclusion: Pictograms proved to be effective tools in aiding comprehension of medical prescriptions, especially when combined with verbal instructions. The use of simple, culturally appropriate images may support the rational use of medications within the SUS.

IntroductionMolnupiravir (MPV) is an oral, potent ribonucleoside analog that inhibits the replication of SARS-CoV-2 and is indicated for the treatment of adults with COVID-19. Patients with COVID-19 are at an elevated risk of adverse outcomes, underscoring the need for precise pharmacokinetic (PK) data to guide safe drug use. For MPV and its active metabolite, N4-hydroxycytidine (NHC), renal excretion is not the primary elimination pathway. Consequently, renal impairment has minimal impact on their PK profiles, and no dose adjustment is recommended for patients with mild to moderate renal impairment. However, there are no relevant pharmacokinetic studies in patients with severe renal insufficiency (eGFR<30 mL/min/1.73 m2) or patients requiring dialysis. This study aims to explore the plasma concentration of MPV in patients with severe renal insufficiency, providing a basis for rational clinical use of drugs.MethodsLiquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to detect the plasma concentrations of MPV and NHC. All analytes were extracted by protein precipitation using acetonitrile at a ratio equivalent to 3:1, and QMPV and QNHC were evaluated by calculating the ratio of plasma concentrations.ResultsA total of four patients with stage 4 or 5 chronic kidney disease (CKD) were enrolled in the study. All patients received a standard oral dose of molnupiravir (MPV), and plasma samples were collected 12 h post-administration (C12h) for analysis. Plasma concentrations of MPV itself were consistently low at 12 h post-dose. In contrast, the 12-h plasma concentration of N4-hydroxycytidine (NHC, the active metabolite of MPV) in patients with severe renal insufficiency (stage 4/5 CKD) was significantly higher than that in reference populations: compared with healthy subjects (NHC C12h: 16.7 ng/mL) and patients with mild to moderate renal impairment (NHC C12h: 31.1 ng/mL), the NHC C12h in the severe renal insufficiency group ranged from 43 to 1,600 ng/mL. Notably, the patient with stage 5 CKD exhibited the highest NHC plasma concentration (1,600 ng/mL) at 12 h post-dose, which remained at a persistently elevated level.ConclusionMPV was rapidly hydrolyzed to NHC in the body and maintained at a low level. The NHC is significantly higher than that of patients with mild to moderate symptoms, especially those with stage 5 chronic kidney disease. The blood drug concentration is equivalent to Cmax, which suggests that when used clinically in patients with uremia, the dosing interval should be adjusted to avoid drug accumulation and occurrence of AEs.

Objective: To evaluate the prevalence of polypharmacy and drug-related problems (DRP) in octogenarians treated at a SUS outpatient clinic in the interior of Espírito Santo. Methods: Exploratory, descriptive study with a qualitative-quantitative approach. The study included elderly people (IP) aged 80 years or over treated at the SUS specialty outpatient clinic located in the interior of the Espírito Santo. After the geriatric medical consultation, the patient was referred to pharmaceutical care, where sociodemographic information, health history and medication use were collected. Results: 41 octogenarians were treated, whose average age was 86 years, with the majority being women (61%) with chronic disease such as hypertension (82,9%), dyslipidemia (56,1%), diabetes (41, 46%) and pain (63,4%). The average number of medications used by octogenarians was 7,6, with antihypertensives, antidepressants and analgesics being common. Although 68.3% reported knowing their treatments, 53.7% had DRP, with non-adherence (32%) being the most prevalent condition. Conclusion: The data show that the octogenarians treated have low education and many chronic diseases. With regard to the use of medications, polypharmacy is accompanied by DRP, especially non-adherence. Therefore, it is necessary to expand strategies to promote health care suited to the needs and understanding of octogenarians. The pharmacist must develop practices aimed at this group to promote the rational use of medicines, contributing to the quality of life of octogenarians.

The article examines aspects of control and supervision over compliance with the norms of current administrative legislation regulating the sphere of renewable energy. It is emphasized that in the context of global environmental challenges and growing demand for energy resources, the development of renewable energy is particularly important. The key role of this industry for the economic development of Ukraine is emphasized. An analysis of the current regulatory framework regulating this sphere has been conducted, the main problems of law enforcement have been identified, and ways to improve administrative and legal mechanisms have been outlined. Particular attention is paid to issues of cooperation between state bodies and business entities operating in the sphere of renewable energy, as well as ensuring transparency and efficiency of control procedures. The importance of control and supervision in the sphere of renewable energy as components of the mechanism for ensuring the legality and efficiency of the functioning of this sector has been noted. Control is carried out by authorized state authorities in accordance with administrative and legal norms and involves checking the compliance of business entities with the requirements of the law. Its task is to prevent violations, ensure compliance with safety and environmental standards, and stimulate sustainable development. Supervision involves constant monitoring of the activities of renewable energy entities in order to identify potential risks and violations. The article states that in Ukraine, several state bodies perform control and supervision functions in the field of renewable energy. In particular, the State Inspectorate for Energy Supervision of Ukraine is responsible for checking the technical condition of energy facilities and their compliance with established standards. The National Commission for State Regulation in the Spheres of Energy and Utilities (NEURC) performs regulatory functions in the market and monitors compliance with licensing conditions by business entities operating in the field of electricity production from renewable sources. The State Ecological Inspectorate of Ukraine implements the policy of state supervision (control) in the field of environmental protection, rational use of natural resources and ensures compliance with environmental standards during the construction and operation of renewable energy facilities.