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The COVID-19 pandemic has significantly influenced antimicrobial use in hospitals, raising concerns regarding increased antimicrobial resistance (AMR) through their overuse. The objective of this study was to assess patterns of antimicrobial prescribing during the current COVID-19 pandemic among hospitals in Pakistan, including the prevalence of COVID-19. A point prevalence survey (PPS) was performed among 11 different hospitals from November 2020 to January 2021. The study included all hospitalized patients receiving an antibiotic on the day of the PPS. The Global-PPS web-based application was used for data entry and analysis. Out of 1024 hospitalized patients, 662 (64.64%) received antimicrobials. The top three most common indications for antimicrobial use were pneumonia (13.3%), central nervous system infections (10.4%) and gastrointestinal indications (10.4%). Ceftriaxone (26.6%), metronidazole (9.7%) and vancomycin (7.9%) were the top three most commonly prescribed antimicrobials among surveyed patients, with the majority of antibiotics administered empirically (97.9%). Most antimicrobials for surgical prophylaxis were given for more than one day, which is a concern. Overall, a high percentage of antimicrobial use, including broad-spectrums, was seen among the different hospitals in Pakistan during the current COVID-19 pandemic. Multifaceted interventions are needed to enhance rational antimicrobial prescribing including limiting their prescribing post-operatively for surgical prophylaxis. [ABSTRACT FROM AUTHOR]

Aortic valve disease and cancer are significant causes of mortality, especially in older populations. This meta-analysis addresses a critical question in the management of patients with both aortic valve disease and cancer. As these two conditions are major contributors to mortality, determining the best course of treatment can be complex. Traditionally, randomized controlled trials (RCTs) exclude cancer patients, leaving a gap in clinical evidence. This study steps in to fill that gap by pooling data from over 120,000 patients in 15 cohort studies, following PRISMA guidelines to evaluate the safety and effectiveness of transcatheter aortic valve replacement (TAVR) in cancer patients. The primary focus of the analysis was all-cause mortality, with secondary outcomes including stroke, pacemaker implantation, acute kidney injury, major bleeding, and vascular complications. The results revealed no statistically significant differences between cancer and non-cancer groups in terms of mortality or complications. These findings suggest that TAVR can be a safe and effective option for patients with cancer, suggesting that deferring cardiovascular interventions in favor of cancer treatment may not always be necessary. However, the observational nature of the included studies does introduce potential biases, such as confounding factors and selection bias. The study highlights the need for more targeted research that focuses on specific types and stages of cancer to better understand how these factors may influence outcomes. Despite these limitations, the meta-analysis provides valuable insights and suggests that TAVR could be a viable treatment path for patients managing both cancer and aortic valve disease., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ahsan et al.)