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Objective This study was conducted to evaluate the parental self-medication (SM) practices in children and associated factors in Adana, Turkey. Methods A web-based cross-sectional survey was carried out among the parents between December 2020 and April 2021. This study was conducted according to the ‘Checklist for Reporting Results of Internet E-Surveys (CHERRIES)’ guidelines. A one-page survey included details about sociodemographic characteristics (gender, age, profession, education of parents and others) sources of information, questions related to parental SM practices for their children (SM practices, common illnesses, drugs used as SM practices and drug-related information) and the reasons behind SM practices were disseminated via social media networks (Instagram, WhatsApp and Facebook) to eligible participants. Online sample size calculator was used, and snow-ball sampling was employed during the study. The final automatic responses from Google Forms were retrieved as ‘Excel datasheet’ and then cleaned, coded and imported into the SPSS statistical tool (v.25.0). Key findings This study included a total of 370 participants (response rate of 95.4%). Parental SM practices were revealed to be more (n = 234; 63.5%) prevalent. The most frequent problems for parents who follow SM practices were fever (39.5%; n = 146) and abdominal pain (23.8%; n = 88). The most commonly used class of drugs was antipyretics followed by analgesics and antibiotics. The main reasons for SM practices were personal experience in treating children (n = 186; 50.3%) and high consultation charges (n = 72; 19.5%). Mother working status and parental educational level were two main factors found to be statistically associated with SM practices (P < 0.05). Conclusions The prevalence of parental SM practices was high. There is an urgent need for the parental educational program, the development of national policies about rational medicine usage and durable actions to discourage SM practices.

Salinity severely affects crop yield by hindering nitrogen uptake and reducing plant growth. Plant growth-promoting bacteria (PGPB) are capable of providing cross-protection against biotic/abiotic stresses and facilitating plant growth. Genome-level knowledge of PGPB is necessary to translate the knowledge into a product as efficient biofertilizers and biocontrol agents. The current study aimed to isolate and characterize indigenous plant growth-promoting strains with the potential to promote plant growth under various stress conditions. In this regard, 72 bacterial strains were isolated from various saline-sodic soil/lakes; 19 exhibited multiple in vitro plant growth-promoting traits, including indole 3 acetic acid production, phosphate solubilization, siderophore synthesis, lytic enzymes production, biofilm formation, and antibacterial activities. To get an in-depth insight into genome composition and diversity, whole-genome sequence and genome mining of one promising Bacillus paralicheniformis strain ES-1 were performed. The strain ES-1 genome carries 12 biosynthetic gene clusters, at least six genomic islands, and four prophage regions. Genome mining identified plant growth-promoting conferring genes such as phosphate solubilization, nitrogen fixation, tryptophan production, siderophore, acetoin, butanediol, chitinase, hydrogen sulfate synthesis, chemotaxis, and motility. Comparative genome analysis indicates the region of genome plasticity which shapes the structure and function of B. paralicheniformis and plays a crucial role in habitat adaptation. The strain ES-1 has a relatively large accessory genome of 649 genes (~ 19%) and 180 unique genes. Overall, these results provide valuable insight into the bioactivity and genomic insight into B. paralicheniformis strain ES-1 with its potential use in sustainable agriculture.

Shigellosis is the main cause of food and waterborne diarrhea and is an emerging threat to human health. The current study characterized the indigenous multidrug-resistant Shigella flexneri serotypes for their plasmid profiles and genetic diversity, to characterize the plasmid evolutionary patterns and distribution. In total, 199 identified S. flexneri isolates belonging to six different serotypes were analyzed for plasmid profiling, followed by an analysis of whole genome sequencing. All isolates of S. flexneri resistant to antibiotics harbored multiple copies of plasmids with sizes ranging from 1.25 kbp to 9.4 kbp. These isolates were clustered into 22 distinct plasmid patterns, labeled as p1-p22. Among these, p1 (24%) and p10 (13%) were the predominant plasmid profiles. All S. flexneri strains were grouped into 12 clades with a 75% similarity level. Also, a significant association was observed among the plasmid patterns, p23 and p17 with the drug-resistant patterns AMC, SXT, C (19.5%) and OFX, AMC, NA, CIP (13.5%), respectively. Moreover, the most widespread plasmid patterns p4, p10, and p1 showed a significant association with the serotypes 1b (29.16%), 2b (36%), and 7a (100%), respectively. After plasmid sequence assembly and annotation analysis, a variety of small plasmids that vary in size from 973 to 6200 bp were discovered. Many of these plasmids displayed high homology and coverage with plasmids from non-S. flexneri. Several novel plasmids of small size were discovered in multidrug-resistant S. flexneri. The data also showed that plasmid profile analysis is more consistent than antibiotic susceptibility pattern analysis for identifying epidemic strains of S. flexneri isolated in Pakistan.

This study aimed to elucidate differentially expressed proteins in drug resistant Salmonella Typhi. Among 100 samples, S. typhi were identified in 43 samples. In drug susceptibility profile, 95.3% (41/43), 80% (35/43) and 70% (30/43) resistances were observed against Nalidixic acid, Ampicillin, and Chloramphenicol respectively. No resistance was observed against Imipenum and Azithromycin while only 11% (5/43) isolates were found resistant to Ceftriaxone. Mass spectrometric differential analysis resulted in 23 up-regulated proteins in drug resistant isolates. Proteins found up-regulated are involved in virulence (vipB, galU, tufA, and lpp1), translation (rpsF, rpsG, rplJ, and rplR), antibiotic resistance (zwf, phoP, and ompX), cell metabolism (metK, ftsZ, pepD, and secB), stress response (ridA, rbfA, and dps), housekeeping (gapA and eno) and hypothetical proteins including ydfZ, t1802, and yajQ. These proteins are of diverse nature and functions but highly interconnected. Further characterization may be helpful for elucidation of new biomarker proteins and therapeutic drug targets.

Objective: To determine the molecular strain typing and drug resistance pattern of Salmonella enterica serovar Typhi prevalent in Northwest Pakistan. Methodology: A total of 2,138 blood samples of ...

Objective Coronavirus disease 2019 (COVID-19) caused a universal psychosocial impact and individuals exposed to threats prefer to try self-care interventions and adhere to non-conventional approaches such as traditional and complementary medicine (T&CM) for preventive purposes. This study was conducted to determine the use and belief about T&CM among the general population during the COVID-19 outbreak. Method A cross-sectional online survey was carried out among the general population (aged ≥ 18 years) of Adana, Turkey during the strict lockdown period (April 11 to April 30, 2020). The survey instrument included details about sociodemographic characteristics, general information, T&CM use and beliefs was distributed among eligible participants via social media channels (Instagram, WhatsApp and Facebook accounts). Results Out of the total 389 participants, almost 39.3% (n=153) of the participants were the T&CM user and 60.7% were non-T&CM user during COVID-19 in this study. Additionally, 61 (39.8%) participants reported the usage of more than one form of T&CM modalities. Most of them used herbal medicine (30.8%), followed by nutritional supplements/vitamins (23.8%). Around 33.9% (n=52 out of 153 T&CM user) of participants did not report T&CM use to their family physicians. A statistically significant difference was observed between T&CM users and non-T&CM users in gender, age, marital status, level of education, income, and prior use of T&CM (p

Background Globally, pharmacovigilance (PV) is crucial for the patient's safety and proper use of drugs. Spontaneous reporting of adverse drug reaction (ADR) is a professional obligation of every healthcare professionals (HCPs). The purpose of this systematic review was to analyze the existing literature about the knowledge, attitude, and practices (KAP) level of HCPs regarding PV and ADRs reporting in Turkey. Methods A systematic and comprehensive articles search strategy was carried out in different seven electronic databases (PubMed, PubMed Central, Goggle Scholar, Ovid-SP, MEDLINE, Wiley Online Library, DergiPark) from 2010 to 2020. We searched to identify existing literature about cross-sectional observational studies investigating the KAP of HCPs regarding PV and ADRs reporting in different geographical regions of Turkey. Quality assessment and risk of bias were assessed among included studies. Results Fifteen studies were chosen for full-text analysis. Finally, according to inclusion criteria, seven research articles were selected for systematic review. Overall, the KAP of HCPs varies across the studies. The lack of a standardized validated measuring tool to evaluate the KAP and differences in questionnaire items were the main limitations in included studies. Around, 69.1% (range: 54.6-100%) of HCPs were not aware of the national pharmacovigilance center in Turkey. About, 37.5% (range: 7.1-75.7%) of HCPs believed that reporting of ADRs is not important and 87.5% (range: 69.3-100%) stated that they never reported ADR previously during their practice. The most frequently highlighted barriers to PV were lack of time, uncertainty and did not know where to report. Conclusion This systematic review revealed a major KAP gap in Turkey towards PV activities. Low ADR reporting practice of HCPs was a major identified issue. The creation of a mandatory unified PV education intervention for future HCPs to rationally report ADR of drugs are crucial for a better healthcare system.

This study was designed to investigate the prevalence and associated risk factors of Shigella flexneri isolated from drinking water and retail raw food samples in Peshawar, Pakistan. A total of 1,020 different samples were collected from various areas of Peshawar between January 2016 and May 2017, followed by identification of S. flexneri through biochemical, serological, and 16S rRNA gene sequencing. Potential risk factors associated with the development and spreading of S. flexneri infection were also investigated. Overall, 45 (4.41%) samples were positive for Shigella species. Among these samples, the predominant species was S. flexneri (n = 44) followed by S. boydii (n = 1). Interestingly, S. sonnei and S. dysenteriae isolates were not found in any sample. The isolation rate of S. flexneri in drinking water samples, market raw milk, and fruits/vegetables from Peshawar were 6.47%, 3.5%, and 2.9%, respectively. The phylogenetic reconstruction showed genetic diversity among three clades, as clades I and II have isolates of S. flexneri that were circulating within the drinking water, milk, fruits/vegetables, while clade III isolates were recovered from milk samples. Most of S. flexneri were detected in June to September. Potential risk factors of S. flexneri were water sources contaminated by toilet wastes (p = 0.04), surface water drainage (p = 0.0002), hospital wastes (p = 0.01), unhygienic handling (p < 0.05), and transportation of raw food (p = 0.04). In conclusion, S. flexneri isolates of closely related lineage originating from non-clinical samples might be associated with an increased human risk to shigellosis in Pakistan, as significant numbers of S. flexneri were observed in the drinking water and retail raw food samples. PRACTICAL APPLICATION: This study demonstrated the presence of S. flexneri in drinking water and retail raw food samples which seem to possess a serious threat to public health. Potential sources of food and water contamination should properly be monitored by public health authorities to reduce cases of shigellosis.

The rapid emergence of resistance to third-generation cephalosporins in Shigella flexneri is crucial in pediatric shigellosis management. Limited studies have been conducted on molecular pattern of antibiotic resistance of S. flexneri in diarrhea endemic areas of Pakistan. The aim of the study was to analyze the antimicrobial resistance of S. flexneri isolated from pediatric diarrheal patients in Peshawar, Pakistan. A total of 199 S. flexneri isolates (clinical, n = 1 55 and non-clinical, n = 44) were investigated for drug resistance and mutational analysis of selected drug resistance genes. All isolates were found to be highly resistant to amoxicillin/clavulanic acid (88%), followed by trimethoprim-sulfamethoxazole (77%), chloramphenicol (43%), and quinolones (41.6%). About 34.5% S. flexneri isolates were found to be resistant to third-generation cephalosporin. None of the isolates was resistant to imipenem, piperacillin-tazobactam, and amikacin. Interestingly high frequency of third-generation cephalosporin resistance was observed in S. flexneri isolated from non-clinical samples (49%) when compared to clinical samples (30.5%). Furthermore, the most prevalent phenotypic-resistant patterns among third-generation cephalosporin-resistant isolates were AMC,CAZ,CPD,CFM,CRO,SXT (13%) followed by OFX,AMC,CAZ,CPD,CFM,CRO,SXT,NA,CIP (10%). The most frequently detected resistance genes were trimethoprim-sulfamethoxazole (sul2 = 84%), beta-lactamase genes (blaOXA = 87%), quinolones (qnrS = 77%), and chloramphenicol (cat = 64%). No mutation was detected in any drug-resistant genes. We are reporting for the first time the sequence of the blaTEM gene in S. flexneri. Furthermore, high third-generation cephalosporin resistance was observed in the patients who practiced self-medication as compared to those who took medication according to physician prescription. This study shows the high emergence of third-generation cephalosporin-resistant S. flexneri isolates, which is a potential threat to the community in the country. This finding will be helpful to develop a suitable antibiotic prescription regime to treat shigellosis.

Prophylactic use of antibiotics before surgery is evidence-based practice for prevention of surgical site infections (SSIs).To investigate adherence to and surgeons' perception of antibiotic prophylaxis guidelines.A two-phase, cross-sectional prospective study conducted in two teaching hospitals. Phase 1: 6-month audit of prescriptions to investigate adherence rate to evidence-based guidelines. The important information was collected from medical charts through a predesigned proforma. Phase 2: self-administration questionnaire was used to investigate the surgeons' perception. Descriptive statistics, independent-sample Kruskal-Wallis test and multivariate linear regression analysis were performed using SPSS version 21.0.A total of 866 eligible surgical cases (acute appendectomy; n = 418; 48.2%), laparoscopic cholecystectomy (n = 278; 32.1%) and inguinal hernia (n = 170; 19.7%) were investigated. Surgical antibiotic prophylaxis was prescribed in 97.5% of procedures. Out of these, 9.5% adhered to guidelines with respect to correct choice, 40% for timing, and 100% for dose and route (optimal value 100%). Most patients received ceftriaxone (n = 503; 59.5%) as prophylactic antibiotic. The questionnaire (good internal consistency; α ≥ 0.7) was filled out by 200 surgeons. More than half (69%) of participants thought that antibiotics were overused. Most surgeons perceive that poor adherence to treatment guidelines is due to poor awareness, underestimation of infection, lack of consensus, and disagreement with guidelines recommendations.Surgeons have positive perception that antibiotics should be used according to guidelines recommendations. However, we found poor treatment adherence to antibiotic prophylaxis guidelines.مراجعة استعمال المضادات الحيوية الوقائية ومدى امتثال الجراحين للمبادئ التوجيهية القياسية في الإجراءات الجراحية المعتادة في منطقة البطن.ذاكر خان، نافيد أحمد، شايستا ظفار، عاصم الرحمن، فايز الله خان، محمد صقلان، سُهيل قامران، حاضر رحمن.يُعتبر استعمال المضادات الحيوية على سبيل الوقاية قبل الجراحة من الممارسات المُسنَدة بالبيّنات للوقاية من حدوث عدوى المواضع الجراحية.هدفت هذه الدراسة إلى تحرّي مدى الامتثال للمبادئ التوجيهية الخاصة باستعمال المضادات الحيوية الوقائية ومنظور الجراحين في هذا الشأن.أُجريت دراسة استباقية مقطعية على مرحلتين في اثنين من المستشفيات الجامعية. المرحلة 1: مراجعة الوصفات الطبية التي حُررت على مدار 6 أشهر لتحري معدل الامتثال بالمبادئ التوجيهية المُسنَدة بالبيّنات. وجُعت المعلومات المهمة من المخططات الطبية للمرضى باستخدام استمارة مُصمَّمة مسبقاً لهذا الغرض. المرحلة 2: استخدام استبيان يُستكمل ذاتياً لتحرِّي منظور الجراحين في هذا الشأن. وقد استُخدم الإصدار 21.0 من برنامج SPSS لإجراء إحصاءات وصفية، واختبار كروسكال واليس القائم على العينات المستقلة، وتحليل الانحدار الخطي المتعدد المتغيرات.بلغ مجموع الحالات الجراحية التي تصلح للخضوع لهذه الدراسة 866 حالة، تراوحت بين استئصال الزائدة الدودية الملتهبة التهاباً حاداً (العدد=418؛ 48.2٪)، واستئصال المرارة بالمنظار (العدد= 278؛ 32.1٪)، والفتق الأُربي (العدد=170؛ 19.7٪). وقد وُصفت المضادات الحيوية الوقائية في 97.5٪ من الإجراءات الجراحية. ومن بين هذه الإجراءات الجراحية، كانت نسبة الامتثال للمبادئ التوجيهية من حيث الاختيار الصحيح، والتوقيت، والجرعة والمسار 9.5٪، و 40٪، و 100٪ على التوالي (القيمة المُثلى 100٪). وتلقى معظم المرضى دواء سيفترياكسون (العدد= 503؛ 59.5٪)، بوصفه أحد المضادات الحيوية الوقائية. وقد أجاب عن الاستبيان 200 جراح (اتساق داخلي جيد؛ α ≥ 0.7). ورأى أكثر من نصف الجراحين المشاركين في الاستبيان (69 ٪) أن هناك زيادة في استعمال المضادات الحيوية. كما رأى معظم الجراحين أن السبب وراء ضعف الامتثال بالمبادئ التوجيهية للعلاج يرجع إلى ضعف الوعي، وعدم تقدير الحجم الحقيقي للعدوى، وغياب التوافق في الآراء، والاختلاف مع التوصيات الخاصة بالمبادئ التوجيهية.لدى الجراحين منظور إيجابي بشأن ضرورة استعمال المضادات الحيوية وفقاً لما ورد في التوصيات الخاصة بالمبادئ التوجيهية، لكن لوحظ ضعف الامتثال للمبادئ التوجيهية الخاصة بالعلاج بالمضادات الحيوية الوقائية.Audit de l’antibioprophylaxie et de l’observance des lignes directrices standard par les chirurgiens dans les actes courants de chirurgie abdominale.L’usage prophylactique des antibiotiques préalablement à un acte chirurgical est une pratique fondée sur des données probantes, qui permet de prévenir les infections du site opératoire (ISO).Étudier l’observance des lignes directrices en matière d’antibioprophylaxie et le point de vue des chirurgiens sur cette pratique.Une étude prospective transversale en deux phases, a été menée dans deux hôpitaux universitaires. Phase 1 : Audit des ordonnances sur six mois, afin d’évaluer le taux de d’observance des lignes directrices fondées sur des données probantes. Les informations importantes ont été recueillies à partir des dossiers médicaux au moyen d’un formulaire conçu à cet effet. Phase 2 : un auto-questionnaire a été utilisé pour étudier le point de vue des chirurgiens. Des statistiques descriptives ont été produites, un test de Kruskal-Wallis sur échantillons indépendants et une analyse de régression linéaire multivariée ont été réalisés à l’aide du logiciel SPPS, version 21.0.Au total, 866 cas chirurgicaux répondant aux critères de l’étude ont été examinés : appendicectomies aiguës, (n = 418, soit 48,2 %), cholécystectomies laparoscopiques, (n = 278, soit 32,1 %) et hernies inguinales (n = 170, soit 19,7 %). Une antibioprophylaxie chirurgicale a été prescrite dans 97,5 % des interventions. Parmi ces dernières, le respect des lignes directrices était de 9,5 % pour le choix de l’antibiotique, de 40 % pour le moment de l’administration et de 100 % pour la dose et la voie d’administration, la valeur optimale étant 100 %. La majorité des patients ont reçu de la ceftriaxone (n = 503, soit 59,5 %) comme antibiotique prophylactique. Le questionnaire a été rempli par 200 chirurgiens, avec une cohérence interne satisfaisante (α ≥ 0,7). Plus de la moitié (69 %) des participants estimaient que les antibiotiques étaient surutilisés. La majorité des chirurgiens pensent que l’observance médiocre des lignes directrices de traitement est due à un manque de sensibilisation, à une sous-estimation de l’infection, à l’absence d’un consensus et à un désaccord avec les recommandations de ces lignes directrices.Les chirurgiens approuvent l’usage des antibiotiques conformément aux recommandations des lignes directrices de traitement. Cependant, notre étude révèle une observance médiocre de ces textes dans les traitements d’antibioprophylaxie.

Summary Objective To evaluate the compliance rate of Surgical antimicrobial prophylaxis (SAP) practices with guidelines among adult surgical patients. Method A cross-sectionalobservational study was conducted in a teaching hospital in Pakistan. A total of 235 surgical procedures were investigated during two-month study period through convenient sampling technique. Important data was collected from patients’ prescription records through specialized data collection form. The observed practices were compared with international evidence-based guidelines. Results Most of the surgical procedures belonged to general surgical wards (60%; n = 141). Clean surgical procedures were more important (51%; n = 120) when compared to clean-contaminated surgeries (49%; n = 115). The selection of antimicrobial was correct in 32% (n = 76), timing in 39.5% (n = 93), route and dose in 100% (n = 235) of the surgical cases. The selection and timing of SAP administration were more adhered with the guidelines in the urological ward as compared to orthopaedic and general surgical wards (P

The recent study investigated the in vitro anti-diabetic impact of the crude extract (MeOH) and subfractions ethyl acetate (EtOAc); chloroform; n-butanol; n-hexane; and aqueous fraction of

Objectives: To investigate the utilization pattern of Surgical antibiotic prophylaxis (SAP) for the prevention of surgical infections in most common abdominal and orthopedic surgical procedures. Methods : A prospective observational and non-intervention study was conducted at two teaching hospitals (PIMS and SIH) in Islamabad, Pakistan. Prescriptions records were reviewed to assess the utilization pattern of SAP during the nine-month duration. Data regarding most common surgical procedures, antimicrobial utilization, dose, route and administration timing of SAP were extracted for analysis. Observed practices were compared with standard treatment guidelines. Results : Out of total 1512 surgical procedures about, 56.9% (n=860) of patients performed abdominal followed by 652 (43.1%) orthopedic surgical procedures. A total of 212 (14%) surgical procedures were completely correct in all steps. SAP were given in 1474 (97.5%) of surgical procedures. In 712 of the participants (48.3%) were given Ceftriaxone following by Cefazolin (n=247, 16.7%). Abdominal surgeries were majorly managed with Ceftriaxone (59%) while the orthopedic surgeries managed with Ceftriaxone (31.3%) and Cefazolin (30%). Appropriate choice of SAP was observed in (n=275; 18.6%) procedures and about half (n=719, 49%) received antibiotics within optimal timing. The appropriate choice/selection of SAP according to the guidelines was greater in orthopedic surgical procedures (n=212; 14.8%) than abdominal surgeries (n=63; 4.3%); p≤0.001. Compliance with respect to timing was significantly lower in an orthopedic surgical procedure (n=301) as compared to abdominal surgeries (n=418); p≤0.001. Similarly, a statistically significant difference observed between PIMS and SIH with respect to SAP practices; p≤0.001. Conclusions : Inappropriate choice, the timing of administration and combination of SAP were observed in the current study. J Microbiol Infect Dis 2019; 9(3):104-111.

Fagonia cretica L. is a known medicinal plant containing important biomolecules. The present study was designed to prepare the silver nanoparticles (AgNP) from F. cretica L. that has never been done before. The AgNP were morphologically characterized using different techniques and their antibacterial activity was also evaluated. The AgNP were crystalline, spherical in shape ranging in size from 20 to 50 nm, and clustered. Different functional groups were detected in AgNP by Fourier transform infrared spectroscopy. Significant antibacterial activities against Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Salmonella enterica were observed. The antibacterial activity of AgNP (50 µg) was compared with ciprofloxacin (10 µg) and negative controls producing a larger inhibitory zone than the negative and positive controls in a concentration-dependent manner. It was concluded that the AgNP prepared from F. cretica extract were spherical and aggregated. They were found effective against different clinical isolates of bacteria.

One of the main problems of the industrialized world is the accumulation of chromium (Cr) in soil, which is a serious threat to the crops. Complete removal of Cr from the contaminated soils poses a great challenge. However, this issue can be minimised by using plant growth promoting microbes as a bioremediation tool. In the present study, healthy plants established near the University campus in Mardan were selected for the isolation of Cr resistant endophytes. From the designated plants, 114 species of endophytic fungi were isolated. Among the 114 isolated strains, 4 strains have induced resistance in L. sativa against Cr. The strains were identified as Aspergillus fumigatus, Rhizopus sp., Penicillium radicum and Fusarium proliferatum based on ITS region (18 S rDNA) homology. The isolates have removed Cr from soil and culture media as well as bio-transformed it from highly toxic hexavalent to least toxic trivalent form, thus helped the Cr stressed L. sativa to restore its normal growth. The Rhizopus Sp. CUC23 has mainly accrued Cr and detoxified intracellularly, whereas A. fumigatus ML43 and P. radicum PL17 has detoxified up to 95% of Cr extracellularly. From the results, it is concluded that the selected endophytic strains might be used as biofertilizer for healthy and safe crop production in Cr contaminated soils.

Objective: Studies on diabetic foot ulcers (DFU) involving a representative sample of patients in Pakistan are scarce. This study aimed to determine baseline characteristics of infected DFUs in patients hospitalised at the Pakistan Institute of Medical Sciences Islamabad. Method: In this cross-sectional study, carried out during May 2015 and June 2016, foot ulcer characteristics of patients with DFUs were investigated and documented. From infected DFUs, aerobic bacterial pathogens were isolated, identified and evaluated for antimicrobial susceptibility. Results: A total of 214 patients were recruited to the study, 62.6% of which were male, 90.2% were aged ≥40 years, 76.2% had type 1 diabetes and 78.5% had poor glycaemic control at time of presentation to hospital. Most patients had grade 3/moderate ulceration (based on the Wagner and International Working Group on the Diabetic Foot/Infectious Diseases Society of America criteria). Over half of the DFUs (57.9%) were of ≤3 months' duration and 70.1% were ≥3 cm2. Of the patients with deep infection grade ulcers, 26.6% underwent amputation, accounting for their prolonged hospital stay (≥20 days). Significant differences were observed between patients with type 1 and type 2 diabetes with DFUs in relation to gender (p≤0.0001), ulcer size (p=0.0421) and duration of hospital stay (p=0.0253). The most significant predictors for lower extremity amputation were osteomyelitis (p=0.0114), retinopathy (p=0.0001) and neuropathy (p=0.0001. Piperacillin/tazobactam was found to be an effective antibiotic against the most commonly isolated Staphylococcus non-aureus (35.48%), Pseudomonas aeruginosa (22.26%), and Staphylococcus aureus (20.96%) species indentified in the DFU infections. Conclusion: The findings of this study may be helpful in the optimal management and appropriate treatment of patients with infected DFUs.

Sugarcane (Saccharum officinarum), a sugar crop commonly grown for sugar production all over the world, is susceptible to several insect pests attack in addition to bacterial, fungal and viral infections leading to substantial reductions in its yield. The complex genetic makeup and lack of resistant genes in genome of sugarcane have made the conventional breeding a difficult and challenging task for breeders. Using pesticides for control of the attacking insects can harm beneficial insects, human and other animals and the environment as well. As alternative and effective strategy for control of insect pests, genetic engineering has been applied for overexpression of cry proteins, vegetative insecticidal proteins (vip), lectins and proteinase inhibitors (PI). In addition, the latest biotechnological tools such as host-induced gene silencing (HIGS) and CRISPR/Cas9 can be employed for sustainable control of insect pests in sugarcane. In this review overexpression of the cry, vip, lectins and PI genes in transgenic sugarcane and their disease resistance potential is described.

Background: Shigella flexneriis an emerging threat in low socioeconomic countries including Pakistan. No previous data is available on the association betweenS. flexneriserotypes and antimicrobial resistance in Pakistan. Objectives: The objective of the present study was to assess the association between serotypes and antimicrobial resistance patterns amongS. flexneriisolated from clinical and nonclinical samples. Methods: A total of 199S. flexneriisolates were subjected to molecular serotyping and antibiotic resistance. Results: The most prevalentS. flexneriserotype was 2b (38%) followed by 1b (24%), 7a (20%), 2a (11%), 1d (5%) and Y (2%). The phylogenetic reconstruction showed 12 clades among which the clades II, III, V, VIII, IX and XI have consisted of serotypes that were found both in human population and environment samples. A high level of multidrug resistance (MDR) was observed in serotype 2b (37.68%) followed by 1b (19.5%) and 7a (19.5%), 2a (11.5%), 1d (5%) and Y (2%). All isolates of serotype 2b showed high level of resistance to amoxicillin/clavulanic acid (100%) followed by quinolone (74.6%) and trimethoprim-sulfamethoxazole (54.6%). Interestingly, none of the serotype was resistant to piperacillin-tazobactam, imipenem and amikacin. The most frequently detected resistance genes among serotype 2b werebla(OXA)(100%) followed byqnrS(88%),cat(81%) andsul2(63%). Conclusion: The most frequentS. flexneriserotype was 2b while 1d and Y was first time reported in Pakistan. High frequency of MDR serotypes ofS. flexneriis a serious threat in diarrhea endemic regions and thus require urgent strategies for its continuous monitoring and prevention.

Bacillary diarrhea caused by Shigella flexneri is mediated by various virulence factors which make it the leading agent of diarrhea in developing countries. Previously, a high prevalence of S. flexneri, associated with diarrhea has been reported in Pakistan but no data is available on their virulence profile. The present study reports for the first time analysis of various virulence factors among S. flexneri serotypes isolated from clinical (diarrheal stool) and non-clinical (retail raw foods and drinking water) sources. A total of 199 S. flexneri (clinical: 155, raw foods: 22, water: 22) belonging to various serotypes were subjected to virulence genes detection and virulence profiling. The most frequent virulence gene was found to be ipaH (100%), followed by sat (98%), ial (71.3%), set1B (65.8%) and set1A (38.7%). A high level of virulence was detected in serotype 2b as compared to other serotypes as 32.3% of all serotype 2b have the entire set of five virulence genes including ipaH (100%), ial (100%), sat (37.7%), set1A (89.3%), and set1B (100%). Seven different virulence gene profiles (V1 - V7) were detected and the most frequently observed to be V1 (ipaH+, ial+, sat+, set1A+, set1B+) followed by V3 (ipaH+, ial+, sat+, set1B+). The predominant virulence gene pattern in serotype 2b isolated from clinical and non-clinical samples were V1 and V3. Furthermore, about 32% strains belonging to serotype 2b contain the complete set of five virulence genes isolated from patients with high disease severity. In conclusion, the current finding revealed for the first times that serotype 2b was the most virulent strains in both clinical and non-clinical samples in Pakistan. In addition, the virulence of serotype 2b was well correlated with high disease severity.

Summary The novel pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible to cause coronavirus disease-2019 (COVID-19). It is a global pandemic disease and has reached a new dimension with a higher death ratio. On 2 June 2020, World Health Organization (WHO) data showed more than 6,194,500 confirmed and 376,300 deaths globally due to the COVID-19. There are currently no approved medications or vaccines which have been claimed to be effective in COVID-19 prevention or treatment. Drug repurposing of available drugs and research studies for the search of new therapeutic agents are underway in various countries to try different combinations to treat their patients. It is too early to be sure of them as safe treatments because some reports seem to suggest some alarming side effects. However, a lot of work needs to be done to achieve a successful treatment result and the full safety and efficacy of the trial drugs will take some time to be developed. In this narrative perspective review, we addressed evidence-based literature on various possible antiviral medications, plant-derived antivirals drugs, and other valuable treatment options for COVID-19 management.

The World Health Organization (WHO) called the outbreak of coronavirus infectious disease-2019 (COVID-19) a "Public Health Emergency of International Concern" (PHEIC). According to the WHO, Centers for Disease Control and Prevention (CDC), and the US Food and Drug Administration (FDA), currently there are no medicines or vaccines that have been claimed to be useful in the prevention or treatment of COVID-19. Several existing antiviral drugs, previously developed or used as treatments for severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), human immunodeficiency virus (HIV), and malaria, are being investigated as COVID-19 treatments and some of them are being used in clinical trials. According to the CDC and Chinese treatment guidelines for COVID-19, chloroquine, hydroxychloroquine, lopinavir/ritonavir, and one of the investigational agents (remdesivir) are recommended in critically ill older patients. The use of other potential drugs reported in different studies may be considered if treatment with first-line drugs is ineffective. There are currently no complete data available from large randomized clinical trials (RCTs) to provide clinical guidance on the use, dosing, or duration to validate the effective role, safety profile, and adverse effects of all of the trial drugs for prophylaxis or treatment of COVID-19. Until now, it is still unclear which drug can successfully fight against the disease. Therefore, for the better safety of patients with COVID-19, further clinical trials and large randomized controlled studies are needed to validate the effective role, safety profile, and adverse effects of all the potential drugs. Such a measure requires action at the global level.

The World Health Organization (WHO) called the outbreak of coronavirus infectious disease-2019 (COVID-19) a "Public Health Emergency of International Concern" (PHEIC). According to the WHO, Centers for Disease Control and Prevention (CDC), and the US Food and Drug Administration (FDA), currently there are no medicines or vaccines that have been claimed to be useful in the prevention or treatment of COVID-19. Several existing antiviral drugs, previously developed or used as treatments for severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), human immunodeficiency virus (HIV), and malaria, are being investigated as COVID-19 treatments and some of them are being used in clinical trials. According to the CDC and Chinese treatment guidelines for COVID-19, chloroquine, hydroxychloroquine, lopinavir/ritonavir, and one of the investigational agents (remdesivir) are recommended in critically ill older patients. The use of other potential drugs reported in different studies may be considered if treatment with first-line drugs is ineffective. There are currently no complete data available from large randomized clinical trials (RCTs) to provide clinical guidance on the use, dosing, or duration to validate the effective role, safety profile, and adverse effects of all of the trial drugs for prophylaxis or treatment of COVID-19. Until now, it is still unclear which drug can successfully fight against the disease. Therefore, for the better safety of patients with COVID-19, further clinical trials and large randomized controlled studies are needed to validate the effective role, safety profile, and adverse effects of all the potential drugs. Such a measure requires action at the global level.

Objectives The aim of the present study was to develop miltefosine loaded chitosan nanoparticles (MLCNPs) to enhance the therapeutic efficacy of conventional miltefosine drug and to compare the in vitro activities of both forms of the drug against Leishmania tropica. Methods MLCNPs were synthesized through ionic gelation with sodium tripolyphosphate (TPP). For the stabilization of nanoparticles, a controlled oxidation of MLCNPs was done with hydrogen peroxide (H2O2). The anti-leishmanial activities of MLCNP were determined by MTT cell viability colorimetric assay. The in vitro hemolysis assay was performed for assessment of toxicity in the human blood. Results The MLCNPS displayed spherical shape with irregular surface morphology, had a mean size of 200nm and a zeta potential of +10.9 ± 4 mV. A high encapsulation efficacy and drug loading capacity of miltefosine loaded chitosan nanoparticles was also observed. The anti-leishmanial activities of MLCNP were determined by MTT cell viability colorimetric assay. The IC50 value of MLCNPs against promastigote and amastigote were recorded as 0.85µg/ml and 0.92µg/ml respectively. MLCNPs proved to be more effective as compared to conventional miltefosine. In terms of toxicity the MLCNPs caused only 2.25% hemolysis. Conclusions The engineered MLCNPs could be potential alternative for the treatment of cutaneous leishmaniasis.

The interleukin (IL)-12/interferon(IFN)γ axis plays an important role in the control of mycobacterial diseases as demonstrated by the increased susceptibility to mycobacterial species in patients with an inborn error of the IL-12-dependent IFNγ immunity. Here, we report a novel mutation in the IL-12Rβ1 gene in a female Pakistani patient who was born in a consanguineous marriage and developed severe bacille Calmette–Guérin (BCG) infection and recurrent tuberculosis. After reviewing the patient’s clinical records, she was investigated for IL-12/IFNγ defects using enzyme-linked immunosorbent assay (ELISA), flow cytometry, and DNA genetic Sanger sequencing. Quantification of secretory cytokines from the patient’s peripheral blood mononuclear cells (PBMCs) revealed significantly reduced IFNγ production. Flow cytometric analysis revealed no surface expression of IL-12Rβ1 on PHA-activated T lymphocytes. In addition, IL-12-induced impaired STAT4 phosphorylation in the patient’s lymphocytes when compared with those from five healthy controls. The genetic analysis of IL-12Rβ1 gene identified a novel nonsense mutation c.199G>T/p.E67* within exon 3, which encodes part of the cytokine-binding region (CBR). In silico analysis indicates that this novel nonsense mutation generates a truncated protein with an apparent inactivating effect. Our data expand the genetic spectrum of IL-12Rβ1 deficiency. Moreover, our findings highlight the need for developing newborn screening for patients with primary immunodeficiency associated with mycobacterial infections in areas where BCG vaccination is mandatory in order to improve the treatment of patients, and consequently their quality of life.

Vigorous knowledge on the occurrence and distribution of toxic metals (TMs) in theenvironment is needed to assess their toxicological impacts on human health especially in developing countries like...