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Antimicrobial resistance (AMR) is now a global pandemic and a future threat to the existence of many clinical antibiotics. The excessive overuse in fisheries, poultries, and dairy farms and its irrational prescribing practices are the key factors that lead us to AMR explosions. The current main research objective is to evaluate the empirical practices of ampicillin along with cloxacillin, which are one of the running antibiotics in clinical practices, in most of the tertiary care hospitals in Khyber Pakhtunkhwa, Pakistan. In this study, the prescribing attitude, sensitivity and responsiveness of these two combinatory antibiotics (ampicillin-cloxacillin) in pediatric/adult pneumonia patients were evaluated in one of the public sector tertiary care hospitals in Mardan. Retrospective data was collected from pediatric ward A and medical A ward (adult), among which a total of n= 90 patient’s prescriptions were evaluated for prescribing practices, WHO core indicators, polypharmacy as well as responsiveness and sensitivity of ampicillin and cloxacillin from hospital longevity. The ampicillin responsiveness was sorted out among all those patients that stayed for a long time in the hospital, and during which the antibiotic therapies were switched from time to time. A total of n= 90 pneumonia patients (40 % & 60 % female) cases were evaluated for ampicillin/cloxacillin (combination) hospital stay longevity and responsiveness. 46 % of patients were under the age of 1–20 years, whereas 31 % were adults between the age of 61–80 years. WHO indicators revealed, that in the prescribed medications (n=918 drugs total, among n=90 patients) 22.33 % of antibiotics were prescribed, where 31.37 % consisted of injectables. Among the antibiotics classes, 17 % of pneumonia patients received penicillin, among which 26.25 % were ampicillin + cloxacillin in the prescribing practices. Ampicillin + cloxacillin responsiveness in pneumonia patients was recorded from the hospital stay and longevity (days) of the patients during their empirical therapy. 46.98 % of pneumonia patients recovered within three days, whereas 40.96 % of patients recovered within six days with ampicillin + cloxacillin (combination therapy). While 10.84 % were stabilized within nine days, though, some patients (1.20 %), recovered after 12 days with ampicillin/cloxacillin (combination therapy). Thus, it may be concluded from the current studies, that the decrease in responsiveness to ampicillin/cloxacillin (combination therapy) and the increase in the hospital longevity of patients, may be an indication of antimicrobial resistance (AMR) in pneumonia patients. Though the studies are limited to a very specific number of patients, as well as only to the hospital longevity (stay) parameters of the patients in a tertiary care hospital. These studies should be subjected further to more extensive vigilant research.

OBJECTIVES Most obstructive airway disease medications are used via inhalers, and their proper use is significant for effectively treating these diseases. Most patients misuse it. However, some studies showed that many physicians also do not know the proper meter dose inhaler with the spacer technique. This study aimed to assess metered-dose inhalers with spacer technique among postgraduate trainee doctors. METHODOLOGY This cross-sectional study was carried out in the Khyber Teaching Hospital Peshawar. The total time was six months, from Dec 6 2020, to Jun 5 2021. Postgraduate trainee (PGT) doctors of either gender with an age range of 25 to 35 years were included in the study from different departments. Those with every use of inhalers were excluded from the study. Demographic details of PGTs, like age and gender, were recorded. RESULTS Among 96 patients, males were 85 (88.54%), and females were 11 (11.46%). The mean age was 30.02±1.84 years, and the mean training experience was 2.0521 ±0.89. Inhaler technique was Proper in 20 (20.83%), Improper in 51 (53.13%) and Poor in 25 (26.04%) doctors. Those with more training periods, pulmonology rotation, attended workshops on inhaler techniques and with relatives using inhalers were more acknowledged of proper meter dose inhalers (MDIs) with spacer technique. CONCLUSION Only one-fifth of the postgraduate trainees know proper MDIs techniques. The attendance of workshops and pulmonology rotation is encouraged to enhance the knowledge of physicians regarding MDIs techniques.

Newcastle disease (ND) has been one of the great challenges to Poultry in Pakistan and dealt with vaccination. Mortality and morbidity that are associated with it are economically significant. Two vaccines produced against Newcastle disease virus are Live ND-LaSota and ND Mukteswar vaccines and their immunogenic effects in backyard poultry. For that purpose, a total 130 of 6-8 weeks old layer cockerels were inoculated with both vaccines by different routes including Ocular, drinking water and Injection and serum samples were collected at 14, 21 and 35 days’ post inoculation were analyzed by Heamaglutination inhibition test for antibody titers. The best route of administration for ND-LaSota was observed by ocular drops and ND- Mukteswar through injection. So it was concluded that both the vaccines needed booster doses in 4th to 5th week of primary inoculation. ND-LaSota vaccine was found to be best for primary induction.

Pleural mesothelioma is the disease of the elderly, usually in the seventh decade of life. Asbestos exposure is the most common finding among these patients. Other causes include a simian virus, radiation exposure, genetic predisposition and erionite. Common symptoms include shortness of breath, weight loss, dull achy chest pain on the site of the lesion and anorexia. Pleural effusion is common and video-assisted thoracoscopic (VATS) biopsy is the investigation of choice. pleurectomy, pleuro-pneumonectomy and cisplatin-based therapy are management modalities depending upon the stage of the disease. We are presenting an unusual case of pleural mesothelioma in a young patient with no significant exposure to the causative agent.

Objective: To determine the overall prevalence of overactive bladder in Pakistan, and to determine the difference in prevalence in relation to gender. Method: The multicenter study was conducted from February 2017 to October 2018 at 11 institutions across the country, and comprised randomly selected healthy subjects of either gender who were assessed on the basis of symptoms defined by the International Continence Society for overactive bladder. Data was collected using a questionnaire based on the symptoms which was filled for the respondent by designated health workers. Data was analysed using SPSS 23. Results: Of the 1291 respondents, 632(49%) were males with a mean age of 37.8+14.4 years, and 659(51%) were females with a mean age of 38.3+13.7 years. The overall prevalence of overactive bladder was 82(6.4%). Among the males, it was 15(2.4%) and among the females 67(10.2%) (p=0.001). Urgency, frequency and nocturia were reported by 82(6.4%) respondents; 15(1.2%) males and 67(5.2%) females (p=0.001). Conclusion: The prevalence of overactive bladder was found to be low when assessed with strict application of the three classical symptoms of the condition. Continuous...

This research paper aims at providing a robust understanding about the managerial competencies in both public and private firms. At present, the competency management is widely recognized horizon in developed and developing countries. The paper attempts to explore how managers try to resolve the grievances at their workplaces. This exploratory study is qualitative in nature and data were gathered by conducting twelve semistructured interviews with public and private managerial employees. The current research extensively focuses on exclusive competencies utilized by managers of public-private setups. Both the organizational learning theory and competency management frameworks helped to shape the managerial competencies. This study included work-oriented experiences and subjective perspectives of managers and the working styles were also identified. Drawing on the lens of organizational learning and competencies, peculiar informal practices and strategies were established and managed for effective management. The insightful research findings provide great debate that managers are encountered with many performance issues and they apply multiple competencies like planning & monitoring work, judgment ability, influence, communication, teamwork and integrity & self-awareness which significantly redress the employee impediments, performance pitfalls and organizational predicament. These competencies motivate the managers to perform well; ultimately they contribute in uplifting the organizational image from deterioration. The organizational learning theory has great contribution and it plays a vital role for establishing the manager-competences. The managers collectively need a more interactive approach and clear vision. It is noteworthy here that further research calls emerge for more explanatory mechanism based on subjective perceptions which produce a distinctive combination of factors which may influence and diversify the employee competencies.