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Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empiric therapy to be adjusted according to the result of culture sensitivity reports. Objective: Using culture sensitivity reports to optimize antibiotic prescribing in a teaching hospital in Pakistan. Methods: A retrospective observational study was undertaken in Ghurki Trust Teaching Hospital. A total of 465 positive cultures were taken from patients during the study period (May 2018 and December 2018). The results of pathogen identification and susceptibility testing from patient-infected sites were assessed. Additional data was collected from the patient’s medical file. This included demographic data, sample type, causative microbe, antimicrobial treatment, and whether empiric or definitive treatment as well as medicine costs. Antimicrobial data was assessed using World Health Organization’s Defined Daily Dose methodology. Results: A total of 497 isolates were detected from the 465 patient samples as 32 patients had polymicrobes, which included 309 g-negative rods and 188 g-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was Staphylococcus aureus (Methicillin-sensitive Staphylococcus aureus) (125) (25.1%) and the most common Gram-negative pathogen was Escherichia coli (140) (28.1%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the Acinetobacter baumannii isolates were resistant to carbapenems. Gram-positive bacteria showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics for empiric therapy were cefoperazone plus sulbactam, ceftriaxone, amikacin, vancomycin, and metronidazole whereas high use of linezolid, clindamycin, meropenem, and piperacillin + tazobactam was seen in definitive treatment. Empiric therapy was adjusted in 220 (71.1%) cases of Gram-negative infections and 134 (71.2%) cases of Gram-positive infections. Compared with empiric therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average cost of antibiotics in definitive treatment was less than seen with empiric treatment (8.2%) and the length of hospitalization also decreased. Conclusions: Culture sensitivity reports helped reduced antibiotic utilization and costs as well as helped select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs in hospitals and the development of hospital antibiotic guidelines to reduce unnecessary prescribing of broad-spectrum antibiotics.

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.

Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post-operatively. However, there are concerns with the extent of prophylaxis post-operatively, especially in low- and middle-income countries (LMICs). This increases antimicrobial resistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study on 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. The identified variables included post-operative prophylactic antimicrobials given to all patients for all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures, and among these, the use of third-generation cephalosporins was common. The duration of post-operative prophylaxis was 3–4 days, appreciably longer than the suggestions of the guidelines, with most patients prescribed antimicrobials until discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration need to be addressed. This includes appropriate interventions, such as antimicrobial stewardship programs, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and to reduce AMR.

Antibiotic de-escalation is a key element of antimicrobial stewardship programs that restrict the spread and emergence of resistance. This study was performed to evaluate the impact of positive culture sensitivity reports of or ( ) on de-escalation of antibiotic therapy. This prospective observational study was performed on 256 infected patients. The samples were obtained principally from the pus of infected sites for the identification of pathogens and culture-sensitivity testing. The data were collected from patient medical files, which included their demographic data, sample type, causative microbe and antimicrobial treatment as empiric or definitive treatment based on cultures. Data were analyzed using SPSS. Of 256 isolated microbes, 138 (53.9%) were and 118 were (46.1%). showed 100% sensitivity to cefoxitin, oxacillin, vancomycin, fosfomycin, colistin and more than 90% to linezolid (95.3%), tigecycline (93.1%), chloramphenicol (92.2%) and amikacin (90.2%). showed 100% sensitivity to only fosfomycin and more than 90% to colistin (96.7%), polymyxin-B (95.1%) and tigecycline (92.9%). The high use of cefoperazone+sulbactam (151), amikacin (149), ceftriaxone (33), metronidazole (30) and piperacillin + tazobactam (22) was seen with empiric prescribing. Following susceptibility testing, the most common antibiotics prescribed for were meropenem IV (34), amikacin (34), ciprofloxacin (29) and cefoperazone+sulbactam (25). For cases, linezolid (48), clindamycin (30), cefoperazone+ sulbactam IV (16) and amikacin (15) was used commonly. Overall, there was 23% reduction in antibiotic use in case of and 43% reduction in cases. Culture sensitivity reports helped in the de-escalation of antimicrobial therapy, reducing the prescribing of especially broad-spectrum antibiotics. Consequently, it is recommended that local hospital guidelines be developed based on local antimicrobial susceptibility patterns while preventing the unnecessary use of broad-spectrum antibiotics for empiric treatment.

Gamma-aminobutyric acid (GABA) is a non-protein amino acid known for its role in the nervous system of animals. However, research has also revealed its presence and function in plants recently. In plants, GABA is a signal molecule involved in multiple physiological processes, including stress response, growth, and development. This review aims to present a thorough summary of the current knowledge regarding the role of GABA in plants. We begin by discussing the biosynthesis and transport of GABA in plants, followed by a detailed examination of its signaling mechanisms. Additionally, we explore GABA's potential roles in various plant physiological processes, such as abiotic stress response, and its potential application in horticultural plants. Finally, we highlight current challenges and future directions for research in this area. Overall, this review offers a comprehensive understanding of the significance of GABA in plants and its potential implications for plant physiology and crop improvement.

Dwarfing rootstocks are a valuable genetic resource for managing high-density plantations. The selection of the appropriate scion/rootstock combination is key to improving crop performance and sustainable production in a particular environment and specific training systems. ‘Shatangju’ mandarin scion cultivar grafted onto ‘Flying Dragon’ rootstock tends to be dwarfing and develops short stature plants. To obtain insight into potential mechanisms underlying rootstock-induced dwarfing effects, we conducted a rootstock trial to examine the influence of 11 different rootstocks based on their growth vigor, antioxidants, and hormonal levels of the scion cultivar. The phenotypic observations revealed that size reduction in the ‘Flying Dragon’ rootstock is due to lower node number, shorter internodal length, and a reduced trunk diameter of the scion compared with more vigorous rootstocks. Antioxidant analysis showed that ‘Shatangju’ mandarin grafted onto ’Flying Dragon’ and ‘Trifoliate Orange’ rootstock had significantly lower peroxidase (POD) activity than other tested rootstocks. The hormonal analysis indicated that there were markedly lower amounts of abscisic acid (ABA) in ‘Shatangju’ mandarin grafted with ‘Flying Dragon’ rootstock. In addition, trees grafted with ‘Sour Pummelo’ and ‘Flying Dragon’ depicted minimum amounts of gibberellins (GA24). Moreover, several metabolites associated with organic acids, flavonoids, amino acids, and alkaloids responded differently in plants grafted with ‘Flying Dragon’ (dwarfing) and ‘Shatang Mandarin’ (vigorous) rootstocks. This study concluded that ‘Flying Dragon’ rootstock with a strong dwarfing effect has been proposed to improve high-density cultivation methods. These findings will provide useful insights for future research associated with rootstock-mediated dwarfing mechanisms of citrus rootstocks.

Quantitative analysis of understorey vegetation was carried out at twenty two different sites of Shogran valley at the elevation range between 2357 to 2784m. Circular plots of 2.5m were used for the purpose of sampling. The present study revealed that the most common understorey species of Shogran valley were Fragaria indica, Galium aparine, Galium boreata, Geranium wallichianum, Gentiana argenta, Micromeria biflora, Poa supina, Plantago lanceolata, Ranunculus puchellus, Rumex dentatus, Taraxacum officinale, Trifolium minus, Trifolium repens, Viburnum mullaha, Viola biflora, Anemone rivilaris, Arabidopsis thaliana, Indigofera pulchella, Rumex nepalensis and Trifolium minus. These species were frequently present at the higher elevation and not found at the low elevation. Galium boreata, Ranunculus pulchellus and Ranunculus sceleratus were found at both the elevations. Ranunculaceae was the most common family while Fabaceae, Pinaceae, Labiatae, Primulaceae, Rosaceae and Berberidaceae were the common in this area.