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Objective:To determine pathogen burden and susceptibility pattern of multi-drug resistant (MDR) Pseudomonas aeruginosa isolates from clinical specimens in Karachi.Methods:It was In-vitro Clinical study, conducted in department of Pharmacology, Ziauddin University, and isolates were collected from various specimens such as pus, tracheal aspiration, wound swab, blood and urine in Microbiology department of Ziauddin Hospital, Nazimabad campus, Karachi. The antibiotic susceptibility pattern was determined by Kirby Bauer Disc diffusion method. Samples were processed as per procedures defined by Clinical and Laboratory Standards Institute (CLSI) guidelines 2018.Results:About 55% were found to be multi drug resistant P. aeruginosa. Majority of the isolates (35.4%) were recovered from the age range 60-80 years. Maximum number of MDR P. aeruginosa was isolated from pus (33.1%) followed by tracheal aspiration (20.6%). Highest sensitivity was seen by colistin (100%) followed by ceftolozane/tazobactam (60%). Least sensitivity was observed with imipenem (19%). However, increase trend of resistance was seen among all antipesudomonal drugs.Conclusion:Increasing frequency of infections due to MDR P. aeruginosa is an emerging threat in our set up which can be prevented by prescribing antibiotics judiciously. Consistent lab detection and surveillance regarding this resistant pathogen is compulsory for providing effective health care to community.

Fiscal decentralisation refers to the transfer of authority and responsibility from central government to sub-national or the local government. It is mostly pre-assumed that fiscal decentralisation can play important role in the efficient allocations of resources and improvement of the political, economic and social activities. Many studies unlock the relationship between federal government and sub-national governments or local government. Fiscal decentralisation theories mostly based on Richard Musgrave’s (1939) functions of government. He defined three roles: stabilisation, allocation and distribution whereas, only the allocation function seems to be appropriate to fiscal decentralisation theory. Because these three functions are not equally suitable for all level of governments and it is necessary for efficiency that each function is properly matched to the level. It is a step forward towards more responsive and efficient governance if the decentralisation is done properly [Oates (1972)]. The logic behind fiscal decentralisation is accountability and efficiency; the smaller organisations are more fragile for accountability than the larger ones. However, decentralisation has not always been effective in the provision of service delivery and hardly accountable due to lack of community participation. If there is no spill over effects and in the absence of diseconomies of scale it could be effective and efficient. The sub-national governments where the externalities are internalised and scale economies are acceptable fiscal responsibilities should be assigned [Rodden, et al. (2003)]. The sub-national governments are much closer to the people and they are better informed to respond according to their demands of goods and services [Hayek (1945); Qian and Weingast (1997)]. Service deliveries are highly dependent on transfers from central governments. It is necessary to increase the revenue autonomy of sub-national governments and it is linked with the service delivery in social sector [Elhiraika (2007)]. Lower level of governments is closer to the people and much aware of the preferences of localities. Service deliveries should be located at the lowest level because decentralised provision of services increases the economic welfare [Oates (1999)].

Background It has been noted that there is high prevalence of depression among medical personnel whether it is a student or an on-duty doctor. However, no study has been done to highlight these two vulnerable groups. Accordingly, the objective of current study is to compare the prevalence of depression among medical students and doctors working in hospitals, and its correlation with demographic variables, associated symptoms and history of any recent trauma. A descriptive cross-sectional study design was selected for this study. PHQ-9 was used as study tool. Result Mean age of students was 21 ± 1.83 while the mean age of the doctors included in study was 31 ± 7.8. A multivariate analysis model (MANOVA) was applied where male doctor and students were found to have a significantly high association (p = < 0.001) with depression scores as compared to their counterpart and students. Positive association was observed among sector and symptom of hopelessness, sleep changes and appetite/weight changes. The most common symptom among both groups was sleep changes while the least common symptom among doctors was concentration problem and among students was feeling of helplessness. It was also found that 26% of the students were having suicidal thoughts while only 16% of the doctors were having suicidal intentions. Conclusion It is concluded that depression is highly prevalent among medical students when comparing with on-duty doctors, so they should be screened with regular intervals and good counselling sessions to prepare them for a better health care system.