BackgroundThe inappropriate use of antibiotics in hospitals increases resistance, morbidity, and mortality. Little is currently known about appropriate antibiotic use among hospitals in Lahore, the capital city of Pakistan.MethodsLongitudinal surveillance was conducted over a period of 2 months among hospitals in Lahore, Pakistan. Antibiotic treatment was considered inappropriate on the basis of a wrong dosage regimen, wrong indication, or both based on the British National Formulary.ResultsA total of 2022 antibiotics were given to 1185 patients. Out of the total prescribed, approximately two-thirds of the study population (70.3%) had at least one inappropriate antimicrobial. Overall, 27.2% of patients had respiratory tract infections, and out of these, 62.8% were considered as having inappropriate therapy. Cephalosporins were extensively prescribed among patients, and in many cases, this was inappropriate (67.2%). Penicillins were given to 283 patients, out of which 201 (71.0%) were prescribed for either the wrong indication or dosage or both. Significant variations were also observed regarding inappropriate prescribing for several antimicrobials including the carbapenems (70.9%), aminoglycosides (35.8%), fluoroquinolones (64.2%), macrolides (74.6%) and other antibacterials (73.1%).ConclusionEducational interventions, institutional guidelines, and antimicrobial stewardship programs need to be developed to enhance future appropriate antimicrobial use in hospitals in Pakistan. Policies by healthcare and Government officials are also needed to minimize inappropriate antibiotic use.

Background: The age of out-of-pocket health-care expenditures demands the practice of generic medicine. Our objective was to evaluate the knowledge and attitude about generic medicine among medical and pharmacy students of Lahore, Pakistan. Methods: A cross-sectional study was performed among calculated sample size (via online Raosoft calculator) of 295 students including 185 pharmacy and 110 medical students from third, fourth, and final year of studies using convenient sampling approach. A pre-validated questionnaire was used to assess the knowledge of students regarding generic medicine. Data were analyzed using SPSS version 20. Results: We found that a majority of both pharmacy and medical students were aware of the meaning of brand and generic medicine where 86 (29.7%) students believed that generic medicine is bioequivalent to brand name product and 108 (36.5%) students agreed that cost burden will be reduced with the use of generics. There were concerns about quality (P 0.05) and side effects (P 0.005) of generic medicine as compared to brands. Significant associations were found between the knowledge of medical and pharmacy students (P 0.005). Conclusion: Educational interventions and policies regarding generic medicine practices are strongly needed to overcome the knowledge deficits among pharmacy and medical students.

Abstract-Amplify-and-forward (AF) is one of the most popular and simple approaches for transmitting information over a cooperative multi-input multi-output (MIMO) relay channel. In cooperative communication, relays are employed for improving the coverage or enhancing the spectral efficiency, especially of cell-edge users. However, in a multi-cell context, the use of relays will also lead to an increase in interferences that are experienced by cell-edge users of neighboring cells. In this paper, two novel precoding schemes for mitigating this adverse effect of cooperative communication are proposed. They are designed by taking into account the effect of interference coming from neighboring cells, i.e. other cell-interference (OCI), for maximizing the sumrate of cell-edge users. Our novel OCI-aware precoding schemes are compared against non OCI-aware precoding techniques and results show the large performance gain in terms of sum-rate that our schemes can achieved especially for large numbers of users and/or antennas in the multi-cell system. I. INTRODUCTION Cooperative communication has recently attracted considerable research interests [1]-[3]. Amplify-and-forward (AF) is a simple and practical approach for implementing cooperative multi-input multi-output (MIMO) communication. In AF, the relay node (RN) simply amplifies the received signal from the source node (SN) and forwards it to the destination node (DN). In the original AF scheme [3], the RN was first used as a simple equal gain amplifier. Since then, it has been shown in [4] and other many works that the RN can also be utilized as a smart precoder for improving the spectral efficiency of single and multi-user (MU) MIMO AF communication.As far as the downlink (DL) of MU MIMO AF communication is concerned, some methods have first been proposed in [5] and [6] to efficiently perform the precoding at the RN but only for the single antenna per user case. Recently in [7], a method for the MIMO case has been designed by assuming that the full channel state information (CSI) of the relay channel is available at the SN and that dirty paper coding is employed. Then in [8], we have developed three precoding methods for the DL of MU MIMO AF system, namely the AF-statistical knowledge of the relay-destination links, AF-channel block diagonalization (CBD) and AF-constrained gradient search for DL (CGSDL) methods, by considering two more realistic CSI assumptions than in [7], i.e. only the receive CSI or both receive and transmit CSI is available at the RN and, hence, without relying on DPC at the SN. All the previously cited precoding techniques only considered MU interference from different users within the same cell and, thus, did not take into account OCI. However, it has been shown

Background Potassium ethylenediaminetetraacetic acid (K-EDTA) contamination of serum samples is a common cause of spurious electrolyte results, which may adversely affect patient care. The source of K-EDTA sample contamination is unknown since it is not caused by reverse order of draw. Other possible mechanisms are either direct transfer of blood from K-EDTA containing tubes to other tubes or syringe needle/top contamination when delivering blood into EDTA sample tubes before other sample tubes, but these have not been studied in clinical practice. We report on a quality improvement programme aimed at identifying the source of K-EDTA-contaminated samples. Methods We routinely measure EDTA in all serum samples with a potassium ⩾6.0 mmol/L. We identified individuals responsible for K-EDTA-contaminated samples (EDTA >0.15 mmol/L) and in close-to-real-time discussed their phlebotomy methods for the collection of these samples. Results Over four months, we investigated 96 EDTA-contaminated samples. Of these, we identified and interviewed 64 (67%) individuals responsible for contaminated samples; 52 (81%) doctors, 9 (14%) phlebotomists and 3 (5%) nurses. Fifty-two individuals recalled taking the sample and the phlebotomy method used. All used open phlebotomy methods. Conclusions We report, for the first time, that K-EDTA sample contamination almost always, if not exclusively, occurs following open phlebotomy methods. Phlebotomy training and guidelines should, therefore, encourage use of closed systems as well as include and emphasize the importance of ‘order of blood sample tube fill’ when using open phlebotomy methods.

Background This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. Methods This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score‐matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score‐matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. Results A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score‐matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). Conclusion There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast‐induced nephropathy should not be used as a reason to avoid contrast‐enhanced CT.