Background: Antibiotic stewardship aims to optimise restricted antibiotic use and thereby prevent the emergence of antibiotic resistance and improve treatment outcome. Resistance to conventional antimicrobial’s is a major reason why restricted antibiotics are prescribed. Aim: To assess the prescribing pattern of restricted antibiotics, the indications for which restricted antibiotics were prescribed, the drug related problems associated and the sensitivity pattern of the isolated organisms. Results: Out of 340 patients included in the study, majority of patients was in the age group of 58-67(60.06 ±14.90) in both genders. There was a male (64.12%) dominance observed in the study populace and the minimum and maximum age observed was 18 and 93 years respectively. Most commonly prescribed antibiotic was Piperacillin tazobactum (31%) followed by Linezolid (16.06%). Empirically the most prescribed antibiotic was Piperacillin tazobactum (27.37%) while in definitive therapy it was Cefepime tazobactum (10.63%). The most common indication for which restricted antibiotics prescribed were for respiratory tract infection (n=116), followed by infection prophylaxis (n=114). Mean days of restricted antibiotic therapy was found to be 8.85 days ± 8.11. The maximum duration of antibiotic treatment was 62 days and minimum was 1 day. In 47% of cases IV to oral conversion was possible. When analysed retrospectively, in majority of the patients the duration of restricted antibiotic treatment was inappropriate (69.71%) while the inappropriateness in frequency and dose were 7.05% and 3.23% respectively. The total number of cultures collected were 292 in that 120 cultures were urine and found growth in 50.83%, followed by 84 cultures in sputum which accounted for 67.85% growth. The most common organism isolated was Klebsiella pneumoniae 39.73% cases followed by Pseudomonas aeruginosa 17.46% and Acinetobacter baumannii15.41. There was clinical cure in 91.47% of cases. Conclusion: When analysed retrospectively majority of the restricted antibiotics showed inappropriateness. This higher amount of inappropriateness could have been avoided to a certain extent, by the timely interventions of a clinical pharmacist. By implementing an effective antimicrobial stewardship program we could improve the rational use of restricted antibiotics and thereby prevent the future resistance and improve clinical outcome.

experience by including computers and the internet in the learning process. It is a system for delivering learning materials to students via the web. These systems include assessment, student tracking, collaboration and communication tools. They can be accessed both on and off-campus, meaning that they can support students' learning outside the lecture hall 24 hours a day, seven days a week. This enables institutions to teach not only traditional full-time students but also those who cannot regularly visit the campus due to geographic or time restrictions, e.g. those on distance learning courses, doing evening classes, or workers studying part-time and various leaning disabilities as well

With the popularity of international communication and cooperation, the transformation from general English to general academic English has become an inevitable trend in college English teaching in China. The transformation poses challenges for college English teachers, including the lack of interdisciplinary knowledge, limited general academic English teaching ability and evaluation ability. Accordingly, various measures can be taken to deal with the challenges, such as expanding the interdisciplinary knowledge, establishing the teaching community and reforming the evaluation means. These strategies are intended to construct the harmonious education ecology in college to promote the transformation and development of college English teachers.

Seed germination is the critical stage in plant's life cycle, assisting sapling development, survivorship, and population trends. Plants, as sessile life forms, are easily exposed to abiotic stresses like heat, salinity, cold, soil alkalinization, drought. The interaction of nano-materials with the plant, soil, and the holobiont systems is critical for understanding their behaviors within every complicated ecosystem. The use of nanoparticles has a beneficial impact on germinating seeds and also plant growth and development. Titanium based nanoparticles triggers the development of carbohydrates, which promotes rates of photosynthesis and plant growth. It is hoped that nanotech will provide long-term remedies by replacing conventional bulk fertilizers with nano-particulate counter parts that have excellent characteristics for overcoming current problems such as mineral bio-availability and absorption. Nano-priming could be practiced to seeds to preserve them during storage, enhance germination rate, germination synchronization, and plant growth, and also enhance resistance of crop to biotic and abiotic stressful conditions.

This study aims to analyze the direct and indirect relationship between teacher commitment, teacher discipline and work motivation with teacher performance at SMPN Kahayan District, Pulang Pisau Regency. The method used in this research is a correlational method with a quantitative approach which is formulated into a path analysis model. The research population was 248 teachers from 18 schools in 3 sub-districts and 153 respondents were taken as research samples as research samples using probability simple random sampling technique. Collecting data using a questionnaire instrument and data analysis using descriptive analysis, classical assumption test, hypothesis testing and path analysis. The conclusion of this study is that there is a significant direct relationship between teacher commitment, teacher discipline and work motivation with teacher performance. There is a direct relationship between teacher commitment and teacher discipline with work motivation, there is an indirect relationship between teacher commitment through work motivation and teacher performance at SMPN Kahayan District Pulang Pisau Regency and there is an indirect effect between teacher discipline through work motivation and performance at SMPN Kahayan District Pulang Regency Knife.

Teacher performance is very important in ensuring the achievement of school goals, it needs to be encouraged for better performance. However, this is not easy because many factors influence it. The purpose of this study was to analyze the direct and indirect effects of work motivation, job satisfaction and Organizational Citizenship Behavior (OCB) on teacher performance at SDN Murung Pudak District, Tabalong Regency. This research is a regression research with a quantitative approach which is formulated into a path analysis model. Based on the results of the study, the variable regression coefficient values were positive numbers such as work motivation (X1) with performance (Y) of 0.275, work motivation (X1) with Organizational Citizenship Behavior (OCB) (Z) of 0.433 , job satisfaction (X2) with performance teachers (Y) of 0.375, job satisfaction (X2) with Orgaizational Citizenship Behavior (OCB) (Z) of 0.435, Orgaizational Citizenship Behavior (OCB) (Z) with teacher performance (Y) of 0.269 , work motivation (X1) through organizational Citizenship Behavior (OCB) (Z) with teacher performance (Y) of 0.116 and job satisfaction (X2) through Organizational Citizenship Behavior (OCB) (Z) with teacher performance (Y) of 0.117. Therefore, this study can be concluded that there is a significant direct and indirect effect between work motivation, job satisfaction and Organizational Citizenship Behavior (OCB) on teacher performance.

Chondroblastoma is a rare, giant cell -rich benign neoplasm of bone. Fine needle aspiration cytology (FNAC) is gaining acceptance as a convenient and reliable method in preoperative diagnosis of chondroblastoma. Differential diagnosis of chondroblastoma on FNAC include giant cell-rich tumors and tumor like lesions such as aneurysmal bone cyst, giant cell tumor, chondromyxoid fibroma. Preoperative diagnosis of chondroblastoma is mandatory for treatment protocol and prognosis. We describe a case of 18 year old female patient who presented with painful swelling over right heel of one year duration. FNAC smears of swelling stained with Leishman and Giemsa stain showed neoplastic mononuclear chondroblasts showing round to oval nuclei, nuclear indentation, grooving and intranuclear inclusions with abundant vacuolated glassy cytoplasm, chicken wire calcification, multinucleated osteoclast like giant cells and chondromyxoid matrix. Histopathological examination of excised specimen revealed focal areas of mature cartilage with proliferating chondroblasts showing nuclear grooves and numerous giant cells. Thus confirming the diagnosis of chondroblastoma.

Regional fiscal capacity is the region’s ability reflected in regional revenue, consisting of own-source revenue (PAD), fiscal balance transfers, and other legitimate regional revenues. This study aims at analysing the impact of regional financial capability during the Covid-19 Pandemic towards regional fiscal capacity. The research was conducted in local governments in Indonesia during 2020 using descriptive qualitative analysis. The results showed that generally the Covid-19 Pandemic affected the reduction on own-source revenue (PAD) in almost all provinces in Indonesia during the first semester of 2020. From 66 regencies/cities as the sample from this research, 49 regencies decreased in revenue and expenditure because of the Covid-19 Pandemic. The revenue reduction in each region was caused by regional taxes reduction of around 2,5 percent and 10,68 percent sequentially in the first semester of 2020, fiscal balance transfers around 8,42 percent, and general allocation grant (DAU) around 9,8 percent and 6,94 percent. Meanwhile, to solve the regional fiscal problems, the local governments implemented 2 types of policies: (1) the first policy is to implement a counter-cyclical policy through maintaining economic stability, decreasing revenues, and increasing local government expenditures; (2) the second policy is to implement a pro-cyclical policy through increasing revenues and decreasing expenditures. The present research also found that regencies/cities that implemented a counter-cyclical policy generally increased in expenditure components, such as grant expenditure around 316,51 percent and regional capital expenditure. Some local governments built infrastructure (assets and buildings) during the Covid-19 Pandemic. However, local governments decreased around -1% - 16% for the employee expenditures.

Piper guineense (uziza) leaves may have therapeutic input on male infertility caused by Lead exposure. This study investigated the antioxidant activities of the ethanolic extract of Piper guineense leaves (EEPL) on lead-induced testicular toxicity in rats. Twenty male wistar rats (150-200g) were divided into 4 groups consisting of 5 rats each. Control received 1ml of distilled water, lead only received 150mg/kg of lead, low dose received 150mg/kg of lead + 300mg/kg of EEPL, high dose received 150mg/kg of lead + 600mg/kg of EEPL. Administration was done orally for 14 days and then sacrificed. Blood was collected and analysed for serum testosterone and testes were harvested and homogenised for testicular antioxidant enzymes and zinc levels. Data was analysed for ANOVA using Graph Pad Prism 5. Lead exposure negatively affected the antioxidant enzymes, testosterone and zinc levels. Administration of EEPL significantly (p<0.05) increased the testosterone and zinc levels in a dose dependent manner. EEPL also significantly (p<0.05) increased the testicular Superoxide dismutase, Catalase, and Glutathione peroxidase levels and significantly decreased the testicular Malondialdehyde levels. Piper guineense leaves ameliorate testicular oxidative stress damage induced by lead toxicity.

Urinary tract infection is the attack of a tissue of the urinary tract by one or more micro-organisms. It is a major public health problem. The objective of this work is to propose, based on updated data, the microbial ecology of urinary tract infection at the Avicenne Military Hospital in Marrakech, and to follow the antibiotic sensitivity profile of uropathogenic bacteria. This is a retrospective descriptive study over 4 years from January 2014 to December 2018, which was conducted on urinary cytobacteriological examinations from hospitalized patients and outpatients, treated at the microbiology laboratory of the Military Hospital Avicenne of Marrakech. Of the 17607 ECBUs that were examined, the diagnosis of urinary tract infection was retained in 2349 (13%). 75% of the ECBUs came from hospitalized patients and 25% from outpatients, with a sex ratio of 1.1. The analysis of the ECBU showed that Enterobacteriaceae constituted 80% of the positive urine isolates, with a predominance of Escherichia coli (62%), followed by Klebsiella pneumoniae (13%). The reading and interpretation of the antibiograms showed that Escherichia coli was resistant to aminopenicillin associated with clavulanic acid in 51% of the cases against 55% for Klebsiella pneumoniae. The resistance of enterobacteriaceae to fluoroquinolones is about 33% for Escherichia coli, 30% for Klebsiella spp, while for the Trimmethoprim+Sulfamethoxazole combination more than half of the strains were resistant. On the other hand, aminoglycosides still have a good activity profile on enterobacteriaceae. The prevalence of BMR is 6.5%, represented by enterobacteriaceae producing extended spectrum betalactamases (ESBL) isolated in 89% of cases, with a predominance of Escherichia coli (52%) followed by klebsiella pneumoniae (22%) and Enterobacter cloacae (16%). Then the ceftazidime-resistant Pseudomonas aeruginosa (PARC) occupies the 2nd place with 5%, and finally methicillin-resistant Staphylococcus aureus (MRSA) and imipenem-resistant Acinetobnacter baumanii (ABRI) which occupy the 3rd place with rates at 3%. These BMR constitute a worrying problem, hence the need for rigorous application of hygiene rules and rational prescription of antibiotics. The knowledge of bacteriological profiles and the use of targeted antibiotic susceptibility testing will allow a management adapted to each hospital context.

Different heavy salts accumulated in the soil causing the soil salinity and damage the biological processing occurring in plants such as photosynthesis and light reactions. Climate changes also promote the accumulation of heavy metals by promoting the chemicals substances in the leaves and roots cells that causing the chlorosis. Coal combustion release the large amount of mercury metals that acting as toxic for the plants. There is need to design the biological and mechanical processing the removal of salts and toxic wastes from surfaces in such a way that no eruptions of plant materials occur at the surfaces. Nanotechnology employed the nanoparticles to capture the toxic metals through biological and chemical process that is more reliable and less expensive. A large variety of nanoparticles in the form of nanobased graphene oxides, graphite oxides and CNT, mesoporous silica materials have been used for controlling the pollution caused by heavy metals. These nanoparticles are compatible for the plant growth by suppressing the crop diseases by acting directly on phytopathogens. Therefore, it is reliable for controlling the risk of environmental pollution caused by heavy metals.

Viruses are the group of infectious particles and some of them possess the more complex structures due to which their growth proliferated at the extreme level as compared to the bacterial infections. Pharmacokinetics of some drugs needed to further more in order to explore them in the medical events or sometimes drug research increase the chances of treatment of infectious disease during the course of replicating cycle. Among them, coronaviruses are appearing on different form of variants. These are Beta, Delta, and Omicron variants and each type have different sequence of the amino acids. Due to colonization of the virus particles in the particular tissues, many of the immune cells show response against variety of viral proteins. Severity of viruses attack to the cardiovascular systems causing the borne of different cardiovascular diseases. Different traditional methods for molecular diagnosis of infectious particles but not reliable, but through molecular sequencing of certain mutation associated with lungs tissues may evoke the viral spikes proteins. Due to severe attack on the lung tissues, blood rushes and flow increases in the form of infectious particles. Vaccinations and antibodies are used for control their growth but some of the necessary measures in order to control the viral infections.

This study aims to analyze the direct and indirect influence between the principal's transformational leadership, work culture and teacher work commitment on teacher performance at SMPN Banjarbaru City. This research is a descriptive correlation with a quantitative approach which is formulated into a path analysis model. The research population was 407 teachers from 14 schools and 202 respondents were taken as research samples using proportional random sampling technique. Collecting data using a questionnaire instrument and data analysis using descriptive analysis, classical assumption test, and hypothesis testing and path analysis. The conclusion of this study is that there is a significant direct relationship between transformational leadership, work culture and work commitment with teacher performance. There is an indirect relationship of transformational leadership through work commitment to the performance of Banjarbaru City Junior High School teachers. There is an indirect relationship between work culture through work commitment and the performance of SMPN Banjarbaru City teachers.

An increase in demand for concrete to meet global needs has been accompanied by an increase in global concerns due to an increase in demand for the non-renewable resources that are and comprise the constituents of concrete. To address these concerns and mitigate the impact of their depletion, researchers have investigated the intrinsic properties of a wide range of available materials and assessed their contribution when mixed with concrete. This paper presents the findings of an experimental study that was carried out to assess the structural response of concrete beams made with river gravel as coarse aggregate. Six reinforced beams (100 x 150 x 1100 mm) and six cubes were cast to investigate the specimens' flexural and compressive behavior. The failure modes, bending, and shear capacity were investigated in this study. According to the findings of the study, river gravel used as coarse aggregate in concrete has a roughly equivalent or slightly lower structural performance than conventional coarse aggregate, indicating the feasibility of river gravel as coarse aggregate for building construction.

Background: The coronavirus disease 2019 pandemic is an unprecedented situation. Mass vaccination is a considered a promising solution to combat this global health crisis. Different vaccine have used to control transmission of the disease. Some complications of this vaccine were reported including rare cases of vasculitis. We report a case of leucocytoclastic vasculitis following BNT162b2 corona virus vaccine. Case Presentation: A 42 year old man with no medical history or drug intake presented 3 days after the third dose of BNT162b2 vaccine an infiltrated purpura at the lower extremities, fever, asthenia and myalgia. At physical examination, multiple palpable indurated purpuric papules were present only on the lower extremities. Laboratory tests were normal. The skin biopsy revealed leucocytoclastic vasculitis. The direct immunofluorescence staining detected only fibrinogen deposition. Conclusion: Leucocytoclastic vasculitis is an exceptional vaccine side effect. The resemblance of the vaccine-induced spike proteins with human components is highly likely to produce pathological autoantibodies and vaccine-induced autoimmunity through molecular mimicry.