Aakash Ahmad Khattak

Multidrug-resistant (MDR) Klebsiella pneumoniae represents a major clinical and public health challenge worldwide, particularly in regions with limited genomic surveillance. This study investigated the clinical, phenotypic, and genomic characteristics of clinical K. pneumoniae isolates recovered from a tertiary-care hospital in Peshawar, Pakistan. A total of 2400 non-duplicate clinical specimens were processed, and antimicrobial susceptibility testing was performed according to CLSI guidelines. Whole-genome sequencing (WGS) was conducted on a purposively selected subset of 18 isolates representing diverse resistance and phenotypic profiles. Genomic analyses included multilocus sequence typing, resistome and virulome profiling, identification of resistance-associated chromosomal mutations, plasmid replicon typing, and phylogenomic comparison with publicly available international genomes. K. pneumoniae was identified in 256/2400 (10.7%) specimens, predominantly from urine samples. MDR and extensively drug-resistant (XDR) phenotypes were detected in 83.2% and 13.3% of isolates, respectively. WGS revealed substantial genomic heterogeneity, with ST147 identified as the most frequent lineage among sequenced isolates. Extended-spectrum β-lactamase genes, particularly bla_CTX-M-15, together with carbapenemase genes including bla_OXA-48-like and bla_NDM-5, were identified in multiple isolates alongside resistance-associated chromosomal alterations in gyrA, parC, ompK36, mgrB, pmrB, and ramR. Yersiniabactin-associated loci were detected in all sequenced isolates, whereas canonical hypervirulence-associated determinants (rmpA, iuc, iro) were absent. These findings highlight the complex genomic landscape of MDR K. pneumoniae in Pakistan and underscore the need for continued genomic surveillance and antimicrobial stewardship.

Introduction: Acne vulgaris is a prevalent inflammatory skin disorder. Its prevalence persists into adulthood, even though it is frequently thought of as a self-limiting adolescent illness. Objective: To determine the prevalence and typical causes of self-medication among acne vulgaris patients. Methods: This cross-sectional study was conducted from 13/2/2022 to 13/8/2022 at the Department of Dermatology, Hayatabad Medical Complex, Peshawar. Each patient had a comprehensive clinical examination and history. In order determine the prevalence of self-medication and its common factors; drug knowledge, prior prescription, convenience of access, mildness of condition, and lack of time, all patients underwent extensive interviews. Results: The results of the study demonstrate that out of 145 patients, the average age was 30 years with a standard deviation of ±10.47. Among them, 77 (53%) were female and 68 (47%) were male. Moreover, 88 (61%) patients practiced self-medication. The common contributing factors included drug knowledge (8%), mildness of illness (20%), easy availability (37%), previous prescription (19%), and lack of time (15%). Conclusion: This study concluded that 61% of individuals with acne vulgaris practiced self-medication. The common contributing factors included drug knowledge (9%), easy availability (37%), previous prescription (19%), mildness of disease (20%), and lack of time (15%).