Antimicrobial stewardship (AMS) programmes are central to tackling antimicrobial resistance. Comparative evidence on how barriers differ between high-income countries (HICs) and low-/middle-income countries (LMICs) in tertiary care hospitals is limited. The review aims to identify and compare multilevel barriers to implementing AMS programmes in tertiary care hospitals in HICs and LMICs. We conducted a systematic scoping review following PRISMA-ScR and Joanna Briggs Institute guidance. PubMed and Web of Science were searched for English-language primary studies from January 2015 to November 2025. Studies were considered eligible if they examined barriers to implementing AMS in adult inpatient services in tertiary care hospitals. Using a framework-based thematic approach, barriers were grouped into eight themes and mapped to individual, team, organizational, and system levels. Out of 2311 records, 57 studies met inclusion criteria (23 = HICs, 34 = LMICs). Knowledge, education, and confidence gaps were the most frequent barrier theme in both groups, reported in about three-quarters of studies. Staffing and resource constraints and organisational/governance barriers were also highly prevalent, particularly in LMIC hospitals. Workflow and documentation problems and data-system limitations were more prominent in HIC studies, whereas structural health system constraints were more prominent in LMICs. Qualitative and mixed-methods studies identified a broader range of barriers than surveys or observational designs. AMS implementation in tertiary hospitals is constrained by overlapping multilevel barriers that are broadly similar across income groups but differ in emphasis. Tailored strategies that jointly strengthen workforce capacity, infrastructure and governance are needed, with particular attention to system-level constraints in LMICs and workflow and data challenges in HICs.
In this study, nanostructured Bi2O3/ZnO p–n heterojunction photocatalyst was developed from ZnBi-NO3 Layered Double Hydroxides (LDHs), which was prepared followed by facile co-precipitation method using Zn(NO3)2·6H2O, and Bi(NO3)3·5H2O salts as precursors. The synthesized materials were characterized well by FT-IR, XRD, EDX-SEM, and TGA techniques. The Tauc plot, followed by optical study, was plotted, and bandgap energy of Bi2O3/ZnO p–n heterojunction, was calculated, and found to be 1.8 eV. The material was tested for photocatalytic degradation of methylene blue (MB) under visible light of a Tungsten lamp (100 W), and worked well at pH 8.0, concentration 10 mg L−1 MB, photocatalyst dosage 30 mg and, stirring period of 60 min at 25 °C. Nanostructured Bi2O3/ZnO p-n heterojunction exhibited the efficiency of ≥ 95.00
Sufficient efforts have been carried out to fabricate highly efficient graphene oxide (GO) lamellar membranes for heavy metal ion separation and desalination of water. However, selectivity for small ions remains a major problem. Herein, GO was modified by using onion extractive (OE) and a bioactive phenolic compound, i.e., quercetin. The as-prepared modified materials were fabricated into membranes and used for separation of heavy metal ions and water desalination. The GO/onion extract (GO/OE) composite membrane with a thickness of 350 nm shows an excellent rejection efficiency for several heavy metal ions such as Cr6+ (∼87.5%), As3+ (∼89.5%), Cd2+ (∼93.0%), and Pb2+ (∼99.5%) and a good water permeance of ∼460 ± 20 L m-2 h-1 bar-1. In addition, a GO/quercetin (GO/Q) composite membrane is also fabricated from quercetin for comparative studies. Quercetin is an active ingredient of onion extractives (2.1% w/w). The GO/Q composite membranes show good rejection up to ∼78.0, ∼80.5, ∼88.0, and 95.2% for Cr6+, As3+, Cd2+, and Pb2+, respectively, with a DI water permeance of ∼150 ± 10 L m-2 h-1 bar-1. Further, both membranes are used for water desalination by measuring rejection of small ions such as NaCl, Na2SO4, MgCl2, and MgSO4. The resulting membranes show >70% rejection for small ions. In addition, both membranes are used for filtration of Indus River water and the GO/Q membrane shows remarkably high separation efficiency and makes river water suitable for drinking purpose. Furthermore, the GO/QE composite membrane is highly stable up to ∼25 days under acidic, basic, and neutral environments as compared to GO/Q composite and pristine GO-based membranes.
This work reports the synthesis of a highly efficient, low-cost cow dung-derived humic acid-functionalized magnetite nano-adsorbent (Fe3O4@HA) via a simple co-precipitation protocol and its successful use for the removal of brilliant green (BG) from wastewater. Various analytical tools were used to characterize the resulting nano-adsorbent, including FT-IR, SEM, EDX, XRD, BET, Zeta sizer, and Zeta potential, to assess surface functionality, morphology, elemental composition, crystalline nature, surface porosity, average size, and surface charge. The results revealed that the synthesized nano adsorbent has a cubic spinel structure with an average particle size of 60-68 nm. The BET analysis confirms that the adsorbent is a porous material having a surface area of 71.059 m2 /g. The adsorption behavior and adsorption rate were best described by the Freundlich isotherm and pseudo second order, respectively. The adsorption capacity of the prepared magnetic adsorbent was 93.5% under optimal conditions. The prepared humic-functionalized adsorbent offers high adsorption capacity, cost-effectiveness, reproducibility, fast kinetics, and high magnetic separability. The use of cow dung humic acid as a green source positions it as a potential candidate for wastewater remediation, converting waste materials into valuable products.
OBJECTIVE: To analyze serum metal concentrations in oral cancer (OC) patients and healthy controls, investigating their interrelationship and potential diagnostic and clinical significance. METHODOLOGY: This case-control study was conducted at the Institute of Biochemistry, University of Sindh, Jamshoro, with sample collection from the Liaquat University of Medical & Health Sciences (LUMHS) from May 2023 to February 2024. 145 Newly diagnosed OC patients without prior radiotherapy or chemotherapy, capable of understanding and answering questions and 145 age and gender-matched individuals from the same hospital with no personal or family history of cancer were included in the study. 5 mL of blood was collected from the participants for metal analysis. Blood samples were used to analyze serum metal levels by inductively coupled plasma-optical emission spectroscopy (ICP-OES). Data analysis was performed using SPSS version 20.0, employing statistical tests to compare serum metal levels between patients and controls and among different demographic groups. RESULTS: The study presents a detailed comparison of trace element concentrations between OC patients and controls, highlighting significant differences in metals such as aluminum (Al), arsenic (As), cobalt (Co), chromium (Cr), cadmium (Cd), copper (Cu), manganese (Mn), nickel (Ni), iron (Fe), selenium (Se), lead (Pb), strontium (Sr), and zinc (Zn). Gender-wise comparisons also reveal variations in metal concentrations, suggesting potential differential exposure or metabolic processing between males and females. CONCLUSION: Understanding the mechanisms underlying metal-related cancer development could help improve diagnostic and therapeutic strategies for OC patients.
