Clinical profile and drug utilization pattern in an intensive care unit of a teaching hospital in western Nepal

To analyze the clinical profile of patients admitted to the intensive care unit (ICU) of Manipal Teaching Hospital (MTH) at Pokhara, Nepal, identify the commonly prescribed drugs, drug categories, dosage forms, antimicrobials, sensitivity pattern of antimicrobials and the treatment outcomes. A cross sectional, descriptive study in which he case records of all the patients admitted in the ICU during 1st August to 30th September, 2007 were collected and the details were entered in the patient profile form. The filled patient profile forms were retrospectively analyzed as per the study objectives. Altogether, 201 patients [males 101 (50.25%)] were admitted. Most common diagnosis was 'Myocardial Infarction /Ischemic heart disease' [13.96 % (n=62)]. The median (interquartile range) of the ICU stay was 3 (2-4) days. Cardiovascular drugs [31.7% (n=761) were the most commonly prescribed. Among the antimicrobials, metronidazole was most commonly prescribed followed by ceftriaxone. The morality rate in the ICU was 17.41 % and the major causes of mortality were cardiovascular and respiratory diseases. Antimicrobials was the most common drug category used in the ICU and 'pantoprazole' was the most commonly prescribed individual drug. Cardiovascular and respiratory diseases were major causes of death in the ICU

Formulation & Evaluation of Fluconazole Gel for Topical Drug Delivery System

Fluconazole is a recent triazole antifungal drug that is used in the treatment of superficial and systemic fungal infection. The oral use of fluconazole is not much recommended as it has many side effects. Thus this formulation is made for better patient compliance and to reduce the dose of the drug and to avoid the side effects like liver damage and kidney damage. This research was designed to formulate & evaluate different formulation of a topical gel containing fluconazole by using a polymer with different concentration as Carbopol 940 & NaCMC. Methanol was used as a penetration enhancer. The evaluation of formulated fluconazole topical gel was carried out for a physical appearance, pH-value, spreadability, homogeneity, drug content. The formulated gel showed good physical characteristics. The formulation F3 (101.18%) & F6 (105.4%) show good drug content as the polymer concentration in them was higher. The percentage yield of F4 (98.26%) was the highest. The spreadability of gel decreases with an increase in polymer concentration. The pH of the formulation was in the range of 5-8 which is considered acceptable to avoid the risk of irritation upon application to the skin

Age-Related Clinical Spectrum of Plasmodium knowlesi Malaria and Predictors of Severity.

Background: Plasmodium knowlesi is increasingly reported in Southeast Asia, but prospective studies of its clinical spectrum in children and comparison with autochthonous human-only Plasmodium species are lacking. Methods: Over 3.5 years, we prospectively assessed patients of any age with molecularly-confirmed Plasmodium monoinfection presenting to 3 district hospitals in Sabah, Malaysia. Results: Of 481 knowlesi, 172 vivax, and 96 falciparum malaria cases enrolled, 44 (9%), 71 (41%), and 31 (32%) children aged ≤12 years. Median parasitemia was lower in knowlesi malaria (2480/μL [interquartile range, 538-8481/μL]) than in falciparum (9600/μL; P 15000/μL the best predictor (adjusted odds ratio, 16.1; negative predictive value, 98.5%; P 15000/μL

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A time-motion study of the COVID-19 vaccination process in an urban primary health center of Odisha, India

Vaccination is a critical tool in protecting against COVID-19. It is essential to know the time for each activity in a COVID-19 vaccination process for better management, especially during a pandemic. Thus, we conducted a time-motion study to identify activities that led to delayed/increased waiting time in an urban primary health center in Bhubaneswar, India. We observed 196 COVID-19 vaccine beneficiaries over one month (June 2021) from when they arrived at the vaccination center until they left the center. A data collection form and a Stopwatch were used to estimate the time taken for various activities involved in COVID-19 vaccine delivery. The time taken was expressed in mean and median. We also compared the time taken during the first and second doses using the Mann-Whitney U test. The total mean time spent at the vaccination center was 40:56 ± 20:52 minutes. The activity that took the longest was ‘waiting time in queue before vaccination’, which was 34:22 ± 20:56 min constituting 82% of the total time. The activity that took longer for the second dose than the first was the beneficiary verification in the Co-WIN portal with a median of 27 seconds and 36 seconds, respectively (p < .001). This study will help program managers formulate better strategies to improve the vaccination process making it more efficient

Copper-Catalyzed Suzuki–Miyaura Coupling of Arylboronate Esters: Transmetalation with (PN)CuF and Identification of Intermediates

An efficient Cu^I-catalyzed Suzuki–Miyaura reaction was developed for the coupling of aryl- and heteroarylboronate esters with aryl and heteroaryl iodides at low catalyst loadings (2 mol %). The reaction proceeds under ligand-free conditions for aryl–heteroaryl and heteroaryl–heteroaryl couplings. We also conducted the first detailed mechanistic studies by synthesizing [(<b>PN-2</b>)­CuI]₂, [(<b>PN-2</b>)­CuF]₂, and (<b>PN-2</b>)­CuPh (<b>PN-2</b> = <i>o</i>-(di-<i>tert</i>-butylphosphino)-<i>N</i>,<i>N</i>-dimethylaniline) and demonstrated that [(<b>PN-2</b>)­CuF]₂ is the species that undergoes transmetalation with arylboronate esters

Removal of Noble Metal Ions (Ag⁺) by Mercapto Group-Containing Polypyrrole Matrix and Reusability of Its Waste Material in Environmental Applications

A novel approach was introduced to remove metal (Ag⁺) ions from aqueous solution and subsequently restate the metal-loaded materials for a number of environmentally friendly applications. A versatile adsorbent, polypyrrole with mercapto-functionalized chelating groups (PPy/MAA), successfully adsorbed Ag⁺ ions through subsequent reduction to silver nanoparticles (Ag⁰ NPs) into the composite matrix. The as-prepared composite (PPy/MAA) and Ag-adsorbed PPy/MAA (PPy/MAA/Ag⁰) were fully characterized by FE-SEM, EDS, HR-(S)­TEM, XRD, FTIR, BET, XPS, and zeta potential measurements. Batch adsorption results showed that the adsorption process can be explained well by a pseudo-second-order model. The maximum adsorption capacity calculated using a Langmuir isotherm model was 714.28 mg/g at 25 °C. XRD, XPS, and HR-TEM analyses confirmed the presence of metallic silver nanoparticles on the surface of the composite matrix after the <i>in situ</i> reduction of Ag⁺ to Ag⁰. Among the applications tested, the metal-loaded waste (PPy/MAA/Ag⁰) was found to have antimicrobial activity, as it inhibited the growth of Escherichia coli, while pure adsorbent without silver showed no killing effect toward E. coli. PPy/MAA/Ag⁰ also played an important role in the catalytic reduction of 4-nitrophenol and also exhibited good sensitivity to NO₂ in gas-sensing applications. Therefore, the developed PPy/MAA composite achieved 2-fold environmental benefits, not only remediating Ag⁺ from polluted waterways but also opening a new window for subsequently acting as an agent for antibacterial ability, catalytic activity, and gas-sensing efficiencies

Copper-Catalyzed Suzuki–Miyaura Coupling of Arylboronate Esters: Transmetalation with (PN)CuF and Identification of Intermediates

An efficient Cu^I-catalyzed Suzuki–Miyaura reaction was developed for the coupling of aryl- and heteroarylboronate esters with aryl and heteroaryl iodides at low catalyst loadings (2 mol %). The reaction proceeds under ligand-free conditions for aryl–heteroaryl and heteroaryl–heteroaryl couplings. We also conducted the first detailed mechanistic studies by synthesizing [(<b>PN-2</b>)­CuI]₂, [(<b>PN-2</b>)­CuF]₂, and (<b>PN-2</b>)­CuPh (<b>PN-2</b> = <i>o</i>-(di-<i>tert</i>-butylphosphino)-<i>N</i>,<i>N</i>-dimethylaniline) and demonstrated that [(<b>PN-2</b>)­CuF]₂ is the species that undergoes transmetalation with arylboronate esters

Attitudes of ambulatory care older Nepalese patients towards deprescribing and predictors of their willingness to deprescribe

Introduction: Older adults continue to receive potentially inappropriate medications necessitating the need for medication optimization, by deprescribing. To ensure a holistic approach to deprescribing, it is essential to understand the perception of older adults towards deprescribing. This study aimed to assess the attitude of older ambulatory patients towards deprescribing and to identify factors predicting their willingness to deprescribe. Methods: A cross-sectional survey was conducted in central Nepal between March and September 2019 among 385 older ambulatory care patients (aged ⩾65 years) who were taking at least one regular medicine. The perception of patients towards deprescribing was assessed using the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire via a face-to-face interview method. Descriptive statistics were performed to describe patients’ characteristics and their attitudes towards deprescribing. A multivariate logistic regression analysis was used to determine predictors of the willingness of older ambulatory patients towards deprescribing. Results: The median [interquartile range (IQR)] age of patients was 72 (8) years. Nearly three in five patients (64.9%) had hypertension, with 11.2% having polypharmacy. More than half of the patients (57.4%) would be willing to stop one or more of their regular medicines if their doctor said it was possible to do so. Regression analysis showed that age [odds ratio (OR) 0.946; 95% CI 0.913, 0.981; p = 0.003] and concerns about stopping medicine score (OR 0.541; 95% CI 0.334, 0.876; p = 0.013) were predictors of the willingness of the older patients towards deprescribing. Conclusion: One in two older ambulatory care patients in Nepal would be willing to have one or more of their medicines deprescribed. The factors predicting their willingness to deprescribe are their age and concerns about stopping medicines. Clinicians should consider discussing the possibility of deprescribing with older patients for the prevention of potential medication-related harms. Plain Language Summary: What do older Nepalese patients think about withdrawal or dose reduction of an inappropriate medication? Introduction: Research suggests that older adults (aged ⩾65 years) continue to receive medications that have the potential for harm rather than a benefit. This necessitates the need for withdrawal or dose reduction of such inappropriate medications, the process known as deprescribing. Understanding what older patients think about this process could be a stepping-stone to the general approach for its implementation. Data on deprescribing is lacking from Nepal. Therefore, we designed a survey to explore the attitude of older patients towards deprescribing and factors that could predict their willingness to deprescribe. Methods: This study was conducted between March to September 2019 among 385 older patients who were taking at least one regular medicine and were visiting selected hospitals of Nepal for outpatient services. We performed a face-to-face interview to assess the attitude of patients towards deprescribing using a validated tool called revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire that quantified the response through scoring. The data were subjected to statistical analysis to determine the attitudes of Nepalese older patients towards deprescribing and to develop a model to predict their willingness to deprescribe. Results: The average age of the participant was 72 years with 65% having hypertension and 11% using more than five medications. Our data suggested that one in two older Nepalese patients would be willing to stop one or more of their regular medications if their doctors said it was possible to do so. Their willingness to deprescribe could be predicted from their age and concerns about stopping medications. Conclusion: Clinicians should consider discussing the possibility of deprescribing with older patients for the prevention of potential medication-related harms.</p