PHYTOCHEMICAL SCREENING AND EVALUATION OF ANTIDIARRHOEAL ACTIVITY OF BUNIUM BULBOCASTANUM SEEDS EXTRACT IN EXPERIMENTAL WISTAR RATS

Objective: The main objective of this study was to evaluate the antidiarrheal activity of Bunim bulbocastanum seeds extracts, to exploit the medicinal use of plant in the traditional system of medicine scientifically. Methods: The adult Wistar albino rats were divided in four groups, i.e. Group M1 (control group) receiving normal saline, group M2 (test group 1) receiving the 250 mg/kg Bunium bulbocastanum extract, group M2 (test group 2) receiving the 500 mg/kg Bunium bulbocastanum extract and group M4 (reference) receiving 3 mg/kg P. O Loperamide. Each group of mice with a bodyweight of 1 ml/100 g received castor oil. Mice were sacrificed and the distance traveled by the charcoal meal and the total length of the intestine was then measured. The peristaltic index and percentage of inhibition were calculated by using the formula. Results: It was found that in the castor oil-induced intestinal transit method extract produced a significant (p<0.0001) dose-dependent reduction in the distance traveled by charcoal meal comparable to the control peak effect was at the dose of 500 mg/kg (PI=12.06±3.38). Likewise, in the diarrheal dropping test, Bunium bulbocastanum extract causes a significant (p<0.05) dose-dependent reduction in the number of wet feces i.e. the mean wet of feces was decreased from 2.3±0.44 gm to 1.28±0.36 gm i.e. significantly different from that elicited by control (0.80±0.17 gm) (p=0.0081). However, there were no significant differences in inhibition at a dose of 250 mg/kg of extract. Conclusion: This study demonstrated that the crude methanol extract from B. bulbocastanum seeds possesses significant antidiarrheal property and the presence of various secondary metabolites. This justified the antidiarrheal use of plant in the traditional system of medicine

A comparative study on efficacy of amitriptyline and escitalopram in the treatment of depression

Background: Several generations of antidepressant medication which act by distinct pharmacological mechanisms have been introduced for the treatment of depression; tricyclic antidepressants (TCAs) were first line of treatment for many years. However, over the last decade, selective serotonin reuptake inhibitors (SSRIs) have displaced TCAs, mainly because of better side effect profile. There are no references in literature on comparison of efficacy of TCAs and SSRIs in Nepalese population. This study attempted to compare the efficacy of amitriptyline, a reference standard TCA with escitalopram, a newer SSRI in Nepalese population.Methods: An open level, randomised, prospective study was conducted for one year duration. Eighty outpatients suffering from major depression who met inclusion and exclusion criteria were randomly assigned to either amitriptyline or escitalopram group for four week study. Seventy one patients (amitriptyline N: 36, escitalopram N: 35) completed the study. Hamilton Depression Rating Scale (HDRS) was used to measure the antidepressant effect. Antidepressant efficacy was evaluated on reduction of HDRS score before and after therapy (End of four weeks).Results: In amitriptyline group, mean percentage reduction in HDRS score was 58.29% (13.5 points), while in escitalopram group was 60.78% (14.03 points). Both the drugs significantly improved the HDRS score at the end of the study (p0.05).Conclusions: This study suggests that escitalopram is effective in the treatment of depression and its efficacy appears to be comparable to amitriptyline at the end of four weeks

Live online lecture versus classroom lecture: perception of undergraduate medical and nursing students and faculty

Introduction: During COVID-19 pandemic, live online lectures were offered for the first time to the undergraduate students. Due to its novelty, it was important to identify the effectiveness. Thus, the aim of this study was to compare the perception of students and faculty regarding the attributes of lectures delivered via live online versus classroom platform. Method: In this descriptive study, after approval from the ethical committee, link to the validated questionnaire was sent via email to all participants. Quantitative data were expressed as numbers and percentage while thematic analysis was done for qualitative data. Result: In this study 22 faculty members and 176 students participated. Twenty-one(95%) faculty and 159(90.3%) students agreed that it was a good initiative to start live online lectures during the pandemic, and 18(81.8%) faculty and 160(91%) students were satisfied or partially satisfied with online mode. Limitations identified were technical issues and lack of physical interaction. Both faculty members 18(81.8%) and students 11665.9% agreed or strongly agreed that online lectures were less interactive, and suggested ways to improve online lectures by making sessions more interactive, proper lecture scheduling and using different online media. Conclusion: Participants identified various strengths of live online mode which is encouraging to use during adverse situations or even continue as a standard platform but it is not without limitations. Thus, for successful implementation, proper planning and designing of lectures are required

Total Phenolic Content, Flavonoid Content and Antioxidant Potential of Wild Vegetables from Western Nepal

Eight selected wild vegetables from Nepal (Alternanthera sessilis, Basella alba, Cassia tora, Digera muricata, Ipomoea aquatica, Leucas cephalotes, Portulaca oleracea and Solanum nigrum) were investigated for their antioxidative potential using 2,2-dyphenyl-1-picrylhydrazyl (DPPH) scavenging, hydrogen peroxide (H2O2), ferric reducing antioxidant power (FRAP), and ferric thiocyanate (FTC) methods. Among the selected plant extracts C. tora displayed the highest DPPH radical scavenging activity with an IC50 value 9.898 μg/mL, whereas A. sessilis had the maximum H2O2 scavenging activity with an IC50 value 16.25 μg/mL—very close to that of ascorbic acid (16.26 μg/mL). C. tora showed the highest absorbance in the FRAP assay and the lowest lipid peroxidation in the FTC assay. A methanol extract of A. sessilis resulted in the greatest phenolic content (292.65 ± 0.42 mg gallic acid equivalent (GAE)/g) measured by the Folin–Ciocalteu reagent method, while the smallest content was recorded for B. alba (72.66 ± 0.46 GAE/g). The greatest flavonoid content was observed with extracts of P. oleracea (39.38 ± 0.57 mg quercetin equivalents (QE)/g) as measured by an aluminium chloride colorimetric method, while the least was recorded for I. aquatica (6.61 ± 0.42 QE/g). There was a strong correlation between antioxidant activity with total phenolic (DPPH, R2 = 0.75; H2O2, R2 = 0.71) and total flavonoid content (DPPH, R2 = 0.84; H2O2, R2 = 0.66). This study demonstrates that these wild edible leafy plants could be a potential source of natural antioxidants

Impact of hospital pharmacist-delivered individualised pharmaceutical service intervention on clinical and patient-reported outcomes in patients with hypertension: A randomised controlled trial

Objectives: Patients with hypertension in Nepal are often known to have poor medication adherence and quality of life. This randomised controlled trial aimed to evaluate the impact of a hospital pharmacist-delivered individualised pharmaceutical service (P-DIPS) intervention on blood pressure, medication adherence and health-related quality of life (HRQoL) among patients with hypertension in a hospital setting in Nepal. Methods: In an open trial, 56 adult patients with hypertension who had been receiving antihypertensive medication for ≥6 months were randomly allocated to a control group (n=28) which received the usual care and an intervention group (n=28) which received a P-DIPS along with the usual care. The difference in blood pressure, medication adherence and HRQoL between the two groups at baseline, 2 and 4 months was compared using the Mann-Whitney U test, independent t-test or χ2 tests. Results: Participants were mostly ≥40 years (86%) and female (57%). There were no significant differences in the baseline characteristics between the control (C) and intervention (I) groups. At 2 months, the two groups had a significant improvement in the median (IQR) Morisky-Green-Levine (MGL) Medication Adherence Score (I=1 (2) vs C=2 (2); p<0.001) and the median (IQR) mental component of HRQoL (I=43.6 (9.5) vs C=37.5 (8.6); p=0.013). At 4 months, there were significant differences in the median (IQR) values of all the outcome measures between the groups (systolic blood pressure: I=125 (10) mmHg vs C=130 (15) mmHg, p=0.008; diastolic blood pressure: 80 (14) mmHg vs 90 (10) mmHg, p=0.012; MGL score: I=1 (1) vs C=2 (1), p<0.001; physical component of HRQoL: 45.0 (9.0) vs 40.3 (8.2), p=0.046; and mental component of HRQoL: 47.1 (11.1) vs 38.8 (8.5), p=0.003). Conclusions: The findings suggest that a P-DIPS intervention in the hospital setting of Nepal has a significant potential to improve blood pressure, medication adherence and HRQoL in patients with hypertension.</p

Antipyretic, Antinociceptive, and Anti-Inflammatory Activities from Pogostemon benghalensis Leaf Extract in Experimental Wister Rats

Background: Pogostemon benghalensis leaves have traditionally been utilized for relieving body aches, headaches and fever. Based on its uses, the present study was designed to investigate the antinociceptive, antipyretic and anti-edematogenic activities from P. benghalensis leaves&rsquo; methanol extract (PBME) in Wister rats. Methods: The thermal (hot plate) and chemical (acetic acid-induced writhing and formalin test) models for antinociceptive effects, and the Brewer&rsquo;s yeast induced hyperthermia test for antipyretic action and rat paw edema by carrageenan for anti-edematogenic activity, were applied for PBME at different dose levels. The acute toxicity of PBME through the oral route was performed to determine the lethal dose. Results: PBME significantly and dose-dependently reduced pyrexia and diminished edema volume, which depicted its antipyretic and anti-edematogenic effects respectively. The inhibition of writhing reflex, increased reaction latency and reduced frequency of licking indicated that PBME has significant dose-dependent antinociceptive activity. P. benghalensis methanol extract at 4000 mg/kg shows no sign of toxicity, which is a considerable, good margin of safety. Conclusions: The study illustrated the antipyretic, antinociceptive and anti-inflammatory potential of P. benghalensis leaf extract with a safety margin, and validated its traditional use to alleviate fever, pain, and inflammation

Adverse events following Pfizer-BioNTec vaccine against COVID-19 in population more than 12 years of age, Nepal: Adverse events following Pfizer-BioNTec vaccine

Introduction: Pfizer-BioNTec vaccine was started in Nepal for the age group of more than 12 years. This study was conducted to find out the adverse event following immunization with Pfizer-BioNTech vaccine against COVID-19 at Patan Academy of Health Sciences (PAHS). Method: This is a descriptive study conducted at PAHS from November to December 2021. The vaccine recipients were called over the phone after 72 hours of receiving the vaccine to find out adverse events following immunization (AEFI). They were inquired about the list of pre-defined AEFI. Result: A total of 1377(27.4%) individuals among 5014receivingthe first dose and 983(71.4%) of 1377 receiving the second dose were enrolled in the study. Vaccine recipients who had minor AEFI in the first dose were 462(33.6%) and in the second dose were 205(20.9%). The most commonly reported AEFI in both first and second dose was pain which was reported by 377(27.4%) and 97(9.9%) respectively, while fever was the second most common AEFI in both first and second dose reported by 65(4.8%) and 91(9.3%) respectively. There were no severe AEFI reported in both doses of vaccination. Most of the AEFI started within 24 h and subsided within 72 h. Conclusion: Minor AEFI was reported with the first and second dose of the Pfizer-BioNTech vaccine. There were no severe and serious AEFI reported in this study population

Assessment of Cardiovascular Disease Risk in Females with Subclinical Hypothyroidism

Background. Subclinical hypothyroidism (SCH) is a common endocrine disorder prevalent in the Nepalese female population. Dyslipidemia, a prerequisite to the development of cardiovascular disease, links the thyroid profile and cardiovascular disease risk. This study is aimed at assessing the cardiovascular disease risk in females with SCH. Methods. This laboratory-based cross-sectional study was carried out at Manmohan Memorial Teaching Hospital, Kathmandu, Nepal, where 100 females with SCH and 100 euthyroid controls were included. Estimates of thyroid and lipid profiles were made, and lipid variables were used to calculate lipid indices. Results. In comparison to controls, females with SCH had significantly higher lipid profiles, thyroid profiles, and lipid indices but significantly lower HDL-C. The TSH (p<0.001), TG (p=0.039), VLDL (p=0.039), and AIP (p=0.031) were significantly associated with mild and severe SCH. AIP was significantly correlated with TSH (r=0.256, p=0.010) among SCH females. Conclusion. Our findings suggest that women with SCH are more likely to get CVD. Hence, timely monitoring of cardiovascular status among females with SCH is crucial, and it can be performed using simple lipid indices like AIP, AI, and LCI

Adverse events following Immunization with Sinopharm (Vero Cell) inactivated COVID-19 vaccine: Adverse events of Vero Cell vaccine

Introduction: Various types of COVID 19 vaccines are being used globally to control the current pandemic. Post-licensure surveillance of vaccines is essential to ensure safety. This study aimed to determine Adverse Events Following Immunization (AEFIs) of Sinopharm (Vero cell), the inactivated COVID-19 vaccine from China.   Method: This is a cross-sectional observational study conducted at Patan hospital, Patan Academy of Health Sciences (PAHS). Vaccine recipients between April and May were contacted through a phone call after 72 h of vaccination to record the AEFIs. Pattern and distribution of AEFIs were analyzed. Ethical approval was taken from PAHS IRC.   Result: A total of 6142 individuals got the first dose of the vaccine and out of them we were able to contact 4574 through phone calls. Of the 4574, only 941 were included for the follow-up phone call after the second dose of the vaccine. A total of 1336 AEFIs were reported in 868(19%) first dose vaccine recipients while 147 AFEIs were reported in 105(11.2%) second dose vaccine recipients.  The frequently reported AEFIs were pain at the injection site, lethargy, headache, muscle ache, and fever. All the AEFIs were mild to moderate in severity. Most of the AEFIs started within 24 h and resolved within 72 h.   Conclusion: The Sinopharm (Vero cell) vaccine was found to have mild to moderate AEFIs in our study cohort and no case of severe AEFI was identified.

Individual Gestalt Is Unreliable for the Evaluation of Quality in Medical Education Blogs: A METRIQ Study

Open educational resources such as blogs are increasingly used for medical education. Gestalt is generally the evaluation method used for these resources; however, little information has been published on it. We aim to evaluate the reliability of gestalt in the assessment of emergency medicine blogs. We identified 60 English-language emergency medicine Web sites that posted clinically oriented blogs between January 1, 2016, and February 24, 2016. Ten Web sites were selected with a random-number generator. Medical students, emergency medicine residents, and emergency medicine attending physicians evaluated the 2 most recent clinical blog posts from each site for quality, using a 7-point Likert scale. The mean gestalt scores of each blog post were compared between groups with Pearson's correlations. Single and average measure intraclass correlation coefficients were calculated within groups. A generalizability study evaluated variance within gestalt and a decision study calculated the number of raters required to reliably (>0.8) estimate quality. One hundred twenty-one medical students, 88 residents, and 100 attending physicians (93.6% of enrolled participants) evaluated all 20 blog posts. Single-measure intraclass correlation coefficients within groups were fair to poor (0.36 to 0.40). Average-measure intraclass correlation coefficients were more reliable (0.811 to 0.840). Mean gestalt ratings by attending physicians correlated strongly with those by medical students (r=0.92) and residents (r=0.99). The generalizability coefficient was 0.91 for the complete data set. The decision study found that 42 gestalt ratings were required to reliably evaluate quality (>0.8). The mean gestalt quality ratings of blog posts between medical students, residents, and attending physicians correlate strongly, but individual ratings are unreliable. With sufficient raters, mean gestalt ratings provide a community standard for assessmen