Pre-operative Hypoglycemia in Patients Presenting for Surgery: A Hospital Based Cross-sectional Study

Introduction: Peri-operative glycemic control is an important factor for post-operative recovery and is well protocoled for diabetic patients in every setup. It is not always so with non-diabetic patients. This study aimed to observe the pre-operative glucose level and prevalence of hypoglycemia in patients presenting for surgery and its association with the duration of nil per oral period (NPO), age and intravenous fluids used in the pre-operative period. Methods: A cross-sectional study was conducted in the Department of Anesthesiology in a Nepalese medical college including all the patients posted for elective surgery over a period of three months. Socio-demographic and clinical details of the participants were collected in the operating theatre. Duration of  NPO period and intravenous fluid prescribed in the pre-operative fasting period were recorded. A glucose strip test was performed on all the participants. Results: Participants were found to have fasted for an unnecessarily longer duration (12.84±2.27 hours). The incidence of hypoglycemia in patients posted for elective surgery was very high (43.3%). Ringer lactate and normal saline were equally prescribed (38.4%) and dextrose-normal saline was prescribed in the rest of the participants. Gender and type of intravenous fluids were positively correlated whereas NPO period was negatively correlated in overall participants though statistically insignificant. In hypoglycemic participants, we observed that lower glucose was influenced by pre-operative fluids, age and NPO duration. Conclusion: Pre-operative use of glucose-containing fluids during NPO period is an important step to prevent hypoglycemia and related consequences

Reality of having bed nets at home, their status and pattern of using it at night among the population of Lakhantari Village Development Committee of Nepal

Background &amp; Objectives:The use of insecticide treated nets has been advocated for the prevention of the vector borne transmitted disease (malaria) by the World Health Organization and UNICEF for more than a decade. In spite of this, there is no significant reduction in the transmission of the disease. Main objectives of study were to find out the real pattern of using it, to find out the physical integrity of the bed nets being used, and to prove the correlation in between the physical integrity of bed nets and the disease outcome. Torn bed nets with holes size more than 1.2 mm were considered as “holes” in this study.Materials &amp; Methods:A community based cross- sectional study was carried out in Lakhantari VDC within the duration of two weeks. This VDC has been named recently as Gramthan Gaupalika one of State one.  Sample size of 384 was determined by the WHO sample size calculator. Face to face interview technique was used after taking consent from individual. Confidentiality was maintained. It was ethically approved by the IRC (Institutional Review Committee) of Nobel Medical College.Results:A total of 384 household were studied. Total household had bed nets but the physical integrity of bed nets was not intact. Almost 73% of the bed nets were torn having more than four holes in them. Nearly 94% of household used bed nets only for three to four days a week. Nearly half of the   Malaria was found among 22% and encephalitis in 17% of household. Conclusion:Use of bed nets do not prevent and provide guarantee from vector borne disease unless it is properly used. Torn bed nets are of almost no use unless people are using other preventive measures.</p

Folate-targeted nanostructured chitosan/chondroitin sulfate complex carriers for enhanced delivery of bortezomib to colorectal cancer cells

Folate-targeting self-assembled nanoparticles (NPs) using biocompatible and biodegradable natural polymers chitosan (Cs) and chondroitin sulfate (Chs) were developed to address the major challenge in cancer treatment, the selective delivery of nanoparticles to the target site. In this study, we successfully incorporated a hydrophobic drug, bortezomib (Bor), into folic acid (FA)-conjugated Cs/Chs self-assembled NPs (Bor/Cs/Chs-FA) for colorectal cancer therapy. The particle size and polydispersity index of Bor/Cs/Chs-FA were ∼196.5 ± 1.2 nm and ∼0.21 ± 0.5, respectively. A pH-dependent release profile was observed, facilitating cancer cell-targeted drug release under an acidic tumor microenvironment. Moreover, in vitro data revealed enhanced cellular uptake and apoptosis in folate receptor-expressing colorectal cancer cells (HCT-116 and HT-29) as compared to that in lung cancer cells (A549), which do not express folate receptors. Furthermore, intravenous administration of Bor/Cs/Chs-FA in a HCT-116 bearing xenograft mouse model showed that the NPs were a safe and effective drug delivery system. The results suggest that folate-targeted nanoparticle can be effectively applied for efficient chemotherapy of colorectal cancer. Keywords: Bortezomib, Chitosan chondroitin sulfate, Colorectal cancer, Folic aci

Multilayer-Coated Liquid Crystalline Nanoparticles for Effective Sorafenib Delivery to Hepatocellular Carcinoma

Hepatocellular carcinoma is one of the most common cancers in adults and develops due to activation of oncogenes and inactivation of tumor suppressor genes. Sorafenib (SF) is a U.S. Food and Drug Administration (FDA) approved drug for the treatment of hepatocellular carcinoma. However, its clinical use is limited by its poor aqueous solubility and undesirable side effects. Monoolein-based liquid crystalline nanoparticles (LCN) are self-assembled structures that have been determined as promising drug-delivery vehicles. Therefore, the main aim of this study was to prepare layer-by-layer (LbL) polymer-assembled SF-loaded LCNs (LbL-LCN/SF) for effective delivery of SF to hepatocellular carcinoma. Results revealed that LbL-LCN/SF presented optimum particle size (∼165 nm) and polydispersity index (PDI, ∼0.14) with appropriate polymer layer assembly confirmed by transmission electron microscopy (TEM) and atomic force microscopy (AFM). Furthermore, LbL-LCN/SF effectively controlled burst release and exhibited pH-sensitive release of SF, thereby increasing drug release in the acidic microenvironment of tumor cells. Compared to free SF and bare LCN, the hemolytic activity of LbL-LCN/SF was significantly reduced (<i>p</i> < 0.01). Interestingly, LbL-LCN/SF was more cytotoxic to HepG2 cells than the free drug was. Additionally, high cellular uptake and greater apoptotic effects of LbL-LCN/SF in HepG2 cells indicates superior antitumor effects. Therefore, LbL-LCN/SF is a potentially effective formulation for hepatocellular carcinoma