A conceptual framework on health professionals' engagement towards pharmacovigilance: a qualitative exploration

Background: With the growing reliance on drug therapy in the recent era, the safety of medications is one of the vital parameters for the success of any medicine. Considering this, pharmacovigilance (PV) was developed to provide adequate identification, reporting, evaluation, and understanding of adverse drug reactions (ADR). The objective of this study was to understand the opinion of health care providers on PV, the current reporting mechanisms, identifying the causes for underreporting, and the existing process in clinical practice.Methods: A qualitative study using pretested interview guide was conducted among 20 different cadres of healthcare personnel (doctors, pharmacists, and staff nurses) from various hospitals such as government, private, corporate, and medical college of Odisha state. The data were analysed using a thematic analysis. The meaning units have been identified from the transcript and coded with MAXQDA software (MAXQDA Analytics Pro 2020, VERBI GmbH Berlin).Results: Participants showed a lack of awareness regarding the concept of PV. A cluster of challenges such as lack of ADR monitoring, non-conducive work atmosphere and lack of cooperation between staff, lack of knowledge among the health professionals, and fear of legal liability as major pitfalls causing poor ADR reporting. To enhance the pharmacovigilance practice, participants suggested context-specific strategies such as IEC activities, innovative ideas to improve ADR monitoring, regular monitoring.Conclusions: Capacity building through training, regular monitoring and supervision to strengthen the pharmacovigilance practices is the current need in India

Promjene srčanih biomarkera i ublažavanje simptoma trovanja arsenom u bijelih pataka pasmine pekinška patka nakon upotrebe đumbira

Cardiotoxicity is an imperative issue in the assessment of heavy metal consumption and inorganic arsenic (As). These have a cardiotoxic effect which is evaluated by biochemical, and oxidative-antioxidant tests, and by the Nrf2- HO-1 pathway. Dried ginger powder is recognized for its efficient antioxidant activities and as a protector of the cardiovascular system from toxic damage caused by heavy metals. However, the possible function of ginger against As in heart via heme oxygenase-1 (HO-1) and nuclear factor erythroid 2-related factor (Nrf2) is unclear. A total of 120 White Pekin ducks were randomly distributed into groups comprising 24 birds in each. Each group comprised 3 replicates having 8 birds in each replicate. The time period of this study was 90 days. The groups were the control [Group I] whereas groups II to IV were fed a basal diet including arsenic at 28 mg/L. Dried ginger powder as an ameliorative agent was mixed with the basal diet and fed at 0.1, 0.3 and 1 g/kg feed to groups III, IV and V, respectively. In the current experiment, dried ginger powder decreased As-induced reactive oxygen species (ROSs) production, oxidative injury and pathological modifications. In addition, cardiac dysfunction factors, intracellular calcium (Ca2+), As accumulation and cAMP deficiency levels were noticed in ducks; these alternations were attenuated by ginger. Furthermore, ginger significantly altered the down regulation of both HO-1 and Nrf2 gene expressions caused by As. Thus, the proven protective role of ginger against As-induced cardiotoxicity may be a consequence of the maintenance of redox homeostasis, i.e. the Nrf2-HO-1 pathway and by enabling As efflux.Kardiotoksičnost je vrlo važna u procjeni problema koji nastaju konzumacijom teških metala. Anorganski arsen (As) ima kardiotoksičan učinak koji se procjenjuje na temelju biokemijskih, oksidacijsko-antioksidacijskih nalaza te na temelju puta Nrf2-HO-1. Sušeni đumbirov prah poznat je po svojoj učinkovitoj antioksidacijskoj aktivnosti i zaštitnom djelovanju u slučaju intoksikacije kardiovaskularnog sustava teškim metalima. Nejasna je međutim uloga đumbira u odnosu na arsen u srčanom mišiću putem hem-oksigenaze 1 (HO-1) i faktora 2 povezanog s nuklearnim eritroidnim faktorom. Ukupno je 120 bijelih pataka pasmine pekinška patka nasumično podijeljeno u skupine koje su sadržavale po 24 jedinke. U svakoj skupini provedena su 3 ponovljena postupka (replikacije) na po 8 jedinki. Ukupno je vrijeme istraživanja bilo 90 dana. Skupina I bila je kontrolna skupina koja nije primila ni arsen ni đumbir. Pokusnim skupinama od II do V je, uz osnovnu prehranu, u različitim kombinacijama dodavan arsen u dozi od 28mg/L i sušeni đumbirov prah u dozama od 0,1g/kg 0,3g/kg i 1 g/kg. Rezultati su pokazali da je sušeni đumbirov prah smanjio prisutnost reaktivnih vrsta kisika (ROS) uzrokovanu arsenom, oksidacijsko oštećenje i patološke promjene. Osim toga uočene promjene, kao što su su faktori srčane disfunkcije, unutarstanični kalcij (Ca2+), nakupljanje arsena i deficijencija razine cAMP-a, ublažene su đumbirovim prahom. Đumbir je, nadalje, znakovito utjecao na smanjenje genske ekspresije i HO-1 i Nrf2 uzrokovane arsenom. Zaključeno je da bi zaštitna uloga đumbira u slučaju kardiotoksičnosti uzrokovane arsenom mogla biti posljedica održavanja redoks homeostaze, odnosno puta Nrf2-HO-1 i omogućavanja eliminacije arsena

Biochemical, Antimicrobial, and Antioxidant activities of some wild Mushrooms from Nepal

Wild mushrooms represent a crucial dietary staple for many tribal groups throughout the world since they consist of a significant source of bioactive constituents such as phenolic compounds, tocopherol, and act as anti-cancer, anti-allergic, anti-obesity, anti-inflammatory compounds, etc. Wild mushrooms including Scleroderma citrinum, Heterobasidion annosum, Coriolus hirsutus, Cavimalum indicum, Russula sanguinea, and Suillus punctatipes were studied to evaluate their phytochemical constituents, antimicrobial activity, antioxidant activity, toxicity and its importance as a source of food along with safety concerns. Initially, the total flavonoid content (TFC), total phenolic content (TPC), and total tannin content (TTC) along with antioxidant, and antimicrobial activity were assessed using ethanolic extracts of fungus. Furthermore, a Brine shrimp bioassay was performed, the correlation of which with antioxidant activity, TPC, TFC, TTC, and lethal concentration (LC50) value was shown by principal component analysis (PCA). Secondary metabolites like glucosides, flavonoids, polyphenols, alkaloids, terpenoids, saponins, and quinones were identified using phytochemical investigations. The TPC ranged from 45.98 to 102.3 mg GAE/g for the extracts, TFC from 100 to 225 mg QE/g, and the TTC was found to vary between 80 to 180 mg GAE/g. The findings of the antioxidant studies demonstrated that S. punctatipes exhibited the highest antioxidant activity (IC50 = 16.95 µg/mL), followed by C. indicum (IC50 = 22.5 µg/mL), and C. hirsutus (IC50 = 35.34 µg/mL). Likewise, S. punctatipes exhibited strong antimicrobial activity as compared to other extracts. The larvicidal efficacy against brine shrimp tests revealed that three mushrooms; C. hirsutus, C. indicum, and S. punctatipes—contain highly toxic substances while the other three are non-toxic and when properly examined can be consumed to some extent

Prevalence of stunting among under-five children in refugee and internally displaced communities: a systematic review and meta-analysis

BackgroundA pooled estimate of stunting prevalence in refugee and internally displaced under-five children can help quantify the problem and focus on the nutritional needs of these marginalized groups. We aimed to assess the pooled prevalence of stunting in refugees and internally displaced under-five children from different parts of the globe.MethodsIn this systematic review and meta-analysis, seven databases (Cochrane, EBSCOHost, EMBASE, ProQuest, PubMed, Scopus, and Web of Science) along with “preprint servers” were searched systematically from the earliest available date to 14 February 2023. Refugee and internally displaced (IDP) under-five children were included, and study quality was assessed using “National Heart, Lung, and Blood Institute (NHLBI)” tools.ResultsA total of 776 abstracts (PubMed = 208, Scopus = 192, Cochrane = 1, Web of Science = 27, Embase = 8, EBSCOHost = 123, ProQuest = 5, Google Scholar = 209, and Preprints = 3) were retrieved, duplicates removed, and screened, among which 30 studies were found eligible for qualitative and quantitative synthesis. The pooled prevalence of stunting was 26% [95% confidence interval (CI): 21–31]. Heterogeneity was high (I2 = 99%, p < 0.01). A subgroup analysis of the type of study subjects revealed a pooled stunting prevalence of 37% (95% CI: 23–53) in internally displaced populations and 22% (95% CI: 18–28) among refugee children. Based on geographical distribution, the stunting was 32% (95% CI: 24–40) in the African region, 34% (95% CI: 24–46) in the South-East Asian region, and 14% (95% CI: 11–19) in Eastern Mediterranean region.ConclusionThe stunting rate is more in the internally displaced population than the refugee population and more in the South-East Asian and African regions. Our recommendation is to conduct further research to evaluate the determinants of undernutrition among under-five children of refugees and internally displaced populations from different regions so that international organizations and responsible stakeholders of that region can take effective remedial actions.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387156, PROSPERO [CRD42023387156]

Resolution of Resilience: Empirical Findings on the Challenges Faced and the Mitigation Strategies Adopted by Community Health Workers (CHWs) to Provide Maternal and Child Health (MCH) Services during the COVID-19 Pandemic in the Context of Odisha, India

Community health workers (CHW) faced increased challenges in delivering maternal and child health services during the current COVID-19 pandemic. In addition to routine services, they were also engaged in pandemic management. In view of a dearth of evidence, the current study explores the challenges faced by CHWs while rendering maternal and child health services. A qualitative study through in-depth interviews (IDI) and focus group discussions (FGD) in six districts of Odisha was conducted from February to April 2021. Data were analyzed using MAXQDA software. Personal-level challenges, like lack of family support, stress, and fear of contracting COVID-19; facility-level challenges, like transportation problems and inadequate personal protective measures; and community-level challenges, like stigma, resistance, and lack of community support were major hindrances in provisioning routine MCH services. Prevailing myths and misconceptions concerning COVID-19 were factors behind stigma and resistance. Sharing experiences with family, practicing yoga and pranayam, engaging ambulance bikes, financial assistance to mothers, counseling people, and involving community leaders were some effective strategies to address these challenges. Development and implementation of appropriate strategy guidelines for addressing the challenges of frontline warriors will improve their work performance and achieve uninterrupted MCH services during pandemics or similar health emergencies

Aflatoxin Occurrence, Detection, and Novel Strategies to Reduce Toxicity in Poultry Species

Aflatoxins (AF) are the commonly occurring mycotoxins produced by various Aspergillus species including A. flavus, A. parasiticus, and A. nominus. As secondary metabolites of these fungi, AF may contaminate a variety of food and feedstuffs, especially corn, peanuts, and cottonseed. Among the many known AFs, AFB1 is the most commonly encountered and the most toxic. In poultry, adverse effects of AF include reduction in growth rate and feed efficiency, decreased egg production and hatchability along with increased susceptibility to diseases, besides residues in food chains. Many rapid screening methods for detecting aflatoxin are available currently, namely: thin layer chromatography (TLC), HPTLC, HPLC, enzyme-linked immunosorbent assay (ELISA), monoclonal antibody kits, and affinity column chromatography, making the detection of AF precise. For field application, rapid assay kits, e.g., Aflatest of Vicam and Afla-2-cup of Romers Labs, are currently available. The most novel ways to counteract aflatoxin already accumulated in the feed could be by getting them bound to inert compounds before absorption from host’s intestine. Among various classes of poultry, ducks followed by turkeys form the two most vulnerable poultry species, among others. Considering the inherently high genetic variation between duck breeds for AFB susceptibility, a genetic selection program to improve AFB resistance can be a long-term option. Further epigenetic sensitization of the AFB-susceptible poultries through mild AFB exposures is getting reported as an emerging genetic approach to counter AFB susceptibilities. The chapter discusses most of these, in greater detail

Assessment of Carbon Sequestration in Private Forests across Two Different Physiographic Regions of Nepal : Implications for Conservation and Climate Change Mitigation

Private forests offer diverse ecosystem services, including carbon sequestration and biodiversity conservation, which are crucial for Nepal. However, there is a notable absence of comprehensive research on these services. Assessing carbon sequestration in private forests can have economic advantages for forest owners by promoting resource conservation and contributing to greenhouse gas reduction. This study aims to estimate and compare carbon stocks in private forests located in two distinct physiographic regions of Nepal while also identifying the factors influencing these carbon stocks. The analysis focuses on 16 private forests (with 0.1 to 0.5 hectares) each from Chitwan district (Terai region) and Kavrepalanchok district (Hilly region). Field data collection involved direct measurements of tree and sapling diameter at breast height (DBH), as well as height and class of trees and poles, utilizing a total enumeration method. These collected values were utilized to calculate aboveground biomass (AGTB), aboveground sapling biomass (AGSB), belowground biomass, and carbon stock. Private forests of Terai region were dominated by Shorea borneensis, Tectona grandis, and Dalbergia sissoo, whereas the Hilly region was dominated by Pinus patula, Alnus nepalensis, Schima wallichii, and Quercus leucotrichophora. The aboveground biomass carbon in the Terai region's private forests was estimated to be 83.53 t center dot ha-1, while in the Hilly region, it was 37.32 t center dot ha-1. The belowground biomass carbon in the Terai region's private forests was found to be 21.72 t center dot ha-1, compared to 9.70 t center dot ha-1 in the Hilly region. Consequently, the estimated total carbon stock in the Terai and Hilly regions' private forests was 105.25 t center dot ha-1 (386.26 t center dot ha-1 CO2-eq) and 47.02 t center dot ha-1 (172.57 t center dot ha-1 CO2-eq), respectively. Carbon sequestration in the Terai region's private forests was discovered to be 2.24 times higher than that in the Hilly region. These findings underscore the significant potential of private forests, which can generate economic benefits through carbon trading and leverage mechanisms such as REDD+/CDM to promote sustainable conservation practices.Peer reviewe

Challenges in Maternal and Child Health Services Delivery and Access during Pandemics or Public Health Disasters in Low-and Middle-Income Countries: A Systematic Review

Maternal and child health (MCH) has been a global priority for many decades and is an essential public health service. Ensuring seamless delivery is vital for desirable MCH outcomes. This systematic review outlined the challenges in accessing and continuing MCH services during public health emergencies—pandemics and disasters. A comprehensive search approach was built based on keywords and MeSH terms relevant to ‘MCH services’ and ‘pandemics/disasters’. The online repositories Medline, CINAHL, Psyc INFO, and Epistemonikos were searched for studies. We included twenty studies—seven were on the Ebola outbreak, two on the Zika virus, five related to COVID-19, five on disasters, and one related to conflict situations. The findings indicate the potential impact of emergencies on MCH services. Low utilization and access to services have been described as common challenges. The unavailability of personal safety equipment and fear of infection were primary factors that affected service delivery. The available evidence, though limited, indicates the significant effect of disasters and pandemics on MCH. However, more primary in-depth studies are needed to understand better the overall impact of emergencies, especially the COVID-19 pandemic, on MCH. Our synthesis offers valuable insights to policymakers on ensuring the uninterrupted provision of MCH services during an emergency