Adverse drug reaction profile and prescription pattern of antihypertensive drug monotherapy at tertiary care hospital Nepalgunj, Nepal

Background: Hypertension is the leading cause of morbidity and mortality worldwide which requires long term therapy to prevent complication associated with it. As drugs are used for longer duration it is necessary to know potential undesirable effects for making the appropriate choice. Aim and objective of the study was to monitor the adverse drug reactions (ADRs) and to know prescribing pattern of antihypertensive monotherapy.Methods: The present work was an open, non-comparative, observational study conducted on seventy-three (73) hypertensive patients who were prescribed single antihypertensive drug at medical OPD of Nepalgunj Medical college by conducting patient interviews, recording the data on ADR monitoring form.Results: Calcium channel blockers were found to be the most frequently associated drugs with adverse drug reactions (n=12), followed by diuretics (n= 6), Angiotensin converting enzyme inhibitors (n=3), β-blockers (n= 2) and Angiotensin receptor blocker (n=1). Among individual drugs, amlodipine was found to be the commonest drug associated with adverse drug reactions (n = 10). On analysis of prescription pattern again amlodipine was most commonly prescribed antihypertensive monotherapy followed by hydrochlorothiazide.Conclusions:Amlodipine was most commonly associated with ADRs and it was also most commonly prescribed antihypertensive drugs as monotherapy. The above findings would be useful for physicians in rational prescribing.

Cyclospora cayetanensis: An Infestation among Diarrheal Children in Kathmandu Valley, Nepal

Cyclospora cayetanensis, a coccidian parasites which is responsible for recurring diarrhea and gastroenteritis especially among children living under poor hygienic condition in developing country like Nepal. Aimed of this research is to find out the prevalence of intestinal parasites and C. cayetanensis among diarrheal children in a Pediatric Hospital in Kathmandu valley, Nepal. Cross-sectional type of study was done. Altogether 196 stool specimens were collected from June to September 2013 among outpatient diarrheal children in Kanti Children’s Hospital. Modified Ziehl Neelson staining method was applied for detection of oocysts of Cyclospora after formal-ether sedimentation. Parasites were detected in 13.7% (27/196) of stool samples from ≤ 15 year old diarrheal patients. C. cayetanensis was detected in 4.8% (8/196). In genderwise, infection rate of C. cayetanensis 4.5 % (5/112), in male were higher than 3.6% (3/84) in female. In agewise, infection rate of C. cayetanensis in 5.7 % (3/52) 11-15 year old were highest followed by 4.1% (3/78) in 0-5 year old and 3.0% (2/66) in 6-10 year old. In seasonwise, infection rate of Cyclospora was highest in the month of August 7.4% (4/54) followed by 3.9% (2/51) in July, 2.3% (1/44) September and 2.1% (1/47) in June. Altogether five different type of parasites were detected. Infection rate of Giardia lamblia were highest 5.1 % (10/196) whereas lowest was Cryptosporidium parvum 1.0 % (2/196). Prevalence of C. cayetanensis is highly probable to infant, neonate, toddler and diarrheal children. Therefore, attention should be made in laboratory investigation of C. cayetanensis while suspecting the diarrheal patients infected with other parasites

Prevalence of multidrug-resistance and blaVIM and blaIMP genes among gram-negative clinical isolates in tertiary care hospital, Kathmandu, Nepal

Background and Objectives: Carbapenems have been the choice of antibiotics for the treatment of infections caused by multidrug-resistant bacteria. The main objective of this study was to determine the prevalence of carbapenemase (blaVIM and blaIMP) producing isolates among Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Materials and Methods: A total of 1,151 clinical samples were collected from the patients visiting Annapurna Neurological Institute and Allied Science and Annapurna Research Centre, Kathmandu, between June 2017 and January 2018. Antibiotic susceptibility testing (AST) was performed on the Enterobacteriaceae, P. aeruginosa and A. baumannii isolates using the Kirby-Bauer disk diffusion method. The modified Hodge test (MHT) was performed on the carbapenem-resistant isolates to confirm carbapenemase production. DNA was extracted and then screened for blaVIM and blaIMP genes by multiplex PCR. Results: Of the total 1,151 clinical samples, 253 (22.0%) showed positive growth. Of them, 226 (89.3%) were identified as Enterobacteriaceae, P. aeruginosa, and A. baumannii. Among the 226 isolates, 106 (46.9%) were multidrug-resistant. Out of the 106, 97 (91.5%) isolates showed resistance to at least one of the carbapenem used. Among the 97 carbapenem-resistant isolates, 67 (69.1%) showed the modified Hodge test (MHT) positive results. blaVIM and blaIMP were detected in 40 and 38 isolates respectively using multiplex PCR assay. Conclusion: This study determined a high prevalence of MDR and carbapenem resistance among Enterobacteriaceae, P. aeruginosa, and A. baumannii as detected by the presence of blaVIM and blaIMP genes. This study recommends the use of rapid and advanced diagnostic tools along with conventional phenotypic detection methods in the clinical settings for early detection and management of drug-resistant pathogens to improve treatment strategies

Filling in the (forest) blanks: the past, present and future of India’s savanna grasslands

For most people, savannas conjure up iconic images of vast open African landscapes, with giraffes, elephants, and large herds of wildebeest, zebras, and other herbivores. In reality, savannas are a pan-tropical vegetation formation, from the pampas and cerrados of Latin America, to the plains of northern Australia

Caesarean Section for Non-medical Reasons: A Rising Public Health Issue

Background: Caesarean section (CS) is a life-saving surgical intervention for childbirth. Emphasis is given to perform CS only for valid medical reasons. However, performing CS on non-medical indications is increasing worldwide. The scoping review aims to explore the non-medical reasons for performing CS. Methods: Articles on CS for non-medical reasons were searched using several electronic databases: PubMed, MEDLINE, CINAHL and open access journal databases such as Nepal journals on-line (NepJOL) and Bangladesh journals on-line (BanglaJOL). Additional articles were searched from the reference list of the selected articles and organizational websites. Eligible full-text articles were appraised, and relevant data extracted. Narrative synthesis of extracted data was performed using a content analysis. Results: Maternal request is the most common non-medical indication of performing CS. The main reason of women’s preference for a CS is to avoid labour pain followed by certainty/convenience, avoid damage pelvic floor and vaginal trauma, and safer for baby. Similarly, the main reason for requesting a CS is fear of labour pain followed by fear of childbirth, safer mode of birth for both mother and baby and maintaining pelvic floor integrity. The main reasons of willingness to perform CS by obstetrician were fear of litigation, financial incentives and convenience. The ethical aspect of non-medically indicated CS remains complex. Conclusions: Performing CS without medical indications is a rising public health issue which has created medical, financial and ethical dilemmas in obstetrics care. The reasons for maternal request for a CS should be explored well. Obstetric care must include education of pregnant women on mode of childbirth including indications, risks and benefits of CS during antenatal visits

Electronics design and development of Near-Infrared Imager, Spectrometer and Polarimeter

NISP, a multifaceted near-infrared instrument for the upcoming 2.5m IR telescope at MIRO Gurushikhar, Mount Abu, Rajasthan, India is being developed at PRL, Ahmedabad. NISP will have wide (FOV = 10' x 10') field imaging, moderate (R=3000) spectroscopy and imaging polarimetry operating modes. It is designed based on 0.8 to 2.5 micron sensitive, 2048 X 2048 HgCdTe (MCT) array detector from Teledyne. Optical, Mechanical and Electronics subsystems are being designed and developed in-house at PRL. HAWAII-2RG (H2RG) detector will be mounted along with controlling SIDECAR ASIC inside LN2 filled cryogenic cooled Dewar. FPGA based controller for H2RG and ASIC will be mounted outside the Dewar at room temperature. Smart stepper motors will facilitate motion of filter wheels and optical components to realize different operating modes. Detector and ASIC temperatures are servo controlled using Lakeshore's Temperature Controller (TC) 336. Also, several cryogenic temperatures will be monitored by TC for health checking of the instrument. Detector, Motion and Temperature controllers onboard telescope will be interfaced to USB Hub and fiber-optic trans-receiver. Remote Host computer interface to remote end trans-receiver will be equipped with in-house developed GUI software to control all functionalities of NISP. Design and development aspects of NISP Electronics will be presented in this conference.Comment: 6 pages, 3 figures, Submitted to SPIE Conference Astronomical Telescopes + Instrumentation 202

COBRA framework to evaluate e-government services: A citizen-centric perspective

E-government services involve many stakeholders who have different objectives that can have an impact on success. Among these stakeholders, citizens are the primary stakeholders of government activities. Accordingly, their satisfaction plays an important role in e-government success. Although several models have been proposed to assess the success of e-government services through measuring users' satisfaction levels, they fail to provide a comprehensive evaluation model. This study provides an insight and critical analysis of the extant literature to identify the most critical factors and their manifested variables for user satisfaction in the provision of e-government services. The various manifested variables are then grouped into a new quantitative analysis framework consisting of four main constructs: cost; benefit; risk and opportunity (COBRA) by analogy to the well-known SWOT qualitative analysis framework. The COBRA measurement scale is developed, tested, refined and validated on a sample group of e-government service users in Turkey. A structured equation model is used to establish relationships among the identified constructs, associated variables and users' satisfaction. The results confirm that COBRA framework is a useful approach for evaluating the success of e-government services from citizens' perspective and it can be generalised to other perspectives and measurement contexts. Crown Copyright © 2014.PIAP-GA-2008-230658) from the European Union Framework Program and another grant (NPRP 09-1023-5-158) from the Qatar National Research Fund (amember of Qatar Foundation