Assessment of Prescription Errors in the Internal Medicine Department of a Tertiary Care Hospital in Nepal: A Cross-Sectional Study

Introduction: Prescription errors are common problems in hospitals that lead to increase in morbidity, mortality and cost of treatments. They also reduce faiths towards healthcare providers. They are avoidable and their adverse outcome can be reduced if they are assessed and recognized earlier. This study was conducted to assess prescription errors occurred in tertiary care hospital Methods: A cross sectional study was conducted in Internal Medicine department of Lumbini Medical College for five months duration. Patients who prescribed at least one drug in prescription form were included. Results: Out of total patients, 39.5% had medication error. Among medication errors, 37.6% patients had error of omission. Among error of omission, dose of the drug was not mentioned in 26.1% patients. Category B (21.6%) of severity of medication error was the most common. Patients with one diagnosis less likely had medication errors comparing to the patients with more than one diagnosis (p = 0.0002). The tendency of making medication errors was higher among patients with polypharmacy (p < 0.001) and patients who prescribed Fixed-Dose Drug Combination (p < 0.001). Similarly, the tendency of making errors of omission was also higher among patients with more than one diagnosis (p = 0.0002), patients with polypharmacy (p < 0.001) and patients who prescribed Fixed-Dose Drug Combinations (p < 0.001). Conclusion: One-third of patients had medication errors. Among them, errors of omission were the most common. The collaborative program between doctors, clinical pharmacologists and hospital administration to minimize the occurrence of errors will be effective. &nbsp

Antihypertensive Drug Use Pattern in a Tertiary Care Hospital of Western Region of Nepal: A Cross-Sectional Study

Introduction: Assessing antihypertensive drug use pattern always plays an important role to mitigate the burden of hypertension and also helps doctors to prescribe the drugs rationally. This study was conducted to assess antihypertensive drug use pattern in a tertiary care hospital. Methods: An observational cross-sectional study was conducted in the Internal Medicine department of Lumbini Medical College and Teaching Hospital from July 2021 to December 2021 for the duration of five months after ethics approval. Hypertensive patients who were prescribed one or more antihypertensive drugs irrespective of age and gender were included. Socio-demographic profiles, clinical characteristics, and antihypertensive drug use-related data were collected. A convenience sampling technique was used. Categorical variables were expressed as frequency and percentage while continuous variables were reported as mean ± standard deviation. Results: A total of 224 patients were included. The average number of antihypertensive drugs per patient was 1.7 ± 0.8. Combination drug therapy (54.5%) was commonly used. Calcium channel blockers (Amlodipine) were commonly prescribed (66.5%). Moreover, 98.7% and 41.5% patients were prescribed drugs from Essential Drug List of Nepal (Revised 2016) and in Fixed Dose Combination respectively. Use of combination drug therapy was higher among male patients (p = 0.003) and patients with stage II hypertension (p < 0.001). Conclusion: Calcium channel blockers were commonly used as monotherapy and in combination therapy as well. In approximately all of the patients, antihypertensive drugs were used from the essential drug list of Nepal which is an essential component of rational use of medicine

A single-dose antibiotic prophylaxis to prevent surgical site infection in clean-contaminated surgery among diabetic patients

Introductions: Guidelines on antibiotics use in surgical patients recommends asingle dose prophylaxis for clean-contaminated cases and therapeutic coursefor contaminated and dirty cases. Compliance to this guideline is poor amongdiabetic patients. The aim of this study was to test the efficacy of single doseantibiotic prophylaxis on the occurrence of postoperative surgical site infection(SSI) in clean-contaminated surgery in diabetic patients.Methods: Retrospective cross-sectional study was carried out at KIST MedicalCollege and Teaching Hospital from September 2008 to August 2012 involving144 diabetic patients who underwent major clean-contaminated surgery. Fortyeight patients received one gram of ceftriaxone intravenously as prophylacticantibiotic within 30 minutes prior to incision (group 1) and 96 patients receivedthree doses of ceftriaxone (group 2). One dose was given within 30 minutesprior to incision and other two doses were given postoperatively. All patientswere followed up for 30 postoperative days on outpatient basis. The SSI rateswere compared in two groups. Pus from the infected wound was tested forculture and sensitivity.Results: The SSI rates in group 1 and group 2 were of 5/48 (10.42%) and of 9/96 (9.37%) respectively. There was no significant difference in SSI rates between group 1 and group 2 (p=0.322).Conclusions: Single dose of Ceftriaxone shows the similar effect as three dosesin clean-contaminated surgery in diabetic patients.Keywords: antibiotic prophylaxis, diabetic patients, surgical site infectio

Patterns and Drivers of Agricultural Biodiversity in South Asia: A preliminary overview of a regional dataset

Food systems face multifaceted challenges ranging from inadequate supply of nutritious food products to a range of negative environmental impacts (Fable et al., 202; Rockstöm et al., 2020; Willet et al., 2019). Fuctional agricultural bidiversity has emerged as an important consideration that, if carefully managed, could help to improved food system outcomes through several pathways including production risk miigation, increased and diversified incomes and livelihoods, and potentially as a contributor to healthier diets (Gaitán-Cremaschi et al., 2018; Klerkx & Rose 2020). However, large-scale regional patterns and drivers of agricultural biodiversity in South Asia remain largely underexplored. To address this gap, TAFFSA is producing a regional agricultural biodiversity database that will support researchers and policy markers in better understanding diversification in the food system and the relationships between agrobiodiversity and key food system outcomes. The current dataset contains regional district-level production data from 2019-2022, depending on availability, and includes a dietary groupings of food groups. Preliminary results show that cereals are by far the largest food category, but also highlight spatial variation in the diversity of food production. Bangladesh, Pakistan, Northen and Eastern India, and Nepal appear to be more diverse and dedicate larger shares of cultivated land to cereals than Western and Central India. After fully harmonizing the data sources,this dataset will help to identify hotspots of agobiodiversity including diagnostics and drivers of diversification that can inform sustainable food system transitions

Association of Preoperative mid-stream urine culture, Renal pelvic urine culture and Renal stone culture in the detection of Systemic inflammatory response syndrome/urosepsis post Percutaneous Nephrolithotomy

Introduction: Urosepsis post Percutaneous Nephrolithotomy (PCNL) is a dreaded complication with high mortality rate. Objective: To find the association of preoperative midstream urine culture (PMUC), renal pelvic urine culture (RPUC) and renal stone culture (RSC) in the post-operative development of Systemic Inflammatory Response Syndrome (SIRS) and urosepsis. Methods: It was a prospective cross-sectional observational study. The study included all symptomatic patients meeting the inclusion criteria who underwent Percutaneous Nephrolithotomy from 18th August, 2019 to 28th March, 2020. PMUC, RPUC and RSC were done and analyzed accordingly. Results: A total of 140 (73 males, 67 females) patients underwent PCNL. PMUC was positive in 15% (21/140) as compared to RPUC and RSC which were 7.9 % (11/140) and 4.3% (6/140) of total cases. None of the patients had simultaneous culture positivity in all the three types of specimens. Only two (1.42%) patients had simultaneous positivity in pelvic urine culture and stone culture. The organisms obtained in pelvic urine culture and stone culture were same i.e. Klebsiella and Escherichia coli respectively. Only two (1.42%) patients developed SIRS post PCNL, where in both the cases stone culture were positive but PMUC and RPUC were negative. Urosepsis was found in none of the patients. In the Fischer Exact test PMUC and RPUC were not statistically significant in the detection of SIRS post PCNL. Whereas only RSC showed statistical significance in the detection of SIRS. Conclusion: Stone culture has high prediction for SIRS and it might be considered for patients undergoing PCNL in order to prevent stone related infective complications

Combination of convalescent plasma therapy and repurposed drugs to treat severe COVID-19 patient with multimorbidity.

Combination of convalescent plasma therapy and repurposed drugs such as dexamethasone and remdesivir could be beneficial for severe COVID-19 patients with obesity and chronic diseases such as diabetes and hypertension

Integrated management systems to control biotic and abiotic stresses in cool season food legumes

Yield losses in cool season food legumes result from several biotic and abiotic Stresses. The most important of these stresses on five cool season food legume crops are listed. and recent progress in research to alleviate some of these is reviewed Although i t is possible to control some stresses by the use of such inputs as agricultural chemicals, economic.............................

Comprehensive Fragment Screening of the SARS-CoV-2 Proteome Explores Novel Chemical Space for Drug Development

12 pags., 4 figs., 3 tabs.SARS-CoV-2 (SCoV2) and its variants of concern pose serious challenges to the public health. The variants increased challenges to vaccines, thus necessitating for development of new intervention strategies including anti-virals. Within the international Covid19-NMR consortium, we have identified binders targeting the RNA genome of SCoV2. We established protocols for the production and NMR characterization of more than 80 % of all SCoV2 proteins. Here, we performed an NMR screening using a fragment library for binding to 25 SCoV2 proteins and identified hits also against previously unexplored SCoV2 proteins. Computational mapping was used to predict binding sites and identify functional moieties (chemotypes) of the ligands occupying these pockets. Striking consensus was observed between NMR-detected binding sites of the main protease and the computational procedure. Our investigation provides novel structural and chemical space for structure-based drug design against the SCoV2 proteome.Work at BMRZ is supported by the state of Hesse. Work in Covid19-NMR was supported by the Goethe Corona Funds, by the IWBEFRE-program 20007375 of state of Hesse, the DFG through CRC902: “Molecular Principles of RNA-based regulation.” and through infrastructure funds (project numbers: 277478796, 277479031, 392682309, 452632086, 70653611) and by European Union’s Horizon 2020 research and innovation program iNEXT-discovery under grant agreement No 871037. BY-COVID receives funding from the European Union’s Horizon Europe Research and Innovation Programme under grant agreement number 101046203. “INSPIRED” (MIS 5002550) project, implemented under the Action “Reinforcement of the Research and Innovation Infrastructure,” funded by the Operational Program “Competitiveness, Entrepreneurship and Innovation” (NSRF 2014–2020) and co-financed by Greece and the EU (European Regional Development Fund) and the FP7 REGPOT CT-2011-285950—“SEE-DRUG” project (purchase of UPAT’s 700 MHz NMR equipment). The support of the CERM/CIRMMP center of Instruct-ERIC is gratefully acknowledged. This work has been funded in part by a grant of the Italian Ministry of University and Research (FISR2020IP_02112, ID-COVID) and by Fondazione CR Firenze. A.S. is supported by the Deutsche Forschungsgemeinschaft [SFB902/B16, SCHL2062/2-1] and the Johanna Quandt Young Academy at Goethe [2019/AS01]. M.H. and C.F. thank SFB902 and the Stiftung Polytechnische Gesellschaft for the Scholarship. L.L. work was supported by the French National Research Agency (ANR, NMR-SCoV2-ORF8), the Fondation de la Recherche Médicale (FRM, NMR-SCoV2-ORF8), FINOVI and the IR-RMN-THC Fr3050 CNRS. Work at UConn Health was supported by grants from the US National Institutes of Health (R01 GM135592 to B.H., P41 GM111135 and R01 GM123249 to J.C.H.) and the US National Science Foundation (DBI 2030601 to J.C.H.). Latvian Council of Science Grant No. VPP-COVID-2020/1-0014. National Science Foundation EAGER MCB-2031269. This work was supported by the grant Krebsliga KFS-4903-08-2019 and SNF-311030_192646 to J.O. P.G. (ITMP) The EOSC Future project is co-funded by the European Union Horizon Programme call INFRAEOSC-03-2020—Grant Agreement Number 101017536. Open Access funding enabled and organized by Projekt DEALPeer reviewe

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Pharmacovigilance: Knowledge, Attitude and Practice among Medical Professionals at a Tertiary Care Hospital in Nepal

Introduction: Awareness regarding pharmacovigilance and adverse drug reaction reporting by medical professionals significantly contribute to the safer use of medicine. Therefore, the objective of this study was to assess the knowledge, attitude, and practices regarding pharmacovigilance among the medical professionals at a tertiary care hospital in Nepal. Methods: This study was a descriptive cross-sectional study conducted at Lumbini Medical College and Teaching Hospital. Printed questionnaires were distributed to all the medical professionals and collected data were analyzed to find the knowledge, attitude, and practices of the medical professionals regarding pharmacovigilance. Results: A total of 107 medical professionals, 77 (71.96%) males and 30 (28.04%) females, participated in the study. The overall response rate was 98.16%. In this study,70.1% of medical professionals knew the definition of pharmacovigilance, and more than half of the participants(63.6%) did not know the existence of the national pharmacovigilance center. Regarding attitude, 52.3% of the medical professionals strongly agreed that adverse drug reaction reporting and monitoring systems were beneficial to patients or improved patient care. Half of the medical professionals would sometimes counsel the patients about adverse drug reactions. Almost half of  medical professionals mentioned that the major factor behind underreporting was insufficient knowledge of where to report adverse drug reactions. Training on pharmacovigilance was the main recommendation from the participants (52.3%) to improve the pharmacovigilance program. Conclusion: There is room for improvement in the knowledge, attitude and practice of the participants. Most medical professionals suggested training or continuing medical education as a way to improve pharmacovigilance programs