“Solidarity Trial”: A Feeling of Trust Towards COVID-19 Treatments

Corona Virus Disease (COVID-19) drugs are not being developed at the pace in which the disease is spreading throughout the world. WHO and its partners have announced the worldwide clinical trial on 18th March 2020, known as “Solidarity Trial” for greater co-ordination of developments of drugs. “Solidarity Trialis an international clinical trial to help find an effective treatment for COVID-19”. The trial is randomized, open-label and adaptive. This trial will analyze four treatment options against standard of care, after recruiting patients from various countries, and then will approach to their relative effectiveness against the disease. The aim of this trial is to rapidly explore if any of the administered drugs will slow progression of disease or improve survival. The rationale of conducting “Solidarity Trial” is to reduce time taken by the trials. Randomized clinical trials generally take years to conduct, while, “Solidarity Trial” will reduce the duration by 80%. By enrolling patients from around the world, this trial might be able to provide result more rapidly than multiple small trials. Moreover, those small multiple trials will not be able to gather solid evidence required to determine the relative effectiveness of given unproven drugs.&nbsp

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

Pattern, Management, and Outcome of Poisoning in a Tertiary Care Hospital

Introduction: Poisoning is a significant global public health problem. The appropriate management of poisoning at emergency needs accurate assessment and immediate treatment. The immense chance for better outcomes occurs with early diagnosis and treatment. This study was conducted to assess pattern, management, and outcome of poisoning in tertiary care hospital. Methods: An observational cross-sectional study was conducted in which records of patients with a diagnosis of poisoning over a period of four years were reviewed. Results: A total of 138 patients were included in the study. A majority (63%) of them were females. Most (67.4%) were managed by general or supportive measure only. Gastric lavage was done in 60% of total patients while 52.9% patients received activated charcoal. Pralidoxime and atropine was received by 51.1% of patients treated with specific antidote. All the antidotes were administered through intravenous route. Regarding outcome, 89.9% were completely recovered. Suicidal poisoning was significantly higher in married as compared to unmarried patients (p = 0.029). Similarly, there was a significant relationship between occupation of the patients and manner of poisoning (p = 0.003). Outcome of treatment had a significant association with the manner of poisoning (p < 0.001). Further analysis revealed that the patients who expired in the hospital were more likely to ingest poison accidentally. Conclusion: Suicidal poisoning is common and females are more susceptible. Insecticide and rodenticide are the commonly ingested poisons. Treatment outcome of poisoning cases is generally favorable

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

Estimation of Height from Foot Dimensions

Introduction: Height determination by measuring various body parts is of value in medicolegal investigations as well as in anthropology. The current study was conducted to analyze interrelation between foot dimensions and stature, and to predict stature from foot dimensions. Methods: The study was done in medical students where stature, foot length, and foot breadth were quantified using standard instruments. We calculated correlations between variables with correlation test and predicted stature from foot length and foot breadth using linear regression. Results: The correlation between foot length and stature, and foot breadth and stature were statistically significant in both gender (p < 0.05). Greater correlation coefficient between foot length and stature than that for foot breadth and stature indicated stronger correlation between foot length and stature. Separate formulae were drawn for calculation of stature from foot breadth and foot length by regression analysis. Conclusion: Both foot breadth and foot length were correlated with stature. Foot length was found to be a better predictor of stature

Drug Utilization Pattern by Using WHO Core Prescribing Indicators in Orthopedics and Obstetrics / Gynecology Departments of a Tertiary Care Hospital

Introduction: Drug utilization research is an important tool to facilitate rational use of drugs. In low income countries irrational use of drugs is a common problem like overuse of drugs and inappropriate use of antibiotics, leading to poor treatment outcome and increased burden of treatment. This study was conducted to provide understanding of drug utilization pattern by using WHO Core Prescribing Indicator. Methods: This study was conducted in Orthopedics and Obstetrics / Gynecology departments. Patients visiting these Out Patient Departments with at least one drug on prescription form were included in the study. Further, information related to WHO Core Prescribing Indicators were collected in pre-designed proforma. Results: Average number of drugs prescribed per prescription was 2.6. Means of number of drugs prescribed in Orthopedics and Obstetrics / Gynecology departments were 2.9 and 2.3 respectively (p < 0.001). Drugs prescribed in generic name and from essential drug list was 41.4% and 34.3% respectively. Prescription forms with generic name in Orthopedics department were significantly more compared to Obstetrics / Gynecology department (p = 0.00002). However, there was an increased tendency to prescribe drugs from essential drug list in Obstetrics / Gynecology department compared to Orthopedics department (p < 0.001). Conclusion: Drugs were prescribed by generic name and from essential drug list, but this was not sufficient to meet the ideal values of WHO Core Prescribing Indicator. Therefore, prioritization on prescribing drugs by generic name and from essential drug list by respective departments to achieve the standards of WHO needs to be encouraged

Pattern of Head Injuries in Western Hilly Region of Nepal: A Hospital-based Cross-sectional Study

Introduction: Subtle or gross structural changes of scalp, skull and its contents due to application of direct or indirect external force are known as head injuries. Head being the most vulnerable and prominent part of body, injuries to it cause major mortality and morbidity globally. This study focussed to find the pattern of traumatic head injuries in patients presented to Lumbini Medical College Teaching Hospital, Palpa, Nepal. Methods: The data was collected from 252 patients (164 males and 88 females) with head injuries attending Emergency or out-patient department of Neurosurgery of the institute. All patients with traumatic head injuries (scalp injury, skull fracture, intracranial haemorrhage and brain injury) were included in the study and brought dead patients and patients with non-traumatic brain lesions were excluded. Results: Among the various modes of head injuries, the most frequent was road traffic accidents accounting 125 (49.60%) cases and fall from height 108 (42.86%) cases was second to it followed by physical assault 12 (4.76%) and others 7(2.78%). Manner of injuries were unintentional in 238 (94.44%) of cases. Among males, intentional injuries were present in 5 (2.98%) cases and among females, 9 (10.72%) cases presented with intentional injuries. In 105 (41.67%) of the cases, head injuries were associated with injuries to the other body parts as well. Conclusion: The most common cause of head injury was found to be road traffic accident followed by fall from height. Intentional injuries were more common in females when compared to males

Economic analysis of fish production using different feed types practiced in Dhanusha district, Nepal

A study on the economic analysis of fish production using different feed types practiced in Dhanusha district was conducted in 2018. Out of 600 fish farmers, sixty fish farmers(10%) from the Fish Superzone region i.e. Janakpur sub-metropolitan city, Bideh municipality, Sahidnagar municipality, Kamala municipality, Hanspur municipality, Janaknandani rural municipality and Aaurahi  rural municipality, selected using simple random sampling, were surveyed using semi-structured questionnaire. The study revealed that locally formulated mash feed was commonly used feed type in which rice bran and mustard oil cake (RB+MOC) was the principle feed ingredient. 55% of the farmers used rice bran and mustard oil cake (RB+MOC), 20% used rice bran, mustard oil cake and soybean (RB+MOC+SOB), 10% used rice bran, mustard oil cake and fish meal (RB+MOC+FM) and 15% farmers mineral and vitamin (RB+MOC+MIN/VIT) in their feed formulation. The productivity of the fish production in feed type RB+MOC+SOB (3.41±1.02) was significantly higher than other feed type.  The total variable cost per ha (5.23±2.11) was found significantly(p<0.05) higher in feed type RB+MOC+SOB. Similarly, gross margin (4.44±2.74) received by farmers of feed type RB+MOC+SOB was also significantly high(p<0.05). The Benefit: Cost (B:C) ratio of the study area was found to be 1.69, high being of feed type RB+MOC+SOB(1.84) compared to others. The feed type RB+MOC+SOB is seen as a economically profitable one in the study area because of the high productivity, profit and B:C ratio. High feed cost was the major problem followed by the unavailability of feed. Fish farming can be a profitable business in Dhanusha with large opportunity to increase the fish production with increasing protein sources in the feed used. Farmers should be provided sufficient information, trainings and be encouraged to incorporate the protein rich sources like soybean and fish meal in the feed prepared to increase the productivity and ultimately return

Projected distribution of the westernmost subpopulation of Assamese macaques (Macaca assamensis pelops) under climate change: conservation implications of a threatened population

Anthropogenic climate change can have a negative impact on the distribution of habitat specialist species with narrow distributional ranges. Among the many areas around the world affected by climate change, the Himalayan region in particular is experiencing marked effects of global warming on its climatic patterns and life forms. This study assessed the current distribution of Assamese macaques (Macaca assamensis) in western Nepal, and projected their likely distribution (via habitat suitability modeling) for the years 2050 and 2070 under the two most plausible greenhouse gas emission scenarios (RCP4.5 and RCP6.0). We recorded a total of 159 Assamese macaques belonging to 10 groups (nine of them residing outside of protected area networks) between 684m and 2550m asl in western Nepal. Climatic niche modeling predicted that 37.03% (25,114 km2) of the total area of western Nepal (67,813 km2) represented suitable habitat of the species, the majority of which ranged between 1000 m and 2000 m asl. Future projections of the current climatic niche of the Assamese macaques revealed a consistent decrease in the suitable habitat for 2050 and 2070 in both of the greenhouse emission scenarios tested. With the RCP6.0 scenario, almost 57% of the current highly suitable habitat would be lost by 2070 with remaining suitable habitat shifted towards higher elevations. The loss of habitat directly affects the species survival and the range shift towards higher elevation exposes them to new areas for conflict with humans. Therefore, the Assamese macaque population in western Nepal requires a high conservation priority with the establishment of new protected areas