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.

Demand Response Potential of Electrical Space Heating

Penetration of renewable energy such as wind and solar has been increasing rapidly in the grid. Due to intermittent properties of these sources, power generation cannot be scheduled as well as predicted easily. A sunny day can result in power variation from solar energy than predicted. Similarly, power generated from the wind power have different profile every day and can change in quick time. So excess generation from these renewable sources may result in over frequency problem in the network. Thus it has increased the necessity of frequency control reserves which can be activated instantaneously for stability of power network. This thesis deals with the potential of using heating energy required for house via electric space heater as frequency responsive reserves during excess generation from renewables. Daily heat loss from a house is calculated on hourly basis with respect to external temperature. Electric space heater stores the equivalent amount of heating energy to compensate loss during the off peak period when price of electricity is cheap. During excess generation from renewables, off peak storing of required heating energy is altered to instantaneous feeding to act as frequency reserves

Phased-based management at Aker Yards Langsten : a lean shipbuilding perspective

Confidential until 23-jan-201

COVID-19: ramifications in surgical practice

Nepal lies between two large countries (India and China) who have reported high incidence of COVID-19.  It is only logical that we prepare the best with the limited medical facilities that we have. There are numerous challenges that impact the surgical department and the hospital administration in general. New guidelines are being formulated and updated frequently. The challenge to provide sufficient personal protective equipment, limited finances and need to train staffs are pertinent challenges. A change in the method of treatment and execution has exerted pressure on the surgeons with a need to keep abreast of new developments.  We describe the numerous impacts of the COVID-19 on surgical practice, the impact on surgeons, patients, surgical residents and even the hospitals which have led to all “new normal” in surgery. Keyword: COVID-19, coronavirus, surgery, impacts on surger

Village Baseline Study: Site Analysis Report for Rupandehi, Madhuri Village, Nepal

This is the report of the village baseline study of Madhuri Village in the CCAFS benchmark site of Rupandehi, Nepal conducted from June 5-9, 2011 to complement an earlier household baseline survey done in the same village. Madhuri is located in the fertile area of the Indo-Gangetic Plain in Nepal yet faces challenges due to increasing populations, encroachment on forests, decreasing soil fertility, limited agriculture and animal productivity, lack of opportunities, and variable climatic conditions. Its circumstances present manageable opportunities to prevent an increase in food insecurity and further degradation natural resources. Madhuri has yet to incur any food or environmental crises

Student’s perceptions and feedback about teaching-learning pharmacology in Nepalgunj Medical College of Chisapani, Nepal

Background: Pharmacology, being both basic and applied science, forms the backbone of rational therapeutics in medical field. Understanding of current perceptions and opinions of medical students is important for the betterment of teaching-learning methodologies in pharmacology subject. This study done with the objective to determine the perception and feedback of teaching learning pharmacology.Methods: Descriptive cross sectional questionnaire based study was conducted in Nepalgunj Medical College Chisapani, Banke Nepal, among second year MBBS students in September 2017. A questionnaire distributed in class and then collected. Data was analysed using the Statistical Package for Social Sciences (SPSS).Results: Total 119 students, 78 male and 41 females participated in this study. The percentage average of agreed responses for 15 questions (58.92±19.53) was significant (p <0.05) when compared with the percentage average of the disagreed (5.42± 5.17). Seventy three (61.3%) students agreed that pharmacology is a favourite subject but the preferences for pharmacology as a subject in post-graduation was low (18.5%). High proportion of students wanted the faculty members to make more use of Audio-Visual aids 93.3%, case based learning 96.6%, more clinical pharmacology, 97.5%, group discussions, 88.2%, integration to clinical sciences 92.4% and 82.4% prefer MCQs to be introduced in the curriculum for effective learning.Conclusions: Introduction of integrated teaching, MCQs, case based, and group based discussion with clinical pharmacology and audio-visual aids was favoured by majority of the students. Regular reviewing perception and feedback of the students help teachers to plan the curriculum and improve the teaching methodologies

Adsorption of Water on Vacancy Defective h-BN Bilayer at B and N Sites

Two dimensional (2D) materials are used to manufacture the various gadgets. Their properties are therefore appealing. In the present work, we have studied the structural, electronic, and magnetic properties of 2D bilayer hexagonal-Boron Nitride (h-BN), single B vacancy defect on h-BN (B-hBN), single N vacancy defect on h-BN (N-hBN), water adsorption; on B-hBN (w-B-hBN) and on N-hBN (w-N-hBN), materials by spin-polarized density functional theory (DFT) methods employing Quantum ESPRESSO (QE) computational tools. The structural stability of the h-BN, B-hBN, N-hBN, w-B-hBN, & w-N-hBN materials has been investigated by determining their minimum ground state energy and binding energy, and found that they are stable materials. The pristine h-BN bilayer supercell structure is also found to be more compact than other defective configurations. By analyzing the band structures and density of states (DoS) plots of these materials, we have examined their electronic properties, and found that pristine h-BN has a broad bandgap, whereas B-hBN, N-hBN, w-B-hBN, & w-N-hBN exhibit semiconducting nature. The DoS and partial density of states (PDoS) computations of the considered materials are used to study their magnetic properties. It is found that pristine h-BN is a non-magnetic, and B-hBN, N-hBN, w-B-hBN & w-N-BN are magnetic materials. Therefore, vacancy defects on pristine h-BN, and water adsorption on vacancy defected h-BN materials cause it to change from non-magnetic to magnetic. They could find use in the domain of device applications

Enterobacter nimipressuralis as a cause of pseudobacteremia

<p>Abstract</p> <p>Background</p> <p>The clinical significance of the <it>Enterobacter nimipressuralis </it>as human pathogens remains unclear.</p> <p>Case presentations</p> <p>The microbiologic culture monitoring system of sterile body fluids revealed on an episode of <it>Enterobacter cloacae </it>and <it>Enterobacter amnigenus </it>in blood culture results on the same day; the antibiotic sensitivity and MIC were nearly the same for both species. First patient was a healthy woman with postmenopausal syndrome, while second patient with herpes zoster. Both patients had febrile sensations without signs of bacteremia. <it>E. amnigenus </it>was also cultured from the unused package of salined cotton in the container through epidemiologic investigation. The cultured <it>Enterobacter </it>species were all identified as <it>E. nimipressuralis </it>through <it>hsp60 </it>gene sequencing and infrequent-restriction-site PCR (IRS-PCR).</p> <p>Conclusion</p> <p>When an unusual microorganisms such as <it>E. nimipressuralis </it>is isolated from blood of a patient with no clinical signs of sepsis, a pseudobacteremia should be suspected. When the antibiogram and MIC test results of bacterial cultures from two or more patients are nearly the same, although the species involved may appear different, it may be necessary to prove that they are the same species through molecular methods. The microbiologic cultures monitoring system will probably help to detect pseudobacteremia and other pseudo infections through reliable and fast identification.</p

A Global Collaboration to Develop and Pilot Test a Mobile Application to Improve Cancer Pain Management in Nepal

INTRODUCTION: Quality palliative care, which prioritizes comfort and symptom control, can reduce global suffering from non-communicable diseases, such as cancer. To address this need, the Nepalese Association of Palliative Care (NAPCare) created pain management guidelines (PMG) to support healthcare providers in assessing and treating serious pain. The NAPCare PMG are grounded in World Health Organization best practices but adapted for the cultural and resource context of Nepal. Wider adoption of the NAPCare PMG has been limited due to distribution of the guidelines as paper booklets. METHODS: Building on a long-standing partnership between clinicians and researchers in the US and Nepal, the NAPCare PMG mobile application (“app”) was collaboratively designed. Healthcare providers in Nepal were recruited to pilot test the app using patient case studies. Then, participants completed a Qualtrics survey to evaluate the app which included the System Usability Scale (SUS) and selected items from the Mobile App Rating Scale (MARS). Descriptive and summary statistics were calculated and compared across institutions and roles. Regression analyses to explore relationships (α = 0.05) between selected demographic variables and SUS and MARS scores were also conducted. RESULTS: Ninety eight healthcare providers (n = 98) pilot tested the NAPCare PMG app. Overall, across institutions and roles, the app received an SUS score of 76.0 (a score > 68 is considered above average) and a MARS score of 4.10 (on a scale of 1 = poor, 5 = excellent). 89.8% (n = 88) “agreed” or “strongly agreed” that the app will help them better manage cancer pain. Age, years of experience, and training in palliative care were significant in predicting SUS scores (p-values, 0.0124, 0.0371, and 0.0189, respectively); institution was significant in predicting MARS scores (p = 0.0030). CONCLUSION: The NAPCare PMG mobile app was well-received, and participants rated it highly on both the SUS and MARS. Regression analyses suggest end-user variables important to consider in designing and evaluating mobile apps in lower resourced settings. Our app design and pilot testing process illustrate the benefits of cross global collaborations to build research capacity and generate knowledge within the local context

PARP-1 regulates DNA repair factor availability.

PARP-1 holds major functions on chromatin, DNA damage repair and transcriptional regulation, both of which are relevant in the context of cancer. Here, unbiased transcriptional profiling revealed the downstream transcriptional profile of PARP-1 enzymatic activity. Further investigation of the PARP-1-regulated transcriptome and secondary strategies for assessing PARP-1 activity in patient tissues revealed that PARP-1 activity was unexpectedly enriched as a function of disease progression and was associated with poor outcome independent of DNA double-strand breaks, suggesting that enhanced PARP-1 activity may promote aggressive phenotypes. Mechanistic investigation revealed that active PARP-1 served to enhance E2F1 transcription factor activity, and specifically promoted E2F1-mediated induction of DNA repair factors involved in homologous recombination (HR). Conversely, PARP-1 inhibition reduced HR factor availability and thus acted to induce or enhance BRCA-ness . These observations bring new understanding of PARP-1 function in cancer and have significant ramifications on predicting PARP-1 inhibitor function in the clinical setting