First Panel Testing In SAARC Regional Networks of TB Reference Laboratories

Setting: South Asian Association for Regional Co-operation (SAARC) region with disproportionately high burden of TB in comparison of regional population. Objective: To establish a quality assurance on sputum smear microcopy in SAARC regional network of TB reference laboratories. Methods: Panel of slides were prepared and sent to national TB reference laboratories. The laboratory technician read the slides and sent report to SAARC TB center and report were analyzed. Results: Seven laboratories had no error of any type and one laboratory got two minor types of errors. Conclusion: Mot of the laboratories had excellent performance in panel testing

Pheochromocytoma: A Rare Cause of Secondary Hypertension

  Introduction: Pheochromocytoma is a rare tumor, originating from the chromaffin tissue. Its frequency is approximately 1/100,000. The clinical manifestation is due to catecholamine excess, which includes high blood pressure, palpitation, headache, sweating, nausea, vomiting, trembling, weakness, irritation, abdominal and chest pain, dyspnea, red warm face, constipation, polyuria, and polydipsia.   Case Report: We present a case of 53 years old male, hospitalized for hypertensive crisis following the manipulation of left sided frozen shoulder. He had labile blood pressure ranging from 220/120 systolic- 90/60 diastolic, profuse sweating and tachycardia. Findings of Contrast enhanced CT of abdomen was consistent with right adrenal pheochromocytoma and 24 hours urinary VMA was 17 mg /24 hr (Normal <13.6 mg /24hr). After the clinical, paraclinical investigations and radiological tests, it was proved to be a pheochromocytoma. The surgical intervention was planned. But due to unavailability of required antihypertensive drugs in Nepal (alpha-blockers like phentolamine and phenoxybenzamine), surgeons were reluctant to operate, although blood pressure was well controlled with use of sodium nitroprusside during hypertensive crisis and prazosin, a selective alpha blocker as maintainance therapy. The use of prazosin to control hypertension secondary to pheochromocytoma is limited to case report and case series.   Conclusion: Although rare, pheochromocytoma is a treatable surgical cause of secondary hypertension

The state of indoor air quality in Pakistan—a review

Background and purpose: In Pakistan, almost 70% of the population lives in rural areas. Ninety-four percent of households in rural areas and 58% in urban areas depend on biomass fuels (wood, dung, and agricultural waste). These solid fuels have poor combustion efficiency. Due to incomplete combustion of the biomass fuels, the resulting smoke contains a range of health-deteriorating substances that, at varying concentrations, can pose a serious threat to human health. Indoor air pollution accounts for 28,000 deaths a year and 40 million cases of acute respiratory illness. It places a significant economic burden on Pakistan with an annual cost of 1% of GDP. Despite the mounting evidence of an association between indoor air pollution and ill health, policy makers have paid little attention to it. This review analyzes the existing information on levels of indoor air pollution in Pakistan and suggests suitable intervention methods. Methods: This review is focused on studies of indoor air pollution, due to biomass fuels, in Pakistan published in both scientific journals and by the Government and international organizations. In addition, the importance of environmental tobacco smoke as an indoor pollutant is highlighted. Results: Unlike many other developing countries, there are no long-term studies on the levels of indoor air pollution. The limited studies that have been undertaken indicate that indoor air pollution should be a public health concern. High levels of particulate matter and carbon monoxide have been reported, and generally, women and children are subject to the maximum exposure. There have been a few interventions, with improved stoves, in some areas since 1990. However, the effectiveness of these interventions has not been fully evaluated. Conclusion: Indoor air pollution has a significant impact on the health of the population in Pakistan. The use of biomass fuel as an energy source is the biggest contributor to poor indoor air quality followed by smoking. In order to arrest the increasing levels of indoor pollution, there is a dire need to recognize it as a major health hazard and formulate a national policy to combat it. An integrated effort, with involvement of all stakeholders, could yield promising results. A countrywide public awareness campaign, on the association of indoor air pollution with ill health, followed by practical intervention would be an appropriate approach. Due to the current socioeconomic conditions in the country, development and adoption of improved cooking stoves for the population at large would be the most suitable choice. However, the potential of biogas as a fuel should be explored further, and modern fuels (natural gas and LPG) need to be accessible and economical. Smoking in closed public spaces should be banned, and knowledge of the effect of smoking on indoor air quality needs to be quantified. © 2010 Springer-Verlag

The state of the world’s antibiotics 2015

 Antibiotics play an important role in modern healthcare and the modern medical system is dangerously and solely dependent on them to fight and prevent infections. Antimicrobial resistance (AMR) is however, becoming increasingly common with the injudicious use of antibiotics being one of the common reasons. AMR is now attracting attention both in the lay and the scientific press and the grim possibility of a world without antibiotics is being visualized. The Center for Disease Dynamics, Economics and Policy, Washington DC, United States of America (USA) has recently published a report on the state of the world’s antibiotics. Eight working groups of the Global Antibiotic Resistance Partnership (GARP), one each from India, Kenya, Mozambique, Nepal, South Africa, Tanzania, Uganda, and Vietnam have contributed to the report and Hellen Gelband, Molly Miller-Petrie, Suraj Pant, Sumanth Gandra, Jordan Levinson, Devra Barter, Andrea White and Ramanan Laxminarayan have authored the report.The authors of the report mention that two factors are driving the world’s increased requirement for antibiotics. Rising incomes is increasing access to antibiotics and an increased demand for animal protein is resulting in intensification of agriculture and animal husbandry with a greater potential for antibiotic use. The book briefly mentions the tool, Resistance Map which brings together AMR statistics from a number of nations. There has been a huge increase in antibiotic consumption in livestock especially among developing nations.Chapter 1 discusses antibiotic resistance in 2015. Methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase producers (ESBL), carbapenem-resistant enterobacteriaceae, are among the major organisms described and resistance is increasing among nearly all micro-organisms. Different countries have or are in the process of setting up AMR surveillance systems which are briefly described in the book.Chapter 2 focuses on human use of antibiotics. Globally the consumption of the two groups of ‘last resort’ antibiotics, carbapenems and polymixins has been rising. As mentioned previously the developing world has been witnessing huge increases in antibiotic consumption. The table showing public campaigns to improve use of antibiotics among outpatients provides an overview of important campaigns. Antibiotics in agriculture and the environment is the focus of chapter 3. Antibiotic use in agriculture is greater than their use among humans. Regulating antibiotic use in agriculture and animal husbandry is becoming a priority area globally.Antibiotics lose effectiveness over time and the report mentions how each new generation of antibiotics has proven exponentially more expensive than its precursors. Issues of antibiotic quality (substandard and counterfeit medicines) persist in many areas of the world and reintroduction of older antibiotics could be an option as bacteria ‘forget’ about antibiotics which are not in common use.Chapter 4 mentions about 1) the stewardship and effective public health measures contributing towards a decline in the use of antibiotics, and hence antibiotic resistance, 2) feasible and practicable interventions that could contribute in maintaining antibiotic effectiveness and 3) alternative and complementary approaches applied to control and treat infections.Vaccines could be an important initiative to reduce antibiotic use. It also describes the six strategies that contribute to slowing resistance and maintaining the effectiveness of current drugs.Excellent maps and tables add to the information presented in the book. High production standards and effective use of color characterize this well-written and presented report. The list of references provided at the end of the book is comprehensive and will be of interest to readers interested in knowing more about the issues discussed. This book will be of interest to specialists in the field of AMR and to health professionals interested in preserving the power of antibiotics for future generations. The technical language used may make reading the book difficult for lay persons but those interested can still do so.About the book: Center for Disease Dynamics, Economics &amp; Policy. 2015. State of the World’s Antibiotics, 2015. CDDEP: Washington, D.C. The report is freely available at http://cddep.org/publications/ state_worlds_antibiotics_2015#sthash.RKLp0pcM. dpbs and can be downloaded for free from https:// cddep.org/sites/default/files/swa_2015_final.pdf  </jats:p

Assessment of nurses’ knowledge on rotahaler device in a teaching hospital of central Nepal

Nurses are among the key personnel for educating patients on use of inhalers. This study aimed to assess the baseline knowledge of practitioner nurses on rotahaler technique and management. A descriptive study was conducted among the practitioner nurses (n=31) in a teaching hospital of Central Nepal. Knowledge on rotahaler technique and management were assessed using questionnaire by giving ‘1’ for correct response and ‘0’ for incorrect response. Descriptive statistics was calculated for statistical analysis using IBM-SPSS 20.0. The mean knowledge score of the participants was 4.74±1.56. Majority of the participants (76.7%) were unable to respond that dry powder inhalers (DPIs) allow maximum deposition of drugs in lung than pressurised metered dose inhalers (pMDIs) and only 2 (6.5%) of them was aware of instructions to clean the rotahaler. About 50% of participants were unaware that patient with asthma and chronic obstructive pulmonary disease (COPD) should hold their breath for around 10 seconds after taking inhaled medication. Similarly, two third participants knew that a quick, forceful and deep inspiration is necessary while using rotahaler. The participating nurses had inadequate knowledge on the technique of rotahaler and its management. Nurses in hospital setting need continued education and training on inhalation technique and the management of inhalation devices. </jats:p

Prescription errors and pharmacist intervention at outpatient pharmacy of Chitwan Medical College

Prescribing errors are harmful to the patients. The role of pharmacist in reducing potential harm from prescription errors have been highlighted by several studies. This study aimed to evaluate the drug related prescription error and pharmacist intervention at outpatient pharmacy of Chitwan Medical College Teaching Hospital. A cross-sectional study was conducted in the outpatient Pharmacy of Chitwan Medical College Teaching Hospital from November 2014 to December 2014. The outpatient pharmacist randomly selected 5000 prescription and checked for drug related prescription error using prescription error checklist. The pharmacist discussed the prescription errors with the prescriber. The prescriptions that were corrected by the prescribers were considered as pharmacist intervened prescriptions (pharmacist intervention). Descriptive statistics including Chi-square test were done for statistical analysis using IBM-SPSS version 20. Out of 5000 prescriptions 176 drug related prescription error was found. The commonest error was dose and dosing frequency error (39.2%), duplication (33.5%) and dosage form related error (19.3%). Most of the prescription errors were noted while prescribing antimicrobial drugs (27.8%), proton pump inhibitors (15.9%) and NSAIDs (12.5%). The pharmacist’s recommendation was accepted by prescriber in 90.3% of prescription . Chi-square test showed significant association (p=0.019) between prescription errors and pharmacist intervention. Pharmacist intervention can reduce the drug related prescription error, so the pharmacist and clinician need to strongly work together for reducing overall prescriptions error.</jats:p

Towards a Modeling Framework of Social Contexts, Roles and Relations for Acquiring Role-Specific Rules

Part 7: Social ComputingInternational audienceKnowing the social roles of a person can help understand his or her interactions with the environment, and identification and acquisition of such social roles are very useful for a number of applications. In this paper, we propose a modeling framework of social contexts, roles and relations, and present a method of extracting role-specific rules from Web story episodes based on this framework. Then we introduce a rule expanding method which expands the seed rules of social roles. We believe that our work is useful for identifying social roles from text