Antinociceptive effects of purified Curcuma longa in mice

Background: Since ancient times Curcuma longa is said to have antinociceptive effects in literature.Methods: It was a quantitative experimental study done in the laboratory setting of the department of Clinical Pharmacology and Therapeutics, BP Koirala Institute of Medical Sciences, Dharan, Nepal (BPKIHS). Hot plate test, Tail flick test and Writhing test were used for evaluating the antinociceptive effects. Animals were divided into five groups of six each, group I as control, group II as standard control whereas groups III, IV and V as test groups (three doses). Control and the three test drug doses were given for 21 days. Data were presented as mean ±Standard Error of Mean. Statistical differences between the test drug and control groups as well as within the test drug groups were calculated using Mann-Whitney U test. A probability level less than 0.05 (p < 0.05) was considered significant.Results: Significant effects in comparison to vehicle were observed in all the three anti nociceptive test models at 200mg /kg test dose of aqueous extract of purified Curcuma longa (CL). No significant effect as compared to vehicle was observed at 50mg/kg and 100 mg/kg test doses of CL.Conclusions: This study showed that CL possesses antinociceptive effect. The mechanism(s) and active principle(s) behind the effects of CL could not be established

Validity of Delone and Mclean’s E-Commerce Model in B2C Student Loan Industry

This paper empirically investigates the popular theoretical model of DeLone & McLean (2004) to measure the perceived benefits of B2C e-commerce for individuals who acquire and manage their student loans online. This study is one of the earliest validation tests on DeLone & McLean’s e-commerce success framework in the context of B2C information system. The result indicated fairly good fit of the model to data, though several relationships in the model were insignificant. It also suggested that System Quality was the least influential among three exogenous constructs and User Satisfaction much more directly influenced Net Benefit than System Use

Adverse effects including sexual problems associated with the use of selective serotonin reuptake inhibitors in a tertiary care center of Eastern Nepal

Background: Selective serotonin reuptake inhibitors (SSRIs) use has been associated with various adverse drug events, including sexual problems in recent literature.Methods: After written informed consent, remitted psychiatric patients were enrolled if they were taking an SSRI. The remitted state was ascertained by clinical assessment of a psychiatrist and reassessed with the use of self-response screening questionnaires (Beck Anxiety Inventory for anxiety, Beck Depression Inventory for depression). The self-response questionnaire “adverse drug effect (ADE) tool” was used to assess ADEs and the Arizona Sexual Experience Scale to assess sexual problems.Results: The total of 200 subjects was enrolled with 63% females. Commonly used SSRIs were escitalopram, fluoxetine, and sertraline for the common diagnosis of depression, recurrent depressive disorder, and panic disorder in this institute. The average duration of remission during the enrollment was 11.99 months (standard deviation: 12.269). The overall prevalence of adverse effects was 91.5%. The incidence of adverse effect and sexual problem were: weight gain (57%), dryness of mouth (32.5%), headache (30%), dizziness (28.5%), paresthesia (24.5%), confusion (23.5%), tremors (21.5%), irritation (20.5%) sexual dysfunction (SD) (17.2%), increase in anxiety (17%), akathisia (16%), nausea (14.5%), itchiness (14.5%), excessive sweating, (14.5%), difficulty in sleeping (10%), weight loss (6%), rash (6%), diarrhea (4%), vomiting (3%), and others (3%).Conclusion: Adverse effect (irrespective of severity) was commonly seen with SSRI use. Common adverse effects seen among remitted subjects were weight gain, dryness of mouth, headache, dizziness, paresthesia, etc. SD was other important side effect

Analysis of inappropriate medication use and drug interaction in older people visiting tertiary care center of eastern Nepal

Background: Medication use in older people has been increasing as the incidence of chronic diseases increases worldwide. Use of more medicines may increase the chance of prescribing potentially inappropriate medications (PIMs) and may increases the risk of potential drug-drug interactions (pDDIs). The objective of this study was to assess PIMs and pDDIs to improve the rational use of medicationsMethods: In this study data from the older people were obtained from patient visiting medicine, OPD, BPKIHS, Dharan. Demographic and medications information were collected. PIM and pDDIs were evaluated from medication data using the Beer’s criteria for potentially inappropriate medication use in older adults, 2015 and lexicomp application respectively.Results: Among 550 patients 50.9% patients were male. Common diagnosis was systemic hypertension 335 (64.5%) followed by type 2 diabetes mellitus 276 (50.18%). The most commonly prescribed drug was metformin (215) followed by amlodipine (205), atorvastatin (176), losartan (158), glimepiride (113) and aspirin (100). One or more fixed drug combination was present in 295 prescriptions. One or more PIM were present in 29 (5.3%) prescriptions. Commonly prescribed PIM was prazosin (11) followed by nitrofurantoin (5). There were total of 753 cases of pDDIs, with 116 (15.40%) cases of risk categories X and D.Conclusions: Our findings demonstrated PIM use were relatively less. However, pDDIs were common in older people suggesting that optimal medication use and further similar studies in larger scale are necessary in this population

Comparative bioavailability study of phenytoin in healthy Nepalese volunteers

Our study aimed to assess and compare the bioavailability of Eptoin 100 mg and Epileptin 100mg tablets in Nepalese healthy volunteers. A randomized, two-treatment cross-over study with two weeks’ wash-out period was conducted in 12 healthy non-smoker and non-alcoholic Nepalese male volunteers over a period of 6 months in the department of Clinical Pharmacology and Therapeutic at B. P. Koirala Institute of Health Sciences, Dharan, Nepal after approval from the Institutional Review Committee. The participants were randomized using sealed envelope system and received a single 100 mg oral tablet of either of the formulations with a two week washout period. Blood samples were collected predose and at regular intervals postdose upto 72 hours. Plasma phenytoin levels were estimated by reverse phase high performance liquid chromatography. The analytical method was validated prior to the start of study. Cmax (Peak Plasma Concentration), Tmax (Time to achieve maximum Plasma Concentration), AUC0-72 (Area under plasma concentration time curve 0 to 72 hours), AUC0-∞ (Area under plasma concentration time curve 0 to ∞) and T½ (Elimination half-life) and Kel (Elimination rate constant) were calculated and 80-120% margin (90% confidence interval) was used to assess bioequivalence. ANOVA test was used to analyze the data at P-value of 0.05. All volunteers completed the study. The log-transformed values of Cmax, Tmax, AUC0-t, and AUC0-∞ of the both formulations were within the specified limits and were bioequivalent according to the regulatory definition of bioequivalence based on the rate and extent of absorption. Both products can be considered equally effective in medical practice. Keywords: Bioavailability, Bioequivalence, healthy volunteer, Nepal, phenytoin sodium

Prescription pattern in ischemic heart disease inpatients at B. P. Koirala Institute of Health Sciences: a cross sectional study

Background: Drug utilization pattern studies seek to screen, evaluate and suggest appropriate modifications in prescription practices. It would help to make patient care rational and cost effective. Objective was to analyze the drug prescribing pattern for treatment of ischemic heart disease (IHD). Methods: A prospective cross-sectional observational study was conducted in patients of IHD admitted in intensive coronary care unit and medicine ward for the period of six months. Data were collected in preformed case record form. The data were analyzed for drug use indicators, demographic parameters, morbidities, pattern of drug use using Microsoft excel 2010. Results: A total of 145 patients were enrolled out of that 89 (61.38%) were males. The mean age was 60.01±12.71 years and majority (26.89%) belonged to age group of 61-70 years. A total of 1208 drugs were prescribed in 145 patients. Most frequently prescribed drugs were antiplatelet group of drugs 100% encounters, followed by hypo-lipidemics (98.62%). Average number of drugs per encounter was 8.33 and percentage of drugs prescribed by generic name was 5.04%.  Conclusions: IHD was more common in males than females. The most commonly prescribed drug classes were anti-platelet drugs followed by hypolipidemic agents

KNOWLEDGE, ATTITUDE AND PRACTICES ON ANTIBIOTIC USE AND RESISTANCE AMONG DOCTORS IN B.P. KOIRALA INSTITUTE OF HEALTH SCIENCES

Background: Assessment of knowledge, attitudes and practices (KAP) of antibiotic prescription among doctors may help in developing guidelines to improve antibiotics use and decrease resistance. Aims and objectives: Our aim was to evaluate KAP regarding antibiotic use and its resistance among doctors. Materials and Methods: A cross sectional, questionnaire based study was conducted among the doctors of B.P. Koirala Institute of Health Sciences, Dharan, Nepal between January-March 2016 and their KAP regarding antibiotic use and resistance was assessed by using a five point Likert scale. The data were analyzed by calculating percentage and frequency. Results: Almost half of the doctors (50.2%) used to prescribe antibiotics more than once daily. Nearly two thirds of the doctors (65.3%) received antibiotic education at a formal lecture on ward rounds. Most of the doctors (87.4%) agreed that antimicrobials are overused. One hundred thirty four doctors (42.3%) agreed that patients’ demands for antibiotics contribute to its overuse. Nearly two third doctors (70.7%) believed that locally developed antimicrobial guidelines would be more useful. Most of the respondents (89.9%) wanted more ongoing education on antibiotic use and its resistance. Conclusions: Our study reveals that antibiotics are overused and patients’ demand contribute to this. Locally developed antimicrobial guidelines would be more useful. More CME on antibiotic use and its resistance should be conducted to enhance the awareness among doctors. Keywords: Antibiotics; Attitude; Antimicrobial drug resistance; Knowledge

Intracranial Ricocheting of Bullet from Anterior Clinoid Process

Gunshot wounds to the head are usually mortal injuries. We present a unique case of intracranial ricocheting of bullet without neurological deficits. Patient was treated conservatively with antibiotics for one week and prophylactic anticonvulsants for six weeks. Patient is doing well at six months follow up. Repeat X-ray skull showed that bullet was lying in the occipital region. It is recommended that deep seated bullets should be left behind as any attempt to remove that bullet may increase the morbidity and mortality. However close follow up of these patients is very important as these patients may come back with brain abscess. JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):145-146

Are Dutch dental students and dental-care providers competent prescribers of drugs?

Dental students and dental-care providers should be able to prescribe drugs safely and effectively. As it is unknown whether this is the case, we assessed and compared the prescribing competence of dental students and dental-care providers in the Netherlands. In 2017, all Dutch final-year dental students and a random sample of all qualified general dental practitioners and dental specialists (oral and maxillofacial surgeons and orthodontists) were invited to complete validated prescribing knowledge-assessment and skills-assessment instruments. The knowledge assessment comprised 40 multiple-choice questions covering important drug topics. The skills assessment comprised three common clinical case scenarios. For the knowledge assessment, the response rates were 26 (20%) dental students, 28 (8%) general dental practitioners, and 19 (19%) dental specialists, and for the skills assessment the response rates were 14 (11%) dental students, eight (2%) general dental practitioners, and eight (8%) dental specialists. Dental specialists had higher knowledge scores (78% correct answers) than either dental practitioners (69% correct answers) or dental students (69% correct answers). A substantial proportion of all three groups made inappropriate treatment choices (35%-49%) and prescribing errors (47%-70%). Although there were some differences, dental students and dental-care providers in the Netherlands lack prescribing competence, which is probably because of poor prescribing education during under- and postgraduate dental training. Educational interventions are urgently needed

Recent advancement in drug delivery system

Abstract Ease of drug administration, safety, affordability and effi cacy are the major concerns in pharmacotherapy leading to exploration of better drug delivery systems. Liposomes are lyotropic liquid crystals composed mainly of ampiphilic bilayers and these are more frequently used as drug carriers. Liposomes help reduce the toxicity and deliver the drug to the target tissue. So far, liposomes have been the most intensively studied lipid-based delivery system. In liposomes, a hydrophilic drug can be trapped in aqueous interior or channels between successive phospholipids bilayers whereas a hydrophobic drug can reside with the bilayer itself. The non-toxic and nonimmunogenic bilayers dissipate allowing the diffusion of the drug into the tissues. Attachment of polyethyl glycol to the surface of liposome (known as stealth liposome) aids in the better targeting of the drug to the tissues. Pegylated proteins and polymers of lactic and glycolic acids have been well studied as drug carriers and found to be resistant to phagocytosis and complement activation. Newer DNA based strategies including DNA vaccination and antisense oligonucleotides and immunomodulation show good results for new therapeutic systems. Though the DNA based therapeutic systems have high selectivity and specifi city with few adverse effects, these systems are so far restricted to animal models and clinical trials