A comprehensive situation assessment of injection practices in primary health care hospitals in Bangladesh

<p>Abstract</p> <p>Background</p> <p>Understanding injection practices is crucial for evidence-based development of intervention initiatives. This study explored the extent of injection use and injection safety practices in primary care hospitals in Bangladesh.</p> <p>Methods</p> <p>The study employed both quantitative and qualitative research methods. The methods used were - a retrospective audit of prescriptions (n = 4320), focus group discussions (six with 43 participants), in-depth interviews (n = 38) with a range service providers, and systematic observation of the activities of injection providers (n = 120), waste handlers (n = 48) and hospital facilities (n = 24). Quantitative and qualitative data were assessed with statistical and thematic analysis, respectively, and then combined.</p> <p>Results</p> <p>As many as 78% of our study sample (n = 4230) received an injection. The most commonly prescribed injections (n = 3354) including antibiotics (78.3%), IV fluids (38.6%), analgesics/pain killers (29.4%), vitamins (26.7%), and anti-histamines (18.5%). Further, 43.7% (n = 1145) of the prescribed antibiotics (n = 2626) were given to treat diarrhea and 42.3% (n = 600) of IV fluids (n = 1295) were used to manage general weakness conditions. Nearly one-third (29.8%; n = 36/120) of injection providers reported needle-stick injuries in the last 6 months with highest incidences in Rajshahi division followed by Dhaka division. Disposal of injection needles, syringes and other materials was not done properly in 83.5% (n = 20/24) of the facilities. Health providers' safety concerns were not addressed properly; only 23% (n = 28/120) of the health providers and 4.2% (n = 2/48) of the waste handlers were fully immunized against Hepatitis B virus. Moreover, 73% (n = 87/120) of the injection providers and 90% (n = 43/48) of the waste handlers were not trained in injection safety practices and infection prevention. Qualitative data further confirmed that both providers and patients preferred injections, believing that they provide quick relief. The doctors' perceived injection use as their prescribing norm that enabled them to prove their professional credibility and to remain popular in a competitive health care market. Additionally, persistent pressure from hospital administration to use up injections before their expiry dates also influenced doctors to prescribe injections regardless of actual indications.</p> <p>Conclusions</p> <p>As far as the patients and providers' safety is concerned, this study demonstrated a need for further research exploring the dynamics of injection use and safety in Bangladesh. In a context where a high level of injection use and unsafe practices were reported, immediate prevention initiatives need to be operated through continued intervention efforts and health providers' training in primary care hospitals in Bangladesh.</p

<span style="font-size:11.0pt;font-family: "Times New Roman","serif";mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Mangal;mso-ansi-language:EN-GB;mso-fareast-language:EN-US;mso-bidi-language: HI" lang="EN-GB">Evaluation of<i> </i><i><span style="font-size:11.0pt;mso-bidi-font-size:14.0pt;font-family:"Times New Roman","serif"; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Mangal; mso-ansi-language:EN-GB;mso-fareast-language:EN-US;mso-bidi-language:HI" lang="EN-GB">Justicia adhatoda </span></i><span style="font-size:11.0pt;mso-bidi-font-size:14.0pt;font-family:"Times New Roman","serif"; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Mangal; mso-ansi-language:EN-GB;mso-fareast-language:EN-US;mso-bidi-language:HI" lang="EN-GB">L. syn. <i><span style="font-size:11.0pt;font-family: "Times New Roman","serif";mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Mangal;mso-ansi-language:EN-GB;mso-fareast-language:EN-US;mso-bidi-language: HI" lang="EN-GB">Adhatoda vasica</span></i><span style="font-size:11.0pt; font-family:"Times New Roman","serif";mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:Mangal;mso-ansi-language:EN-GB;mso-fareast-language:EN-US; mso-bidi-language:HI" lang="EN-GB"> Nees extract by major metabolite analysis</span></span></span>

637-642<span style="font-size:11.0pt;font-family: " times="" new="" roman","serif";mso-fareast-font-family:"times="" roman";mso-bidi-font-family:="" mangal;mso-ansi-language:en-gb;mso-fareast-language:en-us;mso-bidi-language:="" hi"="" lang="EN-GB">The present study reveals an improved method for the evaluation of Adhatoda vasica extract by quantitation of major metabolite vasicine. The plant powder was extracted with methanol and evaporated in vaccuo to obtain an oily residue. The residue was diluted with aqueous solution of citric acid (1%) and was further extracted with chloroform. The preliminary screening for alkaloid was done with alkaloidal reagents and the presence of vasicine was assessed by thin layer chromatography (TLC). The extractive was then subjected to column chromatography using a mixture of ethyl acetate and methanol adjusted to pH 9.5 with liquid ammonia as mobile phase. The TLC chromatograms of the collected column fractions were developed and the fractions indicated the presences of vasicine were combined together. The residue obtained from evaporation of solvent was subjected to preparative TLC along with reference standard to get pure crystalline vasicine. The compound vasicine was ascertained by UV-Vis, FT-IR and LCMS/MS analyses. The quantitative estimation of vasicine was carried out by reversed phase HPLC method. About 99.50% of pure vasicine (647 mg) compared to reference standard was obtained from 250 gm of leaf powder (0.2588% w/w).</span

Phytochemical investigations and antioxidant potential of roots of Leea macrophylla (Roxb.)

Abstract Background Oleanolic acid (NZ-15), 7 α, 28-olean diol (NZ-38) and Stigmasterol (NZ-14) were isolated from the ethanolic extracts of the roots of Leea macrophylla (Family: Leeaceae) by using chromatographic analysis. This is the first report of isolation of these compounds from this plant. Their structures were constructed by spectroscopic analysis and by comparing the data with the published one. Subsequently the ethanolic extract was fractionated with two organic solvents and all the fractions were studied to evaluate their in vitro antioxidant property. Methods The ethanolic extract was fractionated with two organic solvents and all the fractions were studied to evaluate their in vitro antioxidant property by DPPH free radical scavenging assay, superoxide anion radical scavenging assay, nitric oxide radical scavenging assay, and reducing power assay. Results In the DPPH free radical scavenging assay and superoxide radical scavenging assay, the ethyl acetate soluble fraction of ethanolic extract revealed the highest free radical scavenging activity with IC50 value of 2.65 and 155.62 μg/ml, respectively as compared to standard ascorbic acid (IC50 value of 5.8 and 99.66 μg/ml). Ethyl acetate fraction also possessed highest reducing power activity with an EC50 value of 15.27 μg/ml compared to ascorbic acid (EC50 0.91 μg/ml). On the other hand, the carbon tetrachloride fraction exhibited most significant NO scavenging activity with IC50 value of 277.8 μg/ml that was even higher than that of standard ascorbic acid (IC50 value 356.04 μg/ml). In addition, the total phenolic contents of these extract and fractions were evaluated using Folin-Ciocalteu reagent and varied from 7.93 to 50.21 mg/g dry weight expressed as gallic acid equivalents (GAE). Conclusions This study showed that different extracts of roots of L. macrophylla possess potential DPPH, superoxide, and NO free radical scavenging activities. The antioxidant activities of the plant extracts might be due to the presence of oleanolic acid, oleanolic acid derivative 7 α, 28-olean diol and stigmasterol