Protocol for a randomized controlled trial on community education and surveillance on antibiotics use among young children in Nepal

BACKGROUND: Antimicrobial resistance (AMR) is one of the top ten threats to global health. There exists limited empirical evidence on effective approaches to address this threat. In low- and middle-income countries (LMICs), one of the primary drivers of AMR is easy access to antibiotics without prescriptions, in particular from community pharmacies. Interventions to reduce non-prescribed use of antibiotics and surveillance systems to track such usage are critically needed. This protocol describes a study that aims to test the effect of an educational intervention targeted to parents of young children on non-prescribed antibiotics consumption in Nepal and to track such consumption using a phone-based application. METHODS: The study is a clustered randomized controlled trial, in which we randomly assign 40 urban wards of Kathmandu Valley to either treatment group or control group, and randomly select 24 households in each ward. Households in the treatment group will receive an education intervention consisting of an AMR pitch (an in-person interaction that lasts up to an hour) by community nurses, videos and text messages on AMR every two weeks, and a brochure. We will conduct a survey at baseline with the parents of children ages 6 months to 10 years and track consumption of antibiotics and health care use among these children for a period of 6 months using a phone-based application. CONCLUSION: While the study will primarily inform future policy and programmatic efforts to reduce AMR in Nepal, the study-both the education intervention and the surveillance system-can serve as a prototype for tackling AMR in other similar settings

Biosorption of Hexavalent Chromium (Cr(VI)) from contaminated water using charred tea waste

The goal of this study is to develop charred tea waste (CTW) via chemical process for the removal of Cr(VI) from contaminated water. Batch adsorption experiments were conducted as a function of pH, initial concentration, contact time and adsorbent dosage. Characterization of the adsorbent was analyzed by FT-IR and XRD. Maximum adsorption capacity (qm) of the CTW was found to be 85.32 mg/g at optimum pH 2 in 120 minutes. The adsorption on CTW was well fitted to the Langmuir isotherm and the kinetic data is consistent with the pseudo-second order kinetic model. The findings suggest that CTW could be an efficient and promising adsorbent for the removing Cr(VI) from aqueous solution

Never too early for the opportunists!

Primary HIV infection can occur in 40-90% of individuals recently infected with HIV. Variable symptoms usually suggestive of a flu-like illness as well as high-level HIV viraemia and steep decline in CD4 cell count are often noted. We report a case of a previously healthy homosexual man who presented with symptoms suspicious of primary HIV infection as well as non-productive cough associated with chest CT finding of diffuse ground glass appearance in lungs. Recent HIV seroconversion was confirmed. Diagnosis of Pneumocystis jirovecii pneumonia was made on transbronchial lung biopsy. The symptoms improved rapidly after initiation of treatment with trimethoprim-sulfamethoxazole. It is important to recognise that although Pneumocystis pneumonia is generally seen in the setting of AIDS, it can occasionally also occur during primary HIV infection

COVID-19 control strategies and intervention effects in resource limited settings: A modeling study.

IntroductionMany countries with weaker health systems are struggling to put together a coherent strategy against the COVID-19 epidemic. We explored COVID-19 control strategies that could offer the greatest benefit in resource limited settings.MethodsUsing an age-structured SEIR model, we explored the effects of COVID-19 control interventions-a lockdown, physical distancing measures, and active case finding (testing and isolation, contact tracing and quarantine)-implemented individually and in combination to control a hypothetical COVID-19 epidemic in Kathmandu (population 2.6 million), Nepal.ResultsA month-long lockdown will delay peak demand for hospital beds by 36 days, as compared to a base scenario of no intervention (peak demand at 108 days (IQR 97-119); a 2 month long lockdown will delay it by 74 days, without any difference in annual mortality, or healthcare demand volume. Year-long physical distancing measures will reduce peak demand to 36% (IQR 23%-46%) and annual morality to 67% (IQR 48%-77%) of base scenario. Following a month long lockdown with ongoing physical distancing measures and an active case finding intervention that detects 5% of the daily infection burden could reduce projected morality and peak demand by more than 99%.ConclusionLimited resource settings are best served by a combination of early and aggressive case finding with ongoing physical distancing measures to control the COVID-19 epidemic. A lockdown may be helpful until combination interventions can be put in place but is unlikely to reduce annual mortality or healthcare demand

Coriaria nepalensis Stem Alkaloid as a Green Inhibitor for Mild Steel Corrosion in 1 M H2SO4 Solution

Using natural plant extracts on metallic substances is the most frequently studied green corrosion inhibition approach in corrosion science. In this work, Coriaria nepalensis Stem Alkaloid (CNSA) has been successfully extracted and characterized by qualitative chemical (Mayer’s and Dragendroff’s) test and spectroscopic (UV and FTIR) measurement. CNSA has been employed as a green inhibitor for Mild Steel (MS) corrosion subjected to 1 M H2SO4 solution. The corrosion inhibition efficacy has been assessed by weight loss and polarization measurement methods. The effect of inhibitor concentration, immersion period, and temperature on the inhibition efficiency for the MS immersed in both acid and inhibitor solutions of different concentrations have been investigated. The maximum inhibition effect observed for CNSA is 96.4% for MS immersed in 1000 ppm inhibitor solution for 6 h at 18 °C by the weight loss measurement method. Similarly, the polarization measurement method observed a 97.03% inhibition efficiency for MS immersed for 3 h. The adsorption of inhibitor molecules on the MS surface aligns with the Langmuir model. The free energy of adsorption obtained is −28.75 kJ/mol indicating physical adsorption dominance over chemical adsorption. These findings suggested that CNSA has greater potential as an efficient green inhibitor

Protocol for a randomized controlled trial on community education and surveillance on antibiotics use among young children in Nepal

Background: Antimicrobial resistance (AMR) is one of the top ten threats to global health. There exists limited empirical evidence on effective approaches to address this threat. In low- and middle-income countries (LMICs), one of the primary drivers of AMR is easy access to antibiotics without prescriptions, in particular from community pharmacies. Interventions to reduce non-prescribed use of antibiotics and surveillance systems to track such usage are critically needed. This protocol describes a study that aims to test the effect of an educational intervention targeted to parents of young children on non-prescribed antibiotics consumption in Nepal and to track such consumption using a phone-based application. Methods: The study is a clustered randomized controlled trial, in which we randomly assign 40 urban wards of Kathmandu Valley to either treatment group or control group, and randomly select 24 households in each ward. Households in the treatment group will receive an education intervention consisting of an “AMR pitch” (an in-person interaction that lasts up to an hour) by community nurses, videos and text messages on AMR every two weeks, and a brochure. We will conduct a survey at baseline with the parents of children ages 6 months to 10 years and track consumption of antibiotics and health care use among these children for a period of 6 months using a phone-based application. Conclusion: While the study will primarily inform future policy and programmatic efforts to reduce AMR in Nepal, the study—both the education intervention and the surveillance system—can serve as a prototype for tackling AMR in other similar settings