Assessment of Drug-Related Problems among Inpatients in a Tertiary Care Hospital of Eastern Nepal

Background: Drug-related Problems are major safety concerns in hospitalized patients; failure to prevent those medications related errors may lead to therapeutic failure, adverse effects, and poor therapeutic outcomes. This study aims to assess drug-related problems in the medicine ward of a tertiary care hospital in Eastern Nepal. Methodology: Prospective observational study was conducted from March to August 2019. Descriptive analysis was performed, and Bivariate analysis using chi-square was used to test the association between demographic characteristics and drug-related problems. Results: 365 patients were selected, of which 96 patients had drug-related problems. A total of 127 drug-related problems were documented. The most common drug-related problems were drug and therapeutic duplication 31(24.4%), a drug prescribed but no clear indication 22(17.3%), potential ineffective therapy 16(12.6%), inappropriate duration 11(8.7%), and adverse drug reaction 10(7.8%). The majority of recommendations provided by the pharmacist were drug discontinuation 57(44.9%), followed by drug change 16(12.6%), and the need for antibiotic susceptibility testing 14(11%). Antimicrobials 75(59.1%) was the most frequent drug class involved in drug-related problems followed by Corticosteroids 12(9.4%), and Non-steroidal anti-inflammatory drugs 8(6.3%). A significant association with drug-related problems occurrences was found between age groups, length of hospital stay, and polypharmacy which was significant at p<0.05 Conclusion:  Nearly one-fourth of hospitalized inpatients had drug-related problems. Drug and therapeutic duplication were the most common drug-related problems followed by a drug prescribed without clear indication, potential ineffective therapy, and inappropriate duration. The pharmacist plays a crucial role in identifying and resolving drug-related problems during inpatients care

Rapid and Quantitative Detection of Zoonotic Influenza A Virus Infection Utilizing Coumarin-derived dendrimer-based Fluorescent Immunochromatographic Strip Test (FICT)

Great efforts have been made to develop robust signal-generating fluorescence materials which will help in improving the rapid diagnostic test (RDT) in terms of sensitivity and quantification. In this study, we developed coumarin-derived dendrimer-based fluorescent immunochromatographic strip test (FICT) assay with enhanced sensitivity as a quantitative diagnostic tool in typical RDT environments. The accuracy of the proposed FICT was compared with that of dot blot immunoassay techniques and conventional RDTs. Through conjugation of coumarin-derived dendrimers with latex beads, fluorescent emission covering broad output spectral ranges was obtained which provided a distinct advantage of easy discrimination of the fluorescent emission of the latex beads with a simple insertion of a long-pass optical filter away from the excitation wavelength. The newly developed FICT assay was able to detect 100 ng/10 μL of influenza A nucleoprotein (NP) antigen within 5 minutes, which corresponded to 2.5-fold higher sensitivity than that of the dot blot immunoassay or conventional RDTs. Moreover, the FICT assay was confirmed to detect at least four avian influenza A subtypes (H5N3, H7N1, H7N7, and H9N2). On applying the FICT to the clinical swab samples infected with respiratory viruses, our FICT assay was confirmed to differentiate influenza H1N1 infection from other respiratory viral diseases. These data demonstrate that the proposed FICT assay is able to detect zoonotic influenza A viruses with a high sensitivity, and it enables the quantitation of the infection intensity by providing the numerical diagnostic values; thus demonstrating enhanced detectability of influenza A viruses

Targeting Apoptotic Pathway of Cancer Cells with Phytochemicals and Plant-Based Nanomaterials

Apoptosis is the elimination of functionally non-essential, neoplastic, and infected cells via the mitochondrial pathway or death receptor pathway. The process of apoptosis is highly regulated through membrane channels and apoptogenic proteins. Apoptosis maintains cellular balance within the human body through cell cycle progression. Loss of apoptosis control prolongs cancer cell survival and allows the accumulation of mutations that can promote angiogenesis, promote cell proliferation, disrupt differentiation, and increase invasiveness during tumor progression. The apoptotic pathway has been extensively studied as a potential drug target in cancer treatment. However, the off-target activities of drugs and negative implications have been a matter of concern over the years. Phytochemicals (PCs) have been studied for their efficacy in various cancer cell lines individually and synergistically. The development of nanoparticles (NPs) through green synthesis has added a new dimension to the advancement of plant-based nanomaterials for effective cancer treatment. This review provides a detailed insight into the fundamental molecular pathways of programmed cell death and highlights the role of PCs along with the existing drugs and plant-based NPs in treating cancer by targeting its programmed cell death (PCD) network

Community pharmacy personnel understanding of antibiotic dispensing in Eastern Nepal

Background:\ua0Community pharmacies are easily accessible outlets providing medicines to the general public in Nepal, but it is known that irrational dispensing of antibiotics from such outlets contributes to antimicrobial resistance.Objective:\ua0To assess the understanding of community pharmacy personnel around antibiotic-dispensing in Eastern Nepal and the relationship between this understanding and their personal characteristics.Methods:\ua0A cross-sectional survey was conducted on 312 pharmacy personnel working in community pharmacies of three districts within Eastern Nepal using a self-administered questionnaire. Descriptive statistics were used to analyze participants’ characteristics and their understanding of antibiotic dispensing. The relationships between their understanding of antibiotic dispensing and their characteristics were determined using Chi-square tests.Results:\ua0Most of the pharmacy personnel considered that dispensing antibiotics without a valid prescription is a problem (76.9%), and that it would not be legal to do so (86.9%). In the survey, 34.9% of participants agreed that they had dispensed antibiotics without prescription, and 26.9% disagreed with the assertion that inappropriate dispensing of antibiotics could promote antimicrobial resistance. Most (94.5%) reported that they would advise patients to follow their antibiotic dosage regimen, but 34.3% reported that they believed antibiotics to reduce pain and inflammation. Bivariate analysis showed that the level of understanding about antibiotic indication was significantly associated with age (p< 0.001), work experience (p< 0.001) and qualifications (p=0.017) of the pharmacy personnel. Work experience and qualifications also had significant but independent relationships with the level of understanding that irrational dispensing of antibiotics promotes antimicrobial resistance (p=0.018 and p=0.004) and is on the need for patient follow-up after dispensing antibiotics (p< 0.001 and p=0.042).Conclusion:\ua0The understanding of community pharmacy personnel about antibiotic dispensing in Eastern Nepal requires significant improvement. Degree of understanding of some aspects of antibiotic dispensing was influenced by age, work experience and qualifications

Relation between PM2.5 and O3 over Different Urban Environmental Regimes in India

Atmospheric ozone (O3) concentration is impacted by a number of factors, such as the amount of solar radiation, the composition of nitrogen oxides (NOx) and hydrocarbons, the transport of pollutants and the amount of particulate matter in the atmosphere. The oxidative potential of the atmosphere and the formation of secondary organic aerosols (SOAs) as a result of atmospheric oxidation are influenced by the prevalent O3 concentration. The formation of secondary aerosols from O3 depends on several meteorological, environmental and chemical factors. The relationship between PM2.5 and O3 in different urban environmental regimes of India is investigated in this study during the summer and winter seasons. A relationship between PM2.5 and O3 has been established for many meteorological and chemical variables, such as RH, WS, T and NOx, for the selected study locations. During the winter season, the correlation between PM2.5 and O3 was found to be negative for Delhi and Bengaluru, whereas it was positive in Ahmedabad. The city of Bengaluru was seen to have a positive correlation between PM2.5 and O3 during summer, coinciding with the transport of marine air masses with high RH and low wind speed (as evident from FLEXPART simulations), leading to the formation of SOAs. Further, O3 concentrations are predicted using a Recurrent Neural Network (RNN) model based on the relation obtained between PM2.5 and O3 for the summer season using NOx, T, RH, WS and PM2.5 as inputs

A phenomenological model on the deformation mechanism of YBa 2 Cu 3 O 7− x +Ag 2 O composite

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43039/1/10855_2004_Article_BF00727695.pd

Antipyretic, Antinociceptive, and Anti-Inflammatory Activities from Pogostemon benghalensis Leaf Extract in Experimental Wister Rats

Background: Pogostemon benghalensis leaves have traditionally been utilized for relieving body aches, headaches and fever. Based on its uses, the present study was designed to investigate the antinociceptive, antipyretic and anti-edematogenic activities from P. benghalensis leaves&rsquo; methanol extract (PBME) in Wister rats. Methods: The thermal (hot plate) and chemical (acetic acid-induced writhing and formalin test) models for antinociceptive effects, and the Brewer&rsquo;s yeast induced hyperthermia test for antipyretic action and rat paw edema by carrageenan for anti-edematogenic activity, were applied for PBME at different dose levels. The acute toxicity of PBME through the oral route was performed to determine the lethal dose. Results: PBME significantly and dose-dependently reduced pyrexia and diminished edema volume, which depicted its antipyretic and anti-edematogenic effects respectively. The inhibition of writhing reflex, increased reaction latency and reduced frequency of licking indicated that PBME has significant dose-dependent antinociceptive activity. P. benghalensis methanol extract at 4000 mg/kg shows no sign of toxicity, which is a considerable, good margin of safety. Conclusions: The study illustrated the antipyretic, antinociceptive and anti-inflammatory potential of P. benghalensis leaf extract with a safety margin, and validated its traditional use to alleviate fever, pain, and inflammation

Targeting Apoptotic Pathway of Cancer Cells with Phytochemicals and Plant-Based Nanomaterials

Apoptosis is the elimination of functionally non-essential, neoplastic, and infected cells via the mitochondrial pathway or death receptor pathway. The process of apoptosis is highly regulated through membrane channels and apoptogenic proteins. Apoptosis maintains cellular balance within the human body through cell cycle progression. Loss of apoptosis control prolongs cancer cell survival and allows the accumulation of mutations that can promote angiogenesis, promote cell proliferation, disrupt differentiation, and increase invasiveness during tumor progression. The apoptotic pathway has been extensively studied as a potential drug target in cancer treatment. However, the off-target activities of drugs and negative implications have been a matter of concern over the years. Phytochemicals (PCs) have been studied for their efficacy in various cancer cell lines individually and synergistically. The development of nanoparticles (NPs) through green synthesis has added a new dimension to the advancement of plant-based nanomaterials for effective cancer treatment. This review provides a detailed insight into the fundamental molecular pathways of programmed cell death and highlights the role of PCs along with the existing drugs and plant-based NPs in treating cancer by targeting its programmed cell death (PCD) network

Smartphone-Based Fluorescent Diagnostic System for Highly Pathogenic H5N1 Viruses

Field diagnostic tools for avian influenza (AI) are indispensable for the prevention and controlled management of highly pathogenic AI-related diseases. More accurate, faster and networked on-site monitoring is demanded to detect such AI viruses with high sensitivity as well as to maintain up-to-date information about their geographical transmission. In this work, we assessed the clinical and field-level performance of a smartphone-based fluorescent diagnostic device with an efficient reflective light collection module using a coumarin-derived dendrimer-based fluorescent lateral flow immunoassay. By application of an optimized bioconjugate, a smartphone-based diagnostic device had a two-fold higher detectability as compared to that of the table-top fluorescence strip reader for three different AI subtypes (H5N3, H7N1, and H9N2). Additionally, in a clinical study of H5N1-confirmed patients, the smartphone-based diagnostic device showed a sensitivity of 96.55% (28/29) [95% confidence interval (CI): 82.24 to 99.91] and a specificity of 98.55% (68/69) (95% CI: 92.19 to 99.96). The measurement results from the distributed individual smartphones were wirelessly transmitted via short messaging service and collected by a centralized database system for further information processing and data mining. Smartphone-based diagnosis provided highly sensitive measurement results for H5N1 detection within 15 minutes. Because of its high sensitivity, portability and automatic reporting feature, the proposed device will enable agile identification of patients and efficient control of AI dissemination