Effects of climatic variability and soil quality on the production of large cardamom in Dhankuta

This research was objectively carried out to assess the current status of large cardamom production, major climatic induced impact on production and challenges faced by farmers of Dhankuta district and soil fertility status. The local farmers were categorized as large, medium and small. The farmers of Majhgaun-4 of Pakhribas municipality and Namjang-6 of Chhattar Jorpati municipality growing large cardamom were selected for this study. The field work was conducted applying stratified random sampling between July to August, 2019.Total 90 questionnaire survey and 2 key informant interview were organized to collect the primary data. Total 20 soil samples were collected from 0-30 cm depth. Besides, monthly data of temperature and rainfall were collected from Department of Hydrology and Meteorology. The result showed that the average household production of large, medium and small farmers of Majhgaun-4 has been decreasing with an average rate of 0.363 ton/ha, 0.088 ton/ha 0.078 ton/ha per year respectively. Mann Kendall’s tau correlation showed that there was a significant relationship of average annual temperature and average temperature of critical season of Pakhribas and Dhankuta station having R values 0.733 and 0.643 respectively. The rainfall in both the station Pakhribas and Dhankuta , was decreasing with the rate of -2.696 and -8.618 mm/year. The relation between average household production and average temperature of critical season of Majhgaun was significant. The soil fertility of Majhgaun was the best. The principal component analysis showed that the highest challenges faced by farmers was disease and followed by drought. This research will be useful for large cardamom experts.Keywords: Climate change, large cardamom, productivity, soil fertility status

COMBINED EFFECT OF AQUEOUS EXTRACT OF CURCUMA LONGA LINN.WITH METFORMIN IN DIABETES INDUCED NEUROPTAHIC PAIN IN RATS

Objectives: A number of studies previously conducted have shown that the progression of severity of diabetic Neuropathy relates the increased oxidative stress due to hyperglycemia describing the probable underlying mechanism as changes in the anti-oxidant enzyme level leading to several vascular and neuronal changes. The present investigation was carried out to observe the combined effect of Aqueous Extract of Curcuma longa Linn.(Curcumin) with Metformin  in delaying of Diabetes induced Neuropathic Pain in Rats.Methods: The high-fat diet treated male SD rats were induced diabetic by a single intra-peritoneal injection of Streptozocin (35mg/kg). Eddy's Hot Plate and Hot Water Tail Immersion test were the Models used to assess the Neuropathic pain. The high Fat diet treated and Diabetic Rats were treated with Metformin (500mg/kg), Curcumin (300mg/kg) and a combination of low dose of Metformin with Curcumin, followed by the oral glucose tolerance test before and after the treatment on both Normal and Diabetic Rats. After 7 weeks of treatment TBARS, SOD, Catalase and GSH levels were also estimated in the sciatic nerve homogenate of Diabetic Rats and compared with the control followed by a supporting histopathological examination of Sciatic Nerve.Results: Diabetic Rats treated with Curcuma longa Linn. and Metformin  alone and in combination showed a significant improvement in control of blood glucose level and restoration of anti-oxidant enzyme levels. There was a significant improvement in the hyperalgesia (P<0.001) due to Diabetic Neuropathy and also the reaction time to the nociceptive stimuli in Neuropathic pain models was increased after the treatment.Key Words:   Antioxidant, Curcumin, Diabetes, Metformin, Neuropathy, Streptozoci

Случай раннего выявления метастазов в бедренной кости у больного раком полового члена

Background. Bone metastasis is very common in the advanced stage of numerous carcinomas. In penile carcinoma, lymph nodes metastasis is somehow common but it is very rare reported to be secondary from penile cancer. till the date, there are only few cases of penis carcinoma reported bone metastasis in literature worldwide.Case Presentation. Herein, We presented a 51-year-old Nepalese male with squamous cell carcinoma of penis. computed tomography (ct) scan of the patient revealed that there was carcinoma involving glans penis and precure with bilateral external & internal inguinal lymphadenopathies. After then, the patient was under gone for partial penectomy and bilateral inguinal lymphadenectomy and complete 6-cycle chemotherapy. After one year of treatment, patient developed thigh pain and headache and he advised to have magnetic Resonance imaging (mRi) of brain, 99mTc-MDP whole body bone scan and ct scan of pelvis and thigh. The examination report reveals that there was a sclerotic change in vertex of skull bone and moderate 99mTc-MDP uptake in right proximal shaft of femur just below the neck d/d metastasis. The histopathological examination of the true cut biopsy taken from the lesion of the femur showed metastatic keratinizing squamous cell carcinoma which is rare case of femoral shaft bone metastasis secondary from penile carcinoma. Then patient was sent for surgical reconstruction of femur. Based on the case studies review femur shaft bone metastasis from penile cancer is extremely rare.Conclusion. The best of our knowledge; this is the first early detected bone metastases to shaft of the femur in a patient with penile cancer. early diagnosis helps to radical treatment as well as palliative treatment. surgery is the preferred option of the treatments, especially for metastatic foci in the long bones.Аннотация Метастазы в кости часто встречаются на поздних стадиях разных злокачественных новообразований. Для рака полового члена характерно лимфогенное метастазирование, костные метастазы встречаются очень редко. На данный момент в мировой литературе зарегистрировано лишь несколько случаев рака полового члена с метастазами в кости.Описание клинического случая. Мы представляем описание клинического случая плоскоклеточного рака полового члена у 51-летнего мужчины из Непала. Компьютерная томография (КТ) выявила рак полового члена, локализованный на головке и крайней плоти с двусторонней паховой лимфаденопатией. Пациенту выполнена частичная пенэктомия, двусторонняя паховая лимфаденэктомия, проведено 6 курсов адъювантной химиотерапии. Через один год после завершения лечения у пациента появились боли в бедре и головная боль, рекомендована МРТ головного мозга, сканирование костей скелета с 99mTc-MDP и КТ таза и бедра. Обследование показало наличие склеротических изменений в теменной кости черепа и умеренное накопление 99mTc-MDP в проксимальном отделе правом бедренной кости ниже шейки. Гистологическое исследование биоптата, взятого из очага в бедренной кости, выявило метастаз ороговевающего плоскоклеточного рака, что является редким случаем метастазирования рака полового члена в диафиз бедренной кости. Пациент был направлен на хирургическую реконструкцию бедренной кости. Согласно обзору клинических исследований, метастазы в диафизе бедренной кости при раке полового члена встречаются крайне редко.Заключение. Представлен первый случай раннего выявления костных метастазов в диафизе бедренной кости у пациента с раком полового члена. Ранняя диагностика помогает как радикальному, так и паллиативному лечению. Хирургическое вмешательство является предпочтительным вариантом лечения, особенно при метастатических очагах в длинных костях

COVID-19 Infection and Guillain-Barre Syndrome: A Case Series

The coronavirus disease 2019 (COVID-19) pandemic brought about an unprecedented time. Multiple systemic complications have been recognized with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as it can do much more than affect the respiratory system. One of the intriguing neurological complications is Guillain-Barre syndrome (GBS). We reviewed three cases in which patients presented with GBS following COVID-19 infection. All three cases had positive lumbar puncture results with albumino-cytological dissociation. Each patient was treated with plasmapheresis and improved clinically. Although an exact causal relationship between COVID-19 and GBS cannot be drawn from this case series alone, it signifies the importance of this complication. It warrants further studies to establish the causal relationship. One should have a high suspicion for acute inflammatory demyelinating polyneuropathy (AIDP) in patients presenting with acute onset of ascending weakness following COVID-19 infection

Assessing Knowledge, Attitudes and Practices on Antibiotics amongst University Graduates in Bhutan: A Cross-Sectional Survey

Introduction: Concerns about antibiotic resistances is increasing. Antibiotic misuses mostly result from inadequate knowledge impacting attitudes and practices. The literature on this subject is limited in Bhutan.  It is of immense importance to understand the gap and target interventions. Therefore, we assessed the knowledge, attitudes and practices (KAP) on antibiotics amongst Bhutanese university graduates in 2016. Methods: The survey was conducted through a self-administered online questionnaire after seeking consent. The questionnaire was developed by the investigators using past literature.   Results: Of the 2,229 invited graduates, only 220 (≈10%), 52.3% (115) males, completed the survey. Internet was the commonest source of information on antibiotics. Only 51% (113) showed good knowledge with a mean score of 15.5 (range 2-30). Penicillin, amoxicillin and cotrimoxazole were correctly identified as antibiotics by 63.6%, 78.7% and 21.4% but 11.4%, 35% and 31.8% misidentified atenolol, paracetamol and ibuprofen as antibiotics respectively. Side effects of antibiotics were poorly recognized. Fifty-four percent (119) showed good attitude score. About 39% (85), 35% (76) and 46% (101) misconceived that antibiotics would be required for common cold, all fevers and all small clean-cut wounds respectively. Almost 91% knew that antibiotic courses should be completed, 12% thought that antibiotics can be stopped when patients improve and 31.8% repeated antibiotics for similar illnesses. Although 76% knew that antibiotics shouldn’t be bought without a prescription, 28% were able to get them. About 44.1% revealed that the dispensing pharmacists did not explain adequately about antibiotics. Unfortunately, 43.6% suggested others to take antibiotics during illnesses and 60% used topical antibiotics. Conclusion: KAP on antibiotics amongst Bhutanese graduates was unsatisfactory except few good specific practices. Health authorities should educate public on antibiotics and other medicines

Assessing the Knowledge, Attitudes, and Practices onAntibiotics Among the General Public Attending the Outpatient Pharmacy Units of Hospitals in Bhutan: A Cross-Sectional Survey

We assessed the level of knowledge, attitudes, and practices on antibiotics through a questionnaire-based cross-sectional survey among the general public in Bhutan. Of the 692 participants, 52.6% (364) were females with a mean age of 34.2 years. More than half of the respondents showed unsatisfactory knowledge varying significantly from 23.1% to 69.6%. Cotrimoxazole (septran) was the least known while amoxicillin was the most known antibiotics assessed. Two-thirds of the responsents (267) knew that inappropriate use of antibiotics could lead to antimicrobial resistance and 89% (319) were aware of the need to complete the antibiotic courses. In bivariate analysis, satisfactory knowledge was associated with the education level of graduate and higher as compared with no education. This study revealed unsatisfactory knowledge and attitude but satisfactory practices on antibiotics use among participants. Efforts are needed to improve public awareness on antibiotics. Enforcement of regulations on sale of antibiotics over the counter needs a revamp

Herbal Drug Standardization: A Systemic Review

The demand for herbal medicinal products and materials is rising, and maintaining their quality is therefore becoming increasingly important. Numerous physical, chemical, and geographical factors that affect these materials' quality also affect the quality of the herbals. In addition, the quality of herbal materials is becoming increasingly a concern due to adulteration. The quality characteristics of the herbal material the herbal pharmaceuticals are assessed using a variety of chemical and phytochemical tests, analytical techniques, and hyphenated analytical techniques. Formulations made from herbs are now widely accepted as effective treatments for many ailments. the creation of reliable analytical techniques, such as quantitative assessments of marker/bioactive chemicals and other techniques, that can accurately profile the phytochemical makeup. For the manufacture and manufacturing of herbal medications, standardisation is a crucial step in establishing a uniform biological activity, consistent chemical profile, or even just a quality assurance programme. It is crucial to follow WHO-specific recommendations for evaluating the quality, safety, and efficacy of herbal medicines as a condition for worldwide harmonisation. An overview of the numerous methods used for the extraction, characterisation, and standardisation of herbal nanomedicines is presented. Keywords: herbal drugs, standardization, herbal formulation, quality contro

Assessing the Knowledge, Attitudes, and Practices on Antibiotics Among the General Public Attending the Outpatient Pharmacy Units of Hospitals in Bhutan: A Cross-Sectional Survey

We assessed the level of knowledge, attitudes, and practices on antibiotics through a questionnaire-based cross-sectional survey among the general public in Bhutan. Of the 692 participants, 52.6% (364) were females with a mean age of 34.2 years. More than half of the respondents showed unsatisfactory knowledge varying significantly from 23.1% to 69.6%. Cotrimoxazole (septran) was the least known while amoxicillin was the most known antibiotics assessed. Two-thirds of the responsents (267) knew that inappropriate use of antibiotics could lead to antimicrobial resistance and 89% (319) were aware of the need to complete the antibiotic courses. In bivariate analysis, satisfactory knowledge was associated with the education level of graduate and higher as compared with no education. This study revealed unsatisfactory knowledge and attitude but satisfactory practices on antibiotics use among participants. Efforts are needed to improve public awareness on antibiotics. Enforcement of regulations on sale of antibiotics over the counter needs a revamp.</p

Antibiotic resistance in <i>Neisseria gonorrhoea</i> and treatment outcomes of gonococcal urethritis suspected patients in two large hospitals in Bhutan, 2015

<div><p>Introduction</p><p>Gonorrhea is a major sexually transmitted infection (STI) globally with increasing trends. Despite limited data, gonorrhea remains an important public health problem in Bhutan.</p><p>Methods</p><p>A descriptive study was carried out in two Bhutanese hospitals; Jigme Dorji Wangchuck National Referral Hospital and Phuentsholing General Hospital in 2015. Patients suspected of gonococcal urethritis were sampled, treated and followed up at two weeks. Gonococcal isolates were identified and tested for antibiotic susceptibility by the Calibrated Dichotomous Sensitivity Test (CDS) method.</p><p>Results</p><p>Of the 524 patients, 2.3% (12) were females. Most (46.6%) patients belonged to the 26–35 years age group. About 58% were lost to follow up; 62% (277) of males and all (12) females. <i>N</i>. <i>gonorrhoea</i> was positive in 76% (398) of microscopy and 73.1% (383) by culture. Resistance against ciprofloxacin, penicillin, tetracycline and nalidixic acid were 85.1%, 99.2%, 84.8% and 99.7% respectively. Nearly all the isolates were sensitive to cefpodoxime, ceftriaxone and azithromycin. Sixty-seven percent (350) were treated with injection ceftriaxone alone, 32% (169) with ceftriaxone and oral doxycycline and 1% (5) with ceftriaxone, doxycycline and metronidazole. Probable treatment failure was seen only in one patient (0.5%).</p><p>Conclusions</p><p>Gonococcal resistance to currently used antibiotics was low and there was a high clinical cure rate. Compliance to treatment guidelines need reinforcement addressing antibiotic regimen, tracing sexual partners and addressing the social stigma. National STI programs should be more women-friendly for effective management, prevention and control of STIs. Laboratories must adopt more reliable susceptibility testing methods, the Minimum Inhibition Concentration method.</p></div

Map of Bhutan showing the study sites.

<p>JDWNRH (Jigme Dorji Wangchuck National Referral Hospital; PGH (Phuentsholing General Hospital).</p