Knowledge, attitudes, and practices on antimicrobial use and antimicrobial resistance among poultry practitioner veterinarians.

Background: Antimicrobial resistance (AMR) poses a serious global threat to human and animal health. In the context of antimicrobial usage (AMU) in livestock production, veterinarians are key stakeholders. However, there is a lack of comprehensive situational analysis regarding the current Knowledge, Attitudes, and Practices (KAP) among veterinarians concerning AMU and AMR in poultry production in Nepal. Methods: The primary objective of this study was to evaluate the situation of AMU and KAP regarding AMU and AMR of among poultry practitioner veterinarians in Nepal. A total of 327 respondents from 56 districts across seven provinces participated. Demographic information and AMU situation were collected and analyzed using descriptive statistics, and factors affecting KAP on AMU and AMR were performed using logistic regression analysis. Results: Nearly half of veterinarians (49.2%) were from Bagmati, followed by Lumbini (16.5%) and Gandaki (8.9%) provinces. Most of the respondents (85.0%) identified themselves as male with a mean age of 31.9 ± 7.8 years, with a range of 24-74 years. A large proportion of veterinarians held a master's degree (43.8%). Regarding reasons for AMR, 51.1% of them attributed it to the irrational use of antimicrobials. Other identified reasons for AMR, including over-the-counter sales (27.8%), low-dose administration (12.3%), and low-quality antimicrobials (6.7%). Based on antibiotic prescription rates, most veterinarians (50.8%) prescribed antimicrobials at a rate of 20-40%, while 25.9% prescribed at a rate of less than 20.0 and 18.9% at a rate of 40-60%. Approximately 89.0% of veterinarians agreed that vaccination could reduce the use of antimicrobials in poultry, and 75.6% preferred narrow-spectrum antimicrobials than broad-spectrum antimicrobials. A combination of broad-spectrum antimicrobials such as colistin with amoxicillin, gentamicin, tylosin, and tetracycline was commonly used in poultry production. Discussion: In logistic regression analysis, it was observed that veterinarians aged 45-60 years demonstrated significantly higher levels of knowledge concerning AMU and AMR (p = 0.02) compared to those in the 24-30 age group. This study indicates that the need for robust regulatory mechanisms in veterinary drug administration and increased awareness among veterinarians to address the AMR issue livestock production.

Complete form of pachydermoperiostosis with good initial response to etoricoxib: A case report.

Key Clinical Message: Pachydermoperiostosis is a rare genetic disorder that closely resembles acromegaly. Diagnosis is usually based on distinct clinical and radiological features. Oral etoricoxib therapy showed a good initial response in our patient. Abstract: Pachydermoperiostosis (PDP) is a rare genetic disorder with unclear etiopathogenesis. We report a case of a 38-year-old male who presented with classic features of PDP. Our patient showed a good initial response to etoricoxib therapy but the safety and efficacy over long-term use are yet to be determined in further studies.

Situational Analysis and Knowledge, Attitudes, and Practices of Antimicrobial Use and Resistance among Broiler Poultry Farmers in Nepal.

The purpose of this study was twofold: first, to conduct a situational analysis, and second, to assess the knowledge, attitudes, and practices (KAP) of broiler poultry farmers (BPF) regarding antimicrobial use (AMU) and antimicrobial resistance (AMR). Data were collected from 500 BPF across 40 districts, representing 88.1% of Nepal's broiler poultry population. Among these farmers, 81.0% were male, 59.6% had up to 4 years of experience in poultry farming, and 50.8% had completed at least a high school education. The most used antimicrobials on the farms were doxycycline (23.5%), neomycin (17.1%), and colistin sulfate (9.6%) out of 27 reported antimicrobials. While the BPF exhibited limited knowledge (62.6%) and practice (55.5%) related to AMU and AMR, their overall attitude toward these issues was positive (91.6%). This study also identified significant factors influencing farmers' attitudes toward AMU and AMR. Farmers aged 31-40 showed a stronger inclination compared to other age groups (OR = 4.2, p = 0.02), and those using antimicrobials for preventive purposes had a more favorable attitude compared to those using them for other purposes (OR = 5.9, p = 0.02). In light of these findings, this study recommends the implementation of effective regulatory measures for drug usage, along with awareness programs addressing AMU and AMR to address the issue of AMR in poultry production.

Mad honey poisoning presenting with syncopal attack: a case report.

Mad honey contains grayanotoxin, which is commonly derived from the nectar of a few Rhododendron species. It is commonly used by natives of the Himalayas in the belief of its medicinal use. Case presentation: The authors report a case of 62 years old male with mad honey poisoning who was presented to the emergency department with loss of consciousness and had bradycardia and hypotension on arrival. The patient received intravenous fluids, atropine, and vasopressor support and was closely monitored in the coronary care unit for 48 h. Discussion: Grayanotoxin I and II are believed to be primarily responsible for mad honey intoxication and act by persistent activation of voltage-gated sodium channels. Hypotension, dizziness, nausea, vomiting, and impaired consciousness are the common presentation of mad honey intoxication. Toxic effects are usually mild and close monitoring for 24-48 h is sufficient but life-threatening complications like cardiac asystole, convulsions, and myocardial infarction have also been reported. Conclusion: Most cases of mad honey intoxication only need symptomatic treatment and close observation but the potential for deterioration and life-threatening complications must also be considered.

Safety and efficacy of cerebral embolic protection devices for patients undergoing transcatheter aortic valve replacement: An updated meta-analysis.

Background and Aims: Cerebral embolic protection (CEP) devices are employed to capture embolic debris and reduce the risk of stroke during transcatheter aortic valve replacement (TAVR). Evidence is mixed regarding the safety and efficacy of CEP. We aimed to summarize the safety and effectiveness of CEP use during TAVR. Methods: Electronic databases, including PubMed, PubMed Central, Scopus, Cochrane Library, and Embase, were searched using relevant search terms for articles relating to CEP. All relevant data from 20 studies were extracted into a standardized form. Statistical analyses were performed using Revman 5.4. Odds ratio (OR) or mean differences (MDs) were used to estimate the desired outcome with a 95% confidence interval (CI). Results: Twenty studies (eight randomized controlled trials [RCTs]) involving 210,871 patients (19,261 in the CEP group and 191,610 in TAVR without the CEP group) were included. The use of CEP was associated with a lower odds of 30-day mortality by 39% (OR: 0.61, 95% CI: 0.53-0.70) and stroke by 31% (OR: 0.69, 95% CI: 0.52-0.92). Comparing devices, benefit in terms of mortality and stroke was observed with the use of the Sentinel device (Boston Scientific), but not among other devices. No differences were observed in the outcomes of acute kidney injury, major or life-threatening bleeding events, or major vascular complications between groups. When only RCTs were included, there were no observed differences in the primary or secondary outcomes for CEP versus no CEP use during TAVR. Conclusions: The totality of evidence suggests a net benefit for the use of CEP, weighted by studies in which the Sentinal device was used. However, given the RCT subanalysis, additional evidence is needed to identify patients at the highest risk of stroke for optimal decision-making.

Infective endocarditis of tricuspid valve following septic abortion: a case report.

Introduction: Right-sided infective endocarditis (IE) in non-intravenous drug users is a rare finding. IE of the tricuspid valve is considered an important but uncommon complication in patients with a recent history of obstetric and gynecological procedures. Case presentation: We report a case of a 28-year-old female with IE of the tricuspid valve with a prior history of dilatation and curettage. The echocardiography revealed two mobile vegetation in the septal leaflet of the tricuspid valve with severe eccentric tricuspid regurgitation. Blood culture was positive for Staphylococcus aureus. The patient was started on intravenous (i.v.) antibiotics with supportive treatments and improved over the days. Clinical discussion: Infection can get access to the venous system via pelvic veins after the septic obstetric and gynecological procedure and subsequently to the right side of the heart. Different studies have highlighted the role of prophylactic antibiotics in significantly reducing post-abortal infections. In our patient, the disease was diagnosed on the basis of clinical, echocardiographic, and blood culture findings, and the patient responded well to i.v. antibiotics and supportive care under close monitoring in the coronary care unit. Conclusion: It is important for healthcare providers to be aware of the risk factors and symptoms associated with right-sided IE for early diagnosis and treatment. Appropriate antibiotic prophylaxis and adherence to sterile techniques can help to prevent IE.

Benedikt syndrome in a 74-year-old hypertensive woman: A case report.

Benedikt syndrome is a rare neurological disorder of the midbrain. Herein, we present a case of Benedikt syndrome, who presented with left-sided body weakness, right oculomotor nerve palsy, cerebellar ataxia, and Holmes tremor in the left upper limb following midbrain infarction. She was treated with aspirin, clopidogrel, and amiodarone.

Prevalence, awareness, risk factors and control of hypertension in Nepal from 2000 to 2020: A systematic review and meta-analysis.

Objective: To analyse published literatures on prevalence, awareness, risk factors and control of hypertension in Nepal. Methods: We used electronic databases to search relevant articles from January 2000 till October 2020. All relevant data from selected studies were extracted into a standardized form designed in Excel. Statistical analysis was conducted using Comprehensive Meta-Analysis Software (CMA) version 3. Proportions or Odds Ratio (OR) was used to estimate the outcome with 95% confidence interval (CI). The I-squared (I2) test was used for the assessment of heterogeneity. Results: We identified a total of 3726 studies after comprehensive database searching. We performed qualitative and quantitative analysis of 40 studies. Pooling data showed 28.52% of patients with hypertension (CI: 26.40-30.75); 45.28% (CI: 38.89-51.83) aware of their high blood pressure; 31.66% (CI: 23.18-41.56) under treatment; 44.4% (CI: 36.17-53.04) had their blood pressure under optimum range. 27.4% (CI: 21.57-34.11) had pre-hypertensive range elevated blood pressure. 25.99% (CI: 21.81-30.65) of females and 34.25% (CI: 30.49-38.21) of male were hypertensive (p â€‹= â€‹0.007).The pooling of data showed smokers have 1.43 times (CI: 1.1429-1.7889); and alcohol users have 2.073 times (CI: 1.7154-2.5050) higher risk of having hypertension. Individuals with normal BMI have 53.15% (OR: 0.4685 CI: 0.3543-0.6195); with formal educated have 37.27% (OR: 0.6273, CI: 0.5485-0.7175); and with adequate exercise have 31.6% (OR: 0.6839, CI: 0.5203-0.8991) lower chance of having hypertension. Conclusion: Our study shows the prevalence of hypertension in Nepal is high. However, awareness, treatment and subsequently control of high blood pressure are found to be alarmingly low. Hypertension was associated with male gender, smoking, alcohol use, high BMI, no education and inadequate exercise. It calls for more attention to address the burden of hypertension and associated risk factors in Nepal.

Psychological distress among health service providers during COVID-19 pandemic in Nepal.

BACKGROUND: COVID-19 pandemic has provoked a wide variety of psychological problems such as anxiety, depression, and panic disorders, especially among health service providers. Due to a greater risk of exposure to the virus, increased working hours, and fear of infecting their families, health service providers are more vulnerable to emotional distress than the general population during this pandemic. This online survey attempts to assess the psychological impact of COVID-19 and its associated variables among healthcare workers in Nepal. MATERIALS AND METHODS: For data collection purposes, Covid-19 Peritraumatic Distress Index (CPDI) Questionnaire, was used whose content validity was verified by Shanghai mental health center. Data for the survey were collected from 11 to 24 October 2020 which was extracted to Microsoft Excel-13 and analyzed. RESULTS: A total of 254 health care workers from different provinces of the country participated in this study with a mean age of 26.01(± 4.46) years. A majority 46.9% (n = 119) of the participants were not distressed (score ≤28) while 46.5% (n = 118) were mild to moderately distressed (score >28 to ≤51) and 6.7% (n = 17) were severely distressed (score ≥52) due to the current COVID-19 pandemic. Female participants (p = 0.004) and participants who were doctors by profession (p = 0.001) experienced significantly more distress. CONCLUSIONS: COVID-19 pandemic has heightened the psychological distress amongst health care service providers. The findings from the present study may highlight the need for constructing and implementing appropriate plans and policies by relevant stakeholders that will help to mitigate the distress among health service providers in the current pandemic so that we can have an efficient frontline health workforce to tackle this worse situation.