Health-care Professionals' Knowledge and Perception of Adverse Drug Reaction Reporting and Pharmacovigilance in a Tertiary Care Teaching Hospital of Nepal.

Background: Underreporting of adverse drug reactions (ADRs) is common globally, and Nepal is not an exception to this. Health-care professionals (HCPs) play a vital role in reporting ADR during routine practice. Lack of knowledge and awareness about pharmacovigilance and reporting ADRs among HCPs may contribute to underreporting. Objective: The objective of this study was to evaluate the knowledge and perception of HCPs regarding ADR reporting and pharmacovigilance in a tertiary care teaching hospital in, Nepal. Methods: A descriptive cross-sectional study was conducted. A questionnaire was distributed to 215 HCPs (medical doctors, nurses, and pharmacists) between March and September 2018. Knowledge and perception regarding ADR reporting and pharmacovigilance were studied. Data were analyzed using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp, Armonk, New York). Results: The HCPs included 75 medical doctors, 126 nurses, and 14 pharmacists. Majority of the participants were female (67%), and the majority of participants were not aware of pharmacovigilance. Among the participants, pharmacists were found to have better knowledge regarding pharmacovigilance. However, other HCPs (doctors and nurses) strongly agreed about the necessity of having adequate knowledge about pharmacovigilance. Out of 215, 57.7% agreed that the important benefit of reporting ADR was to identify safe drugs and improve patient safety. The main reasons for not reporting were - ADR reporting was not widely promoted by relevant authorities (47%), followed by not knowing where and how to report ADR (34.9%). However, other HCPs (doctors and nurses) strongly agreed about the necessity of having adequate knowledge about pharmacovigilance. Conclusions: The knowledge of HCPs on ADR reporting and pharmacovigilance was poor. Despite a low knowledge of ADR reporting and pharmacovigilance among HCPs, there was a positive perception that ADR reporting is necessary and ADR monitoring system should be established in the hospital. This study also highlights a need for future intervention studies focusing on educating HCPs about ADR and pharmacovigilance.

Enantioselective synthesis of hydantoins by chiral acid-catalysed condensation of glyoxals and ureas.

Hydantoins are important scaffolds in natural products and pharmaceuticals, with only a few synthetic strategies available for their asymmetric preparation. We herein describe a single-step enantioselective synthesis of 5-monosubstituted hydantoins via condensation of glyoxals and ureas in the presence of a chiral phosphoric acid at room temperature. Products were formed in up to 99% yield and 98 : 2 e.r. Using mechanistic and kinetic studies, including time course 1H NMR monitoring, we revealed that the reaction likely proceeds via face-selective protonation of an enol-type intermediate.

Impact of hospital pharmacist-delivered individualised pharmaceutical service intervention on clinical and patient-reported outcomes in patients with hypertension: a randomised controlled trial.

OBJECTIVES: Patients with hypertension in Nepal are often known to have poor medication adherence and quality of life. This randomised controlled trial aimed to evaluate the impact of a hospital pharmacist-delivered individualised pharmaceutical service (P-DIPS) intervention on blood pressure, medication adherence and health-related quality of life (HRQoL) among patients with hypertension in a hospital setting in Nepal. METHODS: In an open trial, 56 adult patients with hypertension who had been receiving antihypertensive medication for ≥6 months were randomly allocated to a control group (n=28) which received the usual care and an intervention group (n=28) which received a P-DIPS along with the usual care. The difference in blood pressure, medication adherence and HRQoL between the two groups at baseline, 2 and 4 months was compared using the Mann-Whitney U test, independent t-test or χ2 tests. RESULTS: Participants were mostly ≥40 years (86%) and female (57%). There were no significant differences in the baseline characteristics between the control (C) and intervention (I) groups. At 2 months, the two groups had a significant improvement in the median (IQR) Morisky-Green-Levine (MGL) Medication Adherence Score (I=1 (2) vs C=2 (2); p<0.001) and the median (IQR) mental component of HRQoL (I=43.6 (9.5) vs C=37.5 (8.6); p=0.013). At 4 months, there were significant differences in the median (IQR) values of all the outcome measures between the groups (systolic blood pressure: I=125 (10) mmHg vs C=130 (15) mmHg, p=0.008; diastolic blood pressure: 80 (14) mmHg vs 90 (10) mmHg, p=0.012; MGL score: I=1 (1) vs C=2 (1), p<0.001; physical component of HRQoL: 45.0 (9.0) vs 40.3 (8.2), p=0.046; and mental component of HRQoL: 47.1 (11.1) vs 38.8 (8.5), p=0.003). CONCLUSIONS: The findings suggest that a P-DIPS intervention in the hospital setting of Nepal has a significant potential to improve blood pressure, medication adherence and HRQoL in patients with hypertension.

Curcumin's Nanomedicine Formulations for Therapeutic Application in Neurological Diseases.

The brain is the body's control center, so when a disease affects it, the outcomes are devastating. Alzheimer's and Parkinson's disease, and multiple sclerosis are brain diseases that cause a large number of human deaths worldwide. Curcumin has demonstrated beneficial effects on brain health through several mechanisms such as antioxidant, amyloid ß-binding, anti-inflammatory, tau inhibition, metal chelation, neurogenesis activity, and synaptogenesis promotion. The therapeutic limitation of curcumin is its bioavailability, and to address this problem, new nanoformulations are being developed. The present review aims to summarize the general bioactivity of curcumin in neurological disorders, how functional molecules are extracted, and the different types of nanoformulations available.

Total Phenolic Content, Flavonoid Content and Antioxidant Potential of Wild Vegetables from Western Nepal.

Eight selected wild vegetables from Nepal (Alternanthera sessilis, Basella alba, Cassia tora, Digera muricata, Ipomoea aquatica, Leucas cephalotes, Portulaca oleracea and Solanum nigrum) were investigated for their antioxidative potential using 2,2-dyphenyl-1-picrylhydrazyl (DPPH) scavenging, hydrogen peroxide (H2O2), ferric reducing antioxidant power (FRAP), and ferric thiocyanate (FTC) methods. Among the selected plant extracts C. tora displayed the highest DPPH radical scavenging activity with an IC50 value 9.898 µg/mL, whereas A. sessilis had the maximum H2O2 scavenging activity with an IC50 value 16.25 µg/mL-very close to that of ascorbic acid (16.26 µg/mL). C. tora showed the highest absorbance in the FRAP assay and the lowest lipid peroxidation in the FTC assay. A methanol extract of A. sessilis resulted in the greatest phenolic content (292.65 ± 0.42 mg gallic acid equivalent (GAE)/g) measured by the Folin-Ciocalteu reagent method, while the smallest content was recorded for B. alba (72.66 ± 0.46 GAE/g). The greatest flavonoid content was observed with extracts of P. oleracea (39.38 ± 0.57 mg quercetin equivalents (QE)/g) as measured by an aluminium chloride colorimetric method, while the least was recorded for I. aquatica (6.61 ± 0.42 QE/g). There was a strong correlation between antioxidant activity with total phenolic (DPPH, R² = 0.75; H2O2, R² = 0.71) and total flavonoid content (DPPH, R² = 0.84; H2O2, R² = 0.66). This study demonstrates that these wild edible leafy plants could be a potential source of natural antioxidants.

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' 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'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.