Risk of Parkinson's disease among users of alpha-adrenergic receptor antagonists: a systematic review and meta-analysis.

Background: Recent studies have tried to establish an association between the use of alpha-1-adrenergic receptor antagonists (A1ARAs) used in benign prostatic hyperplasia (BPH) and the risk of PD. The objective of the study is to compare the risk of Parkinson's disease (PD) between terazosin/alfuzosin/doxazosin (TZ/AZ/DZ) users and tamsulosin users. Methods: PubMed, Google Scholar, and Embase were systematically searched from inception to April 2023. Observational studies comparing the risk of PD among patients using different types of A1ARAs were included in the meta-analysis. The primary outcome was the hazard ratio (HR) with a 95% CI for the risk of occurrence of PD among A1ARAs users of two different classes. Results: This study was based on a total of 678 433 BPH patients, out of which 287 080 patients belonged to the TZ/AZ/DZ cohort and 391 353 patients belonged to the tamsulosin cohort. The pooled incidence of PD was higher in tamsulosin users (1.28%, 95% CI: 1.04-1.55%) than in TZ/AZ/DZ drug users (1.11%, 95% CI: 0.83-1.42%). The risk of occurrence of PD was significantly lower in patients taking TZ/AZ/DZ than tamsulosin (n= 610,363, HR = 0.82, 95% CI = 0.71-0.94, P = 0.01; I2 = 87.4%). Conclusion: This meta-analysis demonstrated that patients with BPH who take TZ/AZ/DZ have a lower risk for developing PD than those who take tamsulosin.

Immediate impacts of COVID-19 vaccination on glycemic control in type 1 diabetes mellitus: a systematic review and meta-analysis.

Objective: COVID-19 vaccination is recommended in diabetic patients since diabetes is associated with worse clinical outcomes in COVID-19 infection. The safety profile of different types of COVID-19 vaccines, especially on glycemic control, can be explored due to availability of data from continuous glucose monitoring (CGM) devices. This meta-analysis aimed to quantify the impact of COVID-19 vaccination on glycemic control in patients with type 1 diabetes mellitus (T1DM). Methods: A systematic search of PubMed, Embase, and Google Scholar was conducted using a search strategy for studies published till January 2023 in English language. Comparative observational studies reporting glycemic control obtained from CGM before and after COVID-19 vaccination in T1DM patients were included. The primary outcome was time in range (TIR) metric of proportion of glucose results falling within the range: 3.9-10 mmol/l. Other outcomes were time above range (TAR) (>10 mmol/l), time below range (TBR) (<3.9 mmol/l), coefficient of variation (CV), and mean blood glucose levels. The pooled outcomes were compared pre-vaccination and post-vaccination using Hedges' g (HG) with 95% CI. Results: A total of seven studies (632 participants) were included in the meta-analysis. COVID-19 vaccination caused small and statistically insignificant decrease in TIR after both the first (HG = 0.21, 95% CI: -0.02 to 0.44, P=0.07) and second dose (HG = 0.09, 95% CI: -0.04 to 0.21, P = 0.19). Likewise, TAR was not affected after neither first (HG = -0.09, 95% CI: -0.22 to 0.03, P = 0.12) nor second vaccine dose (HG = -0.07, 95% CI: -0.21 to 0.06, P = 0.30). Likewise, TBR, mean blood glucose levels, and CV were not significantly altered following uptake of either of the doses. Conclusion: COVID-19 vaccination has an excellent safety profile in T1DM patients owing to its minimal impacts on immediate glycemic control.

Precision medicine and implications in medical education.

Precision medicine (PM) is a revolutionary approach that gathers and analyzes massive amounts of data on patient's history, lifestyle, genetic, and environmental factors to tailor the most effective treatment for the patient. The low utilization of PM in healthsector today can be tackled with the introduction of PM in medical education. In near future, medical education will observe gradual integration of PM in undergraduate and postgraduate curricula. The increased need of training of faculties, protection of patient's data and the use of advanced technologies are the likely ramifications of introduction of PM in medical education and healthcare.

Utility of neutrophil-to-high-density lipoprotein-cholesterol ratio in patients with coronary artery disease: a narrative review.

The neutrophil-to-high-density lipoprotein-cholesterol ratio (NHR) is thought to reflect inflammatory status and dyslipidaemia, both of which play significant roles in coronary artery disease (CAD). The objective of this narrative review is to summarise the results of studies that have explored the utility of NHR for the diagnosis and management of CAD. The PubMed, Google Scholar, Scopus, Embase and Web of Science databases were searched for articles related to NHR from their inception to October 2022. Seven relevant articles were obtained for review. There were unclear relationships of NHR with age, sex, smoking status, hypertension and diabetes. However, NHR had a sensitivity and specificity as high as 94.8% and 59%, respectively, for the identification of significant coronary stenosis. NHR was also a superior predictor of prognosis to conventional parameters. NHR had a sensitivity and specificity as high as 77.6% and 74.2%, respectively, for the prediction of adverse events, including mortality, associated with acute coronary syndrome. Thus, NHR could be used in clinical cardiovascular medicine for risk stratification and the prediction of the short-term and long-term outcomes of CAD. However, more studies are required before a quantitative assessment of the efficacy of NHR for use in patient management can be completed.

Augmented reality-based training versus standard training in improvement of balance, mobility and fall risk: a systematic review and meta-analysis.

Augmented reality (AR) technology is being used recently in healthcare, especially for rehabilitation purposes, owing to its ability for repetition, rapid feedback, and motivation for patients. This systematic review and meta-analysis aims to compare the efficacy of AR-based interventions to conventional physical interventions in improving balance, mobility, and fall risk. Material and methods: PubMed, Google Scholar, Scopus, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to January 2023. Randomized trials and observational cohort studies comparing the effects of AR-based exercises with conventional training in patients 18 years and older were included in the analysis. Studies using virtual reality, case reports and series, reviews, meta-analyses, letters, and editorials were excluded. Post-intervention data on the Berg Balance Scale (BBS) and Timed Up and Go (TUG) Test were extracted and studied. The fixed-effects inverse variance model was utilized to pool the extracted data. Results: Out of 438 articles, seven articles (199 participants) comparing AR-based exercise with the standard training were included in the systematic review. Six articles with sufficient data on the parameters were included in the meta-analysis. AR-based exercises resulted in a significantly higher BBS score than conventional exercise (Hedge's g=0.48, 95% CI=0.19-0.77, P<0.001). The BBS value was significantly higher in AR-based training of 8 weeks or more (Hedge's g=0.88, 95% CI=0.46-1.31) when compared with trainings conducted for less than 8 weeks (Hedge's g=0.11, 95% CI=-0.30 to 0.52), P=0.01). Likewise, the TUG Test score was found to be to be significantly lower in ARgroup than the controls (Hedge's g= -0.54, 95% CI=-0.85 to -0.23, P<0.01). Conclusion: In comparison to conventional methods, AR-based exercises had higher improvements in balance, mobility, and fall risk parameters. The use of AR technology in elderly patients can promote independence while preventing falls and associated morbidity and mortality. There is a need for a larger randomized controlled trial to provide a more accurate comparison on efficacy and safety of different modalities of training.

Rheumatic heart disease in school-attending Nepalese children: A descriptive analysis of the national heart screening database.

OBJECTIVE: Rheumatic Heart Disease (RHD) remains a significant public health problem with high morbidity and mortality in children and young adults from lower-middle income countries like Nepal. However, a nation-wide database of the disease is lacking for designing effective future prevention and control programmes and strategies. The aim of our study is to estimate the prevalence of RHD in school-attending Nepalese children. METHODS: We performed a cross-sectional descriptive analysis of a nationally representative database of Nepal Heart Foundation (NHF) national RHD screening programme which included school-attending Nepalese children between five and sixteen years of age. The screening was conducted between May 2015 and March 2020 in 236 schools, representing all seven provinces, across all three ecological zones of Nepal. Transthoracic two-dimensional echocardiography was performed in all eligible children with more than grade one murmur on cardiac auscultation. We estimated the prevalence of RHD among school-attending children as the number of RHD cases per 1000 school-attending children with a 95% confidence interval. RESULTS: The database included a total of 107,340 children who were screened clinically, of whom 10,600 (9·9%) underwent transthoracic two-dimensional echocardiography. The overall prevalence of RHD was 2.22 cases per 1000 school-attending children (95% CI:1·94 - 2·50). The highest prevalence was observed among children living in the southern Terai ecological zone (2·89 per 1000, 95% CI (2·32-3·46)) of Nepal. Among the provinces, Karnali had the highest prevalence of RHD (3·45 per 1000, 95% CI (2·42-4·48)). Among the districts screened, Kalikot had the highest RHD prevalence (5.47 per 1000, 95% CI (3.02-7.92)). CONCLUSION: Primordial, primary and secondary prevention programmes should pay special attention to southern Terai zone, particularly the under-privileged children from remote districts.

Risk factors, lab parameters, angiographic characteristics and outcomes of coronary artery disease in young South Asian patients: a systematic review.

This systematic review provides a qualitative summary of the risk factors, angiographic characteristics, treatment, and complications of young South Asians with coronary artery disease (CAD). PubMed, Embase, and Google Scholar were searched to identify research articles published between 1 January 2010 and 13 November 2022. Studies in patients aged 18 to 45 years that were conducted in South Asian countries, were published in the English language, and included information on patients' clinical profiles and at least two risk factors for young CAD were included in the review. Smoking, dyslipidemia, high body mass index, increased high-sensitivity C-reactive protein, and hyperhomocysteinemia were observed in high proportions in young patients with CAD. Single-vessel disease was more common than multi-vessel disease in young CAD. The complications of CAD such as arrhythmias, cardiogenic shock, and heart failure were also commonly observed in young patients. Large-scale health promotion activities that curb modifiable risk factors such as smoking, obesity, and a sedentary lifestyle should be conducted in South Asian countries.

Epidemiology, clinical characteristics, diagnosis, and complications of scrub typhus infection in Nepal: a systematic review.

Introduction: Scrub typhus (ST) is a neglected tropical disease of serious concern in Nepal. This systematic review aims to describe the burden of disease, clinical presentation, and complications of ST infection in Nepal. Methods: A systematic search of PubMed, EMBASE, Google Scholar, and national databases was conducted for any literature published in English between January 2000 and January 2023. Any type of study design (observational studies, case series, and interventional studies) that reported laboratory-confirmed ST and was conducted in Nepal among patients of all age groups was included. The seroprevalence of ST among acute undifferentiated febrile illness (AUFI) cases, geographical distribution, monthly distribution, clinical presentations, complications, and treatment were assessed by the study. Result: A total of 15 studies with 10, 977 participants were included in the review. The seroprevalence of ST among the AUFI cases in Nepal was 19.31%. Young people at or below 20 years of age were mostly affected. The maximum number of cases were reported from Bagmati province (59.46%) and in the month of August (26.33%). Fever, headache, cough, shortness of breath, nausea, and abdominal pain were the clinical characteristics in decreasing order of occurrence. The most common complication was acute kidney injury, followed by respiratory problems, cardiac issues, and neurological manifestations. The case fatality rate of ST in Nepal was 2.56%. Conclusion: The authors findings showed a significant burden of ST among AUFI cases in Nepal. Improved surveillance, general public awareness, and early detection post-calamities could help reduce the disease burden and improve patient outcomes.

Lack of association of the alpha-ketoglutarate-dependent dioxygenase (FTO) gene polymorphisms with pulmonary tuberculosis risk: a systematic review and meta-analysis.

Objective: Our meta-analysis aims to explore the association of two single nucleotide variants; rs9939609 and rs8050136, within the FTO gene with risk of pulmonary tuberculosis (PTB). Methods: The association of two single nucleotide variants with PTB in three genetic models was evaluated using pooled odds ratios (ORs) with 95% CIs. Results: No significant association was observed between the rs9939609 polymorphism and PTB when assuming an allelic model (OR: 1.10; 95% CI: 0.85-1.41; P=0.47; I2 = 64.98%), a recessive model (OR: 2.04; 95% CI: 0.87-4.77; P=0.10; I2 = 67.18%), or a dominant model (OR: 0.96; 95% CI: 0.83-1.11; P=0.56; I2 = 27.45%). Likewise, no association was observed between rs8050136 polymorphism and PTB when assuming allelic model (OR: 1.17; 95% CI: 0.87-1.58; P=0.31; I2 = 64.20%) or recessive model (OR: 1.04; 95% CI: 0.32-3.38; P=0.95; I2 = 68.82%) or dominant model (OR: 1.22; 95% CI: 0.87-1.71; P=0.26; I2 = 58.69%). Conclusion: There might be no association between the rs9939609 and rs8050136 variants in the FTO gene, and the risk of PTB.

Antiretroviral drug use and the risk of falls in people living with HIV: a systematic review and meta-analysis.

Objective: The risk of falls in people living with HIV (PLHIVs) on antiretroviral therapy (ART) has received little attention in the literature. The aim of the meta-analysis is to quantify the association between fall risk and various categories of drugs used in ART. Material and Methods: PubMed, Google Scholar, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to January 2023. Any observational study or controlled trial that reported on the relationship of at least one antiretroviral drug with falls in PLHIVs was included. Data on the frequency of single fallers, multiple fallers (≥2 falls), and non-fallers were extracted and studied for each drug and drug category. The pooled results were reported as an odds ratio (OR) with a 95% confidence interval (CI). Results: A total of five observational studies (51 675 participants) were included out of 414 articles obtained through a literature review. Stavudine use was found to be associated with an increased risk of single falls in PLHIVs (OR: 1.69, 95% CI: 1.08-2.66, P=0.02). However, efavirenz (OR: 0.82, 95% CI=0.76-0.89, P<0.001) and zidovudine (OR: 0.82, 95% CI=0.77-0.92, P<0.001) were found protective against the single falls. Didanosine had no significant association with fall risk (OR: 1.23, 95% CI: 0.78-1.93, P=0.37). Likewise, protease inhibitors, integrase inhibitors, nucleoside reverse transcriptase inhibitors, and non-nucleoside reverse transcriptase inhibitors were discovered to have no significant association with fall risk. Conclusion: Most drug categories of ART have no significant association with the risk of falls in PLHIVs. However, certain drugs, such as didanosine and stavudine, which have the inherent effect of causing balance deficits and neuropathy, should be used cautiously.

Detection and management of latent rheumatic heart disease: a narrative review.

Rheumatic heart disease (RHD) is a public health concern in many developing nations around the world. Early detection of latent or subclinical RHD can help in reversing mild lesions, retarding disease progression, reducing morbidity and mortality, and improving the quality of life of patients. Echocardiography is the gold-standard method for screening and confirming latent RHD cases. The rates and determinants of progression of latent RHD cases as assessed by echocardiography have been found to be variable through studies. Even though latent RHD has a slow rate of progression, the rate of progression of its subtype, 'definite' RHD, is substantial. A brief training of nonexpert operators on the use of handheld echocardiography with a simplified protocol is an important strategy to scale up the screening program to detect latent cases. Newer advancements in screening, such as deep-learning digital stethoscopes and telehealth services, have provided an opportunity to expand screening programs even in resource-constrained settings. Newer studies have established the efficacy and safety profile of secondary antibiotic prophylaxis in latent RHD. The concerned authorities in endemic regions of the world should work on improving the availability and accessibility of antibiotic prophylaxis.

Potential Drug-drug Interactions among Hospital Discharge Prescriptions in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: In our setup, potential drug-drug interactions are overlooked in routine clinical practice. In general, most of the discharges are handwritten in the developing world, and the discharge prescriptions are not checked with the database for potential drug-drug interactions checker. This study aimed to determine the prevalence of potential drug-drug interactions in the prescribed drugs in clinical practice in a tertiary care centre of Nepal. METHODS: A descriptive cross-sectional study was conducted in a tertiary care center from October 2019 to December 2019. Ethical approval was taken from the Institutional Review Committee (Reference number: 394(6-11)E2/075/76). Through simple random sampling, the data about drug prescription was collected from the patient discharge records of the Department of Internal Medicine. The potential drug interactions were checked by using Lexicomp® drug interactions. Data was analysed using Statistical Package for the Social Sciences version 20.0. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean, standard deviation and mode. RESULTS: Among 382 discharge prescriptions, the prevalence of potential drug-drug interactions was 299 (78.3%) (74.1-82.4 at 95% Confidence Interval). A total of 1519 drug interactions with a mean of 5.08±3.89 drug interactions per prescription was identified. The major, moderate and minor drug-drug interactions according to the severity were found to be 163 (10.7%), 1162 (76.5%), and 178 (11.7%) respectively. CONCLUSIONS: The prevalence of potential drug-drug interactions is high among the patients on discharge compared to similar studies. Use of drug-drug interactions checker databases before discharge with computer-based discharge prescriptions is recommended.

Adverse Events following Immunization with COVID-19 Vaccines: A Narrative Review.

Numerous COVID-19 vaccines are being administered to people around the world. Adverse events following immunization (AEFI) with COVID-19 vaccines have been reported by health care workers as well as surveillance bodies. A wealth of information on the efficacy and safety of vaccines exists in the literature, and the knowledge in this sector is growing exponentially. A narrative literature review was conducted on sources accessed from PubMed, Google Scholar, and Cochrane Review from March 2021 to July 2021. This review is aimed at describing AEFI associated with currently available COVID-19 vaccines, with an emphasis on narrating probable AEFI, and at assisting in a better understanding of the COVID-19 vaccines.

Factors affecting length of hospital stay in chronic obstructive pulmonary disease patients in a tertiary hospital of Nepal: A retrospective cross-sectional study.

Background: Despite the increasing burden of chronic obstructive pulmonary disease in Nepal, studies analyzing the factors associated with inpatient length of hospital stay are lacking. Methods: This is a retrospective, cross-sectional hospital-based study conducted between July 2020 and July 2021 on patients admitted to the inpatient ward of Pulmonary and Critical Care Medicine of Tribhuvan University Teaching Hospital with a primary diagnosis of acute exacerbation of chronic obstructive pulmonary disease. The sample size of our study was 90. Clinical and demographic factors, blood investigation parameters, and treatment received were analyzed via univariate and multivariate analysis to find the factors associated with length of stay. Results: The mean age of chronic obstructive pulmonary disease patients was 68.84 ± 10.22 years, with 42.2% of males and 43.3% of current smokers. The length of hospital stay ranged from 2 to 25 days, with an average stay of 6.69 ± 4.02 days. Factors associated with length of stay are the number of comorbidities (p = 0.007), blood eosinophils at admission (p = 0.022), and use of mechanical ventilatory support (p < 0.001). Conclusions: Proper management of comorbidities and eosinophilic exacerbations as well as careful use of mechanical ventilatory support are required to further reduce the duration of hospital stay in chronic obstructive pulmonary disease patients.

Prevalence of Gestational Diabetes Mellitus in Nepal: A Systematic Review and Meta-analysis.

BACKGROUND: Gestational diabetes mellitus is a condition of glucose intolerance during pregnancy. The burden of Gestational diabetes mellitus is ever increasing including a lower middle-income country like Nepal. METHODS: This meta-analysis was conducted in accordance to the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases of "Embase", "Google Scholar", "Scopus", "Web of Science" were searched for observational studies in Nepal from 2000 to July 2021. Random effect model was used to estimate the pooled prevalence subgroup analysis. RESULTS: This systematic review and meta-analysis analyzed 9 studies with a total of 20865 participants. Pooled prevalence of gestational diabetes mellitus was 2.61% (95% CI: 1.25- 5.37). From subgroup analysis, the prevalence of Gestational diabetes mellitus according to the diagnostic criteria were: International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria 6.56% (95% CI: 4.79-8.92), World Health Organization (WHO) criteria 4.81% (95% CI: 3.79-6.08), Diabetes in Pregnancy Study Group of India (DIPSI) criteria 4.71% (95% CI: 3.06-7.18), Carpenter and Coustan criteria (CC) 1.08% (95% CI: 0.43-2.71); prevalence according to the publication time: before 2015 1.20% (95% CI: 3.64-6.41), in and after 2015 4.84% (95% CI: 0.42-3.39); prevalence according to the place: within Kathmandu valley 2.70% (95% CI: 1.17-6.08), outside Kathmandu valley 2.28% (95% CI: 0.26-17.15). CONCLUSION: Our study revealed the increasing prevalence of GDM in Nepal. Further large observational studies at local levels are essential to measure the actual burden, risk factors and potential preventive measures for Gestational diabetes mellitus.

Prevalence of rheumatic heart disease in South Asia: A systematic review and meta-analysis.

INTRODUCTION: Most countries in South Asia are endemic for rheumatic heart disease (RHD). We aimed to estimate the pooled prevalence of RHD in South Asia from population-based screening studies. METHODS: A systematic strategy was developed and used to search online databases for articles which described the prevalence of RHD in the South Asia region. Articles published in the English language between 1991 and 2021 were included in the review after fulfilling eligibility criteria. RESULTS: The pooled prevalence of RHD in South Asia was 2.79 per 1000 (95% Confidence interval (CI): 1.30-4.83) according to studies using auscultation followed by echocardiography of suspected cases and 18.28 per 1000 (95% CI: 11.59-26.44) for studies using echocardiography screening of all participants. The highest prevalence of 8.0 per 1000 (95% CI: 0.71-22.74) was observed in Pakistan, whereas the lowest prevalence of 0.32 per 1000 (95% CI: 0.18-0.48) was observed in Bangladesh. The prevalence of RHD has decreased to 2.30 per 1000 from 3.06 per 1000 by 24.84% in 30 years (1991-2021). The prevalence is more than twice higher using WHF criteria compared to WHO criteria. We observed no sex-related differences in prevalence (p = 0.16). CONCLUSIONS: The prevalence of RHD is still high in the South Asian population. Recent studies utilizing echocardiographic screening have identified subclinical cases of RHD, reflecting the significant burden of the disease in this region. More population-based echocardiography screening studies in every country in South Asia are required to estimate the accurate prevalence of the disease.

Successful management of delayed presentation of massive paracetamol overdose in a resource-limited setting: A case report from Nepal.

We present a case of self-poisoning with a massive dose of paracetamol by a young Nepalese female patient who presented late to our emergency department. This report highlights the successful management of the patient with the extended use of N-acetylcysteine over 4 days and continuous supportive therapy as required. The case is an example of the management of delayed presentation of a massive paracetamol poisoning in a resource-limited setting, where intensive care units and hemodialysis facilities are not easily available. However, when available, massive poisoning should always be managed in continuous monitoring units under the expertise of a toxicologist.

Potential Drug-drug Interaction among the Patients Admitted in Intensive Care Units of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Drug interactions are one of the major contributors to increase hospital stay, inflate health care expenses, and cause serious adverse events and end-organ damage. Patients admitted to the intensive care unit are already critically sick and are at greater risk of these adverse outcomes. The study aimed to find out the prevalence of potential drug-drug interactions in the Intensive Care Units of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among the patients admitted in the Intensive Care Unit of a tertiary care hospital from April-June 2019. Ethical approval was taken from the Institutional Review Board at the institute (Reference number: 399). Convenience sampling method was used. Data was collected using proforma and potential drug-drug interactions were identified using Lexicomp® drug-interactions version 1.1 (Wolters Kluwer). All the drug interactions identified were classified and the severity scale of interactions was also defined. Statistical Package for the Social Sciences version 17.0 was used for data analysis. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean, standard deviation, and mode. Results: Out of 101 patients, the prevalence of the drug-drug interaction was found to be 90 (89.11%) (83.04-95.18 at 95% Confidence Interval). A total of 490 drug-drug interactions were identified. In severity scale, it was seen that 311 (63.46%) were of moderate severity and 303 (61.83%) of drug interactions were categorised as category C in risk rating. Conclusions: Prevalence of potential drug-drug interactions was higher compared to similar published literature. The most common drug with potential interaction was fentanyl and among pairs was fentanyl plus paracetamol. Keywords: drug interactions; intensive care units; Nepal; software.

Efficacy and Safety of Paromomycin for Visceral Leishmaniasis: A Systematic Review.

Visceral leishmaniasis, also known as kala-azar is one of the most commonly neglected tropical diseases affecting a large number of rural and resource-limited people in South Asia, Africa, and South America. Paromomycin, an aminoglycoside drug, is frequently used for the treatment of visceral leishmaniasis. Despite limited therapies for visceral leishmaniasis and emerging drug resistance, a proper review on the action of paromomycin for kala-azar is lacking. This systematic review aims to look for the efficacy and safety aspects of paromomycin for the treatment of visceral leishmaniasis.