Assessment of quality of essential medicines in public health care facilities of Nepal: Findings of nationwide study.

Essential medicines are those medicines that satisfy the primary health care needs of the citizens. Poor quality of essential medicines can have serious impact on public health. Thus, this study is aimed to assess the quality of essential medicines available in public health care facilities of Nepal. A cross sectional descriptive study was carried out in 62 health facilities across 21 districts, representing all seven provinces of Nepal and selected proportionately from all three ecological regions i.e. Terai, Hill and Mountain using lottery method. Health facilities in selected districts were chosen using random number generator. Face to face interview was taken with health facility in charge using structured questionnaire. All storage conditions information was recorded through observation checklists. Temperature and humidity were measured using a digital instrument. Similarly, 20 different generic medicines were collected for quality testing. The obtained data were entered in Epidata version 3.1, cleaned in Microsoft Excel 2007 and analyzed in SPSS version 16.0. Among 62 health facilities, only 13% of health facilities were found to follow the medicine storage guidelines, with temperature and humidity levels exceeding recommended limits. Out of 244 batches of 20 different generics of essential medicines, 37 batches were found to be substandard. These substandard medicines were- Ciprofloxacin hydrochloride eye/ear drop, Iron supplement tablets, Metformin Hydrochloric tablet, Metronidazole Tablets, Paracetamol Oral suspension, Paracetamol tablet and Povidone Iodine solution. The study recommends the urgent need for the Government of Nepal to prioritize ensuring the quality of essential medicines in the country.

In Vitro Antioxidant and Antimicrobial Potency of Mimosa pudica of Nepalese Terai Region: Insight into L-Mimosine as an Antibacterial Agent.

Aim: The study aimed to evaluate the in vitro antioxidant and antimicrobial potency of Mimosa pudica found wildly in the Terai region of Nepal and assess its physicochemical properties, such as total phenolic content (TPC) and total flavonoid content (TFC). Materials and Methods: The physicochemical properties of ethyl acetate extract of Mimosa pudica (EAMP), such as extractive value, total ash content, loss on drying, and phytochemical screening, were calculated using standard protocols. The TPC was determined by using the Folin-Ciocalteu method taking gallic acid as standard, and TFC was conducted by using the AlCl3 colorimetric method, using a 96-well plate reader. The in vitro antibacterial activity of different concentrations of the extract against four bacterial ATCC strains was determined by the agar well diffusion method in the Mueller Hinton agar (MHA) medium. The in silico molecular docking model was used to ascertain the antibacterial potency of L-mimosine against the selected strains of bacteria used for the in vitro study by calculating the binding affinity towards the protein of bacteria. Results: The preliminary screening of the extract showed the presence of several phytochemicals. The total ash content (7.67%), loss on drying (2.30%), and extractive value (8.966%) were determined by analyzing the crude sample. The total phenolic and flavonoid contents were 418.640 ± 0.018 mg GAE/g (dried extract) and 14.126 ± 0.021 mg QE/g (dried extract), respectively. The extract showed a potent free radical scavenging activity with an IC50 value of 158.95 ± 1.12 µg/mL. The plant extract also demonstrated the antibacterial activity against both Gram-positive bacteria Staphylococcus aureus (15 mm) and Bacillus cereus (22 mm) and Gram-negative bacteria Escherichia coli (17 mm) and Klebsiella pneumoniae (16 mm) at 200 mg/mL concentration of extract. There was a noteworthy binding affinity of antibiotics with almost all selected bacterial proteins with binding energy against Escherichia coli DNA gyrase subunit B (-5.7 kcal/mol), Staphylococcus aureus DNA gyrase subunit B (-6.1 kcal/mol), Bacillus cereus metallothiol transferase (-5.2 kcal/mol), and Klebsiella pneumoniaebeta-lactamase (-6.1 kcal/mole), respectively, with the L-mimosine. Conclusion: The findings of the current study suggest that Mimosa pudica from the Terai region of Nepal is rich in phenolic and flavonoid compounds, has a significant impact on bacterial growth inhibition, and has a notable potential to scavenge free radicals (DPPH). According to the in silico analysis, L-mimosine is a potent antibacterial compound that might be utilised to discover novel antibacterial drugs to combat antibiotic resistance.

Knowledge, practices and compliance related to COVID-19 among Nepalese population in Province 2, Nepal.

Aim: The study aimed to access the knowledge, practice, and compliance related to COVID-19 among people residing in Province 2, Nepal. Materials and methods: A descriptive cross-sectional study was conducted from October 2020 to March 2021. A total of 457 participants of eight districts of Province 2 were enrolled after obtaining consent. Data were collected by face-to-face interviews with participants. A total of 31 validated pre-structured questionnaires were asked to participants in which 11 questions were for knowledge, 12 questions were for practices, and 8 questions were for compliance related to COVID-19. For tool validation, pre-testing was done in 10.0% of individuals of the targeted study population of Mahottari district. Results: Out of 457 participants, 353(77.2%) were male. The majority of the participants were unmarried (68.3%), had only school-level education (26.5%), Hindu by religion (89.7%), farmers (23.0%), and businessmen (23.0%). More than 75.0% of individuals had knowledge about the causative agent of COVID-19 symptoms and the purpose of isolation. About 53.8% of participants had good knowledge of social distancing, 31.1% had knowledge of masks, and 39.3% knew about sanitizer. Moreover, 94.3% of the respondents had good knowledge of hand-washing practice with soap-water and use of sanitizer, 89.1% had good knowledge of wearing masks and 82.9% followed social distancing. Compliance with standard procedures of sneezing was recorded in 43.1%, washing hands with soap water/sanitizer was 82.3%, and disposal of masks was 53.6%. A significant association was observed between gender with knowledge and compliance (p < 0.05). District-wise association with knowledge, practice and compliance was found to be significant (p < 0.05). Conclusion: The findings suggest that participants have a good level of knowledge; however, the practice and compliances are considerably low related to COVID-19.

Facebook use and its effects on the life of health science students in a private medical college of Nepal.

BACKGROUND: Facebook, a popular social networking site, has been used by people of different ages and professions for various purposes. Its use in the field of medical education is increasing dramatically. At the same time, the pros and cons of facebook use among the health science students has attracted the attention of educators. The data regarding its use and the effect on the life of Nepalese health science students has not yet been documented. Therefore, this study is carried out to evaluate the effect of facebook use on social interactions, behaviour, academics, and the health of students in a medical college of Nepal. RESULTS: A cross-sectional descriptive study conducted among medical, dental, nursing and allied health science students using self-administered questionnaire. The study showed that 98.2 % of participants were facebook users. Among 452 respondents, 224 and 228 were male and female respectively, with a mean age of 20.2 ± 1.2 years. The main reason for using facebook was to remain in contact with family and friend (32 %), while its use for the academic purpose was only 5 %. However, 80.8 % of students acknowledged ease in acquiring academic materials from others, through facebook. One-fourth of the students acknowledged that they are using facebook late at night on a regular basis, while surprisingly 4.2 % of the students admitted accessing facebook during the classroom lectures. Almost two-third of the users, further admitted that facebook has had a negative impact on their studies. Burning eyes (21 %), disturbed sleep (19 %), and headache (16 %) were the most common adverse health effects reported by the facebook users. Many students (71.4 %) tried and most of them (68.7 %) succeeded, in reducing time spent on facebook, to allow for increased time devoted to their studies. CONCLUSION: The widespread use of facebook among the health science students, was found to have both positive and negative effects on their academics, social life, and health.

Subject preferences of first- and second-year medical students for their future specialization at Chitwan Medical College and Teaching Hospital, Chitwan, Nepal - a questionnaire-based study.

INTRODUCTION: The selection of a discipline for future specialization may be an important factor for the medical students' future career, and it is influenced by multiple factors. The interest of students in the early stages can be improved in subjects related to public health or of academic importance, as per need. METHODS: A questionnaire-based study was conducted among 265 first- and second-year medical students of Chitwan Medical College, Nepal to find out their subject of preference for postgraduation and the factors affecting their selection along with their interesting basic science subject. Only the responses from 232 completely filled questionnaires were analyzed. RESULTS: The preference of the students for clinical surgical (50.9%), clinical medical (45.3%), and basic medical (3.9%) sciences for postgraduation were in descending order. The most preferred specialty among male students was clinical surgical sciences (56.3%), and among female students, it was clinical medical sciences (53.6%). Although all the students responded to their preferred specialty, only 178 students specified the subject of their interest. General surgery (23.4%), pediatrics (23.4%), and anatomy (2.4%) were the most favored subjects for postgraduation among clinical surgical, clinical medical, and basic medical sciences specialties, respectively. More common reasons for selection of specific subject for future career were found to be: personal interests, good income, intellectual challenge, and others. CONCLUSION: Many students preferred clinical surgical sciences for their future specialization. Among the reasons for the selection of the specialty for postgraduation, no significant reason could be elicited from the present study.

Turmeric (curcumin) remedies gastroprotective action.

The purpose of this review is to summarize the pertinent literature published in the present era regarding the antiulcerogenic property of curcumin against the pathological changes in response to ulcer effectors (Helicobacter pylori infection, chronic ingestion of non-steroidal anti-inflammatory drugs, and exogenous substances). The gastrointestinal problems caused by different etiologies was observed to be associated with the alterations of various physiologic parameters such as reactive oxygen species, nitric oxide synthase, lipid peroxidation, and secretion of excessive gastric acid. Gastrointestinal ulcer results probably due to imbalance between the aggressive and the defensive factors. In 80% of the cases, gastric ulcer is caused primarily due to the use of non-steroidal anti-inflammatory category of drug, 10% by H. pylori, and about 8-10% by the intake of very spicy and fast food. Although a number of antiulcer drugs and cytoprotectants are available, all these drugs have side effects and limitations. In the recent years a widespread search has been launched to identify new antiulcer drugs from synthetic and natural resources. An Indian dietary derivative (curcumin), a yellow pigment found in the rhizome of Curcuma longa, has been widely used for the treatment of several diseases. Epidemiologically, it was suggested that curcumin might reduce the risk of inflammatory disorders, such as cancer and ulcer. These biological effects are attributed to its anti-inflammatory and antioxidant activities. It can, therefore, be reported from the literature that curcumin PRevents gastrointestinal-induced ulcer and can be recommended as a novel drug for ulcer treatment.

The treatment of visceral leishmaniasis: safety and efficacy.

Visceral leishmaniasis is the disease of poor; however availability of only expensive treatment of this disease impinges the socioeconomic condition of those affected. If untreated, almost all cases of visceral leishmaniasis are fatal. The demonstration of the leishmania donovani bodies from the tissue aspirates or serological tests confirms the diagnosis of the disease. Pentavalent antimony, amphotericin B, paromomycin, diamine pentamidine, miltefosine, sitamaquine and some new combinations are integrated in the limited therapeutic armoury for treatment of visceral leishmaniasis. The recommended first and second line therapy in the Indian sub-continent is miltefosine and amphotericin B respectively.Pentavalent antimonial, preceding first line therapy, has been replaced by miltefosine due to former increasing failure rate and toxicity.The problem of drug resistance, some of the serious drug toxicities along with high-priced drugs extends challenges equally to pharmaceutical companies and medical practitioners. More research on adverse drug events for the existing drugs and efforts to develop safer and effective drugs to counter resistance outbreaks for the successful management of visceral leishmaniasis are needed.