Post-Transplant Fecal Carriage of Antibiotic Resistant and B-Lactamases-Producing Enterobacteriales among Renal Transplant Recipients.

BACKGROUND: The intestinal colonization and transmission of antibiotic-resistant Enterobacteriales to renal transplant recipients may pose a threat to them because they are profoundly immunocompromised and vulnerable to infection. Hence, it is crucial to identify these antibiotic-resistant fecal Enterobacteriales harboring high-risk populations. The objective of this study was to determine antibiotic resistance as well as ß-lactamases production in fecal Enterobacteriales among renal transplant recipients. METHODS: The stool samples, one collected from each transplant recipient, were processed for isolation and identification of Enterobacteriales and were tested for their antibiotic susceptibility, extended-spectrum ß-lactamase, and metallo-ß-lactamase production by standard methods. RESULTS: A total of 103 Enterobacteriales comprising of Escherichia coli (86.4%), Klebsiella species (11.7%), and Citrobacter species (1.9%) were isolated and more than 60% of the E. coli were found resistant to ceftazidime and ciprofloxacin and around half of the Klebsiella species were resistant to ceftazidime and fluroquinolones. The extended-spectrum ß-lactamase production was seen in 3.4% and 8.3% and metallo-ß-lactamase production in 24.7% and 33.3% of E. coli and Klebsiella species, respectively. The high proportion of ß-lactamase-producers were resistant to piperacillin-tazobactam, meropenem, gentamicin, and amikacin than ß-lactamases non-producers. CONCLUSION: Since the antibiotic resistance is higher in fecal Enterobacteriales, each renal transplant recipient should be screened for these highly resistant intestinal colonizers after transplantation in order to prevent infections and to reduce the rate of transplant failure due to infections.

Depression, Anxiety and Stress among School-going Adolescents of a Secondary School: A Descriptive Cross-sectional Study.

Introduction: Mental health of adolescents can affect growth and development, decrease school performance, and impair social relationships with peers and families. The COVID-19 pandemic has changed the social and educational scenario and affected the psychological condition of children and adolescents. This study aimed to find out the prevalence of depression, anxiety and stress among school-going adolescents in a secondary school. Methods: A descriptive cross-sectional study was done among school-going adolescents of a school from 1 October 2021 to 31 November 2021. Ethical approval was taken from the Institutional Review Committee (Reference number: 0609202101). Data was collected using a questionnaire consisting of sociodemographic parameters and a diagnosis of depression anxiety and stress was made using a standard scale. The whole sampling method was used. Percentage and frequency were calculated for binary data. Results: Among 95 patients, the depression was found in 31 (32.63%), anxiety in 36 (37.89%), and stress in 3 (3.16%). Conclusions: The prevalence of depression, anxiety and stress was lower than in other studies done in similar settings. The mental health status of school-going adolescents should be identified and appropriate timely interventions need to be taken. Family members, teachers and the concerned authorities should give emphasis to the psychological well-being of the adolescents. Keywords: adolescent; anxiety; depression; stress.

Dry Eyes among Visual Display Terminal Users Visiting the Outpatient Department of Ophthalmology of a Tertiary Care Centre.

Introduction: Visual display terminal usage has increased substantially in recent years across all age groups and is considered one of the major risk factors for dry eye disease. Early assesment of dry eyes and prevention is important. The aim of this study is to find the prevalence of dry eyes among visual display terminal users visiting the Outpatient Department of Ophthalmology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients visiting the Department of Ophthalmology in a tertiary care centre after receiving ethical approval from the Institutional Review Committee. Data was collected from 1 October 2021 to 31 March 2022. Convenience sampling method was used. The point estimate was calculated at a 90% Confidence Interval. Results: Among 94 visual display terminal users, the prevalence of dry eyes was 55 (58.51%) (50.18-66.84, 90% Confidence Interval). Conclusions: The prevalence of dry eyes among visual display terminal users visiting the Outpatient Department of Ophthalmology was similar to other studies done in similar settings. Keywords: dry eyes; health; prevalence.

Hypoplastic Left Heart Syndrome: A Case Report.

Hypoplastic left heart syndrome is a rare critical congenital heart defect constituting a prevalence of 1/3,500 to 1/12,500 live births in which there is obstructions to the blood flow within the left heart. Here we present a case of a full-term 38 weeks male baby with a birth weight of 3.5 kg, and no obvious physical deformity referred to our centre at 22 hours of life for respiratory distress and cyanosis. At 23 hours of life, he was diagnosed with hypoplastic left heart syndrome and kept on Prostaglandin E1 infusion till the 12th day of life. The baby had a large ventricular septal defect and atrial septal defect with a severely hypoplastic left ventricle, hypoplastic aortic root, ascending aorta and post-ductal coarctation of the aorta. The diagnosis was reconfirmed by computed tomography cardiac angiography on the 10th day of life with the same cardiac findings suggestive of hypoplastic left heart syndrome. Keywords: case reports; congenital heart disease; hypoplastic left heart syndrome.

Diaphragmatic Hernia in a Preterm with Congenital Heart Defects with Successful Outcome: A Case Report.

Congenital diaphragmatic hernia is an anatomical defect of the diaphragm that is often associated with serious cardiopulmonary complications. It can also be associated with many other problems like multi systemic anomalies, chromosomal aneuploidy and prematurity. Of these, cardiac defects, liver herniation and prematurity seem to have a pivotal role in affecting the outcomes of repair. We hereby present a preterm newborn with such multiple defects repaired on 15th day of life and post operatively managed in a Neonatal Intensive Care Unit with a successful outcome. The key learning objective for our team in this case was to identify the steps taken that led to a successful management of a low birth weight preemie with multiple defects in a resource limited set up. Keywords: congenital diaphragmatic hernia; preterm; surgical repair; ventricular septal defect.

District-Level Risk Factors for COVID-19 Incidence and Mortality in Nepal.

The recent global pandemic of the novel coronavirus disease 2019 (COVID-19) is affecting the entire population of Nepal, and the outcome of the epidemic varies from place to place. A district-level analysis was conducted to identify socio-demographic risk factors that drive the large variations in COVID-19 mortality and related health outcomes, as of 22 January 2021. Data on COVID-19 extracted from relevant reports and websites of the Ministry of Health and Population of Nepal, and the National Population and Housing Census and the Nepal Demographic and Health Survey were the main data sources for the district-level socio-demographic characteristics. We calculated the COVID-19 incidence, recovered cases, and deaths per 100,000 population, then estimated the associations with the risk factors using regression models. COVID-19 outcomes were positively associated with population density. A higher incidence of COVID-19 was associated with districts with a higher percentage of overcrowded households and without access to handwashing facilities. Adult literacy rate was negatively associated with the COVID-19 incidence. Increased mortality was significantly associated with a higher obesity prevalence in women and a higher smoking prevalence in men. Access to health care facilities reduced mortality. Population density was the most important driver behind the large variations in COVID-19 outcomes. This study identifies critical risk factors of COVID-19 outcomes, including population density, crowding, education, and hand hygiene, and these factors should be considered to address inequities in the burden of COVID-19 across districts.

Neonates Born Through Meconium-stained Amniotic Fluid among Deliveries in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: The mortality and morbidity of meconium aspiration syndrome in neonates born with meconium-stained amniotic fluid in developing countries are still high. In Nepal, few studies have estimated the prevalence of meconium-stained amniotic fluid among newborns. The study aimed to find out the prevalence of neonates born through meconium-stained amniotic fluid among deliveries in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among neonates born in a tertiary care centre from November 2021 to March 2022. Neonates born during the study period with meconium-stained amniotic fluid were studied. Ethical approval was obtained from the Institutional Review Committee. Convenience sampling method was used. With permission from the Department of the Neonatal Intensive Care Unit, the data were collected and entered in a Microsoft Excel sheet. Point estimate and 95% Confidence Interval were calculated. Results: Among 576 neonates, the prevalence of neonates born through meconium-stained amniotic fluid was 77 (13.37%) (10.59-16.15, 95% Confidence Interval). Conclusions: The prevalence of neonates born through meconium-stained amniotic fluid was found to be similar to other studies done in similar settings. Keywords: meconium; neonate; Nepal.

Feeding Intolerance among Preterm Neonates Admitted to the Neonatal Intensive Care Unit at a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Premature infants frequently suffer from feeding intolerance related to prematurity and are highly associated with morbidity and mortality. Breast milk is fundamental to the improvement of the infant's immature vulnerable framework and decreases child mortality. The aim of this study was to find out the prevalence of feeding intolerance in premature neonates admitted to the neonatal intensive care unit of a tertiary care centre. Methods: This descriptive cross-sectional study was carried out among premature infants admitted to the Neonatal Intensive Care Unit of a tertiary care hospital, from 15 December 2021 to 15 May 2022 after receiving ethical approval from the Institutional Review Committee (Reference number: 2211202103). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among the 55 preterm neonates, the prevalence of feeding intolerance was 21 (38.18%) (25.34-51.02, 95% Confidence Interval). Conclusions: The study showed that the prevalence of feeding intolerance among neonates was higher than in studies conducted in similar settings. Keywords: feeding patterns; food intolerance; morbidity; mortality; preterm infants.

Hypocalcemia in Jaundiced Neonates Receiving Phototherapy.

BACKGROUND: Hyperbilirubinemia is a common problem in neonates. Phototherapy and exchange transfusion are the primary treatment modalities. Less known, but one of the potential complications of phototherapy is hypocalcemia. Most of the neonates with hypocalcemia are asymptomatic. Though asymptomatic, treatment should be initiated immediately when serum calcium level is reduced. This study was conducted to detect the incidence of hypocalcemia in jaundiced neonates receiving phototherapy. METHODS: It is a hospital-based cross-sectional study conducted from May 2020 to December 2020 in the neonatal intensive care unit of Nepal Medical College Teaching Hospital. A total of 128 full-term neonates with jaundice and a normal serum calcium level before initiating phototherapy were enrolled in the study. Serum calcium level was measured before starting conventional phototherapy and after 48 hours of continuous phototherapy. RESULTS: Hyperbilirubinemia was present in 23.3% of neonates admitted to the neonatal unit. Hypocalcemia was seen in 26 (20.3%) of term jaundiced neonates receiving phototherapy. Signs of hypocalcemia were present only in 3 (2.3%) neonates. CONCLUSIONS: Hypocalcemia is a common complication of phototherapy. Serum calcium levels should be monitored in all the full-term neonates receiving phototherapy.

Culture Positive Cases of Ophthalmia Neonatorum in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Ophthalmia neonatorum although runs a benign course mostly, sometimes may progress to sight threatening complications. The study was conducted to find the prevalence of culture positive cases of opthalmia neonatorum. METHODS: It was a descriptive cross-sectional study conducted at a tertiary care center from January to December 2019. Ethical clearance was obtained from institutional review committee of Kathmandu Medical College. Convenience sampling was done. All data were entered into excel and, then for analysis, exported to Statistal Package for Social Sciences version 21. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: The prevalence of culture positive cases of opthalmia neonaturum is 10 (55.55%) (32.61-78.49 at 95% Confidence Interval). The causative organisms were coagulase negative Staphylococcus 4 (40%), Staphylococcus aureus 3 (30%), Klebsiella 2 (20%) and Pseudomonas 1 (10%). Culture sensitivity of the isolated organisms were different according to the patient even in case of the same organism. Vancomycin 7 ( 70%) was the most sensitive antibiotic followed by Ciprofloxacin 6 (60%), Amikacin 5 (50%) and Cloxacillin 5 (50%) while Azithromycin 1 (10%), Cefixime 1 (10%) and Cotrimoxazole 1 (10%) were the least sensitive. CONCLUSIONS: Staphylococcus species was the most common organism isolated from neonates with ophthalmia neonatorum and vancomycin was the most sensitive antibiotic.

Correlation of Thompson Score in Predicting Early Outcome of Newborn with Birth Asphyxia.

BACKGROUND: Birth asphyxia is one of the important causes of neonatal morbidity and mortality, accounting up to 30% of neonatal death in Nepal. It is also an important cause of long term neurological disability and impairment. Thompson encephalopathy score is a clinical score which can be used to assess the newborn with hypoxic ischemic encephalopathy for the prognosis and their neurodevelopmental outcome. The aim of the study was to assess the role of Thompson score in predicting the early outcome of neonates with birth asphyxia. METHODS: A prospective study was conducted from May 2019 to April 2020 in Nepal Medical College. All the term babies during the period with Apgar score of less than seven at five minutes were considered to have birth asphyxia and included in the study. Neurological examination was done on first, second and third day using HIE score proposed by Thompson and severity of hypoxic ischemic encephalopathy was classified accordingly. Outcome was measured as normal, morbidity with encephalopathy, seizure, organ dysfunction and death. RESULTS: Out of 391 newborn admitted to neonatal unit, 84 (21.4%) had birth asphyxia. Mild Thompson score on day 1,2,3 were 49(58.3%), 49 (58.3%), 51(60.7%); moderate Thompson score on day 1,2,3 were 21 (25%), 21 (25%), 18(21.4%) and severe Thompson score on day 1, 2, 3 were 14 (16.7%), 14 (16.7%), 15(17.9%) respectively. Out of 14 babies who had severe Thompson score on day 1, 11(91.7%) expired and 3 (16.7%) developed encephalopathy. CONCLUSIONS: There was strong correlation of severity of Thompson score with the outcome.

Efficacy of Topical Cyclosporine 0.05% the Treatment of Vernal Keratoconjunctivitis.

INTRODUCTION: Vernal Keratoconjunctivitis is a chronic bilateral seasonally exacerbated allergy affecting the conjunctiva and cornea of children. As technology has advanced, newer medications have been developed for the control of the disease. PURPOSE: To assess the effectiveness of an immunomodulator, cyclosporine, in the treatment of vernal keratoconjunctivitis. MATERIALS AND METHODS: Fifty patients of moderate, severe to very severe vernal keratoconjunctivitis were selected for the study. They were given cyclosporine 0.05% eye drops in loading dose followed by gradual tapering. Symptoms and signs were recorded at presentation, after two weeks, after four weeks, after two months and after three months. RESULTS: Vernal keratoconjunctivitis, being a chronic disease showed marked improvement with immunomodulator therapy. There was significant improvement in the symptom and sign score initially, at the first follow up itself with symptom score reduction from median of mean of 2.4 to 0.6 (p=0.00) and a similar sign score reduction from 1.75 to 0.625 (p=0.00). There was gradually more improvement as therapy continued and the beneficial effects were maintained till the end point of the study at three months where median of mean symptom score was 0.4 (p=0.00) and similar sign score of 0.375 (p= 0.000). CONCLUSION: Topical cyclosporine proved to be an effective and safe treatment strategy to treat cases of moderate, severe and very severe vernal keratoconjunctivitis.

Prevalence of Congenital Malformations among Babies Delivered at a Tertiary Care Hospital.

INTRODUCTION: Congenital malformations have emerged as a major cause of stillbirths and neonatal mortality. It is a common cause of morbidity and mortality not only in the newborn but also in childhood and beyond. The objective of this study was to find the prevalence of congenital malformation at birth. METHODS: The descriptive cross-sectional study was conducted among 2456 live births in Kathmandu Medical College and Teaching Hospital from April 2017 to March 2018 after obtaining ethical approval from the institutional review committee (Ref no. 08052017). A convenient sampling method was applied. All the live-born babies delivered in this hospital during the study period were clinically examined for the presence of congenital anomalies. All malformations were classified according to the International Classification of Diseases-10 classification. The mothers of the newborns with congenital malformations were interviewed in a predesigned proforma. Statistical analysis was done using statistical package for the social sciences version 20. RESULTS: Out of 2456 examined live births, congenital malformations were observed in 66 cases. The prevalence of congenital malformation was 66 (2.6%) at 95% confidence interval (4.19-1.98) of total live births. The genitourinary system was the most common system involved with congenital malformations being 16 (24.2%), followed by musculoskeletal system 14 (21.2%), and cardiovascular system 12 (18.2%). CONCLUSIONS: Congenital malformation plays a major role in the mortality and morbidity of neonates as well as children. The genitourinary system was the most common system involved.

Knowledge, Attitude and Practices among Mothers of Children 6 to 24 months of Age Regarding Complementary Feeding.

INTRODUCTION: Complementary foods fill the gap between the total nutritional needs of the child and the amounts provided by breast milk. Inappropriate feeding practices are a major cause of the onset of malnutrition in young children. The objective of this study was to assess the knowledge, attitude, and practices of mothers of children between 6 to 24 months of age regarding complementary feeding. METHODS: This Knowledge, Attitude, and Practice Study was conducted among 250 mothers in Kathmandu Medical College and Teaching Hospital from June 2019 to November 2019 after obtaining ethical approval from the institutional review committee (Ref no. 150320199). Convenient sampling method was applied. The mothers of children between 6 to 24 months were interviewed using a structured questionnaire to ascertain the knowledge, attitude, and practices regarding complementary feeding. Statistical analysis was done using SPSS version 20. RESULTS: Two hundred and fifty mothers were interviewed. 151 (60.4%) mothers knew initiation of breastfeeding soon after birth and 179 (71.6%) were knowledgeable about exclusive breastfeeding for 6 months. 161 (64.4%) mothers knew the proper age of initiating complementary feeding but only 139 (55.6%) mothers practiced it. Early initiation of complementary feeding was done by 87 (34.8%) mothers while 24 (9.6%) mothers delayed it beyond 6 months. CONCLUSIONS: There was a gap in knowledge and practice among mothers regarding adequate age of initiation of complementary feeding, complementary foods, preparation, and practices.

Premenstrual Syndrome in Students of a Teaching Hospital.

BACKGROUND: Premenstrual syndrome is group of psychosomatic symptoms which occurs during second half of menstrual cycle. Significant number of reproductive aged females suffer from it with its impact on their daily activities. This study was conducted to assess the prevalence, severity and impacts of Premenstrual syndrome on female students of a teaching hospital of Kathmandu, Nepal. METHODS: This cross-sectional study was conducted among female students of a teaching hospital from Kathmandu over a period of three months. Premenstrual Symptom Screening Tool was used to quantify the symptoms severity and their effect in activities. In addition; patient profile, socioeconomic status were recorded. The obtained information was entered in Statistical Package for Social Sciences and analyzed. Findings were then interpreted using chi-square test. RESULTS: Out of the 285 respondents, 206 (72.3%) reported at least one premenstrual syndrome symptom of moderate to severe intensity among which 74 (25.9%) had at least one severe symptom. Six individuals (2.1%) fulfilled all criteria for Pre-Menstrual Dysphoric Disorder and 49 (17.2%) fulfilled the criteria for moderate to severe premenstrual syndrome and rest (80.7%) were having no or mild premenstrual syndrome with isolated symptoms. PMS was found to have significant association to menstrual bleeding (p?0.001) and severity of dysmenorrhea (p?0.001), family history of premenstrual syndrome (p=0.019) and physical activity (p=0.021). CONCLUSIONS: Premenstrual syndrome is common in female and has a considerable impact on day to day activities activities although its severe form Pre-Menstrual Dysphoric Disorder is less common.

Perceived social support, coping, and stigma on the quality of life of people living with HIV in Nepal: a moderated mediation analysis.

Perceived social support, coping strategy, and internalized stigma have been linked with the quality of life (QOL) among people living with HIV (PLHIV). However, little is known about how these psychosocial factors interact with each other and affect QOL. This study incorporated a moderated mediation model to investigate whether coping strategy mediates the relationship between perceived social support and QOL, and to examine whether this mediating effect varies with the level of internalized stigma among PLHIV. A cross-sectional study was conducted among 599 PLHIV in Nepal. The multidimensional scale of perceived social support, World Health Organization Quality of Life-BREF, Brief COPE, and AIDS-related stigma scales were used to measure perceived social support, QOL, coping strategy, and internalized stigma, respectively. Data were analyzed using structural equation modeling, and moderated mediation analysis was conducted with multi-group approach. The relationship between perceived social support and QOL was significantly and partially mediated by problem-focused coping strategy. Internalized stigma significantly moderated the mediating effect of coping strategies on the association between perceived social support and QOL. For high internalized stigma group (total stigma score > 2), the effects of perceived social support on QOL were indirect (ß = 1.48; 61.0% of total effects) through the mediating effect of coping strategy, especially problem-focused coping one. For low internalized stigma group (total stigma score ≤ 2), problem-focused coping strategy did not significantly affect the QOL, and most of the effects of perceived social support were direct (ß = 1.24; 99.2% of total effects). Internalized stigma was found to moderate the mediating effect of problem-focused coping on the relationship between perceived social support and QOL. Enhancing the problem-focused coping and social support may be helpful to improve QOL among PLHIV reporting high stigma.

Sageretia thea fruit extracts rich in methyl linoleate and methyl linolenate downregulate melanogenesis via the Akt/GSK3ß signaling pathway.

BACKGROUND/OBJECTIVES: Sageretia thea is traditionally used as a medicinal herb to treat various diseases, including skin disorders, in China and Korea. This study evaluated the inhibitory effect of Sageretia thea fruit on melanogenesis and its underlying mechanisms in B16F10 mouse melanoma cells. The active chemical compounds in anti-melanogenesis were determined in Sageretia thea. MATERIALS/METHODS: Solvent fractions from the crude extract were investigated for anti-melanogenic activities. These activities and the mechanism of anti-melanogenesis in B16F10 cells were examined by determining melanin content and tyrosinase activity, and by performing western blotting. RESULTS: The n-hexane fraction of Sageretia thea fruit (HFSF) exhibited significant anti-melanogenic activity among the various solvent fractions without reducing viability of B16F10 cells. The HFSF suppressed the expression of tyrosinase and tyrosinase-related protein 1 (TRP1). The reduction of microphthalmia-associated transcription factor (MITF) expression by the HFSF was mediated by the Akt/glycogen synthase kinase 3 beta (GSK3ß) signaling pathway, which promotes the reduction of ß-catenin. Treatment with the GSK3ß inhibitor 6-bromoindirubin-3'-oxime (BIO) restored HFSF-induced inhibition of MITF expression. The HFSF bioactive constituents responsible for anti-melanogenic activity were identified by bioassay-guided fractionation and gas chromatography-mass spectrometry analysis as methyl linoleate and methyl linolenate. CONCLUSIONS: These results indicate that HFSF and its constituents, methyl linoleate and methyl linolenate, could be used as whitening agents in cosmetics and have potential for treating hyperpigmentation disorders in the clinic.

Nonsteroidal Anti-inflammatory Drugs (NSAIDS) Inhibit the Growth and Reproduction of Chaetomium globosum and Other Fungi Associated with Water-Damaged Buildings.

Indoor mold due to water damage causes serious human respiratory disorders, and the remediation to homes, schools, and businesses is a major expense. Prevention of mold infestation of building materials would reduce health problems and building remediation costs. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit yeasts and a limited number of filamentous fungi. The purpose of this research was to determine the possible inhibitory activity of nonsteroidal anti-inflammatory drugs (NSAIDs) on germination, fungal growth, and reproduction of Chaetomium globosum and other important filamentous fungi that occur in water-damaged buildings. Several NSAIDs were found to inhibit C. globosum germination, growth, and reproduction. The most effective NSAIDs inhibiting C. globosum were ibuprofen, diflunisal, and diclofenac. Fusarium oxysporum, Fusarium solani, Aspergillus niger, and Stachybotrys atra were also tested on the various media with similar results obtained. However, F. oxysporum and A. niger exhibited a higher level of resistance to aspirin and NaSAL when compared to the C. globosum isolates. The inhibition exhibited by NSAIDs was variable depending on growth media and stage of fungal development. These compounds have a great potential of inhibiting fungal growth on building materials such as gypsum board. Formulations of sprays or building materials with NSAID-like chemical treatments may hold promise in reducing mold in homes and buildings.

Sageone, a diterpene from Rosmarinus officinalis, synergizes with cisplatin cytotoxicity in SNU-1 human gastric cancer cells.

BACKGROUND AND PURPOSE: Chemotherapy resistance is a major obstacle for the effective treatment of cancers. Although several studies have described the anticancer properties of rosemary extract and its components, the detailed mechanisms of action are poorly understood. METHODS: Activity-guided fractionation and repeated chromatographic separation of the n-hexane fraction of the aqueous methanol extract over silica gel, RP C18, and Sephadex LH-20 led to the isolation of three compounds. The structures of the compounds were determined using 1H, 13C, and two-dimensional nuclear magnetic resonance spectroscopy, mass spectroscopy, and infrared spectroscopy. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay was used to evaluate the cytotoxicity of these compounds. Cell cycle, apoptotic cell populations, and mitochondrial membrane potential were analyzed by flow cytometry. Western blot analysis was conducted to detect apoptosis-related proteins. RESULTS: An abietane diterpenoid, sageone (1), an icetexane diterpenoid, (-)-barbatusol (2), and a monoterpene, (+)-verbenone (3), were identified. Of these compounds, sageone (1) showed cytotoxicity against SNU-1 cells with an IC50 of 9.45 ± 1.33 µM. Sageone reduced the expression of Akt dramatically, as opposed to cisplatin, which increased phosphorylated Akt. Sageone combined with a subtoxic dose of cisplatin had synergistic effects on apoptosis induction in SNU-1 cells, as confirmed by calculating the combination index. Co-treatment was significantly more effective than monotherapy at reducing cell viability and inducing apoptosis, as determined by analyzing DNA fragmentation. The combined treatment of sageone and cisplatin markedly reduced Akt expression and phosphorylation, accompanied by increases in cleaved caspase-3, -9 and PARP. CONCLUSION: This is the first time compounds 1 and 2 have been isolated from R. officinalis. Sageone induced apoptosis in SNU-1 human gastric cancer cells and notably enhanced the cytotoxicity of cisplatin in SNU-1 cells, which are known to be resistant to cisplatin. These findings suggest that sageone represents a promising anticancer agent against gastric cancer that warrants further study.