Drug Utilization Study in Outpatient Department of Ophthalmology in Tertiary Care Hospital.

Background The advancement in drug development and availability of newer drugs has improved overall health services including decrease in mortality and hospital stay. Along, it has brought negative impacts such as polypharmacy and associated adverse drug reactions and antimicrobial resistance. Drug utilization research is an essential approach to understand the drug use pattern, identify the early signs of such irrational drug use and to improve quality of drug use. Objective To study the drug utilization pattern in the Ophthalmology Outpatient department (OPD) of Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH). Method A descriptive, cross sectional study was conducted from March 2019 to August 2019 in patients attending OPD of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital. Prescriptions of 311 patients were analyzed using World Health Organization (WHO) International Network of Rational Use of Drug (INRUD) and additional other indices. The descriptive data was presented in mean and standard deviation. Result The average number of drugs per prescription was 2.10±1.35. Out of total 311 prescriptions, drugs prescribed in generic name were 152 (23.30%). Total antibiotics encountered were 247 (37.90%) and total drugs prescribed from National Essential Medicine List (NEML) were 371 (56.90%). Antibiotics 247 (37.90%) were the most commonly prescribed drugs followed by lubricants 146 (22.40%). Conclusion Practice of polypharmacy was very high. Most of the drugs were prescribed in brand names and antibiotics were the most frequently used drugs.

Study on Patient's Perception on Medication Counseling at Community Pharmacy in Sub-urban Area of Nepal.

Background Community pharmacists are the primary contact point in a healthcare system who provide medication information to the patients and enable them to make appropriate decision regarding their therapy. Hence, this study explored patients' perception of community pharmacist based on medication counseling. Objective To study patient's perception on medication counseling by community pharmacist at Manohara Municipality, Kathmandu, Nepal Method A cross sectional study was conducted from November 2020 to April 2021 in population visiting pharmacies of Kageshwori Manohara Municipality of Kathmandu valley. A total of 384 participants included in the study were surveyed using a structured questionnaire exploring the content of medication counseling, level of satisfaction on counseling and use of various means of counseling. Descriptive data were presented in frequencies and percentages using EXCEL 2016. Result This study enrolled 384 participants out of which 354, 92.19% received medication counseling. The main reason of pharmacy visit was to obtain over the counter medicines, 262, 68.23%. Majority of the participants rated satisfied with informations provided on use of medication 218, 56.77%, duration of therapy 261, 67.97%, about side effects 211, 54.95% and on action to be taken following side effects 246, 64.06%. Most of the participants rated satisfied with counseling on storage 189, 49.22% and for referral 250, 65.10% while 201, 52.34% participants rated highly satisfied with advice on lifestyle and dietary changes required. Conclusion This study concludes that the patients' perception regarding the medication counseling by community pharmacist was acceptable. Thus pharmacists should be encouraged to support patients with their medication to promote patient care.

Comparative Efficacy and Safety of Diacerein in Patients with Knee Osteoarthritis: A Pilot Study.

Background Osteoarthritis (OA) is the most common chronic rheumatic disease. The prevalence of OA is skyrocketing with time. Providing a proper treatment regimen for OA is also growing as a major public health challenge. Conventional pharmacological treatments are mainly for alleviating pain and have some severe adverse effects. Diacerein is a new oral anti-inflammatory drug especially developed for the management of OA having only mild to moderate adverse effects. However, the evidence of efficacy and safety of Diacerein in OA is not well documented and yet to be explored. Objective To compare the efficacy and safety of Diacerein in knee OA with conventional nonsteroidal anti-inflammatory drugs (NSAIDs). Method A comparative study was conducted among knee OA patients attending OutPatient Orthopedic department in Dhulikhel Hospital, Nepal from December 2019 to September 2020, using self-structured and standard questionnaire. The patients were randomized to receive either a conventional standard treatment (Treatment Group I: NSAIDs) or alternative treatment regimen (Treatment Group II: NSAIDS+ Diacerein). Patients were followed-up after two months and data were analyzed using SPSS 21.0. Result Among 72 patients enrolled in this study, majority (44.44%) were between 51-60 years of age in which 81.94% of the patients were female. Post treatment data was collected from 15 participants. The mean KOOS-PS score of the participants in Treatment Group I decreased from 35.56 ± 14.33 to 35.14 ± 12.65 while that of the Treatment Group II participants reduced from 63.31 ± 12.08 to 49.99 ± 13.10 in two months. Similarly, the mean WOMAC score decreased from 46.87 ± 17.80 to 34.37 ± 16.83 in Treatment Group I and from 54.23 ± 14.66 to 46.22 ± 12.16 in Treatment Group II. The mean Lysholm score in Treatment Group I increased from 55.57 ± 8.16 to 60.86 ± 15.01 and in Treatment Group II, it increased from 46.62 ± 13.01 to 60.25 ± 17.598. Conclusion Diacerein treatment group had better functional outcome compared to the patients in the treatment group with conventionally used drugs. Also, the adverse effects faced by the patients were minor. The current study are suggestive of better efficacy and safety of Diacerein compared to other drugs.

Adherence to Iron, Folic Acid and Calcium Supplement and Factors Affecting it among the Antenatal Care Attending Women in a Tertiary Care Hospital: A Cross Sectional Study.

Background Pregnancy or gestation is the time during which a single or more children grows and develops inside a woman. Antenatal care improves the pregnancy outcomes under which a group of medication i.e. iron, folic acid and calcium are supplemented. Despite the effectiveness of such supplements, poor clinical outcomes are often encountered because of poor-adherence to the regimen. Objective To determine the adherence pattern and factors affecting adherence in antenatal care patients under iron, folic acid, and calcium therapy. Method A cross-sectional study was conducted in Dhulikhel Hospital, Kathmandu University Hospital. Pregnant women attending antenatal care under iron, folic acid, and calcium therapy fulfilling the inclusion criteria were enrolled in this study. After obtaining the informed consent from the patients, structured questionnaire was used to interview the patients. Statistical analysis was performed by using SPSS 23.0. P-value < 0.05 was considered as statistically significant. Result Among 191 patients enrolled in this study majority (39.3%) of them belonged to age group 26-30 years. More than half (61.3%) of the patients were illiterate. Of the total 191, 64.40% were non-adherent to the medication. Forgetfulness was the main reason for missing the dose in majority (52.06%) of the non-adherent subjects while adverse effects (55.40%) was the most prominent cause for discontinuing the medication among non-adherent participants. Significant association was found between patients' adherence and busy work schedule, visiting doctor for follow up. Conclusion More than half of the patients had not adhered to the medication under antenatal care. Forgetfulness was the most common factor for missing the dose in nonadherent patients. Illiteracy was associated with poor adherence. Patient-provider relationship, Socio-economic factors were determined as major barrier to medication adherence.

Analysis of Antimicrobial Drugs Usage Pattern and it's Cost Analysis in the Pediatric Department of a Tertiary Care Hospital.

Background Antimicrobials agents are the most widely and often imprudently used therapeutic drugs globally. The pediatric population comprises 20-25% of the total world population, and various acute and chronic diseases are prone to this group. It is also estimated that 50% to 85% of children are prescribed with antimicrobials in developed and developing countries. The misuse of antimicrobials not only contributes not only to the development of antimicrobial resistance but also results in economic burden on the health care system. Objective To analyze the antimicrobial usage and its cost analysis in the Pediatric department of a tertiary care hospital at sub-urban area. Method A hospital based retrospective study was conducted among patient (aged 1 to 18 years) admitted in pediatric ward and intensive care unit for at least 24 hours and dispensed at least one antimicrobial drug from January 2018 to December 2019. Data were collected from electronic medical record using a structured data collection form. The data was entered and analyzed using Microsoft Excel. A descriptive analysis was presented as mean ± (standard deviation) for the continuous variables and frequencies and proportions for categorical variables. Result Among the 1,281 patients, the antimicrobials were prescribed mostly in the respiratory tract infection (39.6%), followed by sepsis (19.75%), enteric fever (11.94%), seizure (10.07%), urinary tract infection (4.29%). Penicillins (1238 times) were highly prescribed followed by Cephalosporin (733 times), Nitro-imidazole (292 times), Aminoglycosides (180 times) and Fluoroquinolones (144 times). During study period in the Pediatric Department, approximately NRs. 1,619,121.11 was spent in the antimicrobial drugs and the highest expenditure was found to be in the Cephalosporin group of antimicrobials (NRs. 530,988.6), followed by Penicillin group of drug (NRs. 3,81,842.2). Conclusion The study concludes that the Penicillin groups of drugs were the most commonly prescribed drug and the highest cost was found to be in Cephalosporin group drugs followed by Penicillin group of drugs.

Hormonal Contraceptives Use and Their Adverse Effects: A Cross-sectional Study among the Women Visiting Tertiary Care Center.

Background Hormonal contraceptives are one of the most commonly used means of contraception. Lack of contraception may lead to large family size, increased preexisting illness on pregnancy, social and economic instability, risk of unsafe abortion and so on. This may also lead to unintended pregnancies which may alter the outcomes of pregnancies as well. However, improper uses are associated with several serious adverse effects. Therefore, to achieve the optimum benefit with the least adverse effects, safe and effective use of these agents with monitoring of their pattern of use and patient compliance is very essential. Objective To investigate the usage of hormonal contraceptives and the adverse effects associated with them. Method A cross-sectional study was conducted in a family planning center of a tertiary care hospital. All women of reproductive age using hormonal contraceptives for at least 1 month were included in this study. Informed consent was taken from the patients and interviewed using a structured questionnaire. Statistical analysis was performed by using SPSS 20. Result Among the 105 participants under this study, the mean (±SD) age was 29.08 (± 6.12) years. A majority (42, 40.0%) of them were using injectables. The average duration of use of hormonal contraceptives was 25.1 months ± 31.8 while a majority (60, 57.1%) were using contraceptives from < 3 months. Less chance of missed dose was the major reason (26.8%) for choosing injectable. Adverse effects were reported by 75.2% of the patients. The most common adverse effect was menstrual abnormalities (21.7%). Conclusion Among various hormonal contraceptives, injectables were more commonly used. The majority of the participants responded to use injectables because of the least chance of missing the dose. The most common adverse effect reported was menstrual abnormalities.

Study of Prescription Pattern and Factors Associated with Clinical Outcomes in Type 2 Diabetes Mellitus with Reference to Short Term Glycemic Control.

Background Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Though oral hypoglycemic agents (OHAs) or/and insulin are prescribed to control the hyperglycemia, still glycemic control is not seen in most of the cases. Evaluating the treatment pattern including the glycemic control and associated factors are of utmost importance for better patient care. Objective To investigate the treatment pattern and short term glycemic control among Type 2 Diabetes Mellitus (DM2) patients and study the factors associated with it. Method Patients meeting the inclusion criteria with DM2 attending laboratory or Out-Patient Department or Emergency Department in Dhulikhel Hospital and patients who were admitted to the ward taking various OHAs and/or insulin at the time of data collection were considered. Informed consent was taken prior to the interview. The collected data was entered as well as analyzed using the SPSS (Statistical Package for Social Sciences) version 21.0 and the p-value <0.05 was considered statistically significant. Result Among the 118 patients, 50.8% of them were males. Majority (28%) of the patients belonged to the age group of 51-60 years. Out of the 118 patients, 22% had their fasting blood glucose (FBG) level under control whereas 78% had uncontrolled FBG level. Metformin was the most (28%) commonly prescribed drug. Significant association was found between gender; knowledge about disease and medication with short term glycemic control (p=0.034, p=0.004 ans p=0.039 respectively). Conclusion All the patients enrolled in this study were under various anti-diabetic medications, however, majority of them didn't have their glycemia under control. Significant association was found between FBG level and gender, knowledge about disease and knowledge about medication.

Medication Adherence to Levothyroxine Therapy among Hypothyroid Patients and their Clinical Outcomes with Special Reference to Thyroid Function Parameters.

Background Non-adherence to medication in hypothyroid patients leads to poor clinical outcome and increased health care costs. Study related to adherence to levothyroxine in hypothyroid patients is limited worldwide. Objective To determine the adherence pattern and factors affecting adherence in hypothyroid patients and compare the clinical outcomes among adherent and non-adherent patients. Method A cross-sectional study was conducted in Dhulikhel hospital, Kathmandu University hospital. Patients with hypothyroidism on levothyroxine fulfilling the inclusion criteria were enrolled in this study. After obtaining the informed consent from the patients, structured questionnaire was used to interview the patients. Statistical analysis was performed by using SPSS 23.0. P-value < 0.05 was considered as statistically significant. Result Among 113 patients enrolled in this study, 85.8% of them were females. Majority (76.10%) of them belonged to the age group of 31-40 years. More than half (51.3%) of the patients were adherent to medication. Non-adherence was significantly associated with literate people following medication (p=0.003, OR=0.305), missed appointment to follow-up (p=0.007, OR=0.346) and longer duration of medication (p=0.019, OR=4.385). However, there was no statistically significant association of clinical outcomes with reference to TSH, fT4, fT3 and patients' age, adherence to medication and concomitant use of other drugs. Conclusion More than half of the patients were adhered to the Levothyroxine therapy. Forgetfulness was the main reason for missing the dose and non-specific reasons attributed to discontinuation of medication for these patients. Good adherence was seen among illiterate people. Treatment related factor, patient-provider relationship and patient related factor were determined as the major barrier to medication adherence. Most of the non-adherent patients had uncontrolled TSH.

A Prospective Study of Commonly Prescribed Drugs in the Management of Neuropathic Pain and its Medication Adherence Pattern.

Background Neuropathic pain is one of the common complains of patients visiting neurology and orthopedic departments in hospitals. Management of neuropathic pain is difficult and is often symptomatic rather than being curative. Adherence to medication is necessary for pain management to be effective. However, there are various factors related to patient, physician, drug regimen and other socio-economic affecting adherence. Objective To study commonly prescribed drugs in neuropathic pain management and the medication adherence pattern including its associated factors. Method Patients already diagnosed as neuropathic pain were interviewed using structured questionnaire and data entered in Microsoft Office Excel 2007. Informed consent was taken from the patients. Result Among the 84 patients in the study, 69% were females. Majority 53.6% of patients had low back pain as cause of neuropathic pain. Anticonvulsants were mostly prescribed (75%) followed by non-steroidal anti-inflammatory drugs (52.4%) and Methylcobalamin (47.6%). More than 50% (n=49) patients were not adherent to the prescribed medication and majority (61.2%) of them were housewives. Significant association was observed between patient's adherence to gender, occupation, polypharmacy, drug regimen, cost and availability of medicine. Conclusion Anticonvulsants were commonly prescribed drugs in patients with neuropathic pain. Neuropathic pain was seen more in females with low back pain. Majority of patients were non-adherent and forgetfulness was the major reason for missing dose in them.

Medication Adherence Pattern and Factors affecting Adherence in Helicobacter Pylori Eradication Therapy.

Background Helicobacter pylori (H. pylori) infection is the most common chronic bacterial infection worldwide affecting approximately half of the world's population. A number of screening tests as well as complex multi-drug therapies are available for the detection and treatment of H. pylori infection. However, the optimum eradication rates of H. pylori infection can only be achieved if adherence to drug therapy is higher. Therefore, it is of utmost importance to determine the factors leading to poor adherence to obtain successful treatment outcomes. Objective To determine the medication adherence pattern in patients with H. pylori infection and assess the factors associated with non-adherence to the prescribed drug therapy. Method Patients meeting the inclusion criteria who were confirmed as H. pylori positive by rapid urease test (histopathology) and/ or stool antigen test and those under H. pylori eradication therapy were considered. Informed consent was taken from the patients or from the patient party in incapacitated patients. They were then interviewed using structured questionnaire. Statistical analysis was done using SPSS version 20 and a p-value < 0.05 was considered as statistically significant. Result Among the 70 participants included in this study, 57.10% (n=40) of them were males. The mean (±SD) age of the patients was 42.36 years (±17.93). Higher number (85.70% (n=60)) of the patients were adherent to the recommended medication. Forgetfulness was the reason for missing dose in a majority (80% (n=8)) of the nonadherent patients. A highly significant association (p<0.05) was observed between adherence and absence of symptomatic relief. However, there was no statistically significant association (p>0.05) between patients' adherence to gender, age, literacy, and the prescribed treatment regimen. Conclusion Majority of the patients with H. pylori infection were adherent to medication. Forgetfulness was the major reason for missing dose in the non-adherent patients.

A Cross-Sectional Study of Medication Adherence Pattern and Factors Affecting the Adherence in Chronic Obstructive Pulmonary Disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is considered as a major health problem, associated with mortality and morbidities. Various disease management strategies have been established to optimize patient's longevity and functional status where patient adherence to the prescribed treatment plays a key role. Poor adherence to medication is common among COPD patients and is affected by number of factors like number of medicines, delivery devices and patient-related factors. OBJECTIVE: This study aims to investigate the adherence pattern in the management of COPD and factors affecting patient adherence to the prescribed treatment. METHOD: This study is a cross-sectional study which was conducted in a tertiary care hospital. Those patients suffering from COPD of all age were enrolled in this study and prior informed consent was obtained from patients. The structured questionnaire was used to interview those patients. RESULT: Total 100 patients were enrolled in this study, among which most patients (45%) were of age groups 60-70 years. Unintentional non-adherence to medication attributed for 65% of patients and the major reason was forgetfulness (52.3%). Most patients had discontinued the medication due to experience of side effects (63.3%). The result showed significant association between adherence and polypharmacy (p=0.00). However, there was no significant association between adherence and age, sex, mode of administration of drugs, technics to use delivery devices etc. CONCLUSION: Majority of COPD patients were elderly (mean age= 68.4 years). Forgetfulness was associated with medication non-adherence. Most of the patients had discontinued medication because of side effects. Polypharmacy is one of the major factors associated with non-adherence to medication in COPD.

Study of Pre-disposing Factors of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Antibiotic Prescribing Pattern with Reference to Antibiotic Sensitivity Test.

Background Chronic Obstructive Pulmonary Disease (COPD) affects about 329 million people worldwide, which is nearly 5% of the entire global population. In the context of Nepal, COPD accounts for 43% of the non-communicable disease burden and 2.56% of hospitalizations. Various pre-disposing factors like bacterial, viral, fungal, smoking, occupational exposures and genetic factors have been proposed to precipitate COPD and its exacerbation though, the definitive pre-disposing factors and factors related to acute exacerbation have not been determined in the context of Nepal. Objective To find out the pre-disposing factors and the related causative agents for COPD. Method A cross sectional study was conducted in a tertiary care hospital. Patients of all age group who were diagnosed as COPD and admitted in the hospital were included in this study. Patients were interviewed using structured questionnaire. The sociodemographic data including personal and medical history were recorded from those participants. In addition, sputum from those patients was sent for culture to investigate the possible responsible pathogens as well as its antibiotic sensitivity pattern. Result A total of 150 patients having Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) who have admitted from either emergency or out-patient department of the hospital were included in this study. Among the total number of patients, more than half of them were female (n=82). In addition, analysis of occupations shows that most of them were either farmer (36.0%) or housewife (30.7%). In total studied patients (n=150), most of them were using traditional firewood (83%) for cooking purpose and majority of patients (91%) were smokers. Most of the sputum samples show growth of gram-positive cocci (26.7%) and gram negative bacilli (27.5%). Considering the overall sensitivity pattern, the higher sensitivity was recorded for Co-trimoxazole and Ciprofloxacin while higher rate of resistance was noted for Penicillin group of drugs. The most widely used antibiotics were found to be Cephalosporin group of drugs (68%). Conclusion The present study revealed that the case of COPD is more in female and the commonest pre-disposing factor is found to be smoke/firewood. Cephalosporin group of drugs is the most commonly prescribed drug.

Study on Corticosteroids use Pattern in Dermatological Practice and Investigating Adverse Effect of Corticosteroids Including its Associated Factors.

Background Corticosteroids are highly effective drugs with anti-inflammatory and immunosuppressive properties. Due to this, they have become a mainstay of pharmacotherapy in dermatology. However, improper and long term uses are associated with a number of serious adverse effects. Objective To investigate the corticosteroids use pattern, adverse effects and various factors associated with adverse effects in dermatological practice. Method A cross-sectional study was conducted in a dermatology department of tertiary care hospital. All patients using at least one corticosteroids, either topically or systemically or the combination were included in this study. Informed consent was taken from the patients and interviewed using structured questionnaire. Statistical analysis was performed by using SPSS 20. p-value < 0.05 was considered as statistically significant. Result Among the 60 participants under this study, 81.67% of them were females. The mean (±SD) age of the patients was 31.03 years (±15.0). A majority (58.30%) of the patients was prescribed with topical corticosteroids with low potency (25%). Most of them had used corticosteroids for urticaria. Adverse effects were reported by 33.30% of the patients. The most common adverse effect reported was the shedding of skin. Adverse effects was significantly associated with gender; use of systemic corticosteroids; regular use of corticosteroids; discontinuation of dose abruptly; and missed dose. However, there was no significant association between adverse effects and the duration of use of corticosteroids. Conclusion In conclusion, the present study suggested that the proper counselling and clear instruction regarding the use of corticosteroid should be provided to the patients for avoiding the abrupt discontinuation of the prescribed medication leading to treatment failure.

Immune responses in neurodegenerative diseases.

Neurodegenerative disease is a progressive loss of neurons from central nervous system and has a huge impact on health care system. Various causes have been proposed of which inflammation has been suggested to be a probable key factor in the most of such conditions. The involvement of immune cells including lymphocytes in such diseased condition of the CNS supports this notion. The effective therapy for these diseases has been sought for more than a half century but still lacking such therapy. On such basis this review article has mainly focussed on evidence of the involvement of immune cells in various neurodegenerative diseases including Alzheimer's disease, Parkinson's diseases and Multiple sclerosis and suggests a possible therapy of such diseased conditions of the CNS by the modulation of immune system.

Neurotransmitter phenotypes of descending systems in the rat lumbar spinal cord.

Descending systems from the brain exert a major influence over sensory and motor processes within the spinal cord. Although it is known that many descending systems have an excitatory effect on spinal neurons, there are still gaps in our knowledge regarding the transmitter phenotypes used by them. In this study we investigated transmitter phenotypes of axons in the corticospinal tract (CST); the rubrospinal tract (RST); the lateral component of the vestibulospinal tract (VST); and the reticulospinal tract (ReST). They were labelled anterogradely by stereotaxic injection of the b subunit of cholera toxin (CTb) into the motor cortex, red nucleus, lateral vestibular nucleus and medial longitudinal fascicle (MLF) to label CST, RST, VST and ReST axons respectively. Neurotransmitter content of labelled axons was investigated in lumbar segments by using immunoflurescence; antibodies against vesicular glutamate transporters (VGLUT1 and VGLUT2) were used to identify glutamatergic terminals and the vesicular GABA transporter (VGAT) was used to identify GABA- and glycinergic terminals. The results show that almost all CST (96%) axons contain VGLUT1 whereas almost all RST (97%) and VST (97%) axons contain VGLUT2. Although the majority of ReST axons contain VGLUT2 (59%), a sizable minority contains VGAT (20%) and most of these terminals can be subdivided into those that are GABAergic or those that are glycinergic because only limited evidence for co-localisation was found for the two transmitters. In addition, there is a population of ReST terminals that apparently does not contain markers for the transmitters tested and is not serotoninergic. We can conclude that the CST, RST and VST are 'pure' excitatory systems whereas the ReST consists of a heterogeneous population of excitatory and inhibitory axons. It is anticipated that this information will enable inputs to spinal networks to be defined with greater confidence.

Inhibitory inputs to four types of spinocerebellar tract neurons in the cat spinal cord.

Spinocerebellar tract neurons are inhibited by various sources of input via pathways activated by descending tracts as well as peripheral afferents. Inhibition may be used to modulate transmission of excitatory information forwarded to the cerebellum. However it may also provide information on the degree of inhibition of motoneurons and on the operation of inhibitory premotor neurons. Our aim was to extend previous comparisons of morphological substrates of excitation of spinocerebellar neurons to inhibitory input. Contacts formed by inhibitory axon terminals were characterised as either GABAergic, glycinergic or both GABAergic/glycinergic by using antibodies against vesicular GABA transporter, glutamic acid decarboxylase and gephyrin. Quantitative analysis revealed the presence of much higher proportions of inhibitory contacts when compared with excitatory contacts on spinal border (SB) neurons. However similar proportions of inhibitory and excitatory contacts were associated with ventral spinocerebellar tract (VSCT) and dorsal spinocerebellar tract neurons located in Clarke's column (ccDSCT) and the dorsal horn (dhDSCT). In all of the cells, the majority of inhibitory terminals were glycinergic. The density of contacts was higher on somata and proximal versus distal dendrites of SB and VSCT neurons but more evenly distributed in ccDSCT and dhDSCT neurons. Variations in the density and distribution of inhibitory contacts found in this study may reflect differences in information on inhibitory processes forwarded by subtypes of spinocerebellar tract neurons to the cerebellum.

Dietary intakes of retinol, beta-carotene, vitamin D and vitamin E in the European Prospective Investigation into Cancer and Nutrition cohort.

OBJECTIVES: To describe the intake of the fat-soluble nutrients retinol, beta-carotene, vitamin E and vitamin D and their food sources among 27 redefined centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. METHODS: Between 1995 and 2000, 36,034 subjects (age range: 35-74 years) completed a single standardized 24-h dietary recall using a computerized interview software program (EPIC-SOFT). Intakes of the fat-soluble nutrients were estimated using the standardized EPIC Nutrient Database. RESULTS: For all the nutrients, in most centres, men had a higher level of intake than did women, even after adjustments for total energy intake and anthropometric confounders. Distinct regional gradients from northern to southern European countries were observed for all nutrients. The level intake of beta-carotene and vitamin E also showed some differences by level of education, smoking status and physical activity. No meaningful differences in the nutrient intake were observed by age range. CONCLUSIONS: These results show differences by study centre, gender, age and various lifestyle variables in the intake of retinol, beta-carotene, vitamin E and vitamin D between 10 European countries.