In vitro and in silico assessment of anti-biofilm and anti-quorum sensing properties of 2,4-Di-tert butylphenol against Acinetobacter baumannii.

Introduction. Acinetobacter baumannii is a nosocomial pathogen with a high potential to cause food-borne infections. It is designated as a critical pathogen by the World Health Organization due to its multi-drug resistance and mortalities reported. Biofilm governs major virulence factors, which promotes drug resistance in A. baumannii. Thus, a compound with minimum selection pressure on the pathogen can be helpful to breach biofilm-related virulence.Hypothesis/Gap Statement. To identify anti-biofilm and anti-virulent metabolites from extracts of wild Mangifera indica (mango) brine pickle bacteria that diminishes pathogenesis and resistance of A. baumannii.Aim. This study reports anti-biofilm and anti-quorum sensing (QS) efficacy of secondary metabolites from bacterial isolates of fermented food origin.Method. Cell-free supernatants (CFS) of 13 bacterial isolates from fermented mango brine pickles were screened for their efficiency in inhibiting biofilm formation and GC-MS was used to identify its metabolites. Anti-biofilm metabolite was tested on early and mature biofilms, pellicle formation, extra polymeric substances (EPS), cellular adherence, motility and resistance of A. baumannii. Gene expression and in silico studies were also carried out to validate the compounds efficacy.Results. CFS of TMP6b identified as Bacillus vallismortis, inhibited biofilm production (83.02 %). Of these, major compound was identified as 2,4-Di-tert-butyl phenol (2,4-DBP). At sub-lethal concentrations, 2,4-DBP disrupted both early and mature biofilm formation. Treatment with 2,4-DBP destructed in situ biofilm formed on glass and plastic. In addition, key virulence traits like pellicle (77.5 %), surfactant (95.3 %), EPS production (3-fold) and cell adherence (65.55 %) reduced significantly. A. baumannii cells treated with 2,4-DBP showed enhanced sensitivity towards antibiotics, oxide radicals and blood cells. Expression of biofilm-concomitant virulence genes like csuA/B, pgaC, pgaA, bap, bfmR, katE and ompA along with QS genes abaI, abaR significantly decreased. The in silico studies further validated the higher binding affinity of 2,4-DBP to the AbaR protein than the cognate ligand molecule.Conclusion. To our knowledge, this is the first report to demonstrate 2,4- DBP has anti-pathogenic potential alone and with antibiotics by in vitro, and in silico studies against A. baumannii. It also indicates its potential use in therapeutics and bio-preservatives.

Availability of access, watch, and reserve (AWaRe) group of antibiotics in community pharmacies located close to a tertiary care hospital in Lalitpur, Nepal.

INTRODUCTION: The access, watch, and reserve (AWaRe) classification of antibiotics was developed in 2019 by the WHO Expert Committee on the Selection and Use of Essential Medicines as a tool to support antibiotic stewardship efforts at local, national, and global levels. The objectives of this study were to assess the availability of antibiotics as per WHO AWaRe classification at community pharmacies located around a tertiary care hospital in Lalitpur and to compare these antibiotics with the national essential medicine list of Nepal. METHOD: The cross-sectional study was conducted at community pharmacies located within a two-kilometer radius of a teaching hospital from August to November 2022. A total of 82 community pharmacies registered with the Nepal Chemist and Druggists Association and the Department of Drug Administration were studied. Data was collected using a standard proforma containing the names of the antibiotics classified as per the WHO's AWaRe classification. RESULTS: Access group of antibiotics, Ampicillin, (82;100%), Amoxycillin, (82;100%), Flucloxacillin, (82;100%), and Metronidazole, (82;100%) were available in all community pharmacies. Results from the watch group showed that Azithromycin, (80; 97.6%) was available in all pharmacies followed by Cefixime, (80; 97.6%), Ciprofloxacin, (73; 89%), Levofloxacin, (74; 90.2%)and Ofloxacin, (74; 90.2%). Linezolid, (24; 29.3%) was the most common antibiotics available from the reserve group of antibiotics. Colistin was the second commonly available antibiotic. The most available antibiotic from the not recommended group were Ampicillin/Cloxacillin (82; 100%), followed by Piperacillin/Sulbactam, (39; 47.6%). There were differences in the classification of antibiotics between the WHO AWaRe list and the Essential Medicines list of Nepal in terms of numbers of antibiotics listed. CONCLUSION: Antibiotics from the not recommended and reserve groups were commonly available in community pharmacies. The implementation of antibiotic guidelines should be emphasized along with strict monitoring of the sale of antibiotics without a prescription in community pharmacy settings.

Pattern of drug therapy related problems encountered by clinical pharmacists in a critical care setting in Nepal

Background: Most hospitalized patients experience Drug Therapy-Related Problems (DTRPs) resulting in morbidity, mortality, and an increase in the cost of treatment. DTRPs are an important issue and a serious yet preventable problem. Objective: To identify DTRPs in the department of critical care medicine of a tertiary care center in Nepal. Methods: This was a cross-sectional study carried out at the department of critical care medicine in a tertiary care hospital in Kathmandu, Nepal from August to November 2021. All the patients admitted to ICU/ high care unit (HCU) for more than 48 hours during the study period were recruited in this study. Two clinical pharmacists visited the ICU/ HCU daily to identify any drug therapy-related problems. The Pharmaceutical Care Network Europe (PCNE) Classification system version 9.1 was referred for the classification of identified DTRPs. Descriptive statistics were applied for demographic variables. The Chi-square test was used for categorical variables. Pearson correlation was used to study the relationship between patient variables and the number and types of DTRPs. Results: DTRPs were identified in 74.2% (n=89) of patients. More than one DTRP was identified in 38.5% of patients. The identified DTRPs were primarily classified into two sections: Problems and Causes. A total of 106 problems were identified among which unnecessary drug treatment (40.5%, n=43) was the most common problem. For the causes: total of 137 were identified, out of which the drug and dose selection accounted for 44.5 and 16.8%, respectively. The average DTRP per patient was 1.5± 0.7. Antibiotics 30 (22%) and multivitamins, 10 (7%) were the maximal involved in DTRPs. More DTRPs were observed in male patients (n=60, 80%). The association between dose selection and gender was significant. Drug selection issues were observed more in patients prescribed multiple drugs and with a shorter hospital stay. (AU)

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.

Antibiotics Use in a Tertiary Care Hospital Using Point Prevalence Survey Method.

BACKGROUND: Point prevalence survey on antibiotic use developed by WHO are already in use in acute care hospitals around the world. The aim of this study was to collect prescribing of antibiotics using Point prevalence survey method in KIST Medical College and Teaching Hospital. METHODS: This was a cross sectional descriptive study and data collection was completed within 8 working days in the study site. The study was conducted among inpatients admitted at or before 8:00AM on the day of survey in various wards. Patient sampling was done as per the Point Prevalence Survey methodology. Data analysis was done and presented as frequencies and percentages. RESULTS: Out of 32 patients, maximum patients were of age group 20-30 years and 19 (59%) patients were females. Most patients, 8 (32%) were from the surgery ward. There were patients from 8 different wards including a patient who had renal transplant. Blood, sputum, urine and CSF culture were done in 11 patients, only 2 urine cultures were positive. At least one antibiotic was used among 18 patients. Ceftriaxone (34.4%) was maximally used followed by levofloxacin (3%). One or two antibiotics were used in prophylaxis with a duration of one to five days. CONCLUSIONS: WHO Point prevalence survey methodology has been used in this study. Ceftriaxone was the most commonly used antibiotics. Parenteral administration was the commonest method of administration. At least one antibiotic was used among 18 patients. There is presence of a functioning Drugs and Therapeutics Committee, Infection Prevention and Control Committee and committee on pharmacovigilance. However, many indicators for hospital infrastructure, policy and practice and monitoring and feedback were not present.

Perceptions Regarding Antimicrobial Resistance and Stewardship Programs among Healthcare Professionals.

BACKGROUND: Antimicrobial resistance is an important global problem resulting in an improper response of infections to antimicrobials and an increase in the duration and cost of treatment. Healthcare professionals play an important role in addressing Antimicrobial resistance and positive perception is important for involvement in antimicrobial stewardship policies. Hence the perception of key Healthcare professionals, including physicians, nurses, and hospital pharmacists, towards Antimicrobial resistance antimicrobial stewardship policies was studied. METHODS: A cross-sectional study was conducted in a tertiary care hospital at Lalitpur, from January to March 2021 using stratified random sampling. An online questionnaire was circulated to the selected Healthcare professionals. Median Antimicrobial resistance and antimicrobial stewardship policy scores were calculated and compared among different subgroups. Previous engagement with Antimicrobial resistance and antimicrobial stewardship policies programs was also noted. Descriptive statistics, Mann Whitney, and Kruskal Wallis tests were used for data analysis. RESULTS: The response rate was 89.3% (202/226). Antimicrobial resistance was regarded as a serious problem in the Nepali community by participants with work experience of 1-5 years, 87 (75.6%, p=0.029), and female participants, 62 (45.5%, p<0.001). Most physicians, females, and participants with working experience 1-5 years believed inappropriate use of antibiotics can harm patients and is professionally unethical. Physicians supported the availability of local antimicrobial guidelines and protocols. The median scores for Antimicrobial resistance (p<0.001) and Antimicrobial resistance eradication (p=0.048) differed according to age groups. CONCLUSIONS: Healthcare professionals believed Antimicrobial resistance was an important issue. Antibiotic guidelines developed should be strictly implemented. Healthcare professionals also believed inappropriate use of antibiotics can harm patients and is professionally unethical.

Undergraduate Medical Students' and Interns' Knowledge and Perception of Artificial Intelligence in Medicine.

Purpose: Artificial intelligence (AI) is playing an increasingly important role in healthcare and health professions education. This study explored medical students' and interns' knowledge of artificial intelligence (AI), perceptions of the role of AI in medicine, and preferences around the teaching of AI competencies. Methods: In this cross-sectional study, the authors used a previously validated Canadian questionnaire and gathered responses from students and interns at KIST Medical College, Nepal. Face validity and reliability of the tool were assessed by administering the questionnaire to 20 alumni as a pilot sample (Cronbach alpha = 0.6). Survey results were analyzed quantitatively (p-value = 0.05). Results: In total 216 students (37% response rate) participated. The median AI knowledge score was 11 (interquartile range 4), and the maximum possible score was 25. The score was higher among final year students (p = 0.006) and among those with additional training in AI (p = 0.040). Over 49% strongly agreed or agreed that AI will reduce the number of jobs for doctors. Many expect AI to impact their specialty choice, felt the Nepalese health-care system is ill-equipped to deal with the challenges of AI, and opined every student of medicine should receive training on AI competencies. Conclusion: The lack of coverage of AI and machine learning in Nepalese medical schools has resulted in students being unaware of AI's impact on individual patients and the healthcare system. A high perceived willingness among respondents to learn about AI is a positive sign and a strong indicator of futuristic successful curricula changes. Systematic implementation of AI in the Nepalese healthcare system can be a potential tool in addressing health-care challenges related to resource and manpower constraints. Incorporating topics related to AI and machine learning in medical curricula can be a useful first step.

Assessment of knowledge, attitude, and practice of disposing and storing unused and expired medicines among the communities of Kathmandu, Nepal.

BACKGROUND: Unused medicines can be stored by many people at their places of residence and houses for later use. This study evaluated knowledge, and attitudes regarding unused and expired medicines and explored medicine storage and disposal practices among selected households in the Kathmandu valley, Nepal. METHOD: A cross-sectional study with a two-stage cluster survey design was done using a semi-structured questionnaire from April to October 2021. The sample size (total number of households) after adjusting for design effect and non-response rate was 210 and the study population was the household heads. Simple random sampling was done to select clusters during the first stage and systematic random sampling to select households during the second stage. Descriptive statistics and t-test/one-way ANOVA were used to compare the respondents' average knowledge scores. Practice variables were presented using frequency distribution. RESULTS: Around half the respondents were from the Kathmandu district, nearly 20% were from Bhaktapur and 30% were from Lalitpur. Nearly two-thirds were male and about 25% had a bachelor's degree. Nearly 90% of respondents agreed that storage of excess medicines at home may promote self-medication. Similarly, 97.6% of respondents agreed there is a lack of adequate information on the safe disposal of unused medicines. The majority [125 (59.5%)] of participants always checked the expiry date of medicines. The safe methods of medicine disposal were not known by 137 (65.2%) participants. Throwing in a dustbin was the preferred method of expired medicine disposal. CONCLUSION: The level of knowledge and practice of disposing of unused and expired medicines requires improvement. Educational interventions may help improve awareness further. Creating a chart summarizing disposal procedures of common medicines is important. Similar studies in other regions are required.

Adverse Events Following the First Dose of Immunization of COVID-19 Vaccine.

BACKGROUND: The COVID-19 pandemic has challenged the entire globe and the need for a vaccine is supreme. Since many vaccines along with Covishield have been granted emergency use authorization, the evaluation and monitoring of safety are crucial. Covishield was rolled out in Nepal on January 27, 2021. So through this study, we aim to identify the prevalence of Adverse Events Following Immunization in general with the first dose of Covishield vaccine, compare Adverse Events Following Immunization in prior COVID-19 positive cases and Adverse Events Following Immunization in co-morbid individuals. METHODS: This was a descriptive cross-sectional study conducted in 440 sample from May 2021 till July 2021 in a provincial government hospital of western Nepal. Ethical approval was received from Ethical Review Board, Nepal Health Research Council (Registration no: 279/2021 P). Simple random sampling was used. Point estimate was done at 95% confidence interval and descriptive analysis was done to identify the prevalence of Adverse Events Following Immunization within one week after Covishield vaccination in the studied population. RESULTS: 79.77% of the study population complaint at least one or more Adverse Events Following Immunization. Fever, myalgia, headache, pain at the injection site, arthralgia, chills, and fever are the most common Adverse Events Following Immunization. 42.73% of the study population self-medicated to manage Adverse Events Following Immunization, 7.89% took leave from work while 0.28% needed medical attention. No major Adverse Events Following Immunization relevance with prior-COVID history or co-morbidity was seen. CONCLUSIONS: Majority of the vaccinated participants had minor adverse effects on the first-day post-vaccination while most of the Adverse Events Following Immunization subsided within seven days.

Readiness for Interprofessional Learning Among First Year Medical and Dental Students in Nepal.

Introduction: Health professional education curricula in Nepal do not include interprofessional education (IPE). Though a previous study conducted in Nepal identified positive attitudes among medical and nursing students, so far there are no studies assessing the health professional students' readiness toward IPE. The aim of the study was to assess the readiness for IPE among medical and dental students. Methods: The present cross-sectional study explored the readiness of conveniently selected first-year medical and dental students towards IPE and compared readiness among subgroups of respondents. The readiness was assessed through an online survey using the standard Readiness for Interprofessional Learning Scale (RIPLS) during June 2021. The nineteen questions in RIPLS were categorized under four domains: teamwork and collaboration (items 1-9), negative professional identity (items 10-12), positive professional identity (items 13-16), and roles and responsibilities (items 17-19). The individual statements were scored and assessed as per the study objectives. The scores were not normally distributed, so non-parametric tests (Mann-Whitney U-test and Kruskal Wallis test) were used. Results: A total of 83 students (69 medical and 14 dental) students responded. The median total score was 75, IQR 6 with the maximum score being 95. The median (IQR) scores for the domains teamwork and collaboration were 38 (IQR 3), negative professional identity 11 (IQR 2), positive professional identity 16 (IQR 3), roles and responsibilities 10 (3). The scores were different between students aged 20 years and below = 37, and above 20 years = 38; (p =< 0.001) in the negative professional identity domain and the total score (p = 0.001). The scores were also different among those with and without previous learning exposure with other discipline students in the same class (p = 0.046). A high median score of 5 was achieved for 8 out of 19 statements in the questionnaire. Conclusion: The findings showed a high level of readiness for IPE among student respondents. Study findings can be considered as a positive factor for implementing IPE sessions.

Knowledge of community pharmacists in the Kathmandu Valley, Nepal about the risks associated with medication use during pregnancy.

BACKGROUND: Community pharmacists are among the most accessible health care providers. OBJECTIVE: This study evaluates the knowledge of community pharmacists about the risks associated with medication use during pregnancy. METHODS: A cross-sectional study was carried out in March 2021 among the 344 community pharmacies in the Kathmandu Valley, Nepal. Convenience sampling was used for data collection using a structured and validated questionnaire. RESULTS: The majority of participants were male: 264 (76.7%), 94.2% were between the age of 21 to 30 years, and 53.1% had work experience of less than one year. Over half had completed diploma in pharmacy. Less than 10 medicines were dispensed to pregnant women daily in 61.6% of the pharmacies. Only 28.8% of the community pharmacists always inquired about pregnancy status from women in the reproductive age group. The median knowledge score was significantly different among individuals with different work experience and qualifications (p < 0.001). There was also difference in median scores according to average number of medicines dispensed daily (p = 0.006). The knowledge score also differed according to average number of medicines dispensed to pregnant woman and inquiry by the pharmacist about pregnancy status (p < 0.001). CONCLUSION: Our study revealed that the median knowledge scores need improvement.

Antibiotics Use in Hospitalised COVID-19 Patients in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Antimicrobial resistance is a global health problem. The widespread and improper antibiotics use is the leading cause of antimicrobial resistance. Bacterial co-infection in COVID-19 patients is the basis for the use of antibiotics in the management of COVID-19. COVID-19 pandemic has seriously impacted antibiotic stewardship and increased the global usage of antibiotics, worsening the antimicrobial resistance problem. The use of antibiotics among COVID-19 patients is high but there are limited studies in the context of Nepal. This study aimed to find out the prevalence of antibiotic use among hospitalised COVID-19 patients in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted on hospitalised COVID-19 patients from April 2021 to June 2021 in a tertiary care centre. Ethical approval was taken from the Institutional Review Committee (Reference number: 2078/79/05). The hospital data were collected in the proforma by reviewing the patient's medical records during the study period of 2 months. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 106 hospitalised COVID-19 patients, the prevalence of antibiotic use was 104 (98.11%) (95.52-100, 95% Confidence Interval). About 74 (71.15%) of patients received multiple antibiotics. The most common classes of antibiotics used were cephalosporins, seen in 85 (81.73%) and macrolides, seen in 57 (54.81%) patients. Conclusions: The prevalence of antibiotic use among hospitalised COVID-19 patients was found to be higher when compared to other studies conducted in similar settings. Keywords: antibiotics; bacterial infection; co-infection; COVID-19.

Knowledge and Practice on Ecopharmacovigilance and Medicine Storage Amongst Medical and Dental Students in Lalitpur, Nepal.

BACKGROUND: Medicines may remain unused and often get expired. Unused medicines can promote self-medication. Unsafe and improper medicine disposal can cause significant environmental harm. Medical and dental students as future prescribers should be aware of the safe disposal of medicines, ecopharmacovigilance and self-medication. The present study examines knowledge and practice about unused and expired medicines and medicine disposal among undergraduate medical and dental students in Nepal. METHODS: The study was conducted during September 2020 using an online survey form. First to final year undergraduate students provided their consent and signed an integrity pledge electronically. Age, gender, program of study, year of study, whether staying with family or not, method of financing education, and whether they had used any allopathic medicines during the past 6 months were noted. The total knowledge score among different subgroups was compared. The frequency of responses regarding practice items and the free-text comments were also listed. Statistical analysis was performed using Mann-Whitney test and Kruskal-Wallis test. RESULTS: Altogether 441 of the 668 students (66%) participated. The majority were below 23 years and female. Over 65% had used allopathic medicines during the last 6 months. The median knowledge score was 8 (maximum 10) and was significantly higher among older respondents, females and students in later years of study. Most kept unused medicines at home/hostel till expiry which were disposed of in the household garbage. Over 40% had educated their family members about safe medicine disposal. Knowledge scores were significantly different among subgroups according to respondents' age, gender and year of study. CONCLUSION: Respondents were aware of expiry of medicines and knew methods to safely dispose expired medicines. However, they practiced self-medication, stored medications at home and did not practice the safe disposal of medications. Understanding why respondents did not dispose medicines properly is important.

Knowledge about the COVID-19 pandemic among undergraduate medical and dental students in Lalitpur, Nepal.

Background: Coronavirus disease-19 (COVID-19) has become a major global problem. There is an urgent need to measure the knowledge of the disease among health science students who can play an active role in pandemic control. The research was conducted to examine COVID-19 knowledge among medical and dental students in a Nepalese medical college, compare the knowledge to other studies in the literature and identify educational needs of students who may be involved in treating COVID-19 patients. Methods: The cross-sectional study was performed during the third week of June among first to final year medical and dental students. As the country was in lockdown, a structured online questionnaire was used. The responses obtained were entered into IBM SPSS Statistics for Windows and the normality of the data checked using one-sample Kolmogorov Smirnov test. The demographic parameters were tabulated, and total score compared among different subgroups of participants. The frequency of different measures mentioned by respondents were also noted. Results: More than half of the participants were females (59.6%). Nearly half 282 (49.8%) belonged to age group 21-23 years. The majority 415 (73.5%) were undergraduate medical and 150 (26.5%) were undergraduate dental students. The largest number of respondents, 140 (24.9%), were from the second year of study and 344 (60.9%) were from urban areas. The median total score was 20 and the interquartile range 4. The maximum possible score was 29. The scores among students belonging to different years of study were significantly different (p=0.006). Total scores were not significantly different among other subgroups. Conclusions: The knowledge of the participants was good. Deficiencies in knowledge were noted in certain areas and these should be addressed through an educational intervention. One of the challenges is the rapid evolution of our knowledge about this condition, which may require regular refresher sessions. Similar studies can be undertaken in other medical colleges in the country and in nursing and pharmacy colleges.

Mean Knowledge Score of Self-Medication among First and Second Year Medical and Dental Students in a Medical College: A Descriptive Cross-sectional Study.

INTRODUCTION: Self-medication is common among medical students. Medical and dental students can also educate the population about the use of medicines. The aim of the study was to find the mean knowledge score of self-medication among first and second year medical and dental students at a medical college in Nepal. METHODS: A descriptive cross-sectional study was carried out in a medical college from 1st to 28th February 2021 using a structured online questionnaire after obtaining approval from the Institutional Review Committee (approval number 077/78/32). Convenience sampling method was undertaken. The responses were analyzed using Statistical Package for Social Sciences version 26. RESULTS: Out of 173 students the mean±SD knowledge score was 79.47±6.76. The mean knowledge score of the participants of age group 17-18, 19-20 and 21-22 years were 83.8, 79 and 79.1 respectively. The mean knowledge scores of the male and female participants were 80.2 and 78.6 respectively. Similarly, the knowledge scores of respondents from undergraduate medical and dental backgrounds were 80.1 and 77.7 respectively. CONCLUSIONS: Knowledge of self-medication was high among the students. However, educational sessions to further improve and strengthen knowledge can be carried out to improve the knowledge.

Knowledge, awareness and preparedness regarding coronavirus disease 2019 pandemic among community pharmacy practitioners working in Kathmandu, Nepal: A pilot study.

Good knowledge, awareness and preparedness regarding coronavirus disease 2019, among community pharmacy practitioners (CPPs), will enable them to provide correct information and support to patients, convey instructions from the public health authorities and protect their own health. OBJECTIVE: The aim of this study was to determine knowledge, awareness and preparedness regarding coronavirus disease 2019 among CPPs working in Kathmandu, Nepal. METHODS: A cross-sectional study was conducted using a convenience sampling method from 10 February to 25 March 2020. Data were analysed descriptively, and one-sample independent t-test and one-way analysis of variance were used to compare scores among different subgroups of respondents (p < 0.05). Post hoc analyses (following analysis of variance) were done using the Bonferroni test. RESULTS: A total of 81 CPPs participated. Mean ± standard deviation age was 26.70 ± 5.29 years. Majority of the respondents were male (64.2%). Many CPPs (40.7%) had work experience between 1 and 5 years. Almost half (45.7%) had an educational qualification of Diploma in Pharmacy. Significant differences in knowledge (p = 0.022) and preparedness (p < 0.001) were found among individuals with differing levels of work experience. Similarly, a significant difference was found between knowledge-preparedness and work experience (p = 0.022 and p < 0.001), location of pharmacy (p < 0.001) and educational qualification (p = 0.031). Awareness (p < 0.001) and preparedness scores (p = 0.049) were different among community pharmacies with the different number of medicines available. CONCLUSION: Knowledge was found to be higher in CPPs with a work experience of more than 5 years. CPPs working at larger community pharmacies were more aware and prepared. CPPs' knowledge, awareness and preparedness should be evaluated more widely and strengthened.

Molecular evaluation of quorum quenching potential of vanillic acid against Yersinia enterocolitica through transcriptomic and in silico analysis.

Introduction. Yersinia enterocolitica is one of the leading food-borne entero-pathogens causing various illnesses ranging from gastroenteritis to systemic infections. Quorum sensing (QS) is one of the prime mechanisms that control the virulence in Y. enterocolitica.Hypothesis/Gap Statement. Vanillic acid inhibits the quorum sensing and other virulence factors related to Y. enterocolitica. It has been evaluated by transcriptomic and Insilico analysis. Therefore, it can be a prospective agent to develop a therapeutic combination against Y. enterocolitica.Aim. The present study is focused on screening natural anti-quorum-sensing agents against Y. enterocolitica. The effect of selected active principle on various virulence factors was evaluated.Methodology. In total, 12 phytochemicals were screened by swarming assay. MATH assay, EPS and surfactant production assay, SEM analysis, antibiotic and blood sensitivity assay were performed to demonstrate the anti-virulence activity. Further, RNA sequencing and molecular docking studies were carried out to substantiate the anti-QS activity.Results. Vanillic acid (VA) has exhibited significant motility inhibition, thus indicating the anti-QS activity with MQIC of 400 µg ml-1 without altering the cell viability. It has also inhibited the violacein production in Chromobacterium violaceum ATCC 12472, which further confirms the anti-QS activity. VA has inhibited 16 % of cell-surface hydrophobicity (CSH), 52 % of EPS production and 60 % of surfactant production. Moreover, it has increased the sensitivity of Y. enterocolitica towards antibiotics. It has also made the cells upto 91 % more vulnerable towards human immune cells. The transcriptomic analysis by RNA sequencing revealed the down regulation of genes related to motility, virulence, chemotaxis, siderophores and drug resistance. VA treatment has also positively regulated the expression of several stress response genes. In furtherance, the anti-QS potential of VA has been validated with QS regulatory protein YenR by in silico molecular simulation and docking study.Conclusion. The present study is possibly the first attempt to demonstrate the anti-QS and anti-pathogenic potential of VA against Y. enterocolitica by transcriptomic and in silico analysis. It also deciphers that VA can be a promising lead to develop biopreservative and therapeutic regimens to treat Y. enterocolitica infections.

Critical Evaluation of Drug Advertisements in a Medical College in Lalitpur, Nepal.

PURPOSE: The information provided in drug advertisements (DAs) often do not follow the recommended criteria and may promote irrational prescribing behaviors. Recently Health Action International (HAI) formulated detailed criteria to evaluate DAs which further develop and expand on the World Health Organization (WHO) criteria. This study was done to evaluate DAs using both criteria. METHODS: The study was carried out from October 2019 to January 2020 in the Department of Pharmacology of KIST Medical College, Lalitpur, Nepal. A structured proforma was used to collect data. RESULTS: Altogether 100 DAs were analyzed. Maximum (85%) were having pictorial presentations. Majority (89%) were found to have authentic information and 3% were found to have exaggerated information. All DAs mentioned generic name, brand name, active drug per dosage form and approved therapeutic uses. Only 4% of DAs mentioned about the adverse effects that can be caused by the use of these medicines. The DAs evaluated as per the HAI criteria for pictures and images showed that people portrayed did not seem to be Nepalese. Females and males were portrayed differently with females being laypersons and males being healthcare professionals. Nineteen DAs contained 33 references to scientific literature. Thirty references contained adequate citation information to be identified and were retrievable. Retrieved references were of high methodological quality and from peer-reviewed journals. There was only one graph in the DAs and it contained the number needed to treat (NNT) information. The graph was not having statistical calculations and was not obscured by other visual material. CONCLUSION: Using both HAI and WHO criteria for assessing the DAs was the strength of this study. None of the DAs fulfilled all the criteria. Additionally, lack of any information on harm in the large majority of DAs, and very limited backing of claims with references was also seen.