Genetic mapping and transcriptome profiling of a chickpea (Cicer arietinum L.) mutant identifies a novel locus (CaEl) regulating organ size and early vigor.

Chickpea is among the top three legumes produced and consumed worldwide. Early plant vigor, characterized by good germination and rapid seedling growth, is an important agronomic trait in many crops including chickpea, and shows a positive correlation with seed size. In this study, we report a gamma-ray-induced chickpea mutant with a larger organ and seed size. The mutant (elm) exhibits increased early vigor and contains higher proline that contributes to a better tolerance under salt stress at germination, seedling, and early vegetative phase. The trait is governed as monogenic recessive, with wild-type allele being incompletely dominant over the mutant. Genetic mapping of this locus (CaEl) identified it as a previously uncharacterized gene (101503252) in chromosome 1 of the chickpea genome. There is a deletion of this gene in the mutant with a complete loss of expression. In silico analysis suggests that the gene is present as a single copy in chickpea and related legumes of the galegoid clade. In the mutant, cell division and expansion are affected. Transcriptome profiling identified differentially regulated transcripts related to cell division, expansion, cell wall organization, and metabolism in the mutant. The mutant can be exploited in chickpea breeding programs for increasing plant vigor and seed size.

Self-medication practice among preclinical university students in a medical school from the city of Pokhara, Nepal.

BACKGROUND: In developing countries like Nepal medicines can be acquired from the chemist's without of a prescription which sometime may have many drawbacks due to intake of excessive drugs without a proper diagnosis. The primary objective of the study was to find out the pattern of self-medication practice among the preclinical medical students at Manipal College of Medical Sciences. MATERIALS AND METHODS: This was a cross sectional study carried out using structured questionnaire at Manipal College of Medical Sciences, Pokhara, Nepal between November 2012- July 2014. RESULTS: The overall response rate of this study was 95.31%. 81.35% of the students were practicing self-medication in this institution. Most common group of drugs that were consumed were antipyretics 31%, antibiotics 26.2%, analgesics 18.89%, antihistaminics 10.1% respectively. Paracetamol was the most common drug used for self-medication 31%, followed by Azithromycin 17.6% and combination of Paracetamol and Ibuprofen 15.6%, Cetirizine 8.6%, Amoxicillin 6.5%, Omeprazole 6.3%, Albendazole 3.3%, Mefenemic acid 2.8%, Cefpodoxime2% respectively. CONCLUSION: Medical student should be educated through awareness programme regarding pros and cons of self-medication practice and they should be motivated regarding the rationale use of antibiotics. .

A survey exploring the knowledge and perceptions of senior medical students in Nepal toward generic medicines.

BACKGROUND: The accurate knowledge of generic medicine issues among future prescribers will enhance the prescribing of cost-effective medicines. This study aimed to explore the knowledge and perception of senior medical students about the generic medicines. METHODOLOGY: A cross-sectional study was conducted among 237 senior medical students (final year students and interns) using a validated self-administered questionnaire. The collected data were analyzed using Statistical Package for the Social Sciences version 20 for windows and comparison of difference was done using linear by linear association. A p value of less than 0.05 was taken as statistically significant. RESULTS: The average age (standard deviation) of the respondents was 23.54 (1.39) years. Almost 5% of respondents correctly answered the question regarding the regulatory limits for bioequivalence. Almost two-thirds of respondents correctly agreed that generic medicine is bioequivalent to a brand-name medicine, and 79.3% and 72.5% of respondents correctly agreed that the medicine should be present in the same dosage form and same dose, respectively, as the brand-name medicines. However, almost half of the respondents had impression that brand-name medicines are required to meet higher safety standard than generic medicines. Almost 90% of respondents felt that advertisement by the drug companies would influence the use of brand-name medicine and they need more information about generic medicine. CONCLUSION: This study highlights the negative perception and knowledge deficit among the respondents. The students' responses to almost all the statements were almost similar to the respondents' academic year (final year students and interns), gender and nationality.

Repeat length variation in the 5'UTR of myo-inositol monophosphatase gene is related to phytic acid content and contributes to drought tolerance in chickpea (Cicer arietinum L.).

Myo-inositol metabolism plays a significant role in plant growth and development, and is also used as a precursor for many important metabolites, such as ascorbate, pinitol, and phytate. Phytate (inositol hexakisphosphate) is the major storage pool for phosphate in the seeds. It is utilized during seed germination and growth of the developing embryo. In addition, it is implicated in protection against oxidative stress. In the present study, a panel of chickpea accessions was used for an association analysis. Association analysis accounting for population structure and relative kinship identified alleles of a simple sequence repeat marker, NCPGR90, that are associated with both phytic acid content and drought tolerance. These alleles varied with respect to the dinucleotide CT repeats present within the marker. NCPGR90 located to the 5'UTR of chickpea myo-inositol monophosphatase gene (CaIMP) and showed transcript length variation in drought-tolerant and drought-susceptible accessions. CaIMP from a drought-tolerant accession with a smaller repeat was almost 2-fold upregulated as compared to a susceptible accession having a longer repeat, even under control non-stressed conditions. This study suggests an evolution of simple sequence repeat length variation in CaIMP, which might be regulating phytic acid levels to confer drought tolerance in natural populations of chickpea.

Knowledge, Attitude and Practice of Self-Medication Among Basic Science Undergraduate Medical Students in a Medical School in Western Nepal.

INTRODUCTION: Studies have shown self-medication to be common among medical students. These studies are however, few in Nepal. The present study assessed knowledge, attitude, and practice of self-medication among second and fourth semesters' undergraduate medical students and studied differences in knowledge and attitude (if any) among different subgroups of the respondents. MATERIALS AND METHODS: A cross-sectional survey was conducted using a questionnaire among basic science medical students of Manipal College of Medical Sciences, Nepal. Semester of study, gender, age, nationality, and the profession of their parents were noted. Students' knowledge and attitude about self-medication was studied by noting their degree of agreement with a set of 40 statements using a Likert-type scale. The average scores and frequency of occurrence of particular behaviors among different categories of respondents were compared using appropriate statistical tests. RESULTS: Two hundred and seventy-six of the 295 (93.6%) students participated. The mean (SD) knowledge, attitude, and total scores were 74.54 (6.92), 67.18 (5.68), and 141.73 (10.76) with maximum possible scores 100, 100 and 200, respectively. There was no significant difference in scores according to respondents' gender, age, and the profession of their parents. However, the mean knowledge, attitude and total scores were significantly different among students of different nationalities. Mean scores of fourth semester students were significantly higher compared to second semester students. There were differences in knowledge and total scores among students of different nationalities. Eighty two percent of respondents had self-medicated during the one year period preceding the study; 149 respondents (54%) shared that previous experience with the medicine was one of the information sources for self-medication. Prevalence of self-medication among respondents according to semester of study, gender, age, and profession of the parents was not significantly different. The use of self-medication was more common among Sri Lankan respondents compared to Nepalese. Painkillers (73.2%), antipyretics (68.8%), and antimicrobials (56.2%) were most commonly used for self-medication. CONCLUSION: Students' knowledge and attitude about self-medication is good. The prevalence of self-medication among medical students was high.

Pharmacotherapy of Bipolar Affective Disorder: A Hospital based Study from Sub Himalayan Valley of Nepal.

INTRODUCTION: In Bipolar disorder the mood of the patients fluctuates between depression and mania. The main objective of the study was to find out the commonest mood stabilizers used for the treatment of Bipolar affective disorders in Western Nepal in hospitalized patients in an actual clinical set up. METHODS: This was a cross-sectional study which was conducted between October 2009 and September 2010 at Psychiatric ward at Manipal teaching hospital, Pokhara, Nepal, a tertiary care hospital situated in Western Nepal. The diagnosis of the disease was based on ICD-10 (Tenth revision) Classification of mental and Behavioural disorders, Diagnostic Criteria for Research. We calculated odds ratio and their 95% confidence intervals (95% CI). p< 0.05 was considered as statistically significant. RESULTS: 62.1% of the patients were less than 40 yrs, 56.3% were male, 72.4% were unemployed and 75.9% of the patients were having monthly income <10,000/month. As far as ethnicity is concerned 37.9% of the cases were Brahmin and by occupation 29.9% of the patients were students followed by housewife 25.3%, labour 17.2%, retired 13.8% respectively. Drugs and Psychotherapy [OR 1.4, 95% (CI 0.575, 3.4017)] was prescribed in age <40 years as compared to age>40 yrs. Male patients [OR 7.22, 95% (CI 0.862, 60.499)] and [OR 2.353, 95% (CI 0.857, 6.455)] received drugs by trade names and drugs not from the national drug list of Nepal as compared to females. Monthly income <10,000/month and [OR 2.8, 95% (CI 0.742, 10.56)] tendency of receiving drugs by trade names. Among the mood elevators Sodium valproate was the commonest drug to be prescribed in 51/87(58.6%) patients followed by Lithium in 30/87 (34.5%) cases and Carbamazepine in 6/87 (6.9%) cases. Sodium valproate was prescribed at 1,000 mg/day, Lithium was prescribed at 900 mg/day in and Carbamazepine was prescribed at 800 mg/day. CONCLUSION: Among all the mood elevators Sodium valproate is the commonest drug prescribed for the treatment of bipolar affective disorder, recommended that there is a trend of using newer drugs like sodium valproate rather than the conventional mood stabilizers like Lithium for bipolar affective disorder in Western Development region of Nepal.

A case of ichthyosis hystrix: unusual manifestation of this rare disease.

Ichthyosis hystrix is a term used to describe an ichthyosiform dermatosis which is characterized by hyperkeratotic spiny scales mainly over extensor aspects of limbs with palmoplantar keratoderma and occasionally associated with deafness and neurological deficit. It is a rare autosomal dominant form of ichthyosis and very few cases are reported in literature. We are presenting a 46 years-old-male patient of ichthyosis hystrix with unusual presentation. He had lesions mainly over the face and scalp with palmoplantar keratoderma and significant nail changes.

Socio demographic profile and utilization pattern of antipsychotic drugs among schizophrenic inpatients: a cross sectional study from western region of Nepal.

BACKGROUND: Currently a large number of atypical antipsychotics available in the market are endorsed as better option for treating schizophrenia than the typical antipsychotics. Information regarding the utilization pattern of antipsychotic drugs is lacking in Nepalese population particularly in Western Nepal. By means of this study one is expected to acquire an idea concerning clinician's preference to the antipsychotic drugs in actual clinical setup. The main objective of the study was to find the commonest antipsychotics prescribed in a tertiary care center among hospitalized patients in Western Nepal. METHODS: This cross sectional study was carried out between 1st January 2009 and 31th December 2010 at Manipal Teaching Hospital, Nepal. The diagnosis of schizophrenia was based on ICD-10 (Tenth revision).The main outcome variables of the study was commonest antipsychotic drug prescribed. Z test, Chi square test and logistic regression were used for analytical purpose. P-value < 0.05 was considered to be statistically significant. This is the first study done on the utilization pattern of antipsychotics drugs among hospitalized patients in Nepal. RESULTS: Out of 210 cases of schizophrenia, most of the patients were less than 40 yrs. 78.6%, male 61.9%, unemployed 86.7% and having their monthly income less than NPR 10000 /month 80.5%. As far as religion, 78.1% patients were the Hindus and ethnically schizophrenia was common among the Dalit 26.2%. The study revealed that 46.2% of patients were students followed by 25.2% of housewives. Olanzapine was the commonest antipsychotic drug to be prescribed 34.3%. It was observed that the psychiatrists had a tendency of using antipsychotic drugs by trade names [OR 3.3 (1.407, 8.031)] in male patients as compared to female patients. CONCLUSION: According to the utilization pattern of antipsychotics, it is concluded that atypical antipsychotics were used relatively more commonly than that of typical antipsychotics. Among the atypical antipsychotic drugs, there is a trend of using Olanzapine during Schizophrenia as compared to other atypical antipsychotic drugs in Western Nepal.

Evaluation of transgenic tobacco plants expressing a bacterial Co-Ni transporter for acquisition of cobalt.

Phytoremediation is a viable strategy for management of toxic wastes in a large area/volume with low concentrations of toxic elemental pollutants. With increased industrial use of cobalt and its alloys, it has become a major metal contaminant in soils and water bodies surrounding these industries and mining sites with adverse effects on the biota. A bacterial Co-Ni permease was cloned from Rhodopseudomonas palustris and introduced into Nicotiana tabacum to explore its potential for phytoremediation and was found to be specific for cobalt and nickel. The transgenic plants accumulated more cobalt and nickel as compared to control, whereas no significant difference in accumulation of other divalent ions was observed. The transgenic plants were evaluated for cobalt content and showed increased acquisition of cobalt (up to 5 times) as compared to control. The plants were also assessed for accumulation of nickel and found to accumulate up to 2 times more nickel than control. At the same initial concentration of cobalt and nickel, transgenic plant preferentially accumulated cobalt as compared to nickel. The present study is perhaps the first attempt to develop transgenic plants expressing heterologous Co transporter with an improved capacity to uptake cobalt.

[The ABC of abscisic acid action in plant drought stress responses]. / Mécanisme moléculaire d'action de l'acide abscissique en réponse à la sécheresse chez les végétaux.

The combined daily consumption of fresh water ranges from 200 to 700 liters per capita per day in most developed countries, with about 70% being used for agricultural needs. Unlike other resources such as the different forms of energy, water has no other alternatives. With the looming prospect of global water crisis, the recent laudable success in deciphering the early steps in the signal transduction of the "stress hormone" abscisic acid (ABA) has ignited hopes that crops can be engineered with the capacity to maintain productivity while requiring less water input. Although ABA was first discovered in plants, it has resurfaced in the human brain (and many other non-plant organisms : sea sponge, some parasites, hydra to name a few), suggesting that its existence may be widespread. In humans, more amazingly, ABA has shown anti-inflammatory and antiviral properties. Even its receptors and key signaling intermediates have homologs in the human genome suggesting that evolution has re-fashioned these same proteins into new functional contexts. Thus, learning about the molecular mechanisms of ABA in action using the more flexible plant model will be likely beneficial to other organisms, and especially in human diseases, which is topical in the medical circle. ABA can accumulate up to 10 to 30-fold in plants under drought stress relative to unstressed conditions. The built up of the hormone then triggers diverse adaptive pathways permitting plants to withstand temporary bouts of water shortage. One favorite experimental model to unravel ABA signaling mechanisms in all of its intimate detail is based on the hormone's ability to elicit stomatal closure - a rapid cellular response of land plants to limit water loss through transpiration. Each microscopic stoma, or pore, is contoured by two specialized kidney-shaped cells called the guard cells. Because land plants are protected by a waxy cuticle impermeable to gas exchange, the stomatal pores are thus the primary portals for photosynthetic CO(2) uptake. Drought, by biasing pathways that lead to rapid closure of these pores, has therefore a negative impact on photosynthesis, and consequently, biomass as well. The stomatal aperture widens and narrows by expansion and contraction, respectively, of these flanking guard cells caused by changes in the intracellular concentrations of ion fluxes. These transport mechanisms most likely share fundamental principles with any excitable cell. These events require coordination of channels, vacuolar and membrane transporters that generate a specific pattern of electrical signals that relay the ABA stimulus. Research on ABA begun in the 1960's has now been crowned by the achievement of having identified the soluble ABA receptor that turns on and off the activities of a kinase/phosphatase pair, as the heart of the signaling complex. Results distilled from the latest structural studies on these ABA receptors, characterized by the so-called START domain, are beginning to tender the most exciting promise for rational design of agonists and antagonists towards modulating stress adaptive ability in plants. This review will chart the recent extraordinary progress that has enlightened us on how ABA controls membrane transport mechanisms that evoke the fast stomatal closing pathway.

A brand new START: abscisic acid perception and transduction in the guard cell.

The soluble receptors of abscisic acid (ABA) have been identified in Arabidopsis thaliana. The 14 proteins in this family, bearing the double name of PYRABACTIN RESISTANCE/PYRABACTIN-LIKE (PYR/PYL) or REGULATORY COMPONENTS OF ABA RECEPTOR (RCAR) (collectively referred to as PYR/PYL/RCAR), contain between 150 and 200 amino acids with homology to the steroidogenic acute regulatory-related lipid transfer (START) protein. Structural studies of these receptors have provided rich insights into the early mechanisms of ABA signaling. The binding of ABA to PYR/PYL/RCAR triggers the pathway by inducing structural changes in the receptors that allows them to sequester members of the clade A negative regulating protein phosphatase 2Cs (PP2Cs). This liberates the class III ABA-activated Snf1-related kinases (SnRK2s) to phosphorylate various targets. In guard cells, a specific SnRK2, OPEN STOMATA 1 (OST), stimulates H(2)O(2) production by NADPH oxidase respiratory burst oxidase protein F and inhibits potassium ion influx by the inward-rectifying channel KAT1. OST1, the kinase CPK23, the calcium-dependent kinase CPK21, and the counteracting PP2Cs modulate the slow anion channel SLAC1, a pathway that contributes to stomatal responses to diverse stimuli, including ABA and carbon dioxide. A minimal ABA response pathway that leads to activation of the SLAC1 homolog, SLAH3, and presumably stomatal closure has been reconstituted in vitro. The identification of the soluble receptors and core components of the ABA signaling pathway provides promising targets for crop design with higher resilience to water deficit while maintaining biomass.

Abscisic acid signal off the STARting block.

The year 2009 marked a real turnaround in our understanding of the mode of abscisic acid (ABA) action. Nearly 25 years had elapsed since the first biochemical detection of ABA-binding proteins in the plasmalemma of Vicia guard cells was reported. This recent--and laudable--achievement is owed largely to the discovery of the soluble ABA receptors whose major interacting proteins happen to be some of the most well-established components of earliest steps in ABA signaling. These soluble receptors, with the double name of PYRABACTIN RESISTANCE (PYR) or REGULATORY COMPONENT OF ABA RECEPTOR (RCAR), are a family of Arabidopsis proteins of about 150-200 amino acids that share a conserved START domain. The ABA signal transduction circuitry under non-stress conditions is muted by the clade A protein phosphatases 2C (PP2C) (notably HAB1, ABI1, and ABI2). During the initial steps of ABA signaling, the binding of the hormone to the receptor induces a conformational change in the latter that allows it to sequester the PP2Cs. This excludes them from the negative regulation of the downstream ABA-activated kinases (OST1/SnRK2.6/SRK2E, SnRK2.2, and SnRK2.3), thus unleashing the pathway by freeing them to phosphorylate downstream targets that now include several b-ZIP transcription factors, ion channels (SLAC1, KAT1), and a NADPH oxidase (AtrbohF). The discovery of this family of soluble receptors and the rich insight already gained from structural studies of their complexes with different isoforms of ABA, PP2C, and the synthetic agonist pyrabactin lay the foundation towards rational design of chemical switches that can bolster drought hardiness in plants.

Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal / Impacto de una intervención educativa en el esquema e incidencias de interacciones medicamentosas potenciales en Nepal

Objective: To study the impact of educational intervention on the pattern and incidence of potential drug-drug interactions (DDIs). Method: All patients admitted to Internal Medicine wards of Manipal Teaching Hospital during the study period were included. Patient details were collected using a patient profile form and the datum from the filled forms was analyzed using Micromedex electronic database. An intervention was carried out through a presentation during clinical meeting and personal discussion. The target groups for the intervention included doctors and the nurses. Results: Altogether 435 patients during preintervention and 445 during postintervention were studied. The incidence of potential DDIs was 53% (preintervention) and 41% (postintervention) [chi-square =11.27, p=0.001]. The average number of drugs per patient was 8.53 (pre-intervention) and 7.32 (post-intervention) [t=3.493, p=0.001]. Sixty-four percent of the potential DDIs were of "Moderate" type and 58% had a "Delayed" onset in both the phases. Seventy percent of the potential DDIs during the pre-intervention phase and 61% during post-intervention phase had a "Good" documentation status. Pharmacokinetic mechanism accounted for 45% of the potential DDIs during pre-intervention and 36% in the post-intervention phase. Cardiovascular drugs accounted for 36% of the potential DDIs during pre-intervention and 33.2% during post-intervention phase. Furosemide was the high risk drug responsible for DDIs in both phases. The most common potential DDIs observed were between amlodipine and atenolol (4.82%) (preintervention) and frusemide and aspirin (5.20%) (postintervention). Conclusion: There was an association between potential DDIs and age, sex, and polypharmacy (AU)

Objetivo: Estudiar el impacto de una intervención educativa en el esquema y la incidencia de las interacciones medicamentosas potenciales (DDI). Método: Se incluyó a todos los pacientes que visitaron el servicio de medicina interna del Hospital Universitario de Manipal. Los detalles de los pacientes se recogieron utilizando un formulario de perfil de paciente y los datos fueron analizados utilizando la base de datos electrónica Micromedex. Se realizó una intervención mediante una reunión clínica y discusión personal. El grupo diana eran los médicos y los enfermeros. Resultados: Se estudiaron 435 pacientes durante la pre-intervención y 445 durante la post-intervención. Las incidencia de DDI potenciales fue del 53% (pre-intervención) y 41% (post-intervención) [chi cuadrado=11,27, p=0,001]. La media de medicamentos por paciente fue de 8,53 (pre-intervención) y 7,32 (post-intervención) [t=3,493, p=0,001]. El 64% de las DDI potenciales eran de tipo "Moderadas" y el 58% tenía una iniciación "Retrasada" en ambas fases. El 70% de las DDI potenciales durante la fase de pre-intervención y el 61% en la post-intervención tenían un estado de documentación "Bueno". Mecanismos farmacocinéticos contabilizaron el 45% de las DDI potenciales durante la pre-intervención y el 36 en la post-intervención. Los medicamentos cardiovasculares sumaron el 36% de las DDI potenciales durante la pre-intervención y el 33,2% en la post-intervención. La furosemida fue el de mayor riesgo de DDI en las dos fases. La DDI potencial más comúnmente observada en la pre-intervención fue entre amlodipino y atenolol (4,82%), y en la post-intervención fue entre furosemida y aspirina (5,29%). Conclusión: Existía una asociación entre DDI potencial y edad, sexo y polimedicación (AU)

Study of prescription of injectable drugs and intravenous fluids to inpatients in a teaching hospital in Western Nepal.

Unnecessary, excessive and poor injection practices in the South East Asia region (including Nepal) have been observed previously. The authors aim to study prescription of injectable drugs to inpatients in a teaching hospital in Western Nepal. Prescription of injectable drugs (IDs) and intravenous fluids (IVFs) to inpatients discharged from the wards of the Manipal Teaching Hospital during 1st January to 30th June 2006 was studied. The mean number of drugs, IDs and IVFs administered, median cost of drugs and of IDs/IVFs per prescription calculated. Comparison of ID/IVF use in the four major hospital departments (Medicine, Obstetrics and Gynecology, Pediatrics and Surgery) was done. The administration of IDs/IVFs and injectable antimicrobials were measured in Defined Daily Dose (DDD)/100 bed-days and of Intravenous fluid in Liters (L)/100 bed-days. Of the 1131 patients discharged, 938 (82.94%) patients received one or more IDs/IVFs. The mean number of drugs, IDs and IVFs prescribed were 8.75, 4.72 and 1.42. Median cost of drugs and IDs/IVFs per prescription were 8.26US$ and 5.12US$ respectively. IDs/IVFs accounted for 81.37% of total drug cost. The most commonly used ID, injectable antimicrobial and IVF were Diclofenac (19.3 DDD/100 bed-days), Metronidazole (7.68 DDD/100 bed-days) and Dextrose normal saline (8.56 L/100 bed-days), respectively. The total IVF consumption was 24.25 L/100 bed-days. Significant differences between departments were observed (p<0.05). In conclusion, the use of IDs/IVFs was higher compared to other studies. Interventions to improve IDs/IVFs prescribing practices may be required.

Pattern and trend of deliberate self-harm in western Nepal.

Acts of deliberate self-harm (DSH) not only affect the people directly involved, but also have grave psychological and social impact on the family and community. In the present study, a cohort of 173 cases of DSH reported from April 2002 to March 2005 was retrospectively analyzed, by perusing the medicolegal register maintained by the Emergency Department at the Western Regional Hospital, Pokhara in the Western Development Region of Nepal. The data were entered and analyzed using SPSS Version 10.1. More than two-thirds of total cases were females. About 60% of cases were observed in the age group of 15-24 years. Poisoning (89.6%) was the most preferred method of deliberate self-harm. Organophosphate pesticides were consumed in nearly two-thirds of the poisoning cases. The majority of cases were reported during the months of May to July and had occurred during the last quarter of the day. More than a twofold increase was observed in the frequency of cases during the 3-year study period. The said observations were compared and contrasted with the available literature across the globe. The presentation is concluded by highlighting the limitations encountered in Nepal and the scope to overcome the same.

Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal.

OBJECTIVE: To study the impact of educational intervention on the pattern and incidence of potential drug-drug interactions (DDIs). METHOD: All patients admitted to Internal Medicine wards of Manipal Teaching Hospital during the study period were included. Patient details were collected using a patient profile form and the datum from the filled forms was analyzed using Micromedex electronic database. An intervention was carried out through a presentation during clinical meeting and personal discussion. The target groups for the intervention included doctors and the nurses. RESULTS: Altogether 435 patients during preintervention and 445 during postintervention were studied. The incidence of potential DDIs was 53% (preintervention) and 41% (postintervention) [chi-square =11.27, p=0.001]. The average number of drugs per patient was 8.53 (pre-intervention) and 7.32 (post-intervention) [t=3.493, p=0.001]. Sixty-four percent of the potential DDIs were of 'Moderate' type and 58% had a 'Delayed' onset in both the phases. Seventy percent of the potential DDIs during the pre-intervention phase and 61% during post-intervention phase had a 'Good' documentation status. Pharmacokinetic mechanism accounted for 45% of the potential DDIs during preintervention and 36% in the post-intervention phase. Cardiovascular drugs accounted for 36% of the potential DDIs during pre-intervention and 33.2% during post-intervention phase. Furosemide was the high risk drug responsible for DDIs in both phases. The most common potential DDIs observed were between amlodipine and atenolol (4.82%) (preintervention) and frusemide and aspirin (5.20%) (postintervention). CONCLUSION: There was an association between potential DDIs and age, sex, and polypharmacy.

Study of adverse drug reactions caused by first line anti-tubercular drugs used in directly observed treatment, short course (DOTS) therapy in Western Nepal, Pokhara.

OBJECTIVE: To study the Adverse Drug Reactions occurring during DOTS therapy and to assess their causality, severity and predisposing factors. METHOD: Patients undergoing DOTS treatment during the 5 month study period (20th January to 20th June, 2005) at the Regional Tuberculosis Center (RTC) in Pokhara, Western Nepal were studied. Patients and/or patient party were interviewed to detect occurrence of any ADRs during their visit to the DOTS center. Causality and severity assessment were carried out as per the 'Naranjo scale' and 'modified Hartwig and Siegel scale' respectively. Statistical analysis (Chi square test) was done to determine the predisposing factors. RESULTS: Totally 137 patients were studied among whom 54.74% (n=75) reported occurrence of ADRs. Total 29.33% of ADRs were reported by the age group 21- 30 years. Nearly half (49.33%) of the ADRs were reported by men and 33.33% were reported by the ethnic group of 'Gurungs'. Half (49.33%) of the patients were illiterate and 70.67% of the ADRs were classified as ADRs 'possibly' due to the suspected drugs and 93.33% were classified as 'mild (level 1)'. Isoniazid accounted for 49.3% of the ADRs. The most commonly reported ADR was tingling and burning sensation in hands and feet experienced by 32 (11.03%) patients. CONCLUSION: Occurrence of ADRs from antitubercular drugs was high in the population of Western Nepal. Further studies encompassing a wider population and covering different regions of Nepal are needed.

Fluoroquinolone utilization among inpatients in a teaching hospital in western Nepal.

OBJECTIVE: To obtain information on the prescribing patterns of fluoroquinolones among hospitalized patients, other antibiotics and drugs co-prescribed, calculate fluoroquinolone utilization using defined daily dose (DDD), calculate mean cost of drugs and detail the sensitivity patterns of isolated microorganisms. METHODS: The study was carried out over a five-month period (1st November 2003 to 31st March 2004) at the Manipal Teaching Hospital, Pokhara, Nepal. Demographic details and duration of hospitalization was noted. The percentage of patients prescribed parenteral antibiotics and fluoroquinolones were recorded. The cost of drugs was determined using the price list supplied by the pharmacy. Fluoroquinolone utilization was measured in DDD/100 bed-days. RESULTS: Fluoroquinolones were prescribed to 263 patients during the study period; 160 females and 103 males. Mean +/- SD number of drugs prescribed and duration of hospitalization were 6.5 +/- 3.3 and 6.2 +/- 5.4 days respectively. Fluoroquinolone utilization was 7.76 DDD/100 bed-days. Ciprofloxacin was the most commonly prescribed drug (6.83 DDD/100 bed-days). Fluoroquinolones were used for prophylaxis in 110 patients (41.8%). Other indications were urinary tract infections and acute gastroenteritis. E.coli, S.aureus and P. aeruginosa were common organisms isolated. The mean cost of drugs was 13.1 U.S. $ and fluoroquinolones contributed to 36.7% of the total drug costs. CONCLUSION: The use of fluoroquinolones was high compared to that reported previously.