Perception about Medicines among the General Public in the Semi-rural Areas of Nepal.

Background Patients' perceptions and beliefs about medicine are affected by their culture, tradition, socioeconomic status, peer influence, educational level, advertisements among other factors. Objective To explore the perception about medicines among the general public in different semi-rural areas of Nepal. Method Cross-sectional study was conducted at different locations within Kathmandu valley from July 2015 to December 2016; 385 individuals were approached using simple random sampling but only 260, aged 18 years and above, who were taking medicines for their health problems, completed the interviewer-administered survey. Their perceptions about medicines were studied using a structured questionnaire based on the WHO booklet "How to investigate the use of medicines by consumers" and analysed using SPSS version 22. Association between respondents' age, gender, education level and perception were statistically analysed using χ2 test and/or Fisher's exact test and multivariate analysis of variance. Result Sixty-one respondents (23.5%) were in age group 56-65 years. Patients' perceptions of medicine safety based on colour, shape, name of medicine, method of administration, compatibility, etc. was statistically different among respondents with regard to their level of education (p = 0.022). More individuals with lower education believed that expensive medicines were more effective (p < 0.001). Increased level of education made them more aware of negative consequences of reusing previous prescriptions (p=0.039). Conclusion Problems with knowledge about medicines were noted among lesser educated individuals. Based on findings, policy makers may develop educational strategies to increase awareness about medicines.

Vitamin D supplementation reduces airway hyperresponsiveness and allergic airway inflammation in a murine model.

BACKGROUND: Asthma is a chronic disease associated with airway hyperresponsiveness (AHR), airway obstruction and airway remodelling. NF-κB is a transcriptional factor that regulates and co-ordinates the expression of various inflammatory genes. The NF-κB subunits, p50 and Rel-A, are translocated to the nucleus by importin α3 and importin α4. There is growing evidence that vitamin D is a potent immunomodulator. However, the evidence for beneficial or adverse effects of vitamin D in asthma is still unclear. OBJECTIVE: In this study, we examined the effect of vitamin D status on AHR, airway inflammation and cytokines in the bronchoalveolar lavage fluid (BALF) in a murine model of allergic asthma. METHODS: Female BALB/c mice were fed with special vitamin D-deficient or vitamin D-sufficient (2000 IU/kg) or vitamin D-supplemented (10,000 IU/kg) diet for 13 weeks. Mice were sensitized and challenged with ovalbumin (OVA). The effect of vitamin D on lung histology, AHR, T regulatory cells (Tregs) and BALF cytokines was examined. The expression of importin-α3 and Rel-A in the lung of OVA-sensitized mice was analysed using immunofluorescence. RESULTS: Vitamin D deficiency was associated with higher AHR in OVA-sensitized and challenged mice than those in vitamin D-sufficient mice. This was accompanied with marked signs of airway remodelling, high BALF eosinophilia, increased BALF pro-inflammatory cytokines, reduced BALF IL-10 levels, reduced blood Tregs, increased expression of importin-α3 and Rel-A in the lung tissue. Vitamin D supplementation attenuated the pro-inflammatory effects, but did not completely reverse the features of allergic airway inflammation. CONCLUSION AND CLINICAL RELEVANCE: Vitamin D could be beneficial as an adjunct therapy in the treatment of allergic asthma.

Development and performance evaluation of amphotericin B transfersomes against resistant and sensitive clinical isolates of visceral leishmaniasis.

The present study was aimed to assess the efficacy of developed transfersome (TF-3) formulation bearing amphotericin B (AmB) against sensitive and resistant clinical isolates of L donovani and compared with conventional liposomal formulation (F-2) and free AmB (F-1). The skin permeation of AmB from TF-3 was performed using Franz diffusion cell using rat skin which showed fickian diffusion across the skin. When tested against L. donovani (intramacrophagic amastigotes), it has been observed that TF was more effective than F-1 and F-2 formulation in sensitive and resistant clinical isolates. The data provides evidences that the TF formulation owing to its fluidized behaviour imparted by sodium deoxycholate, enables to penetrate well in the infected cells and thus provide enhanced activity. The permeation study also supports this data as the flux value of AmB through TF formulation was 1.5 fold higher compared to conventional liposomes suggesting improved penetration and better partitioning in skin layers. Implicit to this preliminary data it is evident that the AmB loaded TF formulation has potential as alternate chemotherapeutic approach to control of VL. Potential utilities of novel formulation as a transdermal delivery of AmB for leishmaniasis necessitates further elaborated investigations which is underway in our laboratory.

Effects of early inhaled beclomethasone therapy on tracheal aspirate inflammatory mediators IL-8 and IL-1ra in ventilated preterm infants at risk for bronchopulmonary dysplasia.

We tested the hypothesis that inhaled beclomethasone therapy for prevention of bronchopulmonary dysplasia (BPD) reduces pulmonary inflammation. As part of a randomized, placebo-controlled trial, interleukin-8 (IL-8) and interleukin-1 receptor antagonist (IL-1ra) concentrations in tracheal aspirates were measured as markers of pulmonary inflammation. On study days 1 (baseline), 8, 15, and day 28 of age, samples were obtained from enrolled infants (birth weights <1,251 g, gestational age <33 week, 3 to 14 days of age) who remained ventilated and had not received systemic glucocorticoid therapy. Cytokine levels (pg/microg of free secretory component of immunoglobulin A) were compared between groups. We determined whether baseline cytokine levels modified treatment effect regarding subsequent need for systemic glucocorticoid therapy or occurrence of BPD (age 28 days). Tracheal aspirates were obtained from 161 infants (77 receiving beclomethasone, 84 receiving placebo). Median IL-8 levels were lower in beclomethasone versus placebo infants on study days 8 (82.9 vs. 209.2, P < 0.01) and 15 (37.4 vs. 77.4, P < 0.03) after controlling for antenatal glucocorticoid therapy and maternal race. Median IL-1ra levels were lower in beclomethasone versus placebo infants only on study day 8 (86.5 vs. 153.3, P < 0.01). Fewer beclomethasone infants with baseline IL-8 levels in the interquartile range required systemic glucocorticoid therapy (beclomethasone 30.6% vs. placebo 65.8%, P < 0.01) or developed BPD (beclomethasone 42.4% vs. placebo 69.4%, P < 0.03). We conclude that early-inhaled beclomethasone therapy was associated with a reduction in pulmonary inflammation after 1 week of therapy. Beclomethasone-treated infants with moderately elevated baseline IL-8 levels received less subsequent systemic glucocorticoid therapy and had a lower incidence of BPD than nontreated infants.

Urinary basic fibroblast growth factor: a noninvasive marker of progressive cystic renal disease in a child.

Autosomal recessive polycystic kidney disease (ARPKD) is a hereditary condition with an estimated incidence of 1 in 20,000 live births. Various growth factors have been implicated in the causation of this disease. We describe a child with ARPKD whose levels of urinary basic fibroblast growth factor (bFGF) were markedly elevated. The concentrations of bFGF increased further following right nephrectomy, in response to the compensatory growth of the remaining kidney. We hypothesize that measurement of urinary bFGF may be useful as a noninvasive marker to assess progression of cystic renal development.

DNA diagnosis for the practicing obstetrician.

Laboratory advances in molecular genetics have resulted in numerous clinical applications for DNA analysis. Currently, because of cost, complexity, and resource limitations, DNA analysis is not used routinely for prenatal screening, but rather is targeted towards families at risk for an inherited condition. This article discusses the types of DNA analyses that are currently performed, the possible tissue sources of DNA for prenatal diagnosis, and the indications for DNA testing in obstetric practice. Internet addresses for the most up-to-date genetic information on a specific condition are given in this article.

Human immunodeficiency virus testing and counseling: nuts and bolts.

The human immunodeficiency virus poses an increasing health hazard to women. Physicians must recognize this risk and evaluate their patients for human immunodeficiency virus. Because of general increased awareness and the recommendations that all prenatal patients be offered human immunodeficiency virus testing and counseling, more and more women will be tested, yet counseling has not become a routine aspect in the evaluation of patients. This article reviews the key components of human immunodeficiency virus testing and counseling, including test interpretation, risk assessment, risk reduction, and pretest and posttest counseling. Familiarity with these areas should enable the practitioner to feel comfortable in providing this service.

Influence of A1 cytoplasmic substitution on the downy-mildew incidence of pearl millet.

Large-scale cultivation of pearl millet [Pennisetum glaucum (L.) R. Br. F1 hybrids in India has led to increased incidence of downy-mildew (Sclerospora graminicola). There is concern that the A1 male-sterile cytoplasm used in all the hybrids released so far is responsible for this increase. The influence of A1 malesterile cytoplasm on downy-mildew incidence in pearl millet was studied by comparing the disease reaction of 40 pairs of F1 hybrids, each pair carrying respectively a1 male-sterile and normal B cytoplasm. Mean downy-mildew incidence was similar in the hybrids carrying either A1 male-sterile or B cytoplasm. The general combining ability of lines with and without A1 cytoplasm was found to be similar for downy-mildew incidence. These results indicated that in pearl millet A1 cytoplasm is not associated with increased downymildew incidence. The possible danger of using only one source of cytoplasm has been briefly discussed.

Evaluation of vaccination coverage.

The cluster sampling methodology based on WHO module on "Evaluate Vaccination Coverage" recommended by Ministry of Health and Family Welfare, Government of India, 1987 was followed to evaluate the vaccination coverage of eligibles. Out of the 215 eligible children between 12-23 months of age, 44.65 38.61 and 16.74 per cent were found to be fully, partially and unimmunized respectively. The dropout rate for OPV and DPT was 21.23 while it was 4.03 per cent for TT. Based on the studied facts responsible for non or partial immunization, suggestions have been made to accelerate the coverage and reduce the dropout rate.

Ehlers-danlos Syndrome in Four Generations.

Thirteen cases of Ehlers-Danlos syndrome are being reported from a twentyfive member family. All had type 11 (mitis) variety of Ehlers-danlos syndrome with autosomal dominant transmission.