Knowledge, attitudes and practices (KAP) regarding the management of diarrhea by pharmacists and licensed drug sellers in eastern Nepal.

Diarrhea constitutes a major cause of morbidity and mortality in developing countries. Inappropriate drug prescribing is common in diarrhea, resulting in an increase in cost and adverse drug reactions. In Nepal, drug sellers often act as the first contact persons for the underprivileged. No information has been available regarding their knowledge, attitudes and practices (KAP) regarding diarrhea management. Using a structured questionnaire, between the 1st of January and the 31st of December 2003, 109 drug sellers in eastern Nepal were interviewed about their educational status, patient/attendant presentation at the outlet and their advice to patients/attendants. Only 2.7% of drug sellers were qualified in health education. Eighty percent of the patients/attendants sought advice from the drug sellers, only 20% presented to the outlet with prescriptions. The data reveals that about half of them were taking note of the nature of the diarrhea. Although 62 (56.8%) of them were aware of dehydration, only 2 (1.8%) of them knew all three signs of dehydration (dry tongue, non-elastic skin and sunken eyes). Sixty-six (60.5%) of them knew about oral rehydration solution (ORS), its principle and the required period of administration. About 50 to 60% of them were aware of the implications resulting from dehydration from uncontrolled diarrhea and of the importance of ORS in its management. Only 20% of the drug sellers advised ORS alone, otherwise it was dispensed along with drugs, such as antimotility agents (AMA) or metronidazole. As a result of the above findings, it is important to educate the drug sellers by conferring knowledge about the ethical aspects of drugs in the management of diarrhea.

Evaluation of pre-ECS antihypertensive drug administration in the attenuation of ECS-induced retrograde amnesia.

Two once-daily electroconvulsive shocks (ECS) produced retrograde amnesia in rats trained on a Hebb-Williams maze; Verapamil (12.5 mg/kg, i.p.) or felodipine (10 mg/kg, p.o.) administered half an hour before each ECS attenuated this ECS-induced amnesia. Hence, these drugs may hold promise for the containment of amnesia induced by electroconvulsive therapy (ECT). Speculatively, one or more of several mechanisms may be involved: cerebral vasodilatation, enhancement of cholinergic tone, and inhibition of calcium-mediated impairment of neuronal function. These drugs may also act by attenuating the systolic surge in blood pressure during ECT, thereby decreasing edema due to cerebral hyperperfusion, as well as decreasing the possible transfer of potentially neurotoxic macromolecules through a putative breach in the blood-brain barrier.

Herbal pharmacotherapy for the attenuation of electroconvulsive shock-induced anterograde and retrograde amnestic deficits.

BR-16A is an herbal (non-allopathic) medication used in India to enhance cognition. Sixty adult male Sprague Dawley rats received either BR-16A (200 mg/kg/day) or vehicle alone for 16 days. During the first 7 days, the rats were trained in a spatial memory task using the Hebb Williams complex maze. Once a day for the next 2 days, rats in BR-16A and control groups received either true or sham electroconvulsive shock (ECS). During the last 7 days of the study, the rats were reexposed to the maze to assess recall of pre-ECS training and to evaluate further improvement in learning scores. BR-16A-treated rats performed better than controls both before and after ECS. It is concluded that BR-16A facilitates learning and that this effect extends to a protection against ECS-induced anterograde and retrograde amnesia. BR-16A may hence hold promise in the restriction of ECT-induced cognitive compromise. An unexpected observation in this study was that BR-16A attenuated seizure duration; implications and mechanisms are discussed.

Placental transfer of paracetamol.

Paracetamol (1 g orally) was given to each of 10 healthy pregnant women undergoing normal vaginal delivery at the onset of second stage of labour. Following delivery, there was no significant difference in the serum concentration of paracetamol in the mother and the foetus (p less than 0.1), the mean value being 5.925 +/- 2.15 mg/ml and 7.875 +/- 2.22 mg/ml respectively. Paracetamol may be recommended as a safe analgesic-antipyretic during pregnancy and labour.