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Gabapentin is a new gamma aminobutyric acid (GABA) analogue that has anticonvulsant activity. Preliminary results are promising with gabapentin for the treatment of refractory anxiety disorders. In a supplementary role in several behavioral disorders, especially in acute mania, it has produced significant beneficial results. In this study, the anxiolytic activity of gabapentin was examined in mice. There was a significant decrease in time spent in the central square, an increase in the crossings, and an increase in rearing in the open field with the low-dose gabapentin (10 and 30 mg/kg), implying anxiolysis. Furthermore, potentiation of diazepam with gabapentin was also reported. On screening the gabapentin for learning and memory with passive avoidance response, there was significant prolongation of step-down latency, decrease in step-down error, and decrease in the total time spent by the mice in the shock zone at 10 and 100 mg/kg of gabapentin. Gabapentin was not associated with any adverse effect on the memory of mice.The lack of effect of gabapentin on memory, exhibiting anxiolytic activity at a low dose, the lack of cognition deficits, lack of drug interaction, alleviating the requirement for plasma monitoring, and its freedom from dependence or abuse liability suggest the potential advantage of gabapentin over the exiting anxiolytics. [ABSTRACT FROM AUTHOR]

Aim: To determine the correlation between vitamin D levels and gestational diabetes mellitus., Materials and Methods: Cross-sectional observational study, conducted in Gauhati Medical College and Hospital, over a period of 1 year, on 350 antenatal patients, with gestational age beyond 24 weeks, keeping in mind the inclusion and exclusion criteria. Age, obstetric score, religion, BMI were noted for all patients. They underwent screening for gestational diabetes mellitus using DIPSI (Diabetes in Pregnancy Study Group of India) guidelines and were divided into two groups. Vitamin D estimation by CLIA method (chemiluminescence method) was done in both groups and results were compared. Association between vitamin D levels and gestational diabetes mellitus was studied using Chi Square Test., Results: The prevalence of vitamin D deficiency in antenatal patients was found to be 63.7%. 73% of gestational diabetes mellitus patients were deficient in vitamin D. There was a statistically significant association seen between vitamin D level and Gestational diabetes mellitus ( p value-0.046). There was 1.34 times increased risk of developing gestational diabetes mellitus when the vitamin D levels were deficient as compared to when the vitamin levels were within the normal range., Conclusion: There was a high level of vitamin D deficiency in the pregnant women of North East. Due to lack of screening of vitamin D levels, many pregnant women suffer from adverse feto-maternal outcomes. There is a need to identify them early in pregnancy, provide vitamin D supplementation and to decrease the likelihood of them developing complications., Competing Interests: Conflict of interestThe authors declare no conflict of interest., (© Federation of Obstetric & Gynecological Societies of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Multilayer thin film assembly by the layer-by-layer (LbL) technique offers an inexpensive and versatile route for the synthesis of functional nanomaterials. In the case of polymer-clay systems, however, the technique faces the challenges of low clay loading and lack of tunability of the film characteristics. This is addressed in the present work that achieves exponential growth in clay-containing polyelectrolyte films having high clay loading and tailored properties. Our approach involves the incorporation of a weak polyelectrolyte and a clay with relatively high charge density and small particle size. The system of investigation comprises poly(diallyldimethylammonium chloride) (PDDA) as the polycation and laponite clay and poly(acrylic acid) (PAA) or poly(sodium-4-styrene sulfonate) (PSS) as polyanions that are used alternately to create multilayers. Successful high clay loading and exponential growth were achieved by two different approaches of polyanion incorporation in the multilayers. A progressive increase in the degree of ionization of PAA was shown to contribute to the exponential growth. Our findings also include novel pathways to manipulate thickness, surface topography, and clay content. The strategy presented here can lead to novel approaches to fabricate tailor-made nanomaterials for distinct applications.

We investigate the two-component quantum walk in one-dimensional lattice. We show that the inter-component interaction strength together with the hopping imbalance between the components exhibit distinct features in the quantum walk for different initial states. When the walkers are initially on the same site, both the slow and fast particles perform independent particle quantum walks when the interaction between them is weak. However, stronger inter-particle interactions result in quantum walks by the repulsively bound pair formed between the two particles. For different initial states when the walkers are on different sites initially, the quantum walk performed by the slow particle is almost independent of that of the fast particle, which exhibits reflected and transmitted components across the particle with large hopping strength for weak interactions. Beyond a critical value of the interaction strength, the wave function of the fast particle ceases to penetrate through the slow particle signalling a spatial phase separation. However, when the two particles are initially at the two opposite edges of the lattice, then the interaction facilitates the complete reflection of both of them from each other. We analyze the above mentioned features by examining various physical quantities such as the on-site density evolution, two-particle correlation functions and transmission coefficients., (© 2021. The Author(s).)

Background: It has been more than a year since the whole world is struggling with COVID-19 pandemic and may experience resurgences in the near future. Along with severe pneumonia, this disease is notorious for extensive thromboembolic manifestations. That is why experts advocated aggressive anticoagulation as a part of the therapy since the beginning. However, from May 2020 onwards, cases of heparin-induced thrombocytopenia (HIT) are being reported. HIT in itself is an autoimmune entity leading to life-threatening thrombosis in the setting of thrombocytopenia. Continuation of heparin can have disastrous consequences in case of unrecognized HIT. Hence, timely recognition of HIT is of utmost value to modify the anticoagulation strategy and salvaging lives. We performed a systemic review trying to find all reported cases of HIT in COVID-19., Methods: It involved extensive search of the databases including PubMed, Google Scholar, Scopus, and Embase in an attempt to find all reported literature in the last 1 year (November 1, 2019-December 25, 2020) using keywords in various combinations. Literature search resulted in a total of 27 articles and 12 articles were finally selected based on the study design and their relevance pertaining to the intervention done and the outcome of interest., Results: A total of 35 patients were included (mean age 56.7 ± 12.8 years, male-to-female ratio = 2:1). The most frequent comorbidity was hypertension. Fifty-seven percent of cases were with low-molecular weight heparin and the rest with unfractionated heparin. Confirmatory functional assay was done in 85.7% of cases (67% by serotonin-release assay [SRA] and 33% by heparin-induced platelet aggregation [HIPA]). All cases tested with HIPA were positive, while with SRA, only 30% were positive. The most common alternate anticoagulation used was argatroban infusion. The new arterial thrombotic event was seen in only 5.7% of cases as repeat myocardial infarction, stroke, and splenic infarction, while clinically significant bleeding was seen in 17.1% of cases. Fifty percent of bleeding episodes were seen where conventional doses of argatroban were used, while no mortality was seen with low-dose argatroban infusion. However, only 45.7% of patients were discharged, 31.4% of patients died, while the outcome was pending for 23% of patients., Conclusion: Severe endotheliitis and immune dysregulation giving rise to HIT antibodies and antiphospholipid antibodies have been demonstrated in COVID-19 and modifying our therapy becomes indispensable when it is pathogenic with potentially fatal consequences. In the light of interim results of REMAP-CAP study in severe COVID-19 cases where heparin does not improve the outcome, the present anticoagulation strategy needs re-evaluation. Unrecognized HIT can be catastrophic and close clinical monitoring is required for patients on heparin therapy., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Anesthesia: Essays and Researches.)

Background: Despite the advances in medical sciences, the morbidity and mortality due to sepsis in critically ill medical or surgical patients remains high, hence the need for an early and accurate diagnosis. In the current armamentarium, we have various biomarkers such as procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), CRP, and band cell percentage for an early clue., Aims: This study explores the accuracy of these markers in distinguishing sepsis from systemic inflammatory response syndrome (SIRS) and their correlation with sequential organ failure assessment (SOFA) scoring in critically ill patients., Materials and Methods: After ethical committee approval and written informed consent from guardians, 180 consecutive patients, with clinically suspected infection from any source fulfilling at least two criteria of SIRS, were enrolled and 150 eligible patients were investigated and analyzed prospectively in one cohort, which was later subdivided into two different groups (Group A and Group B) based on microbiology reports, as having SIRS or sepsis, respectively. Samples for cultures (blood, tracheal, or urine as required), biomarkers such as PCT, hs-CRP, and CRP, and band cell percentage were sent from each patient on days 1, 2, 3, and 5 and whenever there were fever spikes. Clinical follow-up was done for 28 days, and demographics, ventilator days, duration of intensive care unit (ICU) stay, and the survival rates were noted., Statistical Analysis: Receiver operating characteristics, area under curve (AUC-ROC) was used for each of the biomarker variables to decide the cutoff values and performance. Correlation coefficient was also seen for each of the biomarkers with SOFA scoring., Results: Attributes of performance for all the biomarkers were satisfactory but was best for PCT (AUC-ROC of 0.987) followed by band cell percentage (0.881). SOFA scoring could also be used with good diagnostic accuracy (AUC-ROC of 0.920). SOFA score correlated best with PCT among the four biomarkers in diagnosing sepsis (Spearman's coefficient of + 0.734). Band cell percentage was significantly higher in the expired group of sepsis patients than survived patients ( P = 0.02) and correlated well with ICU stay and 28-day mortality than rest (Spearman's coefficient of - 0.54)., Conclusions: The addition of PCT to the standard workup of critically ill patients with suspected sepsis increases diagnostic certainty and generates improved patient management. Band cell percentage also provides a cost-effective alternative to PCT with an analogous diagnostic performance., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Anesthesia: Essays and Researches.)

Delay in diagnosis of falciparum may result in complicated, life-threatening conditions. Though haematological abnormalities and coagulopathy are common complications that occur in malaria but complications with rare manifestations like overt bleeding do pose challenges for the clinicians worldwide. This study reports the incidence and prognosis of overt bleeding from the east coast of India and makes an attempt to relate it with the pathogenesis of the disease in severe Plasmodium falciparum malaria patients. This study was conducted in Sriram Chandra Bhanj Medical College Hospital, Cuttack, Odisha, India. A total of 120 complicated (multi organ dysfunction) malaria cases were included in this study. Amongst them 54 (45.0%) showed signs of overt bleeding and clinically the bleeding was either from one or multiple sites. Out of the total overt bleeding cases, 79.6% had elongated prothrombin time (PT), activated partial prothrombin time (aPTT) and elevated D-dimer with thrombocytopenia indicating disseminated intravascular coagulopathy (DIC). It was observed that case fatality rate was very high in coagulopathy group than the non coagulopathy group. Our observations highlight that awareness of overt bleeding in P. falcipatum infection is necessary for general practitioners in endemic areas for malaria like in Odisha for effective and timely management of complicated patients.Timely diagnosis and treatment of DIC with appropriate prescribed drugs can prevent and cure the complications of severe falciparum malaria with anti-malarial treatment.

Polyelectrolyte complexes (PECs) are three-dimensional macromolecular structures formed by association of oppositely charged polyelectrolytes in solution. Polyelectrolyte multilayers (PEMs) can be considered a special case of PECs prepared by layer-by-layer (LbL) assembly that involves sequential deposition of molecular-thick polyelectrolyte layers with nanoscale control over the size, shape, composition and internal organization. Although many functional PEMs with novel physical and chemical characteristics have been developed, the current practical applications of PEMs are limited to those that require only a few bilayers and are relatively easy to prepare. The viability of such engineered materials can be realized only after overcoming the scientific and engineering challenges of understanding the kinetics and transport phenomena involved in the multilayer growth and the factors governing their final structure, composition, and response to external stimuli. There is a great need to model PEMs and to connect PEM behavior with the characteristics of the PEC counterparts to allow for prediction of performance and better design of multilayered materials. This review focuses on the relationship between PEMs and PECs. The constitutive interactions, the thermodynamics and kinetics of polyelectrolyte complexation and PEM formation, PEC phase behavior, PEM growth, the internal structure and stability in PEMs and PECs, and their response to external stimuli are presented. Knowledge of such interactions and behavior can guide rapid fabrication of PEMs and can aid their applications as nanocomposites, coatings, nano-sized reactors, capsules, drug delivery systems, and in electrochemical and sensing devices. The challenges and opportunities in future research directions are also discussed., (Copyright © 2016. Published by Elsevier B.V.)

Background: Irrational use of drugs as well as inappropriate and over drug prescribing leads to unnecessary expenditures and emergence of resistant bacterial strains. Feedback intervention on drug prescribing habits and face to face educational intervention of prescription audit would be effective in rationalizing prescribing practices., Objective: To measure the impact of educational feedback intervention on the prescribing behavior of dental surgeons., Methods: Prospective audit of twelve hundred outpatients prescriptions in dental OPD at BPKIHS of those dental surgeon who attended the educational intervention session was collected randomly by trained persons on customized data collection sheet before and after educational intervention., Results: A total 1200 prescription were collected, 300 before and 300 after intervention period at the internal of one month, three months and six months. Majority of the prescriptions (39.33%) contained four drugs but after intervention, prescriptions contained mostly one drug, 73% in first month, 78.67% in third month and 65.34% in six month. Mean number of drugs per prescription after intervention were decreased. There was increased number of generic names of drugs after intervention. Amoxicillin, Metronidazole, Chlorhexidine, Povidone iodine gargle, Nimesulide, Ibuprofen, Ibuprofen + paracetamol, and Paracetamol were most commonly prescribed by dental prescribers before and after intervention. Selection of antimicrobial was done on empirical basis which was correct because Amoxicillin concentration reaches effectively in gingival crevicular fluid and Metronidazole covered effectively against anaerobic bacteria were found in orodental infection. The uses of topical anti-infective preparation as irrigants of choice that can kill majority of micro-organisms found is root canal and dental tubules and minimize systemic use of antimicrobials. Nimesulide prescribing needs to be rationalized., Conclusion: Feedback educational intervention of prescription audit is effective to improve their prescribing behaviors and rationalize drug utilization pattern for the benefit of the patients.

A relativistic many-body theory for the electric dipole moment (EDM) of paramagnetic atoms arising from the electric dipole moment of the electron is presented and implemented. The relativistic coupled-cluster method with single and double excitations (RCCSD) using the Dirac-Coulomb Hamiltonian and a weak parity and time reversal violating interaction to the first-order of perturbation has been employed to obtain the EDM enhancement factor for the ground state of the Fr atom due to the intrinsic EDM of the electron. The trends of different correlation effects and the leading contributions from different physical states are discussed. Our results in combination with that of the Fr EDM experiment that is currently in progress possess the potential to probe the validity of the standard model (SM) of elementary particle physics.

Objective: To investigate the effect of Ocimum sanctum, ascorbic acid, and verapamil on macrophage function and oxidative stress in experimental animals exposed to cocaine., Materials and Methods: Mice were used in this study and were divided randomly into different groups of six animals each. They were either treated with intraperitoneal injection of saline or cocaine hydrochloride or an oral feeding of oil of Ocimum sanctum, ascorbic acid or verapamil, or both (ascorbic acid and verapamil), and were evaluated for a respiratory burst of macrophages, superoxide and nitric oxide (NO) production, estimation of TNF-alpha in the serum and supernatant of cultured macrophages, estimation of lipid peroxidation (malondialdehyde- MDA) in the serum, and superoxide dismutase activity in the erythrocytes., Results: Unstimulated respiratory burst as well as superoxide production was enhanced on treatment with cocaine and all the three drugs were found to attenuate this enhancement. The bactericidal capacity of macrophages decreased significantly on chronic cocaine exposure, as it was associated with decreased respiratory burst and superoxide production. There was a significant decrease in NO production by macrophages on chronic cocaine exposure and all the test drugs were found to restore nitrite formation to a normal level. There was an increase in the malonylodialdehyde (MDA) level and decrease in the superoxide dismutase level on chronic cocaine exposure, and all the three drugs effectively decreased the MDA level and increased superoxide dismutase level. There was an increase in serum TNF-alpha on chronic cocaine exposure, which was decreased significantly by ascorbic acid and verapamil., Conclusion: O. sanctum, ascorbic acid, and verapamil were equally effective in improving the macrophage function and reducing oxidative stress. These findings suggested that O. sanctum, ascorbic acid, and verapamil attenuated acute and chronic cocaine-mediated effects.

Objective of this prospective study was to assess the acquisition of prescribing skill of preclinical medical and dental undergraduate students. Prescription writing skills of 258 students of both first and second year of MBBS and BDS students were analyzed through an objective structured practical examination. MBBS student of second year scored 85.01% and 92.82% respectively in physician and drug related component whereas first year MBBS students scored 89.9% and 83.4%. BDS student of first year scored 91.96% and 86.33% in physician and drug related components which is better than second year that scored 83.33% and 77.94% respectively. This study revealed that the students of both courses acquire prescribing skills to a limited extent during preclinical phase. Prescribing errors were found both in physician and drug related components. To minimize the different form of prescribing errors vigorous training in the internship period will help to minimize prescribing errors and improve rational prescribing too.

Ease of drug administration, safety, affordability and efficacy are the major concerns in pharmacotherapy leading to exploration of better drug delivery systems. Liposomes are lyotropic liquid crystals composed mainly of amphiphilic bilayers and these are more frequently used as drug carriers. Liposomes help reduce the toxicity and deliver the drug to the target tissue. So far, liposomes have been the most intensively studied lipid-based delivery system. In liposomes, a hydrophilic drug can be trapped in aqueous interior or channels between successive phospholipids bilayers whereas a hydrophobic drug can reside with the bilayer itself. The non-toxic and nonimmunogenic bilayers dissipate allowing the diffusion of the drug into the tissues. Attachment of polyethyl glycol to the surface of liposome (known as stealth liposome) aids in the better targeting of the drug to the tissues. Pegylated proteins and polymers of lactic and glycolic acids have been well studied as drug carriers and found to be resistant to phagocytosis and complement activation. Newer DNA based strategies including DNA vaccination and antisense oligonucleotides and immunomodulation show good results for new therapeutic systems. Though the DNA based therapeutic systems have high selectivity and specificity with few adverse effects, these systems are so far restricted to animal models and clinical trials.

Tricyclic antidepressant drugs induce antinociceptive effect and suggest that their analgesic action could be related to the monoaminergic activity of the drugs. The analgesic activity of amitriptyline was observed in mouse models of acute pain. Mice were divided into different groups and were given amitriptyline in different doses alone and in combination with morphine. Reaction time in Hot-Plate and Tail-Flick tests was observed. Results showed that amitriptyline had antinociceptive effect in acute pain state in experimental models. Amitriptyline in combination with morphine had better analgesic effect than the morphine alone in Hot-Plate test.

In order to understand the brain function and to treat various neuropsychiatric illnesses including epilepsy, continued search and discovery of newer antiepileptic drugs has failed to revolutionize the approach in the management of this complex disorder. Moreover, in close to 30% of epilepsy patients, the seizure control is either not satisfactory or it is intractable to pharmacotherapy. Amongst the non-pharmacological treatment options for refractory epilepsy, vagus nerve stimulation occupies a unique position as an adjunctive treatment in prevention and control of partial-onset seizures in adults and adolescents older than 12 years. Though the precise mode of action of VNS is still debatable an honest attempt has been mode here to review all possible literatures available on VNS to establish its role in the management of this complex disorder.

Health care costs, and those for inpatient care in particular, pose a barrier to seeking health care, and cost be a major cause of indebtedness and impoverishment, particularly among the poor. The Ministry of Health in Nepal intends to initiate alternative financing schemes such as community and social health insurance schemes as a means to supplement the government health sector financing source. Social Health Insurance (SHI) is a mechanism for financing and purchasing / delivering health care to workers in the formal sector regulated by the government. Considering all these facts BP Koirala Institute of Health Sciences (BPKIHS) has introduced SHI scheme in 2000 as an alternative health care financing mechanism to the community people of Sunsari and Morang districts. In the beginning small area was elected as a pilot project to launch the scheme. A major objective of SHI is to reduce poverty caused by paying for health care and to prevent already vulnerable families from falling into deeper poverty when facing health problems. A total of 26 organizations with 19799 populations are at present in SHI scheme. Sixteen rural based organizations with 14,047 populations and 10 urban based organizations with 5752 people are the beneficiaries in this scheme. BPKIHS SHI Scheme is the outcome of the visionary thinking on social solidarity and as an alternative health care financing mechanism to the community. BPKIHS is mobilizing people's organizations and is offering health services through its health insurance scheme at subsidized expenses. This has helped people to avail with health facilities who otherwise would have been left vulnerable because of their penetrating health needs. There is huge gap between premium collection and expenditures. The expenditures are more and this may be due to knowledge - do gap in the program. If conditions are unsuitable, SHI can lead to higher costs of care, inefficient allocation of health care resources, inequitable provision and dissatisfied patients. It can also be more difficult to realize the potential advantages of SHI in future. The future challenges confronting the scheme are to give the continuity and sustainability of the program to its catchments areas. This might entail a shift in its program operation mechanism. People's active involvement is required, which will further provide a sense of ownership in the scheme amongst the people.

Over the counter (OTC) drugs are commonly used by pregnant women. Most OTC drugs are safe in pregnancy but some have unproven safety and may adversely affect the growing foetus. The safety profile of some of the medication may change according to the gestational age of the foetus. Because an estimated 10% or more of the birth defects results from maternal drug exposure, the US Food and Drug Administration (FDA) has assigned a risk category to each drugs. Among the commonly used OTC drugs Acetaminophen, Chlorpheniramine, Kaolin and Pectin preparations and most antacids have a good safety record. The drugs like H2 blockers; Pseudoephedrine and Atropine/Diphenoxylate should be used with caution. The risk and benefit while using OTC drugs in pregnancy has to be assessed.

Although tremendous progress has been made in the understanding of Bronchial Asthma (BA) over the past decade, asthma remains a frequently encountered challenging condition for the physicians in the health care locale. Inflammation is distinguished as the most important event in the pathogenesis and the knowledge that asthma is an inflammatory disorder has become elementary to our explanation of asthma; this has broadened the perspective for the treatment of BA. However, bronchodilators and corticosteroids are still the mainstay of asthma treatment over the decades. The introduction of superior derivatives of corticosteroids and beta agonists, the choice, safety, duration of action and ease of delivery have enhanced progressively. Surrogated anti-inflammatory agents have been used in severe disease, but have been limited by adverse effects. The introduction of new agents affecting leukotrienes synthesis and action provides an alternative strategy but it needs to be confirmed on a large subset of population of asthmatics. In fact, the past decade has been witnessed by a proliferation of scientific information and a widespread addition of anti-inflammatory therapy to improve asthma outcomes along with the recommended therapies. In this context, there has been much advancement in the available pharmacologic panorama for both chronic and acute therapy and the development and approval of novel medications. Yet, many controversies abound this disorder, and further fundamental developments in novel therapeutics are imminent. This review of asthma for the practicing clinician will summarize these developments and their implications in treatment of BA.

The incidence of different aspects of iatrogenic problems due to drugs is Adverse Events (AEs) 3.7%, Adverse Drug Events (ADEs) 2.4-6.5%, Adverse Drug Reactions (ADRs) is 6.7%. Negligence in serious ADEs and death is 34% and 51% respectively, preventable ADEs is 25-50%. Medication Errors (MEs) occur most often in perscribing (29-56%). The most common cause of MEs is lack of knowledge about the drug (29%) and the patient about 18%. MEs result malpractice claims in 13-25% of cases which occur due to mistakes and slips of action & lapses of memory. The MEs can be prevented by establishing effective Pharmacovigilance control center, which frequently gives proper guidance to the prescribers. Use of computerized decision for prescription writing, effective communication with patient, families, pharmacists and nurses and continuing medical education on information of new drugs and new information on current drugs can be effective tolls to prevent the errors.

The prescription is a vital written document communicating between the physician, the patient and the pharmacist. The audit of prescribing pattern is a component of medical audit, which seeks monitoring, evaluation and necessary modifications in the prescribing practices of prescribers to achieve rational and cost effective medical care for the patients, The present drug utilization study was conducted by fourth year MBBs students during their research posting in the department of Pharmacology at B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan. The prescriptions were randomly collected from BPKIHS pharmacy over a period of 3 weeks. The auditing was done in the form of a semi structured performa containing the patients particulars with regard to age, sex, and residence, the details of the illness and prescribed drug information. The data was analyzed at the end of the study. The study points out that the maximum (27.5%) prescriptions were from General Outpatient Department (GOPD) followed by ENT (16.5%), Internal medicine (15.5%) and General surgery (10%). This indicates the distribution of patient load in hospital and the dominant areas to be targeted for intervention. Further, the proportion of antimicrobial agents (AMAs) i.e. 26.03% use was low and was prescribed empirically in most of the cases. There was use of expensive AMAs and irrational prescribing of combinations of AMAs in some prescriptions. Other prevailing drugs which were prescribed were analgesics. The usage of nimesulide and rofecoxib. withdrawn by FDA were used recurrently in this setup. There was greater use of dubious drugs of unproven benefit like vitamins, calcium etc. The diagnosis of the disease were not mentioned in 32.5% of prescriptions, The dose, frequency and duration of drugs were unascertained in majority of prescriptions that might lead to health hazards. This exercise might change the behavior of existing prescribers and also of the future doctors.

Objective: The objective of this study was to monitor the antimicrobial utilization in ENT out patient services in a tertiary care hospital of Nepal., Materials & Methods: A total of 191 prescriptions were randomly audited at varying time interval from the department of ENT in the year 2003. The data was collected in customized Performa in the form of antibacterial audit questionnaires. It also contained Patient particulars, diagnosis, investigations, drug details and information from the prescriber regarding the indication for prescribing antimicrobial agent, suspecting organism underlying infection, duration of therapy and details of any concomitant medications., Results: The incidence of use of antimicrobial agents (AMA) in 191 prescriptions was analyzed from the enrolled prescriptions, a total of 218 antimicrobials i.e.1.4 antimicrobial agent per patient were prescribed. . The AMAs were indicated therapeutically in 73.29% of patients & 19.37% patients for prophylaxis. The AMAs were advised for more than 72 hours for prophylaxis in 86.48%. In the concomitant medications antihistaminic were prescribed in 32.62% and NSAIDS in 21.98% cases. Most of patients reported with upper respiratory tract infections (URTI-32.56%), Chronic Suppurative otitis Media (CSOM-18.3%), sinusitis (6.28%), tonsillitis (5.75%),. Pharyngitis (3.66%), Acute Suppurative Otitis Media (ASOM-2.61%) and others. The diagnosis was established clinically in 42.40% and confirmative in 35.60%. In 21.46% the diagnosis was not disclosed. Out of 191 patients, culture sensitivity tests were performed for only 31 patients and 13 patients depicted a positive culture sensitivity tests. The common microbes isolated from the culture were staphylococcus aureus (69.2%). Streptococcus (7.7%), Enterobacteriacae (7.7%), Pseudomonas auroginosa (7.7%) & psendomanas mirabilis (7.7%). Clinically suspected organism were mentioned in only 32 prescriptions and most prescriber presumed the infections due to staphylococci & pseudomonas (43.75%), streptococci (21.8%),Gram negative organisms (12.5%) and H influenza (9.3%). The use of a single drug was abundant (89.52%), two drugs (9.94%), and three drugs (0.52% )prescriptions. Ciprofloxacin (23.85%) was preferred, followed by amoxycillin (20.06%), combination of ampicillin + cloxacillin( 9.17%), doxycyclin (5.96%). Erythromycin (4.58%) and cotimoxazole (4.58%). Expensive drugs i.e azithromycin (2.75%), roxithromycin (1.37%) and cephalosporins (3.21%) were also prescribed. The causative microbes were sensitive to amoxycillin (53.84%), cloxacillin (53.84%) ciprofloxacin (46.15%), gentamicin (46.15%), and cephalosporin (46.15%). But resistant to erythromycin, tetracycline, cotrimoxazole and norfloxacin), Conclusions: Majority of patients were prescribed drugs irrationally with misleading indications without confirming the bacteriological culture and sensitivity.

Objectives: To find out the pattern of changes in intraocular pressure after manual small incision cataract surgery., Methods: Consecutive patients (291 eyes of 291 patients) undergoing manual small incision cataract surgery were prospectively evaluated for change in IOP. Patients were further divided into two groups based on whether or not sutures were used to close the scleral tunnel. IOP was serially measured at day 1, 1st, 2nd, 4th, 6th, 8th and 12th week., Results: The mean post operative IOP in eyes where sutures were not applied (12.59+/- 3.02 mmHg, 12.59+/-2.34mmHg, 12.54+/-2.19mmHg and 12.40+/-2.99 mm Hg at day1, 2week and 4weeks respectively) was lower than that where sutures were used to close the wound (15.57+/- 3.86mmHg, 14.05+/-2.52mmHg, 14.43+/-3.39mmHg at day1, 2weeks and 4 weeks respectively). There was a drop of IOP from the preoperative IOP in both suture (1.15+/-3.29mm Hg) and non suture (3.29+/-3.07mm Hg) group at 3 months of follow up., Conclusion: There is a small drop of IOP following sutureless MSICS during long term follow up. Eyes where sutures are applied are more likely to have higher IOP than those without sutures at the initial post operative period.

Epilepsy is a complex disorder affecting brain function having a variety of contributing factors. The genetic predisposition plays a key role in the genesis of epilepsy. The already existing antiepileptic drugs (AEDs) provide effective control of majority of patents with different types of seizures. In some refractory cases and in those patients who can not tolerate the conventional AEDs, there is an urgent need to provide relief by controlling the seizures adequately. Various newer approaches in the rational management of seizures have been evolved during the recent years, based on different mechanisms of action and side effects profile. A brief account of these newer treatment modalities have been incorporated in this review in order to enlighten the readers about the possible beneficial effect of this regimen vis a vis the limitations of such use.

A young Hindu male presented with painful swelling of left lower thigh for 6 months. The provisional diagnosis both clinically and radiologically was osteosarcoma. FNAC and biopsy proved the lesion to be a case of rhinosporidiosis. The present case is reported due to rare incidence of skeletal rhinosporidiosis.

In Orissa, a malaria-hyperendemic area of India, we assessed the relationship between the PfCRT (K76T) point mutation of Plasmodium falciparum and the clinical severity of malaria. Forty uncomplicated and 36 severe malaria cases were selected, and parasite species, density and schizontaemia determined by examination of Giemsa-stained thick or thin blood films. The PfCRT point mutation was analysed by PCR-RFLP and genotypes of the parasite isolates investigated by nested PCR using the polymorphic region of the merozoite surface protein-2. We found that (i) the prevalence of the PfCRT point mutation was significantly higher (P < 0.01) in severe malaria cases and that (ii) heavy parasitaemia along with clone multiplicity was statistically more common (P < 0.01) in severe cases. These associations may be due to progression of uncomplicated to severe disease after chloroquine treatment failure and/or increased virulence of chloroquine-resistant parasites. The implications for antimalarial treatment policy are discussed.

Background & Objectives: Entomological investigations were carried out in Warangal and Karim Nagar districts of Andhra Pradesh during viral encephalitis outbreak in July 2003., Methods: Adult mosquito collections in outdoor were done using sweep cage method and in indoor with the help of aspirator tube and flash light. Larval collections were done by dipping method. JE virus positivity was tested by IgM capture ELISA test., Results: Outdoor collections revealed presence of Culex tritaeniorhynchus, Cx. bitaeniorhynchus and Cx. gelidus and in indoor collections--Cx. quinquefasciatus, Cx. tritaeniorhynchus, An. vagus and An. subpictus. In the outdoor collections Cx. tritaeniorhynchus was predominant (96.3% of total collection). Three samples out of 55 serum samples from human cases and five from contacts showed the presence of antibodies against JE virus., Interpretation & Conclusion: Cx. tritaeniorhynchus, a known vector of JE is predominant in outdoors and playing a main role in JE transmission in this area. Vector control aimed at the outdoor resting population might limit virus circulation in the mosquito vertebrate host cycle and prevent human infection.

Cryptococcal meningitis (CM) is the commonest life threatening opportunistic fungal disease in Human Immunodeficiency Virus (HIV) infected individuals. But there are very little reports of lymphadenopathy along with cryptococcal meningitis, although cases of pulmonary, Intestinal, Bone marrow and retinal involvement have been described earlier. Here we report a case of cryptococcal meningitis associated with generalized lymphadenopathy and hepatosplenomegaly.

In 108 histopathologically proved breast cancer patients, after surgical treatment with modified radical mastectomy, two radiation dose schedules have been compared. Radiation therapy was given on a 60Co teletherapy machine using gent pair technique for chest wall irradiation and direct fields for lymphatic drainage areas. The patients were randomly divided into two groups (Group A and Group B). 54 patients were given external radiotherapy 40 Gy/17 F/3.2 weeks and remaining 54 patients were given 45 Gy/20 F/4 weeks. Results of treatment in Group A versus Group B were as follows; chest wall failure 5/50(10%) versus 3/54 (5.6%), axillary lymphnods failure 3/50(6%) versus 4/54(7%), distant metastasis 16/50(32%) versus 15/54(28%). Radiation reactions were almost similar in both the groups. Skin reactions were most common radiation effects [45/50 (90%) in Group A and 43/54 (79.6% in Group B]. Thus no statistically significant difference in local control and efficacy of these two radiation dose schedules was observed in postmastectomy carcinoma of the breast.