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Many biological activities of pyridine and thiazole derivatives have been reported, including antiviral activity and, more recently, as COVID-19 inhibitors. Thus, in this paper, we designed, synthesized, and characterized a novel series of N-aminothiazole-hydrazineethyl-pyridines, beginning with a N′-(1-(pyridine-3-yl)ethylidene)hydrazinecarbothiohydrazide derivative and various hydrazonoyl chlorides and phenacyl bromides. Their Schiff bases were prepared from the condensation of N-aminothiazole derivatives with 4-methoxybenzaldehyde. FTIR, MS, NMR, and elemental studies were used to identify new products. The binding energy for non-bonding interactions between the ligand (studied compounds) and receptor was determined using molecular docking against the SARS-CoV-2 main protease (PDB code: 6LU7). Finally, the best docked pose with highest binding energy (8a = −8.6 kcal/mol) was selected for further molecular dynamics (MD) simulation studies to verify the outcomes and comprehend the thermodynamic properties of the binding. Through additional in vitro and in vivo research on the newly synthesized chemicals, it is envisaged that the achieved results will represent a significant advancement in the fight against COVID-19.

Background: Breast cancer is the most frequent cancer among women throughout the world. A range of noninvasive techniques have been employed for early prevention. In health-care practice, however, quality and sensitivity remained critical. Objective: The aim of this study is to see how well Breast Magnetic Resonance Imaging (MRIs) and Dynamic Contrast-Enhanced MRI (DCE-MRI) techniques can detect breast cancer and distinguish between malignant and benign lesions. Methods: A retrospective study was conducted at the Taif Hospitals, Saudi Arabia. The Picture Archiving and Communication System was used to acquire medical records and data from 50 individuals with probable breast cancer, and breast MRI pictures were analyzed. Breast Imaging Reporting and Data System (BI-RADS) radiologist reports and DCE-MRI kinetic curves were evaluated. Excel was also used to test the sensitivity and specificity of breast MRI. Results: According to the BI-RADS results, biopsies, and breast MRI data, 52 percent of 50 patients were categorized as benign, 24 percent as malignant, and 24 percent had no abnormalities. Biopsy revealed that 61.5 percent of the malignant lesions were benign, whereas 38.5 percent were appropriately identified as cancerous. The majority of malignant tumors were discovered in patients over the age of 50. The washout curve correctly identified 60% of the malignant lesions and 40% of the benign lesions. Our data demonstrated the usefulness of MRI in detecting breast cancers by analyzing BI-RADS and utilizing DCE-MRI. False-positive, on the other hand, can lead to unnecessary biopsies. Conclusion: Breast cancer is more common among women of their fifties and beyond. Biopsies, breast MRIs, and kinetic curve analysis can all be utilized to differentiate between benign and malignant breast masses with high sensitivity and specificity.

Generic medicines are being promoted in many countries for their added benefits over branded drugs, such as reduced price, therapeutic equivalence, and convenience to the patients. However, generic prescribing is still not up to the optimum level in Nepal to assure access to cost-effective, quality medicines to the public and to reduce the overall economic burden and practice-related errors of medications. This review aimed to discuss the current scenario of generic medicine, generic prescribing, hurdles on the one hand, and potentials ways in promoting generic medicine usage and generic prescribing in Nepal on the other. Extensive literature on generic medicine usage and generic prescribing practice in Nepal was reviewed. This review found some of the major challenges to be addressed for the proper implementation of generic medicine prescribing, and utilization. These challenges include lack of facilities and competency to assure therapeutic equivalence of different brand-name medicines, lack of understanding about generic medicines among health care providers (HCPs) and the public, and lack of stringent regulation towards promoting generic medicines. Rational pharmaceutical promotion and awareness about generic medication to the medical students are also inevitable towards promoting the practice of generic medicines. The practice of generic medicine and generic prescribing is not possible without the assurance of therapeutically equivalent generic alternatives. The study recommended the prompt effort of the regulatory authority to enforce the generic prescribing and generic substitution policy through strengthening policies, procedures and laboratory testing to assure citizens' right to access to cost-effective, and affordable quality medicine, as the Nepal's National Health and Drug Policy mandated.

Aims: The aim of the study was to estimate the prevalence and risk factors of diabetes mellitus among adult population of Albaha region, Saudi Arabia and to identify the diabetic risk clusters among Saudi population using various cluster analysis techniques. Study Design: Cross-sectional observation and Hierarchal cluster analyses. Place and Duration of Study: The study was conducted in three different cities of the Albaha region, Saudi Arabia including Albaha, AlAqiq and Baljurashi among Saudi adults 15 years of age or above. The study was carried out from April 2019 to May 2019. Methodology: The first part of the research was a random cross-sectional observational diabetic risk factors screening using a structured questionnaire among adult volunteers of the Albaha region. The second part constituted a multiple cluster analysis technique performed to identify the diabetic risk factors from 13 regions of Saudi Arabia, clustered into five main regions, using NCSS software. Results: In the first part, the risk factors identified among non-diabetic participants showed a significant association with the development of diabetes mellitus, particularly physical inactivity (49.12%), hypertension (41.15%), and high body mass index (19.03%). Likewise, in 11.54% of diabetic patients, elevated body mass index (30.51%), hypertension (27.12%) and physical inactivity (55.93%), which could be associated with diabetic complications. In the second part, the three forms of cluster analyses (the agglomerate hierarchical cluster, clustered heat map and K means clustering analysis) identified physical inactivity and high body mass index as key risk factors which are connected to all other risk factors among the total of 213591 volunteers. Conclusion: Increased prevalence of diabetes and risk of developing diabetes mellitus in the Kingdom require substantial education and training programs to counsel volunteers on all aspects of self-care. Our data provides a robust evidence to establish diabetic counseling through regular diabetes awareness program that can reduce the risk of developing diabetes mellitus.

This systematic review was conducted with aim of determining different types of barriers that interfere with the adherence to antidiabetic medications among diabetes mellitus patients in Saudi Arabia. A comprehensive systematic literature exploration was performed via databases and search engines as Science Direct, PubMed, Medline, Google Scholar, Scopus, Cochrane Library, and EBSCO. The review includes 20 original research studies on adherence to antidiabetic medications and their associated factors. The review of the studies reveals that the most prominent barriers to antidiabetic medication adherence were forgetfulness, polypharmacy and complexity of regimen, side effects, low perceived self-efficacy of the medications, and feeling better. Likewise, frequent dosing, long history of diabetes, comorbidities, cost of medication or financial issue, disruption of normal routine, carelessness, busy schedule, God centered locus of control, and food habits were among the others. The identified multifaceted barriers can serve as a potential target for interventions to improve adherence to antidiabetic medications and health related quality of life.

Fast-track approval has led to serious concerns on the perception of COVID-19 vaccines' safety among the public. Common adverse drug reactions (ADRs) of COVID-19 vaccines are minor localized reactions, while systemic ADRs have been reported rarely. The serious ADRs include anaphylaxis, vaccine-induced immune thrombotic thrombocytopenia syndrome (VITTS), and reactions related to the pharmaceutical excipients present in the vaccine. A comprehensive review on the safety of COVID-19 vaccines would help in early identification and better management of ADRs. This literature review was conducted using PubMed, Google Scholar, COVID-19 Vaccine package inserts, andThis article provides various aspects of COVID-19 vaccine safety and offers strategies to prevent and clinically manage suspected ADRs related to COVID-19 vaccines.A careful consideration of contraindications and patient education on early identification of serious ADRs are the cornerstones in tackling safety concerns associated with COVID-19 vaccines. Most of the mild ADR cases are manageable with over-the-counter medications, while the serious ones may require physician oversight and hospitalization. It is also mandatory to report all ADRs to the local pharmacovigilance centers, with a higher priority given to the moe significant ones, in order to improve vaccine safety data.

Background: Lack of adherence to anti-diabetic medications use is linked with suboptimal glycemic control which in turn leads to increase rate of diabetic complications. The adherence to anti-diabetic medications among adult diabetic patients in Sana'a city has not been yet evaluated. Objective: This study, therefore, assessed the extent to which diabetic patients are adherent to their antidiabetic medications and explored the factors underlying such adherence attitude in Sana’a City, Yemen. Methods: A cross-sectional method was conducted among a sample of 365 diabetic patients attending public and private hospitals from March to April 2017 in Sana'a City-Yemen. Random patients were selected and data regarding their treatment adherence were obtained using a questionnaire. Adherence to diabetes medications was measured using medication adherence index followed by structured interviews. Descriptive analysis was used to compare between different groups of diabetic patients. Bivariate analyses were conducted to evaluate the associations between clinical variables. Results: The cross-sectional study included 365 patients (263 males; 102 females). A high level of medication adherence rate to anti-diabetic drugs in the present study was (70%). The adherence rate was not similar in both genders where males were more adherent than females. The most common reason for non-adherence was forgetfulness (n= 67; 61%). While the lowest factor for non-adherence was associated with ineffective (n= 7; 6%). Adherence was strongly associated with diabetes duration, monthly income, blood sugar monitoring, communication with physician, and patient’s knowledge regarding importance of medication use (p

The major concern to search for new anti-arthritic drugs is primarily to prevent systemic complications and to maintain quality of life. As these drugs are prescribed for long duration so the objective is to ensure their safety in terms of toxicity. By keeping in view this concept, the present study was investigated to determine new anti-arthritic potential using in-vitro and in-vivo methods. The in-vitro tests comprised of protein denaturation (BSA and egg albumin) and Human Red Blood cell (HRBC) membrane stabilization assays at 50-6400μg/mL, for in-vivo testing, formaldehyde-induced arthritic rats were treated with 40, 80 and 160mg/kg mandelic acid. Mandelic acid (MA) inhibited the protein denaturation and stabilized the membrane of HRBC in a concentration dependent manner. Likewise, mandelic acid exhibited dose dependent reduction in paw volume induced by formaldehyde. For acute and sub-acute treatment, MA did not show any sign of toxicity and mortality in each rat and LDinf50/infmight be greater than 2000mg/kg. In addition, histopathological assessment presented slight increased interstitial spaces in the kidney, disorganization of glomerulus, dilated sinusoids at highest dose 800mg/kg which were not observed in sub-chronic therapy. Hence, these results conclude that mandelic acid has the potential to treat rheumatoid arthritis with observed no significant signs of toxicity and should be tested further to determine anti-arthritic mechanism of drug action at cellular level.

Graphical abstract, Background The SARS-CoV-2 coronavirus epidemic is hastening the discovery of the most efficient vaccines. The development of cost-effective vaccines seems to be the only solution to terminate this Pandemic. However, the vaccines’ effectiveness has been questioned due to recurrent mutations in the SARS-CoV-2 genome. Most of the mutations are associated with the spike protein, a vital target for several marketed vaccines. Many Countries were highly affected by the 2nd wave of the SARS-CoV-2, like the UK, India, Brazil, France. Experts are also alarming the further COVID-19 wave with the emergence of Omicron, which is highly affecting the South African populations. This review encompasses the detailed description of all vaccine candidates and COVID-19 mutants that will add value to design further studies to combat the COVID-19 Pandemic. Methods The information was generated using various search engines like google scholar, PubMed, clinicaltrial.gov.in, WHO database, ScienceDirect, and news portals by using keywords SARS-CoV-2 Mutants, COVID-19 Vaccines, Efficacy of SARS-CoV-2 Vaccines, COVID-19 waves. Results This review has highlighted the evolution of SARS-CoV2 variants and the vaccine efficacy. Currently, various vaccine candidates are also undergoing several phases of development. Their efficacy still needs to check for newly emerged variants. We have focused on the evolution, multiple mutants, waves of the SARS-CoV-2, and different marketed vaccines undergoing various clinical trials and the design of the trials to determine vaccine efficacy. Conclusion Various mutants of SARS-CoV-2 arrived, mainly concerned with the spike protein, a key component to design the vaccine candidates. Various vaccines are undergoing clinical trial and show impressive results, but their efficacy still needs to be checked in different SARS-CoV-2 mutants. We discussed all mutants of SARS-CoV-2 and the vaccine's efficacy against them. The safety concern of these vaccines is also discussed. It is important to understand how coronavirus gets mutated to design better new vaccines, providing long-term protection and neutralizing broad mutant variants. A proper study approach also needs to be considered while designing the vaccine efficacy trials, which further improved the study outcomes. Taking preventive measures to protect from the virus is also equally important, like vaccine development.

Gliomas are one of the prominent cancers of the central nervous system with limited therapeutic modalities. The present investigation evaluated the synergistic effect of paclitaxel (PAX) and resveratrol (RESV)-loaded Soluplus polymeric nanoparticles (PNPs) against glioma cell lines along with in vivo pharmacokinetics and brain distribution study. PAX-RESV-loaded PNPs were prepared by the thin film hydration technique and optimized for different dependent and independent variables by using DoE (Design-Expert) software. The in vitro physiochemical characterization of prepared PAX-RESV-loaded PNPs exhibited appropriate particle size, PDI and % encapsulation efficiency. Cytotoxicity assay revealed that PTX-RESV loaded PNPs had a synergistic antitumor efficacy against C6 glioma cells compared with single and combined pure drugs. Finally, the pharmacokinetic and brain distribution studies in mice demonstrated that the PNPs significantly enhanced the bioavailability of PTX-RESV PNPs than pure PAX and RESV. Thus, the study concluded that PAX-RESV PNPs combination could significantly enhance anti-glioma activity, and this could be developed into a potential glioma treatment strategy.

Aims: The current study aimed to evaluate female consumers’ knowledge and practice about harmful effects of topical clobetasol applied on the face for cosmetic purposes. Study Design: Cross-sectional study. Place and Duration of Study: Randomly selected community pharmacies, well known cosmetic shops and shopping malls of Hail region, Saudi Arabia from March 2018 to June 2018. Methodology: We included 391 participants who only used ‘clobetasol’ as a topical steroid at the time of interview, responses were collected as per the study tool and analyzed using SPSS for Windows, Version 16.0. Chicago, SPSS Inc.. Results: Relatives (28.1%), friends (25.6%) and community pharmacists (15.6%) contributed significantly towards using topical clobetasol cream. In 86.2% of the cases, the pharmacists who dispensed clobetasol did not inform the consumer about the harmful effects. Purchasing the cream without prescription (P = 0.025) was significantly associated with age. In the study, 41.9 % of the females experienced adverse effects, with the commonest one being hair growth on face (23%) followed by dermatrophy (14.8%); with a significant association with frequency of use (p

Objective: Brain tumors are the most challenging of all tumors and accounts for about 3% of all cancer allied deaths. The aim of the present review is to examine the brain tumor prevalence and treatment modalities available in the Kingdom of Saudi Arabia. It also provides a comprehensive analysis of the application of various nanotechnology-based products for brain cancer treatments along with their prospective future advancements. Methods: A literature review was performed to identify and summarize the current status of brain cancer in Saudi Arabia and the scope of nanobiotechnology in its treatment. Results: Depending upon the study population data analysis, gliomas, astrocytoma, meningioma, and metastatic cancer have a higher incidence rate in Saudi Arabia than in other countries, and are mostly treated in accordance with conventional treatment modalities for brain cancer. Due to the poor prognosis of cancer, it has an average survival rate of 2 years. Conventional therapy includes surgery, radiotherapy, chemotherapy, and a combination thereof, but these do not control the disease’s recurrence. Among the various nanomaterials discussed, liposomes and polymeric nanoformulations have demonstrated encouraging outcomes for facilitated brain cancer treatment. Conclusions: Nanomaterials possess the capacity to overcome the shortcomings of conventional therapies. Polymer-based nanomaterials have shown encouraging outcomes against brain cancer when amalgamated with other nano-based therapies. Nonetheless, nanomaterials could be devised that possess minimal toxicity towards normal cells or that specifically target tumor cells. In addition, rigorous clinical investigations are warranted to prepare them as an efficient and safe modality for brain cancer therapy.

Objective: The study is to evaluate Yemeni medical and pharmacy students’ knowledge and attitude regarding generic medicines. Method: A cross-sectional survey was used to collect data from final-year medical and pharmacy students at six public and private universities in Yemen. The questionnaire was distributed among the students through their course coordinators. Students were clearly informed about the objective of the study and their written consents were taken before the survey. The responses were entered in SPSS, and descriptive and inferential analyses were carried out. Results: The response rate was 60.1%. Overall the half of participants’ perception regarding generic medicine was positive. Perceptions of pharmacy students’ regarding generic medicines were better than those of the medical students. Conclusion: The present study concluded that both studied groups had insufficient knowledge about quality, safety and bioequivalence of generic medicines. The medical students showed poorer knowledge than pharmacy students which need to give more attention from educators regarding the use of generic medicines. Key words: Generic drugs, Medical students, Perception, Pharmacy students, Yemen.

Ayurveda, an orthodox as well as main stream system of medicine has been with a source of new concepts and products for healthcare. Euphorbia hirta Linn. (EH) is an advantageously authenticated medicinal plant as observable from the literature. Rural and tribal people of India use different parts of this plant to surmount various diseases. Its use in traditional medicine has been assured on scientific basis by studying pharmacology of the plant in vitro and in vivo Information was collected from different data base resources.MED Phoenix Volume (1), Issue (1) July 2016, page: 31-38

COVID-19 outbreak is pandemic worldwide with increasing total reported cases, new cases and total deaths. This devastating situation has affected every corner of human lives including academic sector globally. Although there are various measures to prevent spread of COVID-19 infection, online education could be the most suitable option concerning academic institutions to curb its spread, and developing nations including Nepal are in urgent need to implement it.

Objective: The study was to investigate antibiotic prescription patterns at outpatient departments (OPDs) at four hospitals in Aden-Yemen. Settings and Design: A cross sectional descriptive study was conducted in the four hospitals in different areas of Aden city, the commercial capital of Yemen, from November 2015 through December 2015. WHO indicators were chosen. The study sampled the prescriptions conveniently. The data collection form used include Core Indicators and Complimentary Indicators of WHO such as average number of medicines per encounter, percentage of medicines prescribed by generic name, percentage of medicines prescribed from the EML and percentage of prescriptions in accordance with treatment guidelines. Data was analysed descriptively. Results: Out of the 400 prescriptions received from the outpatient clinics in the four hospitals during the study period, 337 antibiotic prescriptions were counted for. The percentage of prescriptions involving antibiotics was 84.2%. The average number of drugs per prescription was 3.2. Out of the surveyed antibiotic prescriptions, 65% contain one antibiotic and more than one-third were in the cephalosporin group (38.8%). Generally, 41% of the prescriptions were generic, furthermore, 44.8% of the prescribed medicines across all hospitals were from the EML. Conclusion: Important number of the prescribing indicators showed deviation from the standard values recommended by WHO. This deviation indicated an obvious degree of irrational/inappropriate prescribing in the hospitals, particularly poly pharmacy, underuse of international nonproprietary names (generic names), and over prescription of antibiotics. The study recommended to more adherence to WHO antibiotic prescribing guidelines and improving knowledge of proper and good prescribing procedure among health system prescribers. Key words: Antibiotics, Hospital, Prescribing pattern, WHO indicators, Yemen.

© 2018, Journal of Clinical and Diagnostic Research. All rights reserved. Introduction: Patient counseling is a major component of pharmaceutical care, especially in community pharmacy settings. However, most community pharmacists still do not offer patient-oriented services. Despite the beneficial role of community pharmacists, research examining their roles and responsibilities in developing countries like Yemen is lacking. Aim: To assess the community pharmacy personnel’s perceptions towards patient counseling and to recognise the major barriers to successful counseling; and to assess their perception towards continuing pharmacy education programs in Aden. Materials and Methods: A descriptive, cross-sectional study was conducted among 200 community pharmacy personnel in Aden using a self-administered, structured questionnaire. Data were collected regarding community pharmacy personnel’s knowledge, attitude, and their perception about patients’ attitude concerning patient counseling and respondents’ attitude toward the continuing pharmacy education. Results: The majority of the respondents had a positive attitude towards patient counseling (85%) and continuing pharmacy education (94.0%); dose and frequency (43.0%), duration (34.0%) and indication (11.5%) were the major information mentioned while counseling their patients. Lack of patient interest (47.0%), lack of knowledge (20.0%) and lack of time (15.5%) were the major barriers towards counseling. Conclusion: The present study showed that most community pharmacy personnel in Aden, Yemen had a positive perception towords patient counseling and continuing pharmacy education program.

Introduction Pharmacists in community or hospital setting play a key role in reporting Adverse Drug Reaction (ADRs) during practice. Under reporting is considered as a profession malpractice worldwide. Aim To determine the level of knowledge and perception about phramacovigilance and ADRs reporting among final year pharmacy students of Universities in Sana'a Yemen. Materials and methods A cross-sectional study design was conducted among 385 final year pharmacy students. One public and four private universities were selected randomly using a validated self-administered questionnaire. The questionnaire contained data about student demographic data, knowledge and perception about the ADRs. The data was analysed by SPSS program and Chi-square tests were used to assess the significance of association. Results The male students were more knowledgeable than female (p=0.035), as well as private university students had better ideas on how to report ADRs than public university students (p=0.009). Private university students reported that pharmacovigilance topic is well covered in their curriculum compared to public university students (p≤0.001). A significant difference was seen amongst the students of public and private universities when asked about reporting ADRs in future, former found more confident (p≤0.001). Furthermore, the private university students also had more command on the concept of post-marketing surveillance than public university students (p≤0.001). The private university students in Yemen were more known to causality assessment of ADRs as compared to the students of public universities (p≤0.001). The results of perception revealed regarding perception toward ADRs and pharmacovigilance. Female students (p≤0.018) and private universities students (p≤0.001) had positive perception than male and public university students respectively. Conclusion The findings showed poor knowledge among students in Sana'a Universities and positive perception towards pharmacovigilance and ADRs reporting. A poor knowledge among the future pharmacists suggests need for educational interventions and improvement of strategies to ease the reporting mechanisms. Steps can be taken to improve pharmacovigilance tools and methods in Yemen as well as incorporating subjects of pharmacovigilance in the health faculty's curriculum in Yemen.

Objective: To determine the antimicrobial resistance patterns of Shigella species to the most commonly used antibiotics in mid and far western part of Nepal. Methods: Stool samples were collected from 458 patients who came from mid and far western region of Nepal, attending OPD & IPD Departments of Nepalgunj Medical College, Nepal, between the periods of September 2011 to March 2013. Standard microbiological procedures were used for isolation and identification of Shigella species while the disc diffusion test was used to determine the antimicrobial resistance patterns of the recovered isolates. Results: A total of 65 isolates were identified as Shigella species. Shigella flexneri, Shigella dysenteriae, Shigella boydii and Shigella sonnei were accounted respectively for 43.07%, 27.69%, 21.53% and 7.69% of the total number of Shigella isolated. Resistances to nalidixic acid (95.38%), ampicillin (84.62%), co-trimoxazole (81.54%) and ciprofloxacin (46.15%) were observed. Greater number of isolates (38.46%) was recovered from those aged 1-10 years. This was statistically significant (P

Objectives: Lower respiratory tract infections (LRTIs) are among the most common infectious disease. This study focused on determining the bacterial etiology of LRTIs among the patients attending Nepalgunj Medical College & teaching Hospital, Banke, in western Nepal. Materials and Methods: A prospective study conducted on 426 specimens, received from patients with suspected LRTIs attending out-patients and in-patients departments. The specimens were collected and processed according to standard methodology in the Central Laboratory of Microbiology at Nepalgunj Medical College and Teaching Hospital, Banke, Nepal between the periods of January 2012 to December 2012.Results: Respiratory pathogens were recovered from 49.3% cases (n=210). Bacteria were more commonly recovered from endotracheal (ET) secretion (86, 41%) than in sputum (82, 39%) and bronchial washing (42, 20%). 80% (n=168) growth was monomicrobial while the rest accounted for mixed growth. Gram‐negative bacteria were in 80.9% (n=246) and gram-positive bacteria were 19.1% (n=58). Among the Gram-positive organisms isolated, Streptococcus pneumoniae (30, 51.7%) was the most predominant pathogen followed by Staphylococcus aureus (28, 48.3%) and in Gram-negative organisms isolated, Pseudomonas aeruginosa (116,47.2%) was most predominant pathogen followed by Haemophilus influenzae (68, 27.6%) Klebsiella pneumoniae (36, 14.6%), Escherichia coli (26, 10.6%). Conclusions: P. aeruginosa and S. pnemoniae were the most common gram negative and gram-positive bacterial isolates recovered, respectively from LRTIs urging for monitoring and surveillance of these pathogens. Key words: Bacteria etiological agent, Lower Respiratory tract infections, Respiratory aspirates, Nepal.

Objectives: The aim of this study was to evaluate the prevalence of anemia among adolescent males and females in the far western part of Nepal. Patients and Methods: A hospital based study was carried out in Nepalgunj Medical College, Kohalpur, Banke, Nepal to determine prevalence and distribution of anemia in terms of age and gender among adolescents population. A total of 2027 adolescent (10-19 years old) females and males were included in the study from March 2011 to December 2012. Hemoglobin level was determined by the Cyanmethaemoglobin method. Data were summarized using descriptive statistics. Results: The overall prevalence of anemia was 52% for both males and females. 29.7% of the females and 22.4% of the males were anemic. The prevalence of mild anemia was 67.5% (38.4% in females and 29.0% in males), moderate anemia was 20.0% (10.9% in females and 9.1% in males) and severe anemia was 12.5% (7.7% in females and 4.8% in males). Analyzing data per age groups revealed that the highest prevalence of anemia in general occurred in the 18-19 year old subjects affecting 292 (82 males and 210 females). Conclusions: Anemia in adolescent Nepalese adolescents is mostly mild, occurs more in late teenage years and it mainly affects females. Nutritional improvement and oral iron supplementation is needed for curing of anemia. Keywords: Adolescents, Prevalence, Anemia, Hemoglobin, Western Nepal

I ntroduction: Breast cancer is the commonest female malignancy in Malaysia and other countries the world. All races are affected in Malaysia and breast cancer comprised 30.4% of all newly diagnosed cancer cases. A women in Malaysia has a 1 in 19 chances of getting breast cancer in her lifetime. The Age Standardized Rate (ASR) of female breast cancer in Malaysia is 52.8 per 100,000 people and is higher than that in Singapore, Hong Kong and Shanghai, but it is lower than that in Australia and the UK. Out of the 4,337 new cases of female breast cancer cases reported to the National Cancer Registry of Malaysia in 2002, 52.3% were for women less than 50 years old. Genetic risk factors have not been studies thoroughly in Malaysia. Methods: We prospectively studied 55 patients with breast lumps in whom MR imaging was performed. The T1- and T2-weighted, axial STIR, fat-suppression contrast enhanced fast spin echo and two dimensional dynamic enhanced fast spoiled gradient-echo images were obtained. The tumour margins and shape, enhancement pattern and time-signal intensity curves were analysed. Results: A total of 37 patients fulfilled the study criteria with the mean age of 43.46 ±11.99 years (age ranged 21-70). There were 23 benign and 14 malignant lesions. The MR imaging criteria suggestive of malignancy were poorly defined and spiculated margins, irregular shape, heterogeneous and rim enhancement as well as type II and III curves. On the other hand, the criteria for a benign breast lesions were well-defined margin, regular and lobulated shape, none or homogeneous enhancement and type I curve. Only the malignant lesions are characterised by skin, retroareolar, nipple and pectoralis muscle involvement. Conclusion: MR imaging is a valuable complementary breast imaging tool to further evaluate equivocal findings on conventional x-ray mammography. A combination of lesion morphology and enhancement characteristics is useful in distinguishing benign from malignant lesions. DOI: http://dx.doi.org/10.3126/joim.v34i2.9052 Journal of Institute of Medicine August, 2012; 34:2 28-34

Background and Objectives: Shigella plays an important role as a causative organism of acute gastroenteritis, in children and others. Rapid emergence of antibiotic resistance warrants continuous monitoring of susceptibility pattern of bacterial isolates. We report here our findings about Shigella spp. isolates and their drug resistance patterns in Nepalese patients. Materials and Methods: The study was conducted on 507 Nepalese patients with acute gastroenteritis attending outpatient and inpatient departments of Nepalgunj Medical college and teaching Hospital, Banke, Nepal from September 2011 to April 2013. Stool specimens were processed for isolation and identification of Shigella species following the standard microbiological methods while the disc diffusion test was used to determine antimicrobial resistance patterns of the recovered isolates at the central Laboratory of Microbiology. Results: Sixty nine isolates were identified as Shigella species. S. flexneri, S. dysenteriae, S. boydii and S. sonnei accounted, respectively, for 42.03%, 27.54%, 21.74% and 8.70% of the total number of Shigella isolates. Resistance to nalidixic acid (95.65%), ampicillin (85.51%), co-trimoxazole (82.61%) and ciprofloxacin (47.83%) was observed. Among 69 isolates, 29 (42.03%) were from children aged 1-10 years and this group was statistically significant (P < 0.05), compared to the other age groups. Conclusions: The study revealed endemicity of shigellosis with S. flexneri as the predominant serogroup in Nepalese patients. Children were at a higher risk of severe shigellosis. Nalidixic acid, ampicillin, co-trimoxazole and ciprofloxacin should not be used empirically as the first line drugs in treatment of shigellosis. Continuous local monitoring of resistance patterns is necessary for the appropriate selection of empirical antimicrobial therapy.

Background Cost is a vital component for people with chronic diseases as treatment is expected to be long or even lifelong in some diseases. Pharmacist contributions in decreasing the healthcare cost burden of chronic patients are not well described due to lack of sufficient evidences worldwide. In developing countries like Nepal, the estimation of direct healthcare cost burden among newly diagnosed diabetics is still a challenge for healthcare professionals, and pharmacist role in patient care is still theoretical and practically non-existent. This study reports the impact of pharmacist-supervised intervention through pharmaceutical care program on direct healthcare costs burden of newly diagnosed diabetics in Nepal through a non-clinical randomised controlled trial approach. Methods An interventional, pre-post non-clinical randomised controlled study was conducted among randomly distributed 162 [control (n = 54), test 1 (n = 54) and test 2 (n = 54) groups] newly diagnosed diabetics by a consecutive sampling method for 18 months. Direct healthcare costs (direct medical and non-medical costs) from patients perspective was estimated by ‘bottom up’ approach to identify their out-of-pocket expenses (1USD = NPR 73.38) before and after intervention at the baseline, 3, 6, 9 and 12 months follow-ups. Test groups’ patients were nourished with pharmaceutical care intervention while control group patients only received care from physician/nurses. Non-parametric tests i.e. Friedman test, Mann–Whitney U test and Wilcoxon signed rank test were used to find the differences in direct healthcare costs among the groups before and after the intervention (p ≤ 0.05). Results Friedman test identified significant differences in direct healthcare cost of test 1 (p