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  1. Jha N, Shankar PR, Palaian S
    Risk Manag Healthc Policy, 2021;14:793-802.
    PMID: 33658875 DOI: 10.2147/RMHP.S291025
    Background: Medicines may remain unused and often get expired. Unused medicines can promote self-medication. Unsafe and improper medicine disposal can cause significant environmental harm. Medical and dental students as future prescribers should be aware of the safe disposal of medicines, ecopharmacovigilance and self-medication. The present study examines knowledge and practice about unused and expired medicines and medicine disposal among undergraduate medical and dental students in Nepal.

    Methods: The study was conducted during September 2020 using an online survey form. First to final year undergraduate students provided their consent and signed an integrity pledge electronically. Age, gender, program of study, year of study, whether staying with family or not, method of financing education, and whether they had used any allopathic medicines during the past 6 months were noted. The total knowledge score among different subgroups was compared. The frequency of responses regarding practice items and the free-text comments were also listed. Statistical analysis was performed using Mann-Whitney test and Kruskal-Wallis test.

    Results: Altogether 441 of the 668 students (66%) participated. The majority were below 23 years and female. Over 65% had used allopathic medicines during the last 6 months. The median knowledge score was 8 (maximum 10) and was significantly higher among older respondents, females and students in later years of study. Most kept unused medicines at home/hostel till expiry which were disposed of in the household garbage. Over 40% had educated their family members about safe medicine disposal. Knowledge scores were significantly different among subgroups according to respondents' age, gender and year of study.

    Conclusion: Respondents were aware of expiry of medicines and knew methods to safely dispose expired medicines. However, they practiced self-medication, stored medications at home and did not practice the safe disposal of medications. Understanding why respondents did not dispose medicines properly is important.

  2. Shrestha S, Jha N, Palaian S, Shankar PR
    SAGE Open Med, 2020;8:2050312120974513.
    PMID: 33282309 DOI: 10.1177/2050312120974513
    Good knowledge, awareness and preparedness regarding coronavirus disease 2019, among community pharmacy practitioners (CPPs), will enable them to provide correct information and support to patients, convey instructions from the public health authorities and protect their own health.

    Objective: The aim of this study was to determine knowledge, awareness and preparedness regarding coronavirus disease 2019 among CPPs working in Kathmandu, Nepal.

    Methods: A cross-sectional study was conducted using a convenience sampling method from 10 February to 25 March 2020. Data were analysed descriptively, and one-sample independent t-test and one-way analysis of variance were used to compare scores among different subgroups of respondents (p 

  3. Kafle S, Jha N, Sapkota Y, Shankar PR
    Int J Risk Saf Med, 2021 Oct 26.
    PMID: 34719439 DOI: 10.3233/JRS-210026
    BACKGROUND: Community pharmacists are among the most accessible health care providers.

    OBJECTIVE: This study evaluates the knowledge of community pharmacists about the risks associated with medication use during pregnancy.

    METHODS: A cross-sectional study was carried out in March 2021 among the 344 community pharmacies in the Kathmandu Valley, Nepal. Convenience sampling was used for data collection using a structured and validated questionnaire.

    RESULTS: The majority of participants were male: 264 (76.7%), 94.2% were between the age of 21 to 30 years, and 53.1% had work experience of less than one year. Over half had completed diploma in pharmacy. Less than 10 medicines were dispensed to pregnant women daily in 61.6% of the pharmacies. Only 28.8% of the community pharmacists always inquired about pregnancy status from women in the reproductive age group. The mean knowledge score was significantly different among individuals with different work experience and qualifications (p

  4. Jha N, Mudvari A, Hayat K, Shankar PR
    J Nepal Health Res Counc, 2023 Mar 09;20(3):689-696.
    PMID: 36974858 DOI: 10.33314/jnhrc.v20i3.3992
    BACKGROUND: Antimicrobial resistance is an important global problem resulting in an improper response of infections to antimicrobials and an increase in the duration and cost of treatment. Healthcare professionals play an important role in addressing Antimicrobial resistance and positive perception is important for involvement in antimicrobial stewardship policies. Hence the perception of key Healthcare professionals, including physicians, nurses, and hospital pharmacists, towards Antimicrobial resistance antimicrobial stewardship policies was studied.

    METHODS: A cross-sectional study was conducted in a tertiary care hospital at Lalitpur, from January to March 2021 using stratified random sampling. An online questionnaire was circulated to the selected Healthcare professionals. Median Antimicrobial resistance and antimicrobial stewardship policy scores were calculated and compared among different subgroups. Previous engagement with Antimicrobial resistance and antimicrobial stewardship policies programs was also noted. Descriptive statistics, Mann Whitney, and Kruskal Wallis tests were used for data analysis.

    RESULTS: The response rate was 89.3% (202/226). Antimicrobial resistance was regarded as a serious problem in the Nepali community by participants with work experience of 1-5 years, 87 (75.6%, p=0.029), and female participants, 62 (45.5%, p<0.001). Most physicians, females, and participants with working experience 1-5 years believed inappropriate use of antibiotics can harm patients and is professionally unethical. Physicians supported the availability of local antimicrobial guidelines and protocols. The median scores for Antimicrobial resistance (p<0.001) and Antimicrobial resistance eradication (p=0.048) differed according to age groups.

    CONCLUSIONS: Healthcare professionals believed Antimicrobial resistance was an important issue. Antibiotic guidelines developed should be strictly implemented. Healthcare professionals also believed inappropriate use of antibiotics can harm patients and is professionally unethical.

  5. Kafle S, Jha N, Bhandary S, Ravi Shankar P
    JNMA J Nepal Med Assoc, 2024 Jun 30;62(275):427-432.
    PMID: 39369416 DOI: 10.31729/jnma.8651
    INTRODUCTION: Counterfeit medicines are a significant problem globally. In a developing country like Nepal, community pharmacists play an important role in dispensing medicines. The study was done to assess community pharmacists' perceived prevalence, awareness and attitude towards counterfeit medicines in Kathmandu valley.  Methods: A cross-sectional study design was used. Data was collected conveniently from Kathmandu, Bhaktapur, and Lalitpur districts in March 2022 after obtaining ethical clearance from Nepal Health Research Council (reference no. 2200) and taking written informed consent from Community Pharmacists.  Results: Among the 343 pharmacists who participated, 250 (72.89%) were from Kathmandu, 57 (16.62%) were from Lalitpur, and 36 (10.50%) from Bhaktapur. Most 252 (73.47%) were aged between 20 to 30 years, 222 (64.72%) were male, 239 (69.68%) had done a Diploma in Pharmacy, 201 (58.60%) had working experience of more than 5 years and 342 (99.71%) had done their education in Nepal. Their median perceived prevalence of counterfeit drugs was 10.00% but only 2.30% had clear knowledge of such practice. 332 (96.79%) believed that actions should be taken against community pharmacists dispensing counterfeit drugs, 325 (94.75%) believed that pharmacists who dispense counterfeit medicines are unprofessional; 338 (98.54%) stated that there should be strong law against counterfeit medicine sales.

    CONCLUSIONS: Median perceived prevalence of counterfeit medicines was 10.00% but only 2.30% were aware of counterfeit medicine dispensing. Out of 343 pharmacists, 332 (96.79%) mentioned that  action should be taken against those pharmacists knowingly dispensing counterfeit medicines and 338 (98.54%) stated that there should be strong law against counterfeit medicines.

  6. Thapa B, Pathak SB, Jha N, Sijapati MJ, Shankar PR
    JNMA J Nepal Med Assoc, 2022 Jul 01;60(251):625-630.
    PMID: 36705203 DOI: 10.31729/jnma.7394
    INTRODUCTION: Antimicrobial resistance is a global health problem. The widespread and improper antibiotics use is the leading cause of antimicrobial resistance. Bacterial co-infection in COVID-19 patients is the basis for the use of antibiotics in the management of COVID-19. COVID-19 pandemic has seriously impacted antibiotic stewardship and increased the global usage of antibiotics, worsening the antimicrobial resistance problem. The use of antibiotics among COVID-19 patients is high but there are limited studies in the context of Nepal. This study aimed to find out the prevalence of antibiotic use among hospitalised COVID-19 patients in a tertiary care centre.

    METHODS: A descriptive cross-sectional study was conducted on hospitalised COVID-19 patients from April 2021 to June 2021 in a tertiary care centre. Ethical approval was taken from the Institutional Review Committee (Reference number: 2078/79/05). The hospital data were collected in the proforma by reviewing the patient's medical records during the study period of 2 months. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated.

    RESULTS: Among 106 hospitalised COVID-19 patients, the prevalence of antibiotic use was 104 (98.11%) (95.52-100, 95% Confidence Interval). About 74 (71.15%) of patients received multiple antibiotics. The most common classes of antibiotics used were cephalosporins, seen in 85 (81.73%) and macrolides, seen in 57 (54.81%) patients.

    CONCLUSIONS: The prevalence of antibiotic use among hospitalised COVID-19 patients was found to be higher when compared to other studies conducted in similar settings.

    KEYWORDS: antibiotics; bacterial infection; co-infection; COVID-19.

  7. Jha N, Thapa B, Pathak SB, Pandey A, Pokhrel S, Shankar PR, et al.
    Kathmandu Univ Med J (KUMJ), 2022;20(79):351-358.
    PMID: 37042379
    Background Point prevalence survey (PPS) on antibiotic use developed by the WHO has already been used in many hospitals globally. Objective To obtain information on antibiotic prescribtion using point prevalence survey methodology in six private hospitals in the Kathmandu valley. Method This descriptive cross-sectional study was completed during 20th July to 28th July 2021 using point prevalence survey methodology. The study was conducted among inpatients admitted at or before 8:00 AM on the day of survey in various wards. Data was presented as frequencies and percentages. Result Maximum number of patients were above 60 years [34 (18.7%)]. Number of male and female participants were equal [91 (50%)]. Only one antibiotic was used in 81 patients (44.5%) followed by two antibiotics in 71 (39%) patients. Duration of prophylactic antibiotic use was one day in 66 (63.7%) patients. Blood, urine, sputum, and wound swabs were the common samples for culture. Cultures were positive for 17 (24.7%) samples. The common organisms isolated were E. Coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Ceftriaxone was the most used antibiotic. Drug and therapeutics, infection control committee and pharmacovigilance activities were present in 3/6 (50%) study sites. Antimicrobial stewardship was present in 3/6 (50%) and microbiological services was present in all hospitals. Antibiotic formulary and antibiotic guideline were present in 4/6 sites and facilities to audit or review surgical antibiotic prophylaxis choice in 2/6 (33.3%) sites, facility to monitor antibiotic use in 4/6 (66.6%) and cumulative antibiotic susceptibility reports in 2/6 (33.3%) study sites. Conclusion Ceftriaxone was the most used antibiotic. E. Coli, Pseudomonas aeruginosa and Klebsiella pneumonia were the commonly isolated organisms. Not all parameters for infrastructure, policy and practice and monitoring and feedback were present at the study sites. KEY WORDS.
  8. Jha N, Thapa B, Pathak SB, Kafle S, Mudvari A, Shankar PR
    PLoS One, 2023;18(11):e0294644.
    PMID: 37983218 DOI: 10.1371/journal.pone.0294644
    INTRODUCTION: The access, watch, and reserve (AWaRe) classification of antibiotics was developed in 2019 by the WHO Expert Committee on the Selection and Use of Essential Medicines as a tool to support antibiotic stewardship efforts at local, national, and global levels. The objectives of this study were to assess the availability of antibiotics as per WHO AWaRe classification at community pharmacies located around a tertiary care hospital in Lalitpur and to compare these antibiotics with the national essential medicine list of Nepal.

    METHOD: The cross-sectional study was conducted at community pharmacies located within a two-kilometer radius of a teaching hospital from August to November 2022. A total of 82 community pharmacies registered with the Nepal Chemist and Druggists Association and the Department of Drug Administration were studied. Data was collected using a standard proforma containing the names of the antibiotics classified as per the WHO's AWaRe classification.

    RESULTS: Access group of antibiotics, Ampicillin, (82;100%), Amoxycillin, (82;100%), Flucloxacillin, (82;100%), and Metronidazole, (82;100%) were available in all community pharmacies. Results from the watch group showed that Azithromycin, (80; 97.6%) was available in all pharmacies followed by Cefixime, (80; 97.6%), Ciprofloxacin, (73; 89%), Levofloxacin, (74; 90.2%)and Ofloxacin, (74; 90.2%). Linezolid, (24; 29.3%) was the most common antibiotics available from the reserve group of antibiotics. Colistin was the second commonly available antibiotic. The most available antibiotic from the not recommended group were Ampicillin/Cloxacillin (82; 100%), followed by Piperacillin/Sulbactam, (39; 47.6%). There were differences in the classification of antibiotics between the WHO AWaRe list and the Essential Medicines list of Nepal in terms of numbers of antibiotics listed.

    CONCLUSION: Antibiotics from the not recommended and reserve groups were commonly available in community pharmacies. The implementation of antibiotic guidelines should be emphasized along with strict monitoring of the sale of antibiotics without a prescription in community pharmacy settings.

  9. Jha N, Singh N, Bajracharya O, Manandhar T, Devkota P, Kafle S, et al.
    Med Pharm Rep, 2021 Oct;94(4):440-448.
    PMID: 36105501 DOI: 10.15386/mpr-1928
    BACKGROUND: Coronavirus disease-19 (COVID-19) has become a major global problem. There is an urgent need to measure the knowledge of the disease among health science students who can play an active role in pandemic control. The research was conducted to examine COVID-19 knowledge among medical and dental students in a Nepalese medical college, compare the knowledge to other studies in the literature and identify educational needs of students who may be involved in treating COVID-19 patients.

    METHODS: The cross-sectional study was performed during the third week of June among first to final year medical and dental students. As the country was in lockdown, a structured online questionnaire was used. The responses obtained were entered into IBM SPSS Statistics for Windows and the normality of the data checked using one-sample Kolmogorov Smirnov test. The demographic parameters were tabulated, and total score compared among different subgroups of participants. The frequency of different measures mentioned by respondents were also noted.

    RESULTS: More than half of the participants were females (59.6%). Nearly half 282 (49.8%) belonged to age group 21-23 years. The majority 415 (73.5%) were undergraduate medical and 150 (26.5%) were undergraduate dental students. The largest number of respondents, 140 (24.9%), were from the second year of study and 344 (60.9%) were from urban areas. The median total score was 20 and the interquartile range 4. The maximum possible score was 29. The scores among students belonging to different years of study were significantly different (p=0.006). Total scores were not significantly different among other subgroups.

    CONCLUSIONS: The knowledge of the participants was good. Deficiencies in knowledge were noted in certain areas and these should be addressed through an educational intervention. One of the challenges is the rapid evolution of our knowledge about this condition, which may require regular refresher sessions. Similar studies can be undertaken in other medical colleges in the country and in nursing and pharmacy colleges.

  10. Gyawali S, Rathore DS, Shankar PR, Kc VK, Jha N, Sharma D
    Malays J Med Sci, 2016 Jan;23(1):44-55.
    PMID: 27540325
    BACKGROUND: Unsafe injection practice can transmit various blood borne infections. The aim of this study was to assess the knowledge and practice of injection safety among injection providers, to obtain information about disposal of injectable devices, and to compare the knowledge and practices of urban and rural injection providers.

    METHODS: The study was conducted with injection providers working at primary health care facilities within Kaski district, Nepal. Ninety-six health care workers from 69 primary health care facilities were studied and 132 injection events observed. A semi-structured checklist was used for observing injection practice and a questionnaire for the survey. Respondents were interviewed to complete the questionnaire and obtain possible explanations for certain observed behaviors.

    RESULTS: All injection providers knew of at least one pathogen transmitted through use/re-use of unsterile syringes. Proportion of injection providers naming hepatitis/jaundice as one of the diseases transmitted by unsafe injection practice was significantly higher in urban (75.6%) than in rural (39.2%) area. However, compared to urban respondents (13.3%), a significantly higher proportion of rural respondents (37.3%) named Hepatitis B specifically as one of the diseases transmitted. Median (inter-quartile range) number of therapeutic injection and injectable vaccine administered per day by the injection providers were 2 (1) and 1 (1), respectively. Two handed recapping by injection providers was significantly higher in urban area (33.3%) than in rural areas (21.6%). Most providers were not aware of the post exposure prophylaxis guideline.

    CONCLUSION: The knowledge of the injection providers about safe injection practice was acceptable. The use of safe injection practice by providers in urban and rural health care facilities was almost similar. The deficiencies noted in the practice must be addressed.
  11. Gulati N, Kumar Chellappan D, M Tambuwala M, A A Aljabali A, Prasher P, Kumar Singh S, et al.
    Assay Drug Dev Technol, 2021 05 14;19(4):246-261.
    PMID: 33989048 DOI: 10.1089/adt.2021.012
    Nanoemulsions (NMs) are one of the most important colloidal dispersion systems that are primarily used to improve the solubility of poorly water soluble drugs. The main objectives of this study were, first, to prepare an NM loaded with fenofibrate using a high shear homogenization technique and, second, to study the effect of variable using a central composite design. Twenty batches of fenofibrate-loaded NM formulations were prepared. The formed NMs were subjected to droplet size analysis, zeta potential, entrapment efficiency, pH, dilution, polydispersity index, transmission electron microscopy (TEM), Fourier transform infrared spectrophotometry, differential scanning calorimetry (DSC), and in vitro drug release study. Analysis of variance was used for entrapment efficiency data to study the fitness and significance of the design. The NM-7 batch formulation demonstrated maximum entrapment efficiency (81.82%) with lowest droplet size (72.28 nm), and was thus chosen as the optimized batch. TEM analysis revealed that the NM was well dispersed with droplet sizes <100 nm. Incorporation of the drug into the NM was confirmed with DSC studies. In addition, the batch NM-7 also showed the maximum in vitro drug release (87.6%) in a 0.05 M sodium lauryl sulfate solution. The release data revealed that the NM followed first-order kinetics. The outcomes of the study revealed the development of a stable oral NM containing fenofibrate using the high shear homogenization technique. This approach may aid in further enhancing the oral bioavailability of fenofibrate, which requires further in vivo studies.
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