The oncogenic circular RNA circ_63706 is a potential therapeutic target in sonic hedgehog-subtype childhood medulloblastomas

Medulloblastoma (MB) develops through various genetic, epigenetic, and non-coding (nc) RNA-related mechanisms, but the roles played by ncRNAs, particularly circular RNAs (circRNAs), remain poorly defined. CircRNAs are increasingly recognized as stable non-coding RNA therapeutic targets in many cancers, but little is known about their function in MBs. To determine medulloblastoma subgroup-specific circRNAs, publicly available RNA sequencing (RNA-seq) data from 175 MB patients were interrogated to identify circRNAs that differentiate between MB subgroups. circ_63706 was identified as sonic hedgehog (SHH) group-specific, with its expression confirmed by RNA-FISH analysis in clinical tissue samples. The oncogenic function of circ_63706 was characterized in vitro and in vivo. Further, circ_63706-depleted cells were subjected to RNA-seq and lipid profiling to identify its molecular function. Finally, we mapped the circ_63706 secondary structure using an advanced random forest classification model and modeled a 3D structure to identify its interacting miRNA partner molecules. Circ_63706 regulates independently of the host coding gene pericentrin (PCNT), and its expression is specific to the SHH subgroup. circ_63706-deleted cells implanted into mice produced smaller tumors, and mice lived longer than parental cell implants. At the molecular level, circ_63706-deleted cells elevated total ceramide and oxidized lipids and reduced total triglyceride. Our study implicates a novel oncogenic circular RNA in the SHH medulloblastoma subgroup and establishes its molecular function and potential as a future therapeutic target.

Molecular Modeling and Simulation of the Peptidoglycan Layer of Gram-Positive Bacteria Staphylococcus aureus

The peptidoglycan (PG) layer is a vital component of the bacterial cell wall that protects the cell from rupturing due to internal pressure. Its ubiquity across the bacterial kingdom but not animals has made it the target of drug discovery efforts. The PG layer composed of cross-linked PG strands is porous enough to allow the diffusion of molecules through the PG mesh and into the cell. The lack of an accurate atomistic model of the PG mesh has limited the computational investigations of drug diffusion in Gram-positive bacteria, which lack the outer membrane but consist of a much thicker PG layer compared to Gram-negative bacteria. In this work, we built an atomistic model of the Staphylococcus aureus PG layer architecture with horizontally aligned PG strands and performed molecular dynamics simulations of the diffusion of curcumin molecules through the PG mesh. An accurate model of the Gram-positive bacterial cell wall may aid in developing novel antibiotics to tackle the threat posed by antibiotic resistance.

Immunoinformatic screening of Marburgvirus epitopes and computational investigations of epitope-allele complexes

Marburgvirus (MARV), a member of the Filovirus family, causes severe hemorrhagic fever in humans. Currently, there are no approved vaccines or post exposure treatment methods available against MARV. With the aim of identifying vaccine candidates against MARV, we employ different sequence-based computational methods to predict the MHC-I and MHC-II T-cell epitopes as well as B-cell epitopes for the complete MARV genome. We analyzed the variations in the predicted epitopes among four MARV variants, the Lake Victoria, Angola, Musoke, and Ravn. We used a consensus approach to identify several epitopes, including novel epitopes, and narrowed down the selection based on different parameters such as antigenicity and IC₅₀ values. The selected epitopes can be used in various vaccine constructs that give effective antibody responses. The MHC-I epitope-allele complexes for GP and NP with favorably low IC₅₀ values were investigated using molecular dynamics computations to determine the molecular details of the epitope-allele complexes. This study provides information for further experimental validation of the potential epitopes and the design and development of MARV vaccines.

Ebola virus protein VP40 binding to Sec24c for transport to the plasma membrane

Outbreaks of the Ebola virus (EBOV) continue to occur and while a vaccine and treatment are now available, there remains a dearth of options for those who become sick with EBOV disease. An understanding at the atomic and molecular level of the various steps in the EBOV replication cycle can provide molecular targets for disrupting the virus. An important step in the EBOV replication cycle is the transport of EBOV structural matrix VP40 protein molecules to the plasma membrane inner leaflet, which involves VP40 binding to the host cell's Sec24c protein. Though some VP40 residues involved in the binding are known, the molecular details of VP40-Sec24c binding are not known. We use various molecular computational techniques to investigate the molecular details of how EBOV VP40 binds with the Sec24c complex of the ESCRT-I pathway. We employed different docking programs to identify the VP40-binding site on Sec24c and then performed molecular dynamics simulations to determine the atomic details and binding interactions of the complex. We also investigated how the inter-protein interactions of the complex are affected upon mutations of VP40 amino acids in the Sec24c-binding region. Our results provide a molecular basis for understanding previous coimmunoprecipitation experimental studies. In addition, we found that VP40 can bind to a site on Sec24c that can also bind Sec23 and suggests that VP40 may use the COPII transport mechanism in a manner that may not need the Sec23 protein in order for VP40 to be transported to the plasma membrane.

Significance of the RBD mutations in the SARS-CoV-2 Omicron: from spike opening to antibody escape and cell attachment

We computationally investigated the role of the Omicron RBD mutations on its structure and interactions with surrounding domains in the spike trimer as well as with ACE2. Our results suggest...

Lipid II Binding and Transmembrane Properties of Various Antimicrobial Lanthipeptides

There has been an alarming rise in antibacterial resistant infections in recent years due to the widespread use of antibiotics, and there is a dire need for the development of new antibiotics utilizing novel modes of action. Lantibiotics are promising candidates to engage in the fight against resistant strains of bacteria due to their unique modes of action, including interference with cell wall synthesis by binding to lipid II and creating pores in bacterial membranes. In this study, we use atomic-scale molecular dynamics computational studies to compare both the lipid II binding ability and the membrane interactions of five lanthipeptides that are commonly used in antimicrobial research: nisin, Mutacin 1140 (MU1140), gallidermin, NVB302, and NAI107. Among the five peptides investigated, nisin is found to be the most efficient at forming water channels through a membrane, whereas gallidermin and MU1140 are found to be better at binding the lipid II molecules. Nisin's effectiveness in facilitating water transport across the membrane is due to the creation of several different water trajectories along with no significant water delay points along the paths. The shorter peptide deoxyactagardine B (NVB302) was found to not form a water channel. These detailed observations provide insights into the dual mechanisms of the action of lantibiotic peptides and can facilitate the design and development of novel lanthipeptides by strategic placement of different residues.

Annual consumption of parenteral antibiotics in a tertiary hospital of Nepal, 2017-2019: a cross-sectional study

SETTING

Patan Hospital, a tertiary care hospital in Lalitpur District, Nepal.

OBJECTIVES

To describe the annual parenteral antibiotic consumption in 1) defined daily dose (DDD) and DDD per 100 admissions; 2) calculate DDD per 100 admissions and proportions by pharmacological subgroup, chemical subgroup and AWaRe categories; and 3) describe patient expenditure on parenteral antibiotics as a proportion of the total patient expenditure on drugs and consumables between 2017 and 2019.

DESIGN

This was a cross-sectional study.

RESULTS

Total DDD of parenteral antibiotics increased by 23% from 39,639.7 in 2017 to 48,947.7 in 2019. DDD per 100 admissions increased by 10% from 172.1 in 2017 to 190.2 in 2019. Other beta-lactam antibacterials comprised the most frequently consumed pharmacological subgroup. The chemical substance most often consumed was ceftriaxone, with an increasing trend in the consumption of vancomycin and meropenem. Parenteral antibiotics in 'Watch' category were the most consumed over the study period, with a decreasing trend in 'Access' and increasing trend in 'Reserve' categories.

CONCLUSION

We aimed to understand the consumption of parenteral antibiotics at a tertiary care hospital and found that Watch antibiotics comprised the bulk of antibiotic consumption. Overconsumption of antibiotics from the 'Watch' and 'Reserve' categories can promote antimicrobial resistance; recommendations were therefore made for their rational use.

Mutation-induced changes in the receptor-binding interface of the SARS-CoV-2 Delta variant B.1.617.2 and implications for immune evasion

Following the initial surges of the Alpha (B.1.1.7) and the Beta (B.1.351) variants, a more infectious Delta variant (B.1.617.2) is now surging, further deepening the health crises caused by the pandemic. The sharp rise in cases attributed to the Delta variant has made it especially disturbing and is a variant of concern. Fortunately, current vaccines offer protection against known variants of concern, including the Delta variant. However, the Delta variant has exhibited some ability to dodge the immune system as it is found that neutralizing antibodies from prior infections or vaccines are less receptive to binding with the Delta spike protein. Here, we investigated the structural changes caused by the mutations in the Delta variant's receptor-binding interface and explored the effects on binding with the ACE2 receptor as well as with neutralizing antibodies. We find that the receptor-binding β-loop-β motif adopts an altered but stable conformation causing separation in some of the antibody binding epitopes. Our study shows reduced binding of neutralizing antibodies and provides a possible mechanism for the immune evasion exhibited by the Delta variant.

Structural and Dynamical Differences in the Spike Protein RBD in the SARS-CoV-2 Variants B.1.1.7 and B.1.351

The novel coronavirus (SARS-CoV-2) pandemic that started in late 2019 is responsible for hundreds of millions of cases worldwide and millions of fatalities. Though vaccines are available, the virus is mutating to form new strains among which are the variants B.1.1.7 and B.1.351 that demonstrate increased transmissivity and infectivity. In this study, we performed molecular dynamics simulations to explore the role of the mutations in the interaction of the virus spike protein receptor binding domain (RBD) with the host receptor ACE2. We find that the hydrogen bond networks are rearranged in the variants and also that new hydrogen bonds are established between the RBD and ACE2 as a result of mutations. We investigated three variants: the wild-type (WT), B.1.1.7, and B.1.351. We find that the B.1.351 variant (also known as 501Y.V2) shows larger flexibility in the RBD loop segment involving residue K484, yet the RBD-ACE2 complex shows higher stability. Mutations that allow a more flexible interface that can result in a more stable complex may be a factor contributing to the increased infectivity of the mutated variants.

Structural insights into the repair mechanism of AGT for methyl-induced DNA damage

Methylation induced DNA base-pairing damage is one of the major causes of cancer. O⁶-alkylguanine-DNA alkyltransferase (AGT) is considered a demethylation agent of the methylated DNA. Structural investigations with thermodynamic properties of the AGT-DNA complex are still lacking. In this report, we modeled two catalytic states of AGT-DNA interactions and an AGT-DNA covalent complex and explored structural features using molecular dynamics (MD) simulations. We utilized the umbrella sampling method to investigate the changes in the free energy of the interactions in two different AGT-DNA catalytic states, one with methylated GUA in DNA and the other with methylated CYS145 in AGT. These non-covalent complexes represent the pre- and post-repair complexes. Therefore, our study encompasses the process of recognition, complex formation, and separation of the AGT and the damaged (methylated) DNA base. We believe that the use of parameters for the amino acid and nucleotide modifications and for the protein-DNA covalent bond will allow investigations of the DNA repair mechanism as well as the exploration of cancer therapeutics targeting the AGT-DNA complexes at various functional states as well as explorations via stabilization of the complex.

Extrinsic Measurement of Carbon Black Aggregate Distribution within a Fluoroelastomer Matrix from Nanoindentation Experiments

A novel extrinsic method for the measurement of particle surface distribution in a carbon black-filled elastomer via nanoindentation is developed. This method is based on the measurement of the contact stiffness obtained from the continuous stiffness measurement mode. The proposed tip-particle model is held by two main hypotheses: the particles do not deform significantly during indentation so that only the elastomer matrix elastically deforms; particles are physically bounded with the surrounding matrix. Therefore, when the tip comes in contact with a particle, the latter becomes a hard extension of the tip, able to deform the elastomer matrix. Finally, the evolution of the measured contact stiffness is directly related to the increase of the contact area between the tip-particles set and the elastomer matrix. The proposed model is validated through a numerical and an experimental study. Moreover, an evaluation of the measurements bias allows to correct the particle surface distribution. A good agreement is found between the distribution measured from transmission electron microscopy observations and nanoindentation measurements.

Monitoring steady production of 1,3-propanediol during bioprospecting of glycerol-assimilating soil microbiome using dye-based pH-stat method

AIM

In this investigation, a dye-based pH-stat method was devised for monitoring steady production of 1,3-propanediol (1,3-PDO) during bioprospecting of glycerol-assimilating soil microbiome.

METHODS AND RESULTS

Soil samples were collected from two potential sites of CSIR-IIP, India. Selective enrichment of microbial consortia was done using the glycerol-based medium at initial stage, followed by purification to isolated colonies, after positive high-performance liquid chromatography detection of 1,3-PDO in the fermentation broth. When the purified isolated were re-tested for 1,3-PDO production, only two isolates namely Isolate 1 and Isolate 3 were capable of producing the targeted product preferably under anaerobic conditions. Based on better 1,3-PDO fermentation efficiency (Isolate 3, 22% vs Isolate 1, 4·48%) and acetic acid as the only major by-product, Isolate 3 was shortlisted for further studies. A dye-based technique was devised in which bromothymol blue was incorporated into the medium to monitor the pH drop due to acetic acid formation and hence change in colour. Visual change in colour helped in intermittent pH restoration. During fermentation, with pH stat being 8-8·5, Isolate 3 at 32°C yielded 0·67 mol mol^-1 1,3-PDO within a short span of 12 h only with an initial concentration of glycerol being 20 g l^-1 . Phylogenetic analysis revealed that Isolate 3 shared 95·8% homology with Citrobacter freundii CFNIH1 and hence designated as C. freundii IIP DR3.

CONCLUSION

This study demonstrated that during bioprospecting glycerol-assimilating microbiome, dye-based technique can be successfully employed. This technique can further be exploited to monitor consistent production of all microbial secondary metabolites that accompanies acid production.

SIGNIFICANCE AND IMPACT OF THE STUDY

Incorporation of 'Bromothymol blue' can visually help in the identification of pH drop in the medium, so that pH stat can be easily maintained during 1,3-PDO production from glycerol especially under shake flask conditions.

Conformational Flexibility of the Protein-Protein Interfaces of the Ebola Virus VP40 Structural Matrix Filament

The Ebola virus (EBOV) is a virulent pathogen that causes severe hemorrhagic fever with a high fatality rate in humans. The EBOV transformer protein VP40 plays crucial roles in viral assembly and budding at the plasma membrane of infected cells. One of VP40's roles is to form the long, flexible, pleomorphic filamentous structural matrix for the virus. Each filament contains three unique interfaces: monomer NTD-NTD to form a dimer, dimer-to-dimer NTD-NTD oligomerization to form a hexamer, and end-to-end hexamer CTD-CTD to build the filament. However, the atomic-level details of conformational flexibility of the VP40 filament are still elusive. In this study, we have performed explicit-solvent, all-atom molecular dynamic simulations to explore the conformational flexibility of the three different interface structures of the filament. Using dynamic network analysis and other calculational methods, we find that the CTD-CTD hexamer interface with weak interdomain amino acid communities is the most flexible, and the NTD-NTD oligomer interface with strong interdomain communities is the least flexible. Our study suggests that the high flexibility of the CTD-CTD interface may be essential for the supple bending of the Ebola filovirus, and such flexibility may present a target for molecular interventions to disrupt the Ebola virus functioning.

Molecular mechanisms of pore formation and membrane disruption by the antimicrobial lantibiotic peptide Mutacin 1140

The emergence of antibiotic-resistance is a major concern to global human health and identification of novel antibiotics is critical to mitigate the threat.

Dorsal Metacarpophalyngeal Dislocations of Thumb in Children-Clues to the Clinical Decision Making and a Dorsal Approach to Open Reduction

Dorsal Metacarpophalyngeal joint dislocation of thumb in children is a rare occurrence. All the three different types, namely Simple Complete, Complex Complete and Incomplete dislocations have been described in this article with clinical and radiological clues to differentiate the closely reducible (simple) dislocations from irreducible ones (complex). A simple approach to treatment decision making has been adopted for all cases, starting with attempt of closed reduction which if fails, moving to open reduction. First case is a simple dorsal dislocation presenting after fall injury with hyperextension deformity of thumb Metacarpophalyngeal joint that was reducible by closed maneuver. Second case presented with pain and inability to move thumb Metacarpophalyngeal joint, with less marked deformity than the first case. Closed reduction failed and open reduction was done with dorsal approach to the metacarpophalyngeal joint joint after volar plate interposed in the metacarpophalyngeal joint was pushed anteriorly. Third case was an incomplete dorsal dislocation that was reduced closed. Dorsal metacarpophalyngeal dislocation of thumb in children is rare injury. Diagnosis needs a high index of suspicion ascomplex dislocation can be missed due to less obvious deformity. Dorsal approach to open reduction of complex dislocation is a direct and reliable approach.

Estimation of Stature from Nasal Length

INTRODUCTION

Estimation of stature for the purpose of identification has a significant forensic importance. This technique is based on a principle that bones or human body parts correlate positively with the stature. Stature can be estimated from measurements of various body parts such as arm, leg, feet, finger, facial height, nasal height etc. The aim of study was to correlate Stature of Nepalese with Nasal height and estimate Stature from Nasal height.

METHODS

A cross-sectional study of 214 healthy adults comprising 110 males and 104 females in the age group of 25 to 35 years were carried out. Study was carried out in central Nepal where people from various parts of Nepal are migrated. Total body height and Nasal height were recorded with stadiometer and sliding caliper respectively.

RESULTS

The mean of total body height in the male and female was 160.4 (±6.80) cm and 151.8 (±4.88) cm respectively. The mean of nasal height in the male and female was 4.6 (±0.31) cm and 4.3 (±0.29) cm respectively. This study observed that in both male and female nasal height had positive partial correlation with stature; r = 0.18 for male and 0.19 for female. Stature in nepali population could be calculated as: Stature=148.22+3.02x nasal height in male where as Stature=133.01+3.12x nasal height in female.

CONCLUSIONS

Both Nepali male and female nasal height had positive partial correlation with stature; r = 0.18 for male and 0.19 for female. Stature in Nepali population could be calculated as: Stature=148.22+3.02x nasal height in male where as Stature=133.01+3.12x nasal height in female.

Surgical Results of Non-small Cell Lung Cancer in Nepal

INTRODUCTION

Surgery remains the only curative modality for early stage of Non small cell lung caner (NSCLC). We reviewed overall scenario of lung cancer and surgical results in Nepal.

METHODS

1000 patients with the pathological diagnosis of lung cancer were analyzed to summarize the overall scenario of lung cancer. 157 NSCLC patients underwent pulmonary resection. cIA, IB, IIA, IIB, IIIA (N1) underwent surgery as initial modality of treatment. cIIIA (N2) patients were taken for surgery after neoadjuvant chemo/ chemoradiation.

RESULTS

Analysis of 1000 patients showed squamous cell carcinoma in 41.3%, incurable stage (IIIB/ IV) in 66.8% and rate of curative resection in 6.7% cases. Surgery as a single modality of treatment was used in 38%. Neoadjuvant Chemo/ chemoradiation/ radiation followed by surgery and surgery followed by chemo/ chemoradiation/ radiation was done in 12% and 50%, respectively. In-hospital mortality was 2% (post pneumonectomy: 5.5%; post lobectomy: 1.5%; post sublobar resection: 0%). R0 resction was achieved in 91% cases. Median survival and 5-year overall survival were 36 months and 18%, respectively. Better survival was achieved in pI-II vs pIII/ IV, pN0-1 vs pN2 and pR0 vs pR+ (p <0.05).

CONCLUSIONS

Earlier stage (pI-II), R0 resection and pathological pNo-1 has the best five year overall survival in Nepalese patients with NSCLC as well.

Prevalence of Occlusal Traits in the Deciduous Dentition of Children of Kaski District, Nepal

INTRODUCTION

The prevalence of occlusal traits varies among various populations. Ethnic, genetic and environmental factors are the major contributors, with a role in the specific cause of malocclusion. The aim of this epidemiological study was to assess the prevalence of occlusal traits in the deciduous dentition of children of Kaski District,Nepal.

METHODS

A total of 506 children (251 girls, 255 boys), aged 3-5 years, were assessed. The occlusion examination was carried out by three examiners, in the school camps,community dental care centre and general health camps, utilizing a mouih mirror and probe. Intra investigator error was calculated using kappa statistics. The data were analyzed by the statistical program SPSS version 17 using the Chi-square test.

RESULTS

The present study studied occlusal traits of 506 children (251 girls, 255 boys), aged 3-5 years. The study result showed that bilateral mesial step seen in 40.3%,bilateral flush terminal plane in 33.5%, bilateral distal steps in 8.5%,mesial step one side and flush terminal other side in 12.7%,mesial step one side and distal step other side in 2.6%,flush terminal one side and distal step other side in 2.4%,anterior crossbite in 3%,posterior crossbite in 0.4% and non-spaced dentition in 20% children.

CONCLUSIONS

Mesial step was the most prevalent followed by straight terminal plane and the distal terminal plane showed least prevalence. There were diverse traits for malocclusion. There was no significant difference(p>0.05) in occlusal traits between male and female children.

An anthropometric study of facial height among four endogamous communities in the Sunsari district of Nepal

INTRODUCTION

Facial anthropometry has well-known implications in health-related fields and has been utilised for forensic purposes in the past. It provides an indication of the variations in facial shape in a population. The facial anthropometric profile of a population can characterise the distinctive features of a likely face in that population. The present study aimed to examine the differences in facial height proportions and facial growth patterns in different communities in the Sunsari district of Nepal.

METHODS

The upper facial height (UFH) and lower facial height (LFH) proportions of 857 subjects (429 male and 428 female) aged between three and 18 years old from four communities (Brahmin, Chhetri, Rai and Limbu) in the Sunsari district of Nepal were calculated, and comparisons were made.

RESULTS

Significant differences (p is less than 0.05) in the UFH and LFH percentages were observed between the Brahmin and Rai, Brahmin and Limbu, Chhetri and Rai, and Chhetri and Limbu communities.

CONCLUSION

The study concluded that there is evidence of statistically significant differences of the upper and lower face height proportions among the different racial groups. A change in the facial height proportions of the various age groups was evident. However, differences in facial height proportions between male and female were found to be insignificant.

Congenital anomaly of left renal vein

Double left renal vein is a rare venous anomaly. In 6.5% of cases double left renal vein, one in front (preaortic) and another behind the abdominal aorta (retroaortic) has been reported. The development of renal vessels is very complicated. There are extensive changes which occur in subcardinal, supracardinal and sacrocardinal veins during development that may lead to congenital venous anomalies. Here, we report a case of congenital venous anomaly of persisting retroaortic left renal vein.

Congenital Anomaly of Left Renal Vein

Abstract

Multiple arterial anomalies in upper limb

An isolated neurovascular variation is common but multiple vascular anomalies on same upper limb is a very rare case. We observed an unusual variations in right upper limb during routine dissection of a Nepali cadaver. The variations were observed in Axilla, Forearm and Palm. In axilla, fi rst part of axillary artery did not give any branch, the second part of axillary artery gave off only two branches - (a) thoracoacromial artery and (b) a large common trunk which later gave off lateral thoracic, thoracodorsal, subscapular, posterior circumflex scapular and then continued as posterior circumflex humeral artery. The third part of axillary artery gave off only anterior circumflex humeral artery. In forearm, the ulnar artery runs downward superficial to flexor muscles. Here, radial artery gave off common interosseous artery. In palm radial artery did not give any contribution to superficial palmar arch which is solely formed by the continuation of ulnar artery. This type of anomalies are very rare and is not reported in Nepalese cadaver at all. These anomalies are described in detail and their clinical relevance is highlighted.

Phylogenetic variation in flexor digitorum brevis: a Nepalese cadaveric study

Understanding muscle architecture of the foot may assist in the design of surgical procedures such as tendon transfer, biomechanical modeling of the foot, prosthesis design, and analysis of foot function. Flexor digitorum brevis (FDB) is the most superficial intrinsic muscle of the sole of the foot. When compared to the little finger, the little toe has less function and opposition is absent in humans. Hence, the muscles acting on the little toe are undergoing evolutionary changes. The objective of this study was to review the phylogenetic variation occurring in FDB in the Nepalese cadavers. Sixty soles in 20 male and 10 female adult embalmed cadavers were dissected and attachments of FDB observed. It was noted that the tendon for the fifth toe was missing in all sixty soles. The action of FDB can be compensated by other long flexors of the foot. This could have resulted due to gradual reduction in the usage of the little toe as the bipedal posture evolved. Variations of FDB are clinically important because FDB musculocutanous flap is used in the reconstruction of the heel pad.

Supernumerary head of Biceps brachii: a rare occurrence in the Nepalese population

Unilateral three headed biceps brachii muscle was observed in the dissected cadaver of a 45-year-old Nepalese cadaver. The supernumerary head is taking origin from the tendon of deltoid and crossing in front of the long head of biceps and joining with short head of biceps brachii. The incidence of this variation is very rare and there was no available literature in Nepalese population. Presence of such variation should be kept in mind by surgeons and traumatologists.

Ectopic partial intrahepatic gall bladder with cholelithiasis--a rare anomaly

The study was aimed to view the developmental anomalies of gall bladder (GB) in Nepalese cadavers. Forty GBs were studied for any anomalies during routine cadaveric dissection at the Department of Anatomy, Manipal College of Medical Sciences, Nepal. The study found that the congenital anomalies of GB are very rare. Only one case of ectopic partial intrahepatic GB with cholelithiasis was observed, which to our knowledge is the first reported case in Nepal. Awareness of GB anomalies is important to surgeons, radiologists, and clinicians in general. An ectopic partial intrahepatic GB can make cholecystectomy hazardous, when indicated.

Analgesic use in dentistry in a tertiary hospital in western Nepal

The present study had been planned to determine the pattern of drug utilization of analgesics (non-opioid and opioid analgesics) in dental outpatients in a referral hospital in western Nepal. A total of 1820 prescriptions of dental patients attending the dental outpatient at Manipal Teaching Hospital (MTH), Fulbari, Pokhara, Nepal were collected by a random once-weekly survey between March 2001 and February 2002. The analgesic-containing prescriptions (n = 1346) were separated from the total prescriptions collected. This information was compiled, scored and analyzed in consultation with dentists using WHO guidelines. There were more female patients (56%) than male patients (44%) in this study. The dental disorders most frequently reported in our study were diseases of pulp and periapical tissue (36.5%), gingivitis and periodontal diseases (28.5%) and dental caries (16%) etc. In total, 74% prescriptions contained analgesics which are the second-most commonly prescribed drugs after anti-microbials (44.9%) in dental OPD. The total analgesics prescribed were 1358 that account for 36.7% of total drugs prescribed. Only 5 and 37.8% of analgesics were prescribed generically and from the essential drug list of WHO respectively. All the analgesics were administered orally which included 89.7 and 10.3% of non-opioid analgesics and opioid analgesics (propoxyphene and dextropopoxyphene) respectively. The average duration of analgesic use was 3.5 +/- 0.3 days. The most commonly prescribed non-opioid analgesic was ibuprofen (41%) followed by nimesulide (22%). A total of 38.9% analgesics were fixed-dose combinations (FDCs) of two drugs and the most common analgesic combination used was ibuprofen + paracetamol and paracetamol + opioid analgesics. All opioid analgesics were prescribed in combination with paracetamol (10.3%) only. In total, 1.6% analgesics were prescribed concomitantly with gastroprotective agents. All gastroprotective agents (n = 22) were prescribed concomitantly with opioid analgesics only. No gastroprotective was used when NSAIDs were prescribed alone or in combination with paracetamol. Our present study indicate that all the analgesics were prescribed in oral dosage forms but analgesics prescribed in generic name (5%) and from essential drug lists (37.8%) were very less. There was an inclination to prescribe the older non-opioid analgesics. Selection of analgesics was quite rational in our study but some lacunae were observed. A total of 38.9% analgesics were FDCs and most common FDC analgesics were ibuprofen + paracetamol. Avoiding unnecessary FDCs may help in reducing prescribing costs because FDCs usually cost more than single ingredient preparations. It is best to avoid combination therapy with more than one non-opioid analgesic; there is little evidence of extra benefit to the patient and the incidence of side effects generally is additive. Prescribing generic names aids in avoiding confusion and minimizing the costs. In the present study, coprescription of gastroprotective agents with analgesic use was low compared to a previous study but when opioid analgesics were prescribed, concurrent use of gastroprotective agents were irrational as opioid analgesics usually decrease the secretion of hydrochloric acid. It is also surprizing that, no gastroprotective was used when NSAIDs were prescribed alone, irrespective of sex, age, dose or duration or type of NSAID treatment in our study. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of analgesics in dentistry.

An audit of drug prescribing practices of dentists

OBJECTIVES

Data are scarce on the prescribing habits of dental practitioners. Drug use in dentistry and stomatology is undertaken to determine the pattern of drug use for patients seeking treatment.

METHODS

1820 prescriptions of dental patients attending the dental outpatient departments at Manipal Teaching Hospital, Nepal were collected by a random once weekly survey between March '01 to February '02. The information was compiled, scored and analyzed in consultation with dentists using WHO guidelines.

RESULTS

Males numbered 801 (44%) and females 1019 (56%). Most of the patients were aged between 13-25 years. The dental disorders most frequently reported in our study were diseases of pulp and periapical tissue (36.5%), gingivitis and periodontal disease (28.5%), and dental caries (16%). The average number of drugs prescribed was 2.03 (3698 / 1820) and 66% prescriptions contained antimicrobials (1 or 2). 21% drugs were prescribed in generic names and 38% drugs were fixed dose combinations of 2 or more drugs. 4/5 of the prescribed drugs were systemic agents and 1/5 were local/topical agents. The most commonly prescribed systemic agents were analgesics (43.7%) followed by antimicrobials (39%). The most conmonly prescribed local / topical agents were anti-infectives (74%). In the present study, NSAID's (89.6%) were the preferred analgesics over narcotic analgesics (10.4%). The most frequently prescribed systemic analgesic and antimicrobials were ibuprofen and amoxycillin, respectively.

CONCLUSIONS

This study may help in identifying the problems involved in therapeutic decision making. Also, there is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of drugs in dentistry.