Papers by Rahi B I K R A M Thapa
Bulletin of Pioneering Researches of Medical and Clinical Science, 2024
Fluoroquinolone resistance in uropathogenic Escherichia coli (UPEC) poses a significant challenge... more Fluoroquinolone resistance in uropathogenic Escherichia coli (UPEC) poses a significant challenge in the treatment of urinary tract infections (UTIs), a major global health issue. As resistance rates rise, particularly in developing countries, there is an urgent need for novel derivatives. This study aims to explore fluoroquinolone resistance in UPEC isolates and identify potential lead compounds using in-silico methods to optimize fluoroquinolone derivatives that may overcome resistance. A retrospective observational study of 2,306 UTI cases was conducted at a tertiary care hospital in Nepal, with 167 samples showing significant bacterial growth. Molecular docking using AutoDock 4.2 assessed the binding affinities of 42 novel fluoroquinolone derivatives against E. coli DNA gyrase (PDB ID: 4KFG). Drug-protein interactions were analysed with Drug Discovery Studio, pharmacokinetics with SwissADME, and biological activity and toxicity predictions with PASS Online and ProTox-II. E. coli was identified in 64.7% of cases, with significant resistance to fluoroquinolones (levofloxacin: 83.33%, ofloxacin: 57.14%, ciprofloxacin: 32.67%). Novel derivatives SP9, SP12, and SP42 exhibited superior binding affinities (-11.9,-11.7, and-11.6 kcal/mol), and SP25 interacted with the highest number of amino acids compared to standard fluoroquinolones, forming multiple hydrogen bonds with key residues in DNA gyrase. These derivatives complied with Lipinski's Rule of Five, suggesting favourable pharmacokinetics, though toxicity analysis revealed mutagenicity and other toxicities in SP9, SP12, and SP25. Considering fluoroquinolone resistance in E. coli at high levels, SP42 emerges as a promising candidate for future therapeutic development, while SP9, SP12, and SP25 require further optimization due to toxicity concerns.
Exploratory Research in Clinical and Social Pharmacy, 2024
Background: Inpatients are at higher risk of Drug Therapy Related Problems (DTRPs), and early ide... more Background: Inpatients are at higher risk of Drug Therapy Related Problems (DTRPs), and early identification and management of these DTRPs is crucial for optimal treatment outcomes and ensuring rational drug therapy. Objective: This study aims to assess DTRPs in a general medicine ward of a tertiary care hospital in eastern Nepal. Methods: A three-month prospective observational study was conducted on inpatients admitted to the general medicine ward of the hospital. Pharmacists routinely performed patient drug therapy reviews, by which suspected DTRPs were identified and recorded as per the Pharmaceutical Care Network Europe Association (PCNE) v.9.1 guidelines. Binary logistic regression analysis was used to determine the influence of predictor variables on the occurrence of DTRPs. Results: A total of 301 inpatients were enrolled, out of which 233 (77.4%) had one or more DTRPs. Altogether, 528 DTRPs with an average of 2.27 ± 0.92 DTRPs per patient were identified. The primary causes of the DTRPs were drug selection (40.47%), treatment duration (16.71%), dispensing (15.75%), and dose selection (13.12%). Antimicrobials were involved in 55.18% of the DTRPs. DTRPs were more prevalent in elderly, comorbid patients, patients with longer hospital stay days, and polypharmacy, which was statistically significant (p<0.05). Furthermore, multivariate binary logistic regression analysis showed that geriatric patients had a higher risk of experiencing DTRPs, with an adjusted odds ratio of 1.832 (1.021-3.286) at p-value < 0.05. Conclusion: DTRPs are frequently prevalent in hospital wards, emphasizing the crucial role of clinical pharmacists in identifying, resolving, and preventing DTRPs in inpatient settings for optimal treatment outcomes.
Journal of Manmohan Memorial Institute of Health Sciences (JMMIHS), 2024
Background: Cancer remains the leading cause of the death worldwide and expected that annual canc... more Background: Cancer remains the leading cause of the death worldwide and expected that annual cancer case will rising very rapidly and make the scenario even more troublesome as well as Due to drug resistance makes things even worse. Method: Auto Dock 4.1 was used to evaluate selected tri-substituted fluoro indole molecules against human topoisomerase II and Discovery studio visualizer and marvin sketch was used to create 3D and 2D structure interaction. Tri-substituted fluoro indole derivatives were docked against the human topoisomerase II enzyme using in-silico methods and various web server was used to determine various parameters. Results: Docking studies revealed that tri-substituted fluoro indole derivatives could be a good alternate against human topoisomerase II as an anti-cancer agent. Molecular docking score scored by fludarabine [-7.6,-7.6,-8.6,-7.7] kcal/mol with nine hydrogen bonds, S-2 [-8.8,-7.7,-9.6,-8.7] kcal/mol with elveven hydrogen bonds, and S-14 showed [-9.2,-8.2,-8.6,-8.6] kcal/mol with twelve hydrogen bonds respectively in chain-A, B, C, D with excellent drug likeness, good pharmacokinetics parameters, mild toxicity in In-silico model reveals that Tri-substituted fluoro indole derivatives could be a good alternate against human topoisomerase II as an anti-cancer agent. Conclusion: Among twenty derivatives S-2 and S-14 showed potential inhibitory effect against 4R1F human topoisomerase II with excellent docking score, drug likeness, good pharmacokinetics parameters, mild toxicity in Insilco model.
Background: Peptic ulcer disease (PUD) is a global health concern affecting the stomach and upper... more Background: Peptic ulcer disease (PUD) is a global health concern affecting the stomach and upper small intestine, especially in developing nations. Often caused by Helicobacter pylori infection and Non-steroidal anti-inflammatory drugs (NSAID) use, despite treatment advancements, it still poses significant morbidity and mortality risks.
European Journal of Biomedical AND Pharmaceutical sciences, 2024
IMPACTS ON PRACTICE The study's findings indicate that individuals aged 20-40 are at a higher r... more IMPACTS ON PRACTICE The study's findings indicate that individuals aged 20-40 are at a higher risk for TB infection and drug resistance, suggesting the need for targeted preventive measures and educational campaigns for this demographic. Additionally, the high prevalence of drug-resistant TB cases calls for improved diagnostic and treatment strategies. This includes early detection, effective second-line therapies, and robust support systems to enhance treatment adherence and outcomes.
World Journal of Pharmacy and Pharmaceutical Sciences, 2024
Bioadhesive drug delivery systems offer a promising approach to enhance the bioavailability of me... more Bioadhesive drug delivery systems offer a promising approach to enhance the bioavailability of medications and deliver tailored therapeutic benefits. These systems employ the inherent properties of mucoadhesive polymers, which may adhere to the mucosal surfaces that line various physiological cavities such as the gastrointestinal tract, buccal cavity, nasal passages, and vagina. Enhancing the drug's adhesion to the target site prolongs its residence time, leading to improved drug absorption and heightened therapeutic efficacy. Bioadhesive drug delivery techniques offer several advantages over conventional dosage forms, including enhanced drug bioavailability, reduced dosing frequency, and fewer systemic side effects. Various natural and synthetic polymers, including chitosan, alginate, and polyacrylic acid, have been examined to assess their capacity to stick to mucus. These polymers can be processed into several forms for delivering medication, including pills, gels, patches, and films. The current focus in bioadhesives research has mostly been on developing novel polymers with enhanced biocompatibility and mucoadhesive properties. Furthermore, these enhancements entail the integration of these substances into state-of-the-art drug delivery systems, such as microneedles and nanoparticles. Despite significant progress in the field, there are still challenges that need to be addressed in order to enhance the design and performance of Mucoadhesive drug delivery systems (MDDS) for specific applications. Future research should give priority to the
INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT, 2024
Background: Pharmacists are crucial in the healthcare system due to their accessibility, and to p... more Background: Pharmacists are crucial in the healthcare system due to their accessibility, and to provide quality care, they must be knowledgeable about legislation and fully comply with it. Objective: This study aimed to evaluate knowledge and compliance with drug legislation by Community Pharmacies (CPs). Method: A cross-sectional survey was conducted on Dharan's CPs, assessing their knowledge and compliance status through observation and structured questions using both descriptive and analytic statistics. Results: Most community pharmacists (58.1%) are unaware of the penalties for non-compliance, though they possess good knowledge about drug categorization and narcotic record-keeping (95.2%). While 94.11% of pharmacists use lock-and-key systems for narcotics, only 31% keep records of their sales and distribution. Additionally, 70.5% display their firm registration certificate, 68.6% have up-to-date registration, and 77% are operated by qualified personnel. However, many fail to provide necessary facilities, such as wheelchair accessibility (22.9%) and counselling rooms (34.3%), and only 18.1% have shelves covered by glass. In prescription handling, most pharmacists do not check for prescriber signatures (70.5%) or prescription dates (69.5%). There is a weak positive correlation between knowledge and compliance (r=0.277) and between knowledge and working experience (r=0.2), with both correlations being statistically significant (P<0.05).
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES, 2024
Background: Psychotic disorders, like schizophrenia, are a global public health concern requiring... more Background: Psychotic disorders, like schizophrenia, are a global public health concern requiring efficient management and accessible, affordable treatment options to minimize severe consequences. Objective: To assess the prescription pattern of psychotropic drugs given to patients with schizophrenia and related psychotic disorders. Method: A cross-sectional observational study was conducted at the Mental Hospital, targeting patients diagnosed with schizophrenia and related psychotic disorders. A total of 119 samples were collected over three months. Data was extracted from patient cardex, case sheets, discharge summaries, and interviews. The results were analyzed using descriptive methods and expressed as numbers and percentages. Results: The study analyzed 119 prescriptions for schizophrenia and related psychotic disorders, revealing that the most common age group affected was 30-39 years, with a higher prevalence of male patients. 18.5% of patients had a family history of psychotic disorders, and 10.1% had a history of head injuries. The majority of patients were diagnosed with unspecified non-organic psychosis (66.4%), followed by schizophrenia (25.2%). Atypical antipsychotics were used in 98.3% of patients, with trifluoperazine being the most prescribed WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES
European Journal of Biomedical and Pharmaceutical Sciences, 2024
Background: Drug dispensers, including pharmacists, assistant pharmacists, and professionals (Bav... more Background: Drug dispensers, including pharmacists, assistant pharmacists, and professionals (Bavayashai), are crucial healthcare providers in improving medication use, particularly among pregnant women in their communities.
Objective: This study aimed to evaluate drug dispensers' knowledge about medication safety during pregnancy.
Method: A cross-sectional survey was carried out on practicing drug dispensers in the Dharan City of Nepal. They were asked about the safety of each medicine during pregnancy. It involved both Prescription-only medicine and Over-the-counter medications. Both descriptive and analytic statistics were utilized.
Results: Most drug dispensers have poor knowledge of the safety of dietary supplements (Vitamin A and Caffeine) and Temazepam. While 54.2% believe alprazolam is unsafe, 15.8% assess its use based on a risk-benefit analysis. Only 15.8% know tetracycline should be used if the benefits outweigh the risks, and 43.3% deem amoxicillin safe. The majority (79.2%) recognize ethinylestradiol as unsafe for pregnant women. About 38% identify valproic acid as unsafe, and 20% assess lamotrigine based on benefit-risk. For analgesics, 55.8% know acetaminophen is safe, but there is uncertainty about aspirin and ibuprofen use during pregnancy. Few are aware that pseudoephedrine hydrochloride should be used only if the benefits outweigh the risks. Significant associations were found between dispensers' education, their practice of asking about pregnancy status, and their knowledge of medication safety during pregnancy (P<0.05).
Conclusion: Drug dispensers are the most accessible healthcare providers who can help pregnant women with their medication use. There are still gaps in knowledge where educational interventions are needed.
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Papers by Rahi B I K R A M Thapa
Objective: This study aimed to evaluate drug dispensers' knowledge about medication safety during pregnancy.
Method: A cross-sectional survey was carried out on practicing drug dispensers in the Dharan City of Nepal. They were asked about the safety of each medicine during pregnancy. It involved both Prescription-only medicine and Over-the-counter medications. Both descriptive and analytic statistics were utilized.
Results: Most drug dispensers have poor knowledge of the safety of dietary supplements (Vitamin A and Caffeine) and Temazepam. While 54.2% believe alprazolam is unsafe, 15.8% assess its use based on a risk-benefit analysis. Only 15.8% know tetracycline should be used if the benefits outweigh the risks, and 43.3% deem amoxicillin safe. The majority (79.2%) recognize ethinylestradiol as unsafe for pregnant women. About 38% identify valproic acid as unsafe, and 20% assess lamotrigine based on benefit-risk. For analgesics, 55.8% know acetaminophen is safe, but there is uncertainty about aspirin and ibuprofen use during pregnancy. Few are aware that pseudoephedrine hydrochloride should be used only if the benefits outweigh the risks. Significant associations were found between dispensers' education, their practice of asking about pregnancy status, and their knowledge of medication safety during pregnancy (P<0.05).
Conclusion: Drug dispensers are the most accessible healthcare providers who can help pregnant women with their medication use. There are still gaps in knowledge where educational interventions are needed.
Objective: This study aimed to evaluate drug dispensers' knowledge about medication safety during pregnancy.
Method: A cross-sectional survey was carried out on practicing drug dispensers in the Dharan City of Nepal. They were asked about the safety of each medicine during pregnancy. It involved both Prescription-only medicine and Over-the-counter medications. Both descriptive and analytic statistics were utilized.
Results: Most drug dispensers have poor knowledge of the safety of dietary supplements (Vitamin A and Caffeine) and Temazepam. While 54.2% believe alprazolam is unsafe, 15.8% assess its use based on a risk-benefit analysis. Only 15.8% know tetracycline should be used if the benefits outweigh the risks, and 43.3% deem amoxicillin safe. The majority (79.2%) recognize ethinylestradiol as unsafe for pregnant women. About 38% identify valproic acid as unsafe, and 20% assess lamotrigine based on benefit-risk. For analgesics, 55.8% know acetaminophen is safe, but there is uncertainty about aspirin and ibuprofen use during pregnancy. Few are aware that pseudoephedrine hydrochloride should be used only if the benefits outweigh the risks. Significant associations were found between dispensers' education, their practice of asking about pregnancy status, and their knowledge of medication safety during pregnancy (P<0.05).
Conclusion: Drug dispensers are the most accessible healthcare providers who can help pregnant women with their medication use. There are still gaps in knowledge where educational interventions are needed.