ObjectivesTo evaluate the pattern of substandard and falsified pharmaceutical products recall in Nepal.SettingWe analysed drug recall notices issued by the Department of Drug Administration (DDA), Nepal, and systematically reviewed peer-reviewed research articles during January 2010 to December 2020.ParticipantsThis study did not include human participants. However, data were collected from 72 drug recall notices issued by DDA and four research papers.ResultsA total of 346 pharmaceutical products were recalled during the reported period. The number of recalled pharmaceutical products has increased significantly over the past decade in Nepal. The most frequently recalled drugs were antimicrobials followed by gastrointestinal medicines, vitamins and supplements and pain and palliative medicines among others. Number of imported recalled drugs were slightly higher (42.2%) than domestic recalled drugs (40.7%). Sixty-two percentage of recalled drugs were substandard, 11% were falsified and remaining 27% were not registered at the DDA. Similarly, higher number of modern drugs (62%) were recalled than traditional ones (35%). Hand sanitisers used to minimise COVID-19 transmission contributed significantly to the list of recalled pharmaceutical products in 2020. Most of these sanitisers contained significant amounts of methanol (as high as 75% v/v) instead of appropriate amount of ethyl or isopropyl alcohol. The peer-reviewed research papers reported issues with labelling, unregistered drugs and drugs failed in several laboratory testing.ConclusionOur analysis showed that number of recalls of substandard and falsified drugs are increasing in Nepal. Since the recall data in this paper did not include number of samples tested and location of samples collected, more studies to understand the prevalence of substandard and falsified drugs in Nepal is recommended.

Pharmaceutical products are used to treat, prevent, and save lives of millions of people globally. However, pharmaceutical products known as substandard and falsified that do not meet regulatory standards and quality threaten the health of the population of today and future leading to socio-economic hardship, drug resistances and put life of patients in danger. We analyzed the recall notice from 2010 to 2020 issued by the department of drug administration (DDA), government of Nepal to understand the overview of substandard and falsified pharmaceutical products in Nepal. The number of recalled pharmaceutical products has significantly increased over the past decade in Nepal (p-value< 0.05). The most recalled drugs were antimicrobials followed by gastrointestinal medicines, vitamins and supplements, pain and palliative medicines among others. Number of recalled drugs manufactured by domestic pharmaceutical producers and imported ones were not significantly different. Majority of imported recalled drugs originated from India. Sixty-two percentage of recalled drugs were substandard, 11% were falsified and remaining 27% were not registered at the DDA. Similarly, sixty percentage of recalled drugs were modern and 35% were traditional ones. The hand sanitizers used to minimize the COVID-19 transmission contributed significantly to the list of recalled pharmaceutical products in 2020. Most of these sanitizers contained significant amount of methanol instead of ethyl alcohol or isopropyl alcohol. We also reviewed peer-reviewed research papers that reported data of substandard and falsified drugs. Only four such papers were found in literature. These papers reported issues with labeling, unregistered drugs and drugs failed in a number of laboratory testing. Since the recall data did not include number of samples tested and location of sample collected, a systematic study to understand the prevalence of substandard and falsified drugs in Nepal is recommended.

Introduction: Cold and cough is the common disease condition which effects patient of every age. The treatment approach of medicinal herbs has been recognized for many decades and even longer for the treatment and prevention of cold and cough. The aim of the study was to evaluate the safety and efficacy of polyherbal tablet. Polyherbal tablet containing herbs like Neem (Azadirachta indica), Tulsi (Ocimum tenuiflorum), Ginger (Zingiber officinale), Turmeric (Curcuma longa) is used for curing cold and cough. This tablet formulation reduces the healing time for sore throat and boost up the immunity. Materials and methods: The preparation of the extract and manufacturing of the polyherbal tablet is by processing technique with extract based herbal formulation and evaluation for analytical standardization including qualitative and quantitative determination were carried out. The tablets were weighed individually, the hardness and thickness were measured, friability of the tablet was measured, and the disintegration time was observed. The colour was observed to be brownish yellow and no odour. Discussion: When combining the multiple herbs in a particular ratio, it will give a better therapeutic effect and reduce the toxicity. This review mainly focusses on importance of the polyherbalism and its clinical significance. Keywords: Polyherbal tablets, formulation, evaluation, hardness, disintegration time.

The present pregression of the highly contagious novel coronavirus [COVID-19] has been testing thehealthcare system globally pressing the medical staff everywhere. Present and future healthcare workers’updated knowledge, proper attitude towards the pandemic and adequate preventive practices are ofparamount importance for the combat effectiveness of the healthcare burden.This study assessed theknowledge, practice and attitudes regarding COVID-19 among the nursing students of a tertiary care centerin Eastern India. KAP scores were compared with their socio-demographic variables. Inter-relation betweenknowledge, attitude and practice was also assessed.Out of the 131 students participated in the study the KAPparameters were not significantly different based on the socio-demographic factors. Though knowledgeand attitude parameters were positively correlated among them, it was found that practice was negativelycorrelated to both knowledge and attitude. This finding can be attributed to them being non-exposed andinexperienced in the regular healthcare activities as well to the fact that Indian population was to some extentunprepared to cope up with this type of epidemic for a long time. Training on the updated knowledge alongwith exposure to simulated environment with scheduled supervision to reflect the behavior of the studentsis of great importance so that in extreme situation, the trainee students can also come handy into utilizationif needed.

ObjectivesThe present study aims to investigate the etiology, clinical profile and resistance pattern of the isolated pathogens in Nepalese adults with acute gastroenteritis. This cross-sectional study was conducted at Sukraraj Tropical and Infectious Disease Hospital, from April 2016 to Sep 2017. Subjects’ ages 14 or above, presenting with gastroenteritis with positive stool culture were enrolled for analysis.ResultsOf total 153 patients, 47.72% subjects confirmed the presence of bacterial infection. Vibrio cholerae spp and Shigella spp were detected in 36.6% and 23.28% respectively. The most common resistance among Vibrio cholerae was to nitrofurantoin (92.8%), cotrimoxazole (92.8%) and nalidixic acid (92.8%). Among 17 isolates of Shigella spp, the most frequent drug resistant was observed in ampicillin (64.7%), nalidixic acid (58.8%), ceftriaxone (47%). Chloramphenicol (94.1%), tetracycline (88.2%), and cotrimoxazole (82.3%) were found to be the most sensitive towards this pathogen. High rate of diarrhea due to bacterial infection, especially Shigella spp and Vibrio spp and their high rate of drug resistance emphasize an urgent need of designing a surveillance system for antimicrobial resistance in Nepalese setting.