PLK1 regulates CtIP and DNA2 interplay in long-range DNA end resection

DNA double-strand break (DSB) repair is initiated by DNA end resection. CtIP acts in short-range resection to stimulate MRE11-RAD50-NBS1 (MRN) to endonucleolytically cleave 5'-terminated DNA to bypass protein blocks. CtIP also promotes the DNA2 helicase-nuclease to accelerate long-range resection downstream from MRN. Here, using AlphaFold2, we identified CtIP-F728E-Y736E as a separation-of-function mutant that is still proficient in conjunction with MRN but is not able to stimulate ssDNA degradation by DNA2. Accordingly, CtIP-F728E-Y736E impairs physical interaction with DNA2. Cellular assays revealed that CtIP-F728E-Y736E cells exhibit reduced DSB-dependent chromatin-bound RPA, impaired long-range resection, and increased sensitivity to DSB-inducing drugs. Previously, CtIP was shown to be targeted by PLK1 to inhibit long-range resection, yet the underlying mechanism was unclear. We show that the DNA2-interacting region in CtIP includes the PLK1 target site at S723. The integrity of S723 in CtIP is necessary for the stimulation of DNA2, and phosphorylation of CtIP by PLK1 in vitro is consequently inhibitory, explaining why PLK1 restricts long-range resection. Our data support a model in which CDK-dependent phosphorylation of CtIP activates resection by MRN in S phase, and PLK1-mediated phosphorylation of CtIP disrupts CtIP stimulation of DNA2 to attenuate long-range resection later at G2/M.

Early mobilization as a new pathway to improve functional mobility of cardiac patients in High dependency Unit

Funding Acknowledgements

Non funded project

Background

Early mobilization as a multidisciplinary team approach in cardiac High Dependency Unit-B (HDU B) helps to reduce loss of muscle strength, decrease hospital length of stay, improve functional capacity, cognitive levels, enhances the quality of care, and helps to decrease the hospitals costs.

Purpose

Early mobilization means reducing the time of bed rest from admission to first activity. Based on this definition the project aimed to mobilize more than 95% of cardiac patients within 24 hours of admission by September 2019 in HDU B unit.

Methods

HDU B Initiated Early mobilization program as a part of Value improvement project (VIP). Experts from multidisciplinary team (MDT) worked together to improve the functional mobility of patients. A cross section survey was conducted to identify barriers for early mobility in the unit followed by analyzing barriers through Pareto chart.  An early mobility flow chart (Level1-Passive, Level 2-Active assisted, Level 3-Active) framed in order to standardize the practice of mobilizing patients in HDU B. New changes were tested by using methodology of Plan Do Study Act. Staff education, training given regarding the implementation of early mobility protocol. Patients with mobility level 1 and 2 were identified by nurses, requested for Physiotherapy referral by Physicians. Nursing staff education on mobility assessment given an easy access of data about mobility level of patients in handoff communication, which guided the staff to decide on the need of PT consultation for each patient. In coordination with MDT team referral were also given even during weekend for the patients with mobility level 2. To engage patient and family in the early mobility program a new concept of END PYJAMA PARALYSIS was introduced. Patients with mobility level 3 were identified and encouraged to wear their own dress and move outside their room under supervision.This concept aims to build confidence in patients making them feel that they are ready to go home.

Results

With support and co-operation of the MDT, this project became a highly successful project in VIP. Initially 50% of the patients has been mobilized when the program was introduced in the ward during March 2019 which increased gradually to 90% at the end of the month. After introducing the flow chart, there was increase in 93.3% by April 2019. In addition to Physio referral it went to 100% at the end April 2019. End pyjama paralysis and weekend physio referral sustained the 100% compliance to Early mobility till the end of July 2019. Active interventions of the team helped to early mobilize by 100% till the end of September 2019 and currently it is in sustainable phase.

Conclusion

Early mobilization in HDU-B brought significant change in the culture of mobilization. Commitment, cooperation of MDT, a structural system and End pyjamas paralysis program are key factors of the success for the program that promoted patient safety and prevented adverse events.

Regulation of ETAA1-mediated ATR activation couples DNA replication fidelity and genome stability

Achuthankutty et al. show that the recently identified ATR kinase activator ETAA1 has an important role in protecting against chromosomal instability arising from incompletely replicated DNA, driven by cell cycle– and replication stress–regulated, phosphorylation-dependent control of its ATR-activating domain.

The ATR kinase is a master regulator of the cellular response to DNA replication stress. Activation of ATR relies on dual pathways involving the TopBP1 and ETAA1 proteins, both of which harbor ATR-activating domains (AADs). However, the exact contribution of the recently discovered ETAA1 pathway to ATR signaling in different contexts remains poorly understood. Here, using an unbiased CRISPR-Cas9–based genome-scale screen, we show that the ATR-stimulating function of ETAA1 becomes indispensable for cell fitness and chromosome stability when the fidelity of DNA replication is compromised. We demonstrate that the ATR-activating potential of ETAA1 is controlled by cell cycle– and replication stress–dependent phosphorylation of highly conserved residues within its AAD, and that the stimulatory impact of these modifications is required for the ability of ETAA1 to prevent mitotic chromosome abnormalities following replicative stress. Our findings suggest an important role of ETAA1 in protecting against genome instability arising from incompletely duplicated DNA via regulatory control of its ATR-stimulating potential.

Mycobacterium tuberculosis UvrD1 and UvrD2 helicases unwind G-quadruplex DNA

Unresolved G-quadruplex (G4) DNA secondary structures impede DNA replication and can lead to DNA breaks and to genome instability. Helicases are known to unwind G4 structures and thereby facilitate genome duplication. Escherichia coli UvrD is a multifunctional helicase that participates in DNA repair, recombination and replication. Previously, we had demonstrated a novel role of E. coli UvrD helicase in resolving G4 structures. Mycobacterium tuberculosis genome encodes two orthologs of E. coli UvrD helicase, UvrD1 and UvrD2. It is unclear whether UvrD1 or UvrD2 or both helicases unwind G4 DNA structures. Here, we demonstrate that M. tuberculosis UvrD1 and UvrD2 unwind G4 tetraplexes. Both helicases were proficient in resolving previously characterized tetramolecular G4 structures in an ATP hydrolysis and single-stranded 3'-tail-dependent manner. Notably, M. tuberculosis UvrD1 and UvrD2 were efficient in unwinding G4 structures derived from the potential G4 forming sequences present in the M. tuberculosis genome. These data suggest an extended role for M. tuberculosis UvrD1 and UvrD2 helicases in resolving G4 DNA structures and provide insights into the maintenance of genome integrity via G4 DNA resolution.

Mutations in TOP3A Cause a Bloom Syndrome-like Disorder

Bloom syndrome, caused by biallelic mutations in BLM, is characterized by prenatal-onset growth deficiency, short stature, an erythematous photosensitive malar rash, and increased cancer predisposition. Diagnostically, a hallmark feature is the presence of increased sister chromatid exchanges (SCEs) on cytogenetic testing. Here, we describe biallelic mutations in TOP3A in ten individuals with prenatal-onset growth restriction and microcephaly. TOP3A encodes topoisomerase III alpha (TopIIIα), which binds to BLM as part of the BTRR complex, and promotes dissolution of double Holliday junctions arising during homologous recombination. We also identify a homozygous truncating variant in RMI1, which encodes another component of the BTRR complex, in two individuals with microcephalic dwarfism. The TOP3A mutations substantially reduce cellular levels of TopIIIα, and consequently subjects' cells demonstrate elevated rates of SCE. Unresolved DNA recombination and/or replication intermediates persist into mitosis, leading to chromosome segregation defects and genome instability that most likely explain the growth restriction seen in these subjects and in Bloom syndrome. Clinical features of mitochondrial dysfunction are evident in several individuals with biallelic TOP3A mutations, consistent with the recently reported additional function of TopIIIα in mitochondrial DNA decatenation. In summary, our findings establish TOP3A mutations as an additional cause of prenatal-onset short stature with increased cytogenetic SCEs and implicate the decatenation activity of the BTRR complex in their pathogenesis.

Mycobacterium tuberculosis RecG protein but not RuvAB or RecA protein is efficient at remodeling the stalled replication forks: implications for multiple mechanisms of replication restart in mycobacteria

Aberrant DNA replication, defects in the protection, and restart of stalled replication forks are major causes of genome instability in all organisms. Replication fork reversal is emerging as an evolutionarily conserved physiological response for restart of stalled forks. Escherichia coli RecG, RuvAB, and RecA proteins have been shown to reverse the model replication fork structures in vitro. However, the pathways and the mechanisms by which Mycobacterium tuberculosis, a slow growing human pathogen, responds to different types of replication stress and DNA damage are unclear. Here, we show that M. tuberculosis RecG rescues E. coli ΔrecG cells from replicative stress. The purified M. tuberculosis RecG (MtRecG) and RuvAB (MtRuvAB) proteins catalyze fork reversal of model replication fork structures with and without a leading strand single-stranded DNA gap. Interestingly, single-stranded DNA-binding protein suppresses the MtRecG- and MtRuvAB-mediated fork reversal with substrates that contain lagging strand gap. Notably, our comparative studies with fork structures containing template damage and template switching mechanism of lesion bypass reveal that MtRecG but not MtRuvAB or MtRecA is proficient in driving the fork reversal. Finally, unlike MtRuvAB, we find that MtRecG drives efficient reversal of forks when fork structures are tightly bound by protein. These results provide direct evidence and valuable insights into the underlying mechanism of MtRecG-catalyzed replication fork remodeling and restart pathways in vivo.

Mycobacterium tuberculosis DinG is a structure-specific helicase that unwinds G4 DNA: implications for targeting G4 DNA as a novel therapeutic approach

The significance of G-quadruplexes and the helicases that resolve G4 structures in prokaryotes is poorly understood. The Mycobacterium tuberculosis genome is GC-rich and contains >10,000 sequences that have the potential to form G4 structures. In Escherichia coli, RecQ helicase unwinds G4 structures. However, RecQ is absent in M. tuberculosis, and the helicase that participates in G4 resolution in M. tuberculosis is obscure. Here, we show that M. tuberculosis DinG (MtDinG) exhibits high affinity for ssDNA and ssDNA translocation with a 5' → 3' polarity. Interestingly, MtDinG unwinds overhangs, flap structures, and forked duplexes but fails to unwind linear duplex DNA. Our data with DNase I footprinting provide mechanistic insights and suggest that MtDinG is a 5' → 3' polarity helicase. Notably, in contrast to E. coli DinG, MtDinG catalyzes unwinding of replication fork and Holliday junction structures. Strikingly, we find that MtDinG resolves intermolecular G4 structures. These data suggest that MtDinG is a multifunctional structure-specific helicase that unwinds model structures of DNA replication, repair, and recombination as well as G4 structures. We finally demonstrate that promoter sequences of M. tuberculosis PE_PGRS2, mce1R, and moeB1 genes contain G4 structures, implying that G4 structures may regulate gene expression in M. tuberculosis. We discuss these data and implicate targeting G4 structures and DinG helicase in M. tuberculosis could be a novel therapeutic strategy for culminating the infection with this pathogen.

Design and development of a safer non-invasive transungual drug delivery system for topical treatment of onychomycosis

OBJECTIVE

The main objective of this study is to develop a safer non-invasive treatment for nail infections since the current treatment regimen has drawbacks like, incidence of systemic side-effects and higher cost. Proposed topical treatment on the other hand can drastically improve the situation, hence highly desirable. This work was undertaken with a hypothesis to develop a transungual microemulsion gel for topical treatment of onychomycosis.

METHODS

Benzyl alcohol and isopropyl myristate were used as oil, Pluronic F68 as surfactant and ethanol as co surfactant, in double-distilled water and loading itraconazole as the model antifungal drug. Pseudo-ternary phase diagram was developed by titrating different ratios of total oil and water with total surfactant, and Km ratio was fixed at 1:1. Microemulsion formulations were prepared based on the phase diagram and incorporated in gels by adding Carbopol 934P. Nail permeation enhancers like urea and salicylic acid were used to increase drug permeation through the nail plate. Parameters like drug loading, clarity, particle size distribution, drug entrapment efficiency (DEE), drug release profile, release kinetics and nail uptake were checked for the evaluation of the formulations.

RESULTS

Complete release of drug from the formulation varied from 60 to 120 min. The optimized formulation had DEE of 92.75%, complete drug release in 60 min and highest nail uptake of 0.386%/mm(2) (39 µg of drug) with 5% urea as nail permeation enhancer.

CONCLUSION

The formulation may prove beneficial in safer treatment of onychomycosis.

Antinociceptive property of Emblica officinalis Gaertn (Amla) in high fat diet-fed/low dose streptozotocin induced diabetic neuropathy in rats

Diabetic neuropathic pain is an important microvascular complication in diabetes mellitus and oxidative stress plays a vital role in associated neural and vascular complications. The present study investigated flavonoid rich fruit extract (ethyl acetate:methanol fraction) of E. officinalis (10 mg/kg), in type II diabetes (high fat diet fed/low dose streptozotocin) induced diabetic neuropathy in male Sprague-Dawley rats. Diabetic rats exhibited a significant hyperalgesia (nociception) as compared to control rats. Treatment with E. officinalis extract (EOE) and quercetin in diabetic rats showed significant increase in tail flick latency in hot immersion test and pain threshold level in hot plate test compared to control rats. The changes in lipid peroxidation status and anti-oxidant enzymes (superoxide dismutase and catalase) levels observed in diabetic rats were significantly restored by E. officinalis extract and quercetin treatment. Both, E. officinalis extract and quercetin attenuated diabetic induced axonal degeneration. The study provides experimental evidence of the preventive and curative effect of E. officinalis on nerve function and oxidative stress in animal model of diabetic neuropathy. Since, E. officinalis fruit is already in clinical use for diabetic patients it may be evaluated for preventive therapy in diabetic patients at risk of developing neuropathy.

Design and evaluation of itraconazole loaded solid lipid nanoparticulate system for improving the antifungal therapy

The objective of the study was to design and evaluate itraconazole loaded solid lipid nanoparticles (SLNs) drug delivery system, where itraconazole nanoparticles with suitable size ranges are expected to improve the therapeutic efficacy and reduction of toxicity of this broad spectrum antifungal agent. Components of the SLNs were lipid (palmitic acid) and surfactants (Pluronic F127 and Tween 40). The itraconazole loaded nanoparticles were prepared by microemulsion dispersion method. Experiments were carried out with optimized ratio of excipients, where drug-lipid ratio and surfactant-cosurfactant ratio (Km) were varied to optimize the formulation characteristics. The effects of dispersion media, its pH, ionic content, etc. were investigated to optimize the SLNs production. Particles size analysis and zeta potential measurements were done using Malvern Mastersizer Hydro 2000G. The particles were also subjected to DSC, IR and XRD analyses. The in vitro drug release profile from nanoparticles was found to prolong up to 12 h. Kinetic analysis of release indicated that nanoparticles formed were matrix in nature, in which Itraconazole dispersed uniformly. Optimized formulations were found to have a lipid-drug ratio of 1.5:1 and prepared at a Km ratio of 1:2 to maximize drug loading, modulate release and minimized particle size. The microemulsion mediated nanoparticle preparation methodology ensured high drug loading (ca. 80%), low and narrow size distribution and provided a reproducible and fast production method. The study elaborates on the feasibility and suitability of lipid based colloidal drug delivery system, employing optimize design to develop a clinically useful nanoparticle system with targeting potential.

Formulation and evaluation of mucoadhesive dosage form containing rosiglitazone maleate

Extending the residence time of a dosage form at a particular site and controlling the release of drug from the dosage form are useful especially for achieving controlled plasma level of the drug as well as improving bioavailability. The objective of this study was to extend the GI residence time of the dosage form and control the release of rosiglitazone using mucoadhesive tablet to achieve controlled plasma level of the drug which is especially useful after 8 to 12 weeks of monotherapy using conventional dosage forms when dose is doubled and plasma level also doubles. Direct compression method using simplex lattice design, followed by optimization of the evaluation parameters was employed to get final optimized formulation. The optimized formulation showed a mucoadhesive strength >40 gm-f, and a mucoadhesion time >12 hours with release profile closer to the target release profile and followed Non-Fickian diffusion mediated release of rosiglitazone maleate.

Formualtion and evaluation of floating drug delivery system containing clarithromycin for Helicobacter pylori

Floating matrix tablets are designed to prolong the gastric residence time after oral administration, at a particular site and controlling the release of drug especially useful for achieving controlled plasma level as well as improving bioavailability. With this objective, floating dosage form containing clarithromycin as drug was designed for the treatment of Helicobacter pylori. Tablets containing hydroxypropylmethylcellulose (HPMC), drug and different additives were compressed using wet granulation and D-optimal design technique. The study shows that tablet composition and mechanical strength have great influence on the floating properties and drug release. Incorporation of gas-generating agent together with polymer improved drug release, besides optimal floating (floating lag time < 30 s; total floating time > 10 h). The drug release was sufficiently sustained (more than 8 h) and anomalous diffusion as well as zero-order was confirmed. Optimization of the evaluating parameters with 'design expert' software was employed to get final optimized formulation. The optimized formulation was obtained using 62.5% clarithromycin, 4.95% HPMC K15M, 18.09% HPMC K4M, 12.96% sodium bicarbonate which gave floating lag time < 30 s with a total floating time > 10 h, in vitro release profile very near to the target in vitro release profile and follows anomalous diffusion as well as zero order pattern of release.

Removal of Cr(VI) from Aqueous Solution Using Activated Cow Dung Carbon

Removal of hexavalent chromium from aqueous medium by using activated cow dung carbon was studied. Cow dung was carbonized and activated by treating with concentrated H(2)SO(4) followed by heating for 24 h at 120 degrees C. The extent of adsorption was studied as a function of pH, contact time, amount of adsorbent, concentration of adsorbate, and temperature. At lower pH (<3.5), the prepared sorbent was capable of removing approximately 90% Cr(VI) at 5 ppm concentration from aqueous synthetic solution. The dynamics of migration of the sorbate ions from the bulk onto the sorbent surface was studied and the results obtained under various experimental conditions were found to follow standard adsorption isotherms. The reaction kinetics was found to be of first order. Copyright 2000 Academic Press.

Statistical optimization of transdermal drug delivery system of terbutaline sulfate by factorial analysis

A matrix type of transdermal drug delivery system of terbutaline sulfate was designed and developed by full 3(2) factorial method using polyvinyl alcohol (PVA) of medium molecular weight and polyvinyl pyrrolidone (PVP K-30) as matrix forming polymer and propylene glycol as plasticizer. Patches were designed to deliver 62 micrograms/cm2/hr of the drug into the systemic circulation. These were evaluated for in vitro skin permeation study through excised guinea pig skin. The permeation followed Higuchi kinetics, as its coefficients of correlation (r = 0.965-0.978) predominates over other permeation kinetics. Various physico-chemical parameters of the patches were investigated. Statistical optimization of in vitro permeation rate of the drug from the films were evaluated using two way analysis of variance (ANOVA), regression analysis.

Adsorption of Hexavalent Chromium from Aqueous Solution by Using Activated Red Mud

Adsorption by activated red mud (ARM) is investigated as a possible alternative to the conventional methods of Cr(VI) removal from aqueous synthetic solutions and industrial effluents. Adsorption characteristics suggest the heterogenous nature of the adsorbent surface sites with respect to the energy of adsorption. Various factors such as pH, contact time, Cr(VI) concentration, amount of adsorbent, and temperature are taken into account, and promising results are obtained. The applicability of the Langmuir as well as Freundlich adsorption isotherms for the present system is tested. The loading factor (i.e., milligrams of Cr(VI) adsorbed per gram of ARM) increased with initial Cr(VI) concentration, whereas a negative trend was observed with increasing temperature. The influence of the addition of anions on the adsorption of Cr(VI) depends on the relative affinity of the anions for the surface and the relative concentrations of the anions. Copyright 1999 Academic Press.

Removal of Fluoride from Aqueous Solution by Using Alum Sludge

The ability of treated alum sludge to remove fluoride from aqueous solution has been investigated. The studies were carried out as functions of contact time, concentration of adsorbent and adsorbate, temperature, pH, and effect of concentrations of other anions. The data indicate that treated alum sludge surface sites are heterogeneous in nature and that fits into a heterogeneous site binding model. The optimum pH for complete removal of fluoride from aqueous solution was found to be 6. The rate of adsorption was rapid during the initial 5 minutes, and equilibrium was attained within 240 minutes. The adsorption followed first-order rate kinetics. The present system followed the Langmuir adsorption isotherm model. The loading factor (i.e., the milligram of fluoride adsorbed per gram of alum sludge) increased with initial fluoride concentration, whereas a negative trend was observed with increasing temperature. The influence of addition of anions on fluoride removal depends on the relative affinity of the anions for the surface and the relative concentrations of the anions. Copyright 1998 Academic Press.

Adsorption of Phosphate from Aqueous Solution Using Activated Red Mud

Adsorption of phosphate (PO3-4) from aqueous solution on activated red mud (ARM) was studied as a function of time, pH, temperature, concentration of adsorbent and adsorbate in acetic acid-sodium acetate buffer medium. The adsorption of phosphate follows Langmuir as well as Freundlich adsorption isotherms. The process efficiency was found to be 80-90% at room temperature. This can be extended to the treatment of industrial effluents containing phosphates like that from phosphatic fertilizer plants. Copyright 1998 Academic Press.

Development and evaluation of an ideal formulation of glibenclamide by solid dispersion techniques

An attempt was taken to develop an ideal formulation of Glibenclamide. Considering the physico-chemical nature of the drug the solid dispersion system was utilised using hydrophilic and hydrophobic carriers and formulations were made by fusion as well as solvent evaporation/co-precipitation techniques. The resulting formulations were evaluated in respect of physical nature, yield, assay content and stability. The in vitro release profiles of the formulations were compared with the marketed tablet and simple physical mixtures having same composition of drug and excipients. The effects of various carriers as well as manufacturing procedures on the in vitro release rate of drug were also studied. It is observed that a suitable blend of different batches of solid dispersions containing hydrophilic and hydrophobic carriers will give an optimum formulation with quick onset and prolonged duration of action.

Geraniol dehydrogenase: a determinant of essential oil quality in lemongrass1

Geraniol dehydrogenase, the specific enzyme involved in geraniol to citral TRANS (geranial) transformation, activity was monitored in various lemongrass cultivars differing in amounts and relative percentages of citral and geraniol in their essential oils. The enzyme activity had a positive and significant association with citral to geraniol, and geranial to geraniol ratios. The results are suggestive of a strong relationship between the enzyme activity and essential oil quality in lemongrass cultivars.

Crystal structure of artemisinic acid: a possible biogenetic precursor of antimalarial artemisinin from Artemisia annua

Artemisinic acid [1], a possible biogenetic precursor of the antimalarial artemisinin [2], was isolated from the hexane extract of Artemisia annua. X-ray crystallography of the dimer of artemisinic acid shows that the cyclization during intermolecular hydrogen bonding occurs by the opposite orientation of the alpha, beta-methylene group in each molecule. Complete spectroscopic data of 1 are also given.

Adaptogenic activity of Indian Panax pseudoginseng

The crude extract and saponins of Indian pseudoginseng and saponins of Korean ginseng have been studied using a battery of biological tests in rats and mice. Indian pseudoginseng saponins were found to exhibit better activity than the Korean ginseng saponins in several tests employed. The results indicate a need for in-depth study of Indian pseudoginseng as an adaptogenic agent, after cultivation of the plant under controlled conditions.

Hypotensive activity of some dihydroxycoumarins and their congeners

Evaluation of the hypotensive activity of dihydroxy coumarins and their congeners reveal that the naturally occurring dimethoxy coumarin Scoparone has maximal activity, more significant than L-alpha-methyl dopa. Structure activity relationship studies are reported with an attempt to offer a probable mechanism of action.

Isolation and chemistry of alkaloids from plants of the family Papaveraceae LXVII: Corydalis cava (L.) Sch. et K. (C. tuberosa DC)

From Corydalis cava (L.) Sch. et K. (C. tuberosa DC) (Papaveraceae: genus Corydalis Med.), a mixture of alkaloids (0.53%) was isolated. The main alkaloid was (+)-bulbocapnine, and the minor alkaloids were coptisine, (+)-domestine, adlumidiceine, (+)-predicentrine, protopine, (-)-capnoidine, (+)-stylopine, (+)-isoboldine, 8-oxocoptisine, 1,2-methylenedioxy-6a,7-dehydroaporphine-10,11-quinone, and corysamine. In addition, fumaric acid was obtained. Coptisine, adlumidiceine, predicentrine, 8-oxocoptisine, corysamine, 1,2-methylenedioxy-6a, 7-dehydroaporphine-10,11-quinone, and isoboldine were found in C. cava for the first time, but rhoeadine and papaverrubine alkaloids were not detected. Predicentrine and isoboldine were identified on the basis of the UV, IR, mass, and PMR spectra.

SURGERY IN RURAL NEPAL

The curriculum of the post graduate program in General Practice in Nepal is designed to developcomprehensive and effective health care as well as timely life-saving surgical services in the District Hospital.District hospitals in rural Nepal encounter many surgical emergencies. Most of the times, the patient cannot afford to go to higher centers. General Practitioners (GPs) are effectively providing surgical services atdistrict hospitals. The aim of this study is to focus the types of surgical cases that were managed by GP andestablish the role and utilization of General Practice (GP) specialist as a surgeon at district, zonal andregional hospitals in developing countries. This is retrospective study of all cases at district hospital, Surkhet,(25 beds) of western part of Nepal during the period of one year (March 2000 to February 2001), that weremanaged by GPs. The surgical services provided by GP specialist at the district hospital were analyzed. Atotal of 16,975 cases were attended in the hospital during above period. Out of this, a total of 2,327(13.7%)were hospitalized. The total numbers of surgical cases were 1,205(51.8%). Out of this, 514(42.7%) caseshad undergone surgery. The general surgery cases comprise 447(87.0%), Gynae / Obstetric and Orthopediccases 67(13.0%). All surgeries were performed in limited resources by GPs. GP specialist can effectivelymanage the surgical cases and perform surgery at the district hospital competently. In country like Nepal,where number of surgical specialist are less and not available in majority hospitals, GPs can substitute thesurgical specialist and provide emergency surgical services in urban areas (zonal and regional hospitals).Key Words: Surgery, Rural, General Practice, Nepal.