Unveiling Ecopharmacology: Insights into knowledge, attitude, and practices among medical and nursing students in tertiary care teaching hospital of district Almora, Uttarakhand

Abstract

Background: Ecopharmacology, a field emerging at the intersection of pharmacology and environmental science, focuses on the impact of pharmaceuticals on ecosystems and public health. Given the increasing recognition of environmental issues associated with pharmaceutical waste, understanding the knowledge, attitudes, and practices (KAP) of health-care students toward ecopharmacology is crucial. Aims and Objectives: This study aims to assess KAP toward ecopharmacology among HCPs at a tertiary care center. Materials and Methods: This descriptive and cross-sectional study employed a pre-validated self-administered structured online questionnaire conducted between december 2024 and January 2025. The questionnaire consisted 22 questions to assess the knowledge, attitude, and practices of medical and nursing students regarding ecopharmacology. The data were subsequently analyzed and presented as percentages. Results: Out of 468 consenting participants 453 (291 M.B.B.S. students and 162 nursing students) satisfactorily completed the questionnaire. The mean age was found to be 21.31±1.76 years.It was depicted that in response to knowledge both MBBS and nursing students had good knowledge about few aspects of ecopharmacology while knew less about drug-take back system. Regarding attitude they were empathetic towards the issue and worried about safe disposal of the drugs. Majority (89.3% medical and 97.5% nursing students) of participants agreed regarding the need for guidelines for ecologically safe disposal of drugs by people, whereas 77.3 % of medical students throw away the excess medicines in the household trash. Conclusion: The present study highlights a significant level of awareness and concern regarding pharmaceutical waste management among HCPs.

Keywords

• Ecopharmacology
• Enviromental pharmacology
• KAP Study
• Unused medicine
• Medicinal disposal

References

1. Dubois-Deruy, E., Peugnet, V., Turkieh, A., & Pinet, F. (2020). Oxidative stress in cardiovascular diseases. *Antioxidants*, *9*(9), 1-20.
2. Wang, W., & Kang, P. M. (2020). Oxidative stress and antioxidant treatments in cardiovascular diseases. *Antioxidants*, *9*(12), 1-20.
3. Sack, M. N., Fyhrquist, F. Y., Saijonmaa, O. J., Fuster, V., & Kovacic, J. C. (2017). Basic biology of oxidative stress and the cardiovascular system: Part 1 of a 3-part series. *Journal of the American College of Cardiology*, *70*(2), 196–211.
4. Kibel, A., Lukinac, A. M., Dambic, V., Juric, I., & Selthofer-Relatic, K. (2020). Oxidative stress in ischemic heart disease. *Oxidative Medicine and Cellular Longevity*, *2020*, 6627144.
5. Farías, J. G., Molina, V. M., Carrasco, R. A., Zepeda, A. B., Figueroa, E., Letelier, P., et al. (2017). Antioxidant therapeutic strategies for cardiovascular conditions associated with oxidative stress. *Nutrients*, *9*(9), 1-18.
6. Dhalla, N. S., Temsah, R. M., & Netticadan, T. (2000). Role of oxidative stress in cardiovascular diseases. *Journal of Hypertension*, *18*(6), 655–673.
7. Niemann, B., Rohrbach, S., Miller, M. R., Newby, D. E., Fuster, V., & Kovacic, J. C. (2017). Oxidative stress and cardiovascular risk: Obesity, diabetes, smoking, and pollution: Part 3 of a 3-part series. *Journal of the American College of Cardiology*, *70*(2), 230–251.
8. Rotariu, D., Babes, E. E., Tit, D. M., Moisi, M., Bustea, C., Stoicescu, M., et al. (2022). Oxidative stress—Complex pathological issues concerning the hallmark of cardiovascular and metabolic disorders. *Biomedicine & Pharmacotherapy*, *152*, 113238.

9. Hermenegildo, C., Nies, E., Monsalve, E., Puertas, F. J., Higueras, V., & Romero, F. J. (1990). Some aspects of cardiac antioxidant defence: Ebselen (PZ 51) treatment increases glutathione peroxidase activity in the rat heart. *Biochemical Society Transactions*, *18*(6), 1193–1194.
10. Azad, G. K., & Tomar, R. S. (2014). Ebselen, a promising antioxidant drug: Mechanisms of action and targets of biological pathways. *Molecular Biology Reports*, *41*(8), 4865–4879.
11. Ahwach, S. M., Thomas, M., Onstead-Haas, L., Mooradian, A. D., & Haas, M. J. (2015). The glutathione mimic ebselen inhibits oxidative stress but not endoplasmic reticulum stress in endothelial cells. *Life Sciences*, *134*, 9–15.
12. Xu, Y., Tang, C., Tan, S., Duan, J., Tian, H., & Yang, Y. (2020). Cardioprotective effect of isorhamnetin against myocardial ischemia reperfusion (I/R) injury in isolated rat heart through attenuation of apoptosis. *Journal of Cellular and Molecular Medicine*, *24*(11), 6253–6262.
13. Zhao, T. T., Yang, T. L., Gong, L., & Wu, P. (2018). Isorhamnetin protects against hypoxia/reoxygenation-induced injury by attenuating apoptosis and oxidative stress in H9c2 cardiomyocytes. *Gene*, *666*, 92–99.
14. Abudalo, R., Gammoh, O., Altaber, S., Bseiso, Y., Qnais, E., Wedyan, M., et al. (2024). Mitigation of cisplatin-induced cardiotoxicity by isorhamnetin: Mechanistic insights into oxidative stress, inflammation, and apoptosis modulation. *Toxicology Reports*, *12*, 564–573.
15. Jafari, S., Shoghi, M., & Khazdair, M. R. (2023). Pharmacological effects of genistein on cardiovascular diseases. *Evidence-Based Complementary and Alternative Medicine*, *2023*, 8250219.
16. Farruggio, S., Raina, G., Cocomazzi, G., Librasi, C., Mary, D., Gentilli, S., et al. (2019). Genistein improves viability, proliferation and mitochondrial function of cardiomyoblasts cultured in physiologic and peroxidative conditions. *International Journal of Molecular Medicine*, *44*(6), 2298–2310.
17. Amerizadeh, A., Asgary, S., Vaseghi, G., & Farajzadegan, Z. (2022). Effect of genistein intake on some cardiovascular risk factors: An updated systematic review and meta-analysis. *Current Problems in Cardiology*, *47*(9), 100902.
18. Squadrito, F., Marini, H., Bitto, A., Altavilla, D., Polito, F., Adamo, E. B., et al. (2013). Genistein in the metabolic syndrome: Results of a randomized clinical trial. *The Journal of Clinical Endocrinology & Metabolism*, *98*(8), 3366–3374.
19. National Research Council Committee for the Update of the Guide for the Care and Use of Laboratory Animals. (2011). *Guide for the care and use of laboratory animals* (8th ed.). National Academies Press.
20. Kalayci, M., Coskun, O., Cagavi, F., Kanter, M., Armutcu, F., Gul, S., et al. (2005). Neuroprotective effects of ebselen on experimental spinal cord injury in rats. *Neurochemical Research*, *30*(3), 403–410.
21. Sun, J., Sun, G., Meng, X., Wang, H., Luo, Y., Qin, M., et al. (2013). Isorhamnetin protects against doxorubicin-induced cardiotoxicity in vivo and in vitro. *PLOS ONE*, *8*(5), e64526.
22. Tan, M., Toplu, Y., Varan, E., Sapmaz, E., Özhan, O., Parlakpınar, H., et al. (2022). The effect of genistein on cisplatin-induced ototoxicity and oxidative stress. *Brazilian Journal of Otorhinolaryngology*, *88*(1), 105–111.
23. Walker, M. J., Curtis, M. J., Hearse, D. J., Campbell, R. W., Janse, M. J., Yellon, D. M., et al. (1988). The Lambeth Conventions: Guidelines for the study of arrhythmias in ischaemia, infarction, and reperfusion. *Cardiovascular Research*, *22*(7), 447–455.
24. Mihara, M., & Uchiyama, M. (1978). Determination of malonaldehyde precursor in tissues by thiobarbituric acid test. *Analytical Biochemistry*, *86*(1), 271–278.
25. Ellman, G. L. (2022). Reprint of: Tissue sulfhydryl groups. *Archives of Biochemistry and Biophysics*, *726*, 109245.
26. Waterborg, J. H., & Matthews, H. R. (1994). The Lowry method for protein quantitation. *Methods in Molecular Biology*, *32*, 1–4.
27. Sun, Y., Oberley, L. W., & Li, Y. (1988). A simple method for clinical assay of superoxide dismutase. *Clinical Chemistry*, *34*(3), 497–500.
28. Aebi, H. (1984). Catalase in vitro. *Methods in Enzymology*, *105*, 121–126.
29. Erel, O. (2004). A novel automated direct measurement method for total antioxidant capacity using a new generation, more stable ABTS radical cation. *Clinical Biochemistry*, *37*(4), 277–285.
30. Erel, O. (2005). A new automated colorimetric method for measuring total oxidant status. *Clinical Biochemistry*, *38*(12), 1103–1111.
31. Ozbek, E., Simsek, A., Ozbek, M., & Somay, A. (2013). Caloric restriction increases internal iliac artery and penile nitric oxide synthase expression in rat: Comparison of aged and adult rats. *Archivio Italiano di Urologia, Andrologia*, *85*(3), 113–117.
32. Moya, E. A., Arias, P., Varela, C., Oyarce, M. P., Del Rio, R., & Iturriaga, R. (2016). Intermittent hypoxia-induced carotid body chemosensory potentiation and hypertension are critically dependent on peroxynitrite formation. *Oxidative Medicine and Cellular Longevity*, *2016*, 9802136.
33. Jia, Q., Wang, Y., Liu, X., Ma, S., & Yang, R. (2019). [Effects of genistein on Nrf2/HO-1 pathway in myocardial tissues of diabetic rats]. *Zhong Nan Da Xue Xue Bao Yi Xue Ban*, *44*(8), 850–856.
34. Basarslan, F., Yilmaz, N., Davarci, I., Akin, M., Ozgur, M., Yilmaz, C., et al. (2013). Effects of ebselen on radiocontrast media-induced hepatotoxicity in rats. *Toxicology and Industrial Health*, *29*(8), 746–752.
35. Wu, J., Feng, A., Liu, C., Zhou, W., Li, K., Liu, Y., et al. (2024). Genistein alleviates doxorubicin-induced cardiomyocyte autophagy and apoptosis via ERK/STAT3/c-Myc signaling pathway in rat model. *Phytotherapy Research*, *38*(8), 3921–3934.
36. Poasakate, A., Maneesai, P., Rattanakanokchai, S., Bunbupha, S., Tong-Un, T., & Pakdeechote, P. (2021). Genistein prevents nitric oxide deficiency-induced cardiac dysfunction and remodeling in rats. *Antioxidants*, *10*(2), 1–15.
37. Gupta, S. K., Dongare, S., Mathur, R., Mohanty, I. R., Srivastava, S., Mathur, S., et al. (2015). Genistein ameliorates cardiac inflammation and oxidative stress in streptozotocin-induced diabetic cardiomyopathy in rats. *Molecular and Cellular Biochemistry*, *408*(1–2), 63–72.
38. Santofimia-Castaño, P., Salido, G. M., & González, A. (2013). Ebselen alters mitochondrial physiology and reduces viability of rat hippocampal astrocytes. *DNA and Cell Biology*, *32*(4), 147–155.
39. Li, L., Xue, J., Liu, R., Li, X., Lai, L., Xie, J., et al. (2017). Neuroprotective effects of genistein-3′-sodium sulfonate on focal cerebral ischemia in rats. *Neuroscience Letters*, *646*, 43–48.
40. Yousefi, H., Karimi, P., Alihemmati, A., Alipour, M. R., Habibi, P., & Ahmadiasl, N. (2017). Therapeutic potential of genistein in ovariectomy-induced pancreatic injury in diabetic rats: The regulation of MAPK pathway and apoptosis. *Iranian Journal of Basic Medical Sciences*, *20*(9), 1009–1015.
41. Choi, E. J., & Lee, B. H. (2004). Evidence for genistein-mediated cytotoxicity and apoptosis in rat brain. *Life Sciences*, *75*(4), 499–509.
42. Li, W., Chen, Z., Yan, M., He, P., Chen, Z., & Dai, H. (2016). The protective role of isorhamnetin on human brain microvascular endothelial cells from cytotoxicity induced by methylglyoxal and oxygen-glucose deprivation. *Journal of Neurochemistry*, *136*(3), 651–659.