Assessment Of The Registration Status, Availability, Utilization Pattern And Rationality Of Fixed Dose Drug Combinations In Nepal

Fixed dose drug combinations (FDCs), though offer certain advantage in terms of patient compliance, their use is highly debatable. There is a widespread use of FDCs in Nepal. However, there are no extensive studies on FDCs. The present study evaluated the registration status, availability, utilization pattern and rationality of FDCs in Nepal

Perception Of Nepalese Community Pharmacists Towards Patient Counseling And Continuing Pharmacy Education Program: A Multicentric Study

Objective: To study the perception of community pharmacists towards patient counseling and continuing pharmacy education programs. Methods: A semi structured questionnaire was developed by the researchers. The research was carried out in six major cities in Nepal, namely Kathmandu, Pokhara, Biratanagar, Birgunj, Nepalgunj and Bhairahawa. The filled questionnaires were analyzed as per the study objectives. Results: Altogether, 60 community pharmacists were included. Among them, 88.33% (n=53) were male. More than 50 patients visit most of the community pharmacies [36.67% (n=22)] daily. Most of the dispensers [56.67% (n=34)] took 1-5 minutes for dispensing a prescription. In most of the pharmacies [56.67% (n=34)], there were 2-5 dispensers and the qualification of a majority of dispensers were orientation training. Most of them [56.67% (n=340] believed that counseling was necessary as it was their own duty, but however, 48.33% (n=29) said that it was necessary to increase patient compliance. Our finding suggests that 83.33% (n=50) of retailers were facing some problems during patient counseling. All participants were interested in the continuing pharmacy education program. Conclusion: On the whole, the community pharmacists had a positive response towards patient counseling. Our findings suggest the need for continuing pharmacy education programs in Nepal to strengthen the concept of patient counseling.</p

Impact of deprescribing dual-purpose medications on patient-related outcomes for older adults near end-of-life: a systematic review and meta-analysis

Introduction: The decision to deprescribe medications used for both disease prevention and symptom control (dual-purpose medications or DPMs) is often challenging for clinicians. We aim to establish the impact of deprescribing DPMs on patient-related outcomes for older adults near end-of-life (EOL). Methods: This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Literature was searched on PubMed, EMBASE, CINAHL, PsycINFO and Google Scholar until December 2019 for studies on deprescribing intervention with a control group (with or without randomisation); targeting ⩾65-year olds, at EOL, with at least one life-limiting illness and at least one potentially inappropriate DPM. We were interested in any patient-related outcomes. Studies with similar outcome assessment criteria were subjected to meta-analysis and narrative synthesis otherwise. The risk of bias was assessed using Cochrane Risk of Bias and ROBINS-I tools for randomised controlled trials (RCTs) and quasi-experimental non-randomised controlled studies, respectively. Results: Five studies covering 689 participants with mean age 81.6–85.7 years, the majority (74.6–100%) with dementia were included. The risk of bias was moderate to low. The deprescribing of DPMs lowered the risk of mortality (risk ratio (RR) = 0.59, 95% confidence interval (CI) = 0.44–0.79) and referral to acute care facilities (RR = 0.40, 95% CI = 0.22–0.73), but did not have a significant impact on the risk of falls, non-vertebral fracture, emergency presentation, unplanned hospital admission, or general practitioner visits. No significant difference was observed in the quality of life, physical and cognitive functions between the intervention and control groups. Conclusion: There is some evidence that deprescribing of DPMs for older adults near the EOL can lower the risk of mortality and referral to acute care facilities, but there are insufficient good-quality studies powered to confirm a benefit in terms of quality of life, physical or cognitive function, health service utilisation and adverse events. Plain Language Summary What is the health impact of withdrawal or dose reduction of medication used for disease prevention and symptom control in older adults near end-of-life? Introduction: Older adults (aged ⩾ 65 years) with advanced diseases such as cancer, dementia, and organ failure tend to have a limited life expectancy. With the progression of these diseases towards the end-of-life, the intensity for day-to-day supportive care becomes increasingly necessary. The use of medications for symptom management is a critical part of such care, but the use of medications for long-term disease prevention can become irrelevant due to the already shortened life expectancy and may become harmful due to alterations in physiology and pharmacology associated with age and frailty. This necessitates the withdrawal or dose reduction of inappropriate medications, the process called deprescribing. The decision to deprescribe medications used for both disease prevention and symptom control (DPMs) in this population is often challenging for clinicians. In this context, whether deprescribing of DPMs can improve patient-related health outcomes is unknown. Methods: Evidence from the literature was reviewed and analysed, and the quality of studies was assessed. Five studies were identified, which had 689 participants with an average age above 80 years and mostly suffering from dementia. Results: The analysis of these studies showed deprescribing of DPMs lowered the risk of death and referral to acute care facilities at 12 months but had no significant impact on falls, non-vertebral fractures, emergency presentations, unplanned hospital admission, general practitioner visits, quality of life, physical and mental functions. Conclusion: In conclusion, there were insufficient numbers of high-quality studies powered to confirm whether deprescribing of DPMs reduces adverse events, health service use, or improves the quality of life or functioning in older adults near the end of life

“Estimation and Validation of Methylcobalamin in Tablet Dosage form using UV-Visible Spectrophotometric Method”

An ultraviolet (UV) spectrophotometric method was developed and validated for quantitavie determination of Methylcobalamin (Mecobalamin) in tablet dosage form. Methylcobalamin is a cobalamin, a form of vitamin B12 and used to prevent or treat pathology arising from a lack of vitamin B12 , such as pernicious anemia and is also used in the treatment of peripheral neuropathy, diabetic neuropathy ans as a preliminary treatment for amyotrophic latera sclerosis. The very simple, Fast, accurate and economical methods have been proposed for the determination of Mecobalamin. Mecobalamin was measured by using Uv spectroscopy method with the solution of methanol, the linearity was found to be 0.9981 and the accuracy showed mean % RSD of 0.791694 and with total meam % RSD 0.97923 in intermediate precision, range %RSD 0.652005 all the parameters values were within standard limit thus Analytical method was validated according to ICH guideline for the determination of Methylcobalamin. The method was found to be precise and validated as per ICH guidelines

ASSESSMENT OF DRUG RELATED PROBLEMS IN A TERTIARY CARE TEACHING HOSPITAL, INDIA

ABSTRACTObjective: Drug related problems (DRPs) are frequent in hospitalization where multiple changes in patient's medication regimen and lack of continuity of care may be accompanied. The aim of present research was to identify drug related problems, drug classes involved in DRPs as well as associated factors with the occurrence of DRPs and to assess the pharmacist interventions in a tertiary care teaching hospital.Methods: A prospective observational study was carried out in a tertiary care teaching hospital, over a period of six months from November 2015 to April 2016. All the in patients admitted to all departments of hospital, who satisfied the selection criteria, were included in this study. Necessary demographic and clinical data was collected from the case records. The Pharmaceutical Care Network Europe Classification Version (PCNE) 5.01 was used to classify DRPs. The treatment data was analyzed to determine the rate, pattern, clinical significance, and outcomes of DRPs.Results: A total of 300 patient case sheets were reviewed during the study period, out of which 143 drug related problems were identified from 93 patients. Male (%) predominance was noted over females (%). The most common DRP was drug Interactions 47.55% (68) followed by drug use problems 19.58% (28), drug choice problems 14.68% (21), others 11.88% (17), dosing problems 4.89% (7), and adverse reaction 1.39% (2) were identified.Conclusion: Drug related problems are common among the wards of hospital. Clinical pharmacist's role in identification, resolution and prevention of drug related problems helps in achieving better therapeutic outcomes and improved patient healthcare.Keywords: DRP's, Adverse Drug Reactions, Drug Interactions (DI), Drug choice problems, Dosing problem, Drug use problems, Paediatric, Medicine, PCN

Effects of different mulches and net house on crucifer aphid (Brevicoryne brassicae L.) population, growth and yield of broadleaf mustard (Brassica juncea)

Crucifer aphid, Brevicoryne brassicae, is a key pest of broadleaf mustard and other crucifers. An alternative integrated management approaches are recommended to keep the pest below economic threshold level. A field experiment was carried out to evaluate the effect of mulching and net house on aphid population, growth and yield of broadleaf mustard. Experiment was carried out in randomized complete block design with four replications from September to December 2016 at Rampur, Chitwan, Nepal. Five treatments used in experiment was untreated control, black plastic mulch only, reflective plastic mulch only, black plastic mulch plus imidacloprid 70 WSG @ 0.13gm/liter, and net house plus black plastic mulch. The results showed that the lowest population of crucifer aphid was recorded inside the net house with black plastic mulch and black plastic mulch with imidaclorpid 70 WSG @ 0.13g/L spray. Reflective plastic mulch was superior as compared to black plastic mulch and control to reduce the aphid population. Similarly, the highest yield (26.86t/ha) was obtained inside the net house with black plastic mulch followed by black plastic mulch with imidacloprid spray (25.99 t/ha). But the benefit-cost ratio was the highest (4.09) in black plastic mulch with imidacloprid spray followed by reflective plastic mulch (3.42), black plastic mulch (3.32), and net house with black plastic mulch (3.10). Benefit-cost ratio was lower in net house with black plastic mulch but products are safe from toxins and potentially profitable in long run. Considering its ecological cost, the use of pest exclusion net is recommended as a viable option for controlling insect pests of broadleaf mustard

Effect of Mycorrhiza on Vegetative Growth of Mandarin’s (Citrus reticulata Blanco) Seedlings

Citrus is among the top fruits which are cultivated around the world, and among citrus, Mandarin (Citrus reticulata Blanco) comes first and belongs to the family Rutaceae. A field experiment was conducted in Gorkha, Nepal, from April 2021 to July 2022, to study the effect of different doses of Mycorrhiza in the vegetative growth seedlings. The experiment was set up in a Randomized Complete Block Design (RCBD) with five treatments and four replications. The treatments were named T1: Control, T2: 3g/seedling, T3: 6g/seedling, T4: 9g/seedling, and T5: 11g/seedling, respectively. Eighteen months old seedlings of local Mandarin were uprooted and transplanted in finely pulverized and prepared seedbeds, and Mycorrhiza was added subsequently. Data was collected for plant height, number of leaves, and stem diameter. Data analysis was done through Microsoft- Excel, RStudio, and Analysis of Variance (ANOVA). Results of the study showed that plants treated with 9g of Mycorrhiza produced the highest number of measured parameters compared to plants treated with other doses. Control treatment (0g) produces the least number of plant leaves, Height, and stem diameter, and it can be concluded that a mycorrhizal dose of 9g is the best for the vegetative growth of Mandarin

Herbal fixed dose combinations in Nepal : Growing concerns in a developing country

Herbal medicines are mostly prepared as a combination therapy that has been used since therapeutic was first practiced. Combination products, also known as Fixed Dose Combinations (FDCs) of herbal remedies are in widespread use in Nepal. Herbal FDCs are in common practice because it is believed to have better adherence, less side effects and easy accessibility. Nevertheless, combination products possess greater risk of adverse effects, increases costs associated with treatments and leads to an ineffective dosages. Herbal FDCs are used extensively in Nepal although the rationality beyond the use of these combinations is still unidentified and at times are questionable. Legislations governing the use of herbal medicines is lacking in Nepal. Many herbal FDCs are not supported by any scientific data and test for the presence of ingredients mentioned in the package insert/container label is always difficult. A FDC of herbal products must be based on clear criteria that guarantee consumer safety and appropriate indications. These criteria helps to protect the consumers or patients from the misleading claims and risk associated with the use of unjustifiable combination of herbal substances. Strict monitoring from the regulatory body and the public awareness on the cost as well as advantages and disadvantages of herbal FDCs is urgently required. 2016, Journal of Clinical and Diagnostic Research. All rights reserved.Scopu

Clinical profile and drug utilization pattern in an intensive care unit of a teaching hospital in western Nepal

To analyze the clinical profile of patients admitted to the intensive care unit (ICU) of Manipal Teaching Hospital (MTH) at Pokhara, Nepal, identify the commonly prescribed drugs, drug categories, dosage forms, antimicrobials, sensitivity pattern of antimicrobials and the treatment outcomes. A cross sectional, descriptive study in which he case records of all the patients admitted in the ICU during 1st August to 30th September, 2007 were collected and the details were entered in the patient profile form. The filled patient profile forms were retrospectively analyzed as per the study objectives. Altogether, 201 patients [males 101 (50.25%)] were admitted. Most common diagnosis was 'Myocardial Infarction /Ischemic heart disease' [13.96 % (n=62)]. The median (interquartile range) of the ICU stay was 3 (2-4) days. Cardiovascular drugs [31.7% (n=761) were the most commonly prescribed. Among the antimicrobials, metronidazole was most commonly prescribed followed by ceftriaxone. The morality rate in the ICU was 17.41 % and the major causes of mortality were cardiovascular and respiratory diseases. Antimicrobials was the most common drug category used in the ICU and 'pantoprazole' was the most commonly prescribed individual drug. Cardiovascular and respiratory diseases were major causes of death in the ICU