Assessment of Prescription Errors in the Internal Medicine Department of a Tertiary Care Hospital in Nepal: A Cross-Sectional Study

Introduction: Prescription errors are common problems in hospitals that lead to increase in morbidity, mortality and cost of treatments. They also reduce faiths towards healthcare providers. They are avoidable and their adverse outcome can be reduced if they are assessed and recognized earlier. This study was conducted to assess prescription errors occurred in tertiary care hospital Methods: A cross sectional study was conducted in Internal Medicine department of Lumbini Medical College for five months duration. Patients who prescribed at least one drug in prescription form were included. Results: Out of total patients, 39.5% had medication error. Among medication errors, 37.6% patients had error of omission. Among error of omission, dose of the drug was not mentioned in 26.1% patients. Category B (21.6%) of severity of medication error was the most common. Patients with one diagnosis less likely had medication errors comparing to the patients with more than one diagnosis (p = 0.0002). The tendency of making medication errors was higher among patients with polypharmacy (p < 0.001) and patients who prescribed Fixed-Dose Drug Combination (p < 0.001). Similarly, the tendency of making errors of omission was also higher among patients with more than one diagnosis (p = 0.0002), patients with polypharmacy (p < 0.001) and patients who prescribed Fixed-Dose Drug Combinations (p < 0.001). Conclusion: One-third of patients had medication errors. Among them, errors of omission were the most common. The collaborative program between doctors, clinical pharmacologists and hospital administration to minimize the occurrence of errors will be effective. &nbsp

Age-Adaptive Multimodal Biometric Authentication System with Blockchain-based Re-Enrollment

In the long run, a significant time gap between enrollment and probe image challenges the model's prediction ability when it has been trained on variant biometric traits. Since variant biometric traits change over time, it is sensible to construct a multimodal biometric authentication system that must include at least one invariant trait, such as the iris. The emergence of Deep learning has enabled developers to build classifiers on synthesized age-progressive images, particularly face images, to search for individuals who have been missing for many years, to avail a comprehensive portrayal of their appearance. However, in sensitive areas such as the military and banks, where security and confidentiality are of utmost importance, models should be built using real samples, and any variations in biometric traits should trigger an alert for the system and notify the subject about re-enrollment. This paper proposes an algorithm for age adaptation of biometric classifiers using multimodal channels which securely update the biometric traits while logging the transactions on the blockchain. It emphasizes confidence-score-based re-enrolment of individual subjects when the authenticator module becomes less effective with a particular subject's probe image. This reduces the time, cost, and memory involved in periodic re-enrolment of all subjects. The classifier deployed on the blockchain invokes appropriate smart contracts and completes this process securely

Antihypertensive Drug Use Pattern in a Tertiary Care Hospital of Western Region of Nepal: A Cross-Sectional Study

Introduction: Assessing antihypertensive drug use pattern always plays an important role to mitigate the burden of hypertension and also helps doctors to prescribe the drugs rationally. This study was conducted to assess antihypertensive drug use pattern in a tertiary care hospital. Methods: An observational cross-sectional study was conducted in the Internal Medicine department of Lumbini Medical College and Teaching Hospital from July 2021 to December 2021 for the duration of five months after ethics approval. Hypertensive patients who were prescribed one or more antihypertensive drugs irrespective of age and gender were included. Socio-demographic profiles, clinical characteristics, and antihypertensive drug use-related data were collected. A convenience sampling technique was used. Categorical variables were expressed as frequency and percentage while continuous variables were reported as mean ± standard deviation. Results: A total of 224 patients were included. The average number of antihypertensive drugs per patient was 1.7 ± 0.8. Combination drug therapy (54.5%) was commonly used. Calcium channel blockers (Amlodipine) were commonly prescribed (66.5%). Moreover, 98.7% and 41.5% patients were prescribed drugs from Essential Drug List of Nepal (Revised 2016) and in Fixed Dose Combination respectively. Use of combination drug therapy was higher among male patients (p = 0.003) and patients with stage II hypertension (p < 0.001). Conclusion: Calcium channel blockers were commonly used as monotherapy and in combination therapy as well. In approximately all of the patients, antihypertensive drugs were used from the essential drug list of Nepal which is an essential component of rational use of medicine

Sebaceous horn over scalp

Cutaneous horn is an exophytic keratinized lesion related to sun exposure or burns that most often occurs on the face. Although it is recognized as a slow-growing benign condition, it has also been described as potentially malignant lesion. Only a few cases of cutaneous horn of the scalp have been described in the literature. A 65 year old male came to our hospital with horn like growth over scalp, we did excisional biopsy of the lesion and report came as “sebaceous horn”.on regular follow up, no recurrence has been seen on surgical site

Effect of different additives on nutrient parameter and palatability of ensiled water hyacinth (Eichhornia crassipes)

Water hyacinth, Eichhornia crassipes, is an invasive aquatic weed that covers major water bodies in Nepal, and its silage has great potential to be used as ruminant’s feed. An experiment was conducted with an aim to explore its ensiling attributes along with palatability test for cattle was conducted at Institute of Agriculture and Animal Science, Rupandehi in a completely randomized experimental design with three replications. The quality and palatability of water hyacinth silage prepared with additives such as rice straw, molasses, wheat flour, and rice bran were assessed. The treatments included: water hyacinth with rice straw(T1); water hyacinth with rice straw and rice bran(T2); water hyacinth with rice straw and wheat flour(T3); water hyacinth with rice straw and molasses(T4); water hyacinth with rice straw, wheat flour and molasses(T5); water hyacinth with rice straw, wheat flour and rice bran(T6) and water hyacinth with rice straw, wheat flour, molasses and rice bran(T7). The results showed, crude protein (CP), crude fiber (CF), ether extract (EE), total ash (TA), pH, and palatability had significant differences across all treatments (p<0.05). CP (15.13) and CF (23.73) were found to be highest under control whereas rice straw, wheat flour and rice bran had the highest EE (12.74), TA (15.13), pH (3.87), palatability (100%), and considerably high CP (12.40) and CF (19.75). Hence, silage of water hyacinth with rice straw, wheat flour, and rice bran has high nutrient content, palatability and can be used as a feed alternative to solve the problem of feed scarcity

Ileo-ileal intussusception due to lipomatous growth

Adult intussusception occurs infrequently and differs from childhood intussusception in its presentation, aetiology, and treatment. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms and most cases are diagnosed at emergency laparotomy. With more frequent use of computed tomography in the evaluation of patients with abdominal pain, the condition can be diagnosed more reliably. Treatment entails simple bowel resection in most cases. Reduction of the intussusception before resection is controversial, but there is a shift against this, especially in colonic cases. In present case 40 years old female having abdominal pain on and off since 6 months, multiple ultrasonography reports were done with no abnormality detected

CONVENTIONAL TAXONOMY AND TREATMENT ETIQUETTE OF KAMALA W.S.R.TO MODE OF ACTION OF NAVAYAS LAUHA CHURNA ON SHAKHASHRIT KAMALA (HEPATO-CELLULAR JAUNDICE)

The scientific taxonomy of disease make easy to study, recognition of etiology, diagnosis and planning of treatment of any ailment. The traditional cataloging of diseases have been described in traditional system of medicine is very scientific as well as practical also. Like classification of other ailment, Kamala has been classified basically in various groups like Koshthashrita (haemolytic jaundice) & Shakhashrita (hepato-cellular jaundice), Swatantra (independent) and Partantra (manifest as a complication of another disease), Bahupitta (due to excess generation of bilirubin) and Alpapitta (due to retention of bilirubin). But in this article, the elaborated taxonomy of Kamala is described on the behalf of four types of Samprapti i.e. Vidhi, Vikalpa, Pradhanya and Bala which have great importance in diagnosis and management of Kamala ailment. Everyone knows that abolition of etiology and cleavage of pathological chain of ailment is the steady and complete healing of disease. The treatment protocol of Kamala is entirely based on this theory. There are two segment of treatment of Kamala, first is nonspecific which is common and applicable for all kinds of Kamala and second is specific treatment which is explicit for definite types of Kamala. In Ayurvedic pharmacology, the mode action of drugs and how to cleavage the pathogenesis of ailment is not described but here it is illustrated very clearly and in a mannered way. The Navayas lauha churna has three groups of herbal drugs i.e. Trimada, Trikatu and Triphala and one group of Lauha bhasma. Each groups of drugs of this medicine; where (at which step of pathogenesis) and how to act and cleavage the pathogenesis of Shakhashrita kamal (hepato-cellular jaundice) are narrated with scientific, logical and evidence based discussion and as well as institution of liaison with contemporary science

Drug Utilization Pattern by Using WHO Core Prescribing Indicators in Orthopedics and Obstetrics / Gynecology Departments of a Tertiary Care Hospital

Introduction: Drug utilization research is an important tool to facilitate rational use of drugs. In low income countries irrational use of drugs is a common problem like overuse of drugs and inappropriate use of antibiotics, leading to poor treatment outcome and increased burden of treatment. This study was conducted to provide understanding of drug utilization pattern by using WHO Core Prescribing Indicator. Methods: This study was conducted in Orthopedics and Obstetrics / Gynecology departments. Patients visiting these Out Patient Departments with at least one drug on prescription form were included in the study. Further, information related to WHO Core Prescribing Indicators were collected in pre-designed proforma. Results: Average number of drugs prescribed per prescription was 2.6. Means of number of drugs prescribed in Orthopedics and Obstetrics / Gynecology departments were 2.9 and 2.3 respectively (p < 0.001). Drugs prescribed in generic name and from essential drug list was 41.4% and 34.3% respectively. Prescription forms with generic name in Orthopedics department were significantly more compared to Obstetrics / Gynecology department (p = 0.00002). However, there was an increased tendency to prescribe drugs from essential drug list in Obstetrics / Gynecology department compared to Orthopedics department (p < 0.001). Conclusion: Drugs were prescribed by generic name and from essential drug list, but this was not sufficient to meet the ideal values of WHO Core Prescribing Indicator. Therefore, prioritization on prescribing drugs by generic name and from essential drug list by respective departments to achieve the standards of WHO needs to be encouraged

Healthy mind and conceiving (Saumansya Garbhajananam) - A Critical Analysation with Ayurvedic prospective.

Soumanasya Garbhjananam (piece of mind) causes production of Garbha. As per Acharya Charaka’s guideline, this is a one type of Adravya Chikitsa not mere the placebo effect in the current era as many gynecologists also opine the same aspect with Charaka by means not having any deformity relates to male/female infertility. Thus the topic has keenly reviewed with other substantial approaches to prove the concept of Soumanasya Garbhajananam. The legacy of Charaka has been interpreted with special reference to Shareera Sthana of Charaka Samhita as well as Yonivyapat in Chikitsa Sthana. To evaluate this concept on the basic principle of Karyakarana Siddhant Vada has been enumerated on the parallel lines of current sexual enjoyment era. Day today practice it is also evident the concept of Soumanasya Garbhajananam. It is a matter of further research to calibrate the Soumanasya Bhava which it differs from individual to individual