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Evaluation of Risk Factors for Antituberculosis Drugs-Induced Hepatotoxicity in Nepalese
Get PDFAntitubercular drugs cause derangement of hepatic functions revealed by clinical examination and abnormal liver function test. Many factors are found to predispose patients towards this adverse reaction of anti-tubercular drugs, which can cause economical burden as well as prolong duration of illness. Detection of these risk factors for hepatotoxicity can play an important role in minimizing the incidence. The present study had objectives to assess the role of age, sex, alcohol intake, nutritional status and disease extent as risk factors in the development of hepatotoxicity in patients with active tuberculosis receiving antituberculosis treatment. 50 patients diagnosed of active tuberculosis infection with normal pretreatment liver function were monitored clinically as well as biochemically in a prospective cohort analysis. Four patients (8%) developed drug-induced hepatotoxicity. Antitubercular drugs-induced hepatotoxicity was prevalent in younger patients (6% vs. 2%, P> 0.05, P = 0.368, Odds Ratio [OR]; 2.75). Female gender was found to be at higher risk (P> 0.05, P = 0.219, Odds ratio [OR]; 4.2). Majority of the patients who had developed hepatotoxicity were sputum smear positive ones with advanced tuberculosis infection. Nutritional status, assessed by body mass index (BMI) and serum albumin level, was the next predisposing factor. Risk factors of hepatotoxicity included female sex, disease extent and poor nutritional status. Timely detection and temporary withdrawal of the offending agent can completely cure antitubercular drugs-induced hepatotoxicity
Prevalence Pattern of Cancer and Handling of Cytotoxic Drugs
Get PDFA retrospective study was conducted in two hospitals, namely Bhaktapur Cancer Care Center and Om Hospital and Research Center, focusing on the prevalence pattern, management of cancer, and handling of cytotoxic drugs. A total of 358 cancer cases (179 from each hospital) were analyzed. Questionnaires were utilized to assess the handling of cytotoxic drugs in the hospitals. The study revealed that individuals in the age group of 45-65 were more susceptible to cancer. The top five malignancies identified were stomach, ovarian, Non-Hodgkin’s Lymphoma (NHL), lung, and breast cancer. Females exhibited a higher incidence of cancer compared to males, with the female reproductive system and breast being the most prevalent sites. Assessment of cytotoxic drug management was conducted by reviewing the medical records of in-patients receiving chemotherapy, revealing rational drug therapy prescriptions for all cancer cases in both hospitals. Handling of cytotoxic drugs was evaluated through direct observation of reconstitution and administration procedures, administration questionnaires, and interviews with medical personnel. Inadequate knowledge, insufficient training of personnel, limited financial resources, inadequate handling equipment, and increased risk of accidents and spills were identified as contributing factors to inappropriate drug handling practices
Effect of Drug Therapy and Risk Involved in Coronary Vascular Disease in Type 2 Diabetes Mellitus - A Case Study
Get PDFType 2 Diabetes Mellitus (T2DM) is one of the chronic diseases in the world. According to World Health Organization (WHO) approximately 171 million people worldwide currently on diabetic and that type 2 diabetes accounts to about 90%. This study presents Oral hypoglycemic agent (OHA) prescription pattern by the physicians among Out patients of two hospital and risk involved in coronary vascular disease (CVD). 160 patients previously diagnosed with T2DM were included in the study, which involves review of available documents, interviewing the patients, their sex, age, smoking habit, family history, Body mass index (BMI), lifestyle, associated disease, Cardiac complication, total no of drugs used, no of drugs prescribed and lastly risk involved in development of the CVD in T2DM. 55% male and 45% female were assessed and subjects above 50 years were found susceptible to Hyperglycemia. Smoking status were- present smokers were 19.4 %, ex-smokers were 33.8%, and non-smokers were 46.8%; family diabetic history - 41.9% had family history, 48.8% were overweight and 10.6% were obese, 55.6 % had sedentary , 28.8% had active and 15.6% had highly active lifestyle. The different group of OHA used were Sulfonylurea 48.9%, Biguanide 41.3% Meglitinide 6.4% and Thiozolidinedione 3.8%. With each class most frequently used drugs were: (a) Sulfonylurea-Glimipiride in 45 patients Glibenclamide in 26 patients Gliclazide in 31 patients Glipizide in 13 patients. (b) Biguanide--Metformin in 98 patients (c) Meglitinide- Repaginide in 15 patients and (d). Thiozolidinedione--Rosiglitazone in 9 patients. The risk factors related to cardiovascular complication like smoking habit, Body Mass Index and Diabetic associated disease were compared. Combination drugs are more effective in controlling blood glucose than that of monotherapy
Occurrence of Side Effects from Anti-Tuberculosis Drugs in Urban Nepalese Population under DOTS Treatment
Get PDFTuberculosis is one of the foremost public health problems causing an enormous burden of suffering and deaths. Chemotherapy is the basic approach to clinical tuberculosis control. 1Essential anti-tuberculosis drugs are Isoniazide (INH), Rifampicin (RMP), Pyrazinamide (PZA), Ethambutol (E) and Streptomycin (S). Department of Pharmacy, KU, KUTH, and Dhulikhel conducted this study in collaboration with German-Nepal Tuberculosis Project (GENETUP) and Korea-Thimi Friendship Hospital during March 2005 to July 2005. Total 70 newly diagnosed pulmonary or extra-pulmonary tuberculosis patients were included in the present study. Patients were kept under observation during whole treatment period. Clinical, hematological and biochemical monitoring form the basis of diagnosing side effects due to anti-tuberculosis therapy. Among the 70 cases studied, 70% were male and 30% were female. There was significant increase in the bilirubin total, bilirubin direct, AST, ALT, alkaline phosphatase, eosinophils, lymphocytes, monocytes after anti-tuberculosis treatment whereas there was significant decrease in WBC count, neutrophils, platelets count, and ESR after anti-tuberculosis treatment. Serum level of creatinine was normal before and after anti- tuberculosis treatment. In our study, slight increase in uric acid level was detected after anti- tuberculosis treatment when compared to pretreatment, though it was in the normal range. Of the 70 patients treated for tuberculosis, 80% of the total number of patients reported at least one type of side effects. 24 patients (34.29%) had experienced major side effects. 8 elderly patients (44.44%) and 16 younger patients (30.76%) had experienced major side effects. Female gender (38.10%), alcoholics (38.89%) and sputum-smear positive (32.14%) were associated with increased occurrence of major side effects. The overall side effects indicate that side effects are not to be neglected. It was experienced that timely detection and temporary withdrawal of the offending agent can completely cure anti-tuberculosis drugs- induced side effects. For this, careful patient monitoring clinically, hematologically and biochemically especially during first few weeks of chemotherapy and patient counseling regarding side effects of the anti-TB medications are necessary
Pattern of Antimicrobial Prescription and its Cost Analysis in Respiratory Tract Infection
Get PDFMany reports from different parts of the world show that antimicrobials are used both widely and often indiscriminately. Indiscriminate usage could increase the cost of therapy, incidence of adverse drug reaction, and increase in the rate of emergence of bacterial resistance. There is evidence to show that antimicrobials are widely used in Nepal. This study relates to the drug prescribed treatment of Respiratory Tract Infection (RTI), which is a cause of morbidity and mortality in children and adults. This problem is important considering climate, geographical and living condition of the people. Out of total 190 patients 20% were diagnosed as having Upper Respiratory tract infection (URTI), 48.43% had Lower Respiratory Tract Infection (LRTI) and 31.57% as having chronic obstructive pulmonary disease (COPD) or asthma. 42.1% were male patients and 57.89% were females. Among the six different antimicrobials prescribed the most commonly used therapeutic group were penicillin’s (47.36%) followed by tetracycline (43.15%), macrolides (4.2%), quinlones (3.1%) and cephalosporins (2.1%) .14.56% of the drug was prescribed using generic name and the remaining 85.43% of the drugs were prescribed using brand name. It was found that the Maximum and minimum price of antimicrobial regimen in two hospitals were same although slight difference in brands available was observed. The cheapest antimicrobial regimen in RTI treatment was Doxycycline, 100 mg once daily for 10 days and the most expensive was cefixime 400 mg for 7 days. The cost of the same drug varied according to the brands
Study of the Length Frequency Distribution of Sucker Head, Garra gotyla gotyla (Gray, 1830) in Different Rivers and Seasons in Nepal and Its Applications
Get PDFSize structure data particularly that of length frequency distribution is very important fisheries management tool. This is also applied to assess the health, habitat and integrity of the rivers. Nepal is tremendously rich in both fisheries and water resource and thus, this analysis is very important. However, this kind of analysis is not common in fisheries studies and hence the size structure information of all the fish in Nepal is wanting. This study simply tries to open the door for such studies with the study of the sucker head Garra gotyla gotyla, a very common fish in Nepal. The field observation was done in nine rivers of the country in all the seasons of the 2003 by using electrofishing gear. The length frequency distribution of the river was found to vary both spatially and temporally among rivers and seasons respectively indicating different conditions in different rivers. The study suggested that the beginning of the breeding season should be immediately before monsoon. The rivers Aandhikhola and Tinau were found to possess some of the best distributions of length frequencies of this species and hence have a better habitat conditions and water quality
Impact of Pharmaceutical Intervention on Inhalation Technique
Get PDFThe study carried out presents causes of poor compliance among the patients using inhaler devices. Evaluation of the patient's prior knowledge and practice of using inhalers and the improvement on using inhalers after counseling intervention through standard guidelines were the outcome measures of this study. It was hypothesized that pharmaceutical intervention gives better outcome. There was lesser compliance and lesser improvement in inhalation technique score in females than in males and furthermore the female patients falling under the resting category were mostly above the age of 60 years. Comparing the mean scores and mean improvement before and after counseling in rotahaler users, it was observed that there was 62.25% improvement in discharged patients 57.75% improvement in outpatients after counseling 47.87% improvement in inpatients after first counseling 80.12% improvement after second counseling. In the case of MDI users, there was 63.30% improvement after counseling. From the follow-up (second counseling) in inpatients it was evident that as the number of counseling was increased, there was an increase in improvement in mean score, decrease in numbers of critical point missing, increase in compliance of patients to inhalation techniques and ultimately there were better outcomes
Controlled Release Oral Delivery System Containing Water Insoluble Drug
Get PDFThe objective of this study was to formulate a controlled release oral delivery system and to investigate the influence of different diluents, Carbopol 934P concentration, and granulation technique on the release of a poorly water-soluble drug (Ibuprofen) from Carbopol 934P matrix tablets. Matrix tablets were prepared by direct compression, wet granulation, and dry granulation methods at different polymer concentrations using lactose, dibasic calcium phosphate (DCP), microcrystalline cellulose (MCC), and starch as diluents. Dissolution studies were carried out in 900 ml phosphate buffer pH 7.4 using USP-apparatus I. At 5% Carbopol 934P concentration, the t50% was found in the rank order of tablets containing starch < MCC < DCP < lactose. The integrity of tablets and drug release were primarily governed by the properties of diluents at low polymer concentration. At 12.5% Carbopol 934P concentration, the t50% was found in the rank order of tablets containing MCC < DCP < Starch < Lactose. The effect of polymer predominated as the polymer concentration increased. Similar release profiles were observed at 20% Carbopol 934P concentration with t50% (>9hrs). Drug release rate decreased with polymer concentration. Granulation technique had an appreciable effect on the drug release profile which was in the rank order of direct compression < dry granulation < wet granulation (alcohol) < wet granulation (water). There was a significant effect of granulation technique, polymer concentration on the drug (Ibuprofen) release rate from Carbopol 934P matrix-based tablets (ANOVA, p<0.05). Diluents have an appreciable effect on the drug release rate only at low polymer concentration
Minimization of Soil and Nutrient Losses in Maize-Based Cropping Systems in the Mid-Hills of Central Nepal
Get PDFSoil nutrient depletion is a major concern in terms of resource utilization and optimization of production in the middle hills of Nepal. Soil and nutrient losses from agricultural land is responsible for pollution of surface waters and this reduces the productive capacity of land. A field experiment was initiated in May 2001 on acidic sandy loam soil in Kavre district; Nepal to investigate the efficiency of widely recommended researchable options for soil conservation. The experimental plots were set up as a two factorial design with three main factors (mulching, reduced tillage and conventional farmers' practice as control) and were divided on the basis of cropping patterns (maize sole and maize inter-cropped with soybean). Soil N, P, K, and OM losses were determined from soil eroded in runoff. Nutrient loss in pre- monsoon period (in the month of May) was highly significant among the management practices. Much of nutrient (60 to 90 percent of annual) losses occurred during this period. As compared to conventional farmers' practice, mulching reduced annual soil organic matter loss by 52 percent, annual total nitrogen by 46 percent, annual available P2O5 by 32 percent and annual exchangeable K2O by 53 percent in maize – mustard cropping system. Similarly, in maize + soybean - mustard cropping system, the annual loss of these nutrients were reduced by 58, 49, 26 and 60 percent, respectively. Reduced tillage, on the other hand, produced higher soil loss and hence more nutrient and organic matter loss as compared to mulching practice because of freshly prepared plots and hence less vegetation and more compaction