Browsing by Author "Bharati, L"
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Publication Complications of warfarin in post operative heart valve surgery(Institute of Medicine, 2013) Pradhan, N; Bhandari, NR; Bharati, LAbstract Introduction: Thromboembolic complications and bleeding are the major complications of warfarin. The aim of the study was to focus on the complication of warfarin and monitoring post-valve surgery. Methods: A combined retrospective and prospective study was done in post mechanical heart valve surgery patients at Manmohan Cardiothoracic Vascular and Transplant Center. The study was carried out for 4 months by interviewing patients with self-administered structured questionnaire about any complications during their follow up in OPD and monitoring for their INR values. Results: The majority of patients studied wer male 42 and 56 were female. 55 patients underwent mitral valve replacement, 22 underwent double valve replacement and 46 underwent aortic valve replacement. There were a total of 59 cases of bleeding complications. Hemoptysis was the most common bleeding event .Pericardial bleeding was the most common major bleeding complication with 3.1%. In patients taking warfarin major bleeding complication was 10.2% and minor bleeding was 50%. Out of total INR reading 47% were out of the target INR range, with 19.5% above range and 27.5% below range. Conclusion: Minor bleeding was the most common type of bleeding. A system for proper monitoring of warfarin can bring improvement in better dose adjustment to achieve more appropriate INR values and eventually minimizing warfarin related complications. Introducing pharmacist monitored anticoagulant clinic can reduce the work load of physicians and overcome the time barrier. Keywords: Minor bleeding, Major bleeding, INR, ThromboembolismPublication Prescribing medication in patients with impaired renal function(Institute of Medicine, 2011) Bharati, L; Sigdel, M; Sakya, RAbstract Introduction: Renal failure has been emerging as a major public health problem in Nepal in recent years. Chronic renal failure affects renal drug elimination and other pharmacokinetic processes. Drug dosing errors are common in patients with renal impairment and can cause adverse effects and poor outcomes. Medications with toxic metabolites should be avoided, and alternative medications should be used if potential nephrotoxicity exist. Dosages of drugs cleared renally were adjusted according to creatinine clearance and glomerular filtration rate. Methods:A Descriptive, cross-sectional study was conducted in TUTH. Data were collected from all the renal failure patients admitted at TUTH from 2009 February to April 2009. Parameters studied included age group, gender, duration of hospital stay, causes of renal failure, any associated comorbidity, serum creatinine (Scr) at admission and at discharge, blood urea nitrogen (BUN) and different drugs prescribed. Creatinine clearance (Clcr) in ml/min/1.73 m2 was calculated by using Cockroft-Gault equation. Results: Majority of patient (98.1%) had raised urea level. Renal function at the time of presentation showed that 39.5 % patients had End stage renal failure and 39.5%, 19.7% and 1.3% patients had severe impairment, moderate impairment and mild impairment respectively. Average number of drugs prescribed was 5 to 6. In the list of prescribed medicine, 23% were antibiotic. Of the total antibiotic prescribed, dose adjustment was done for 27.3% and 1.5% drugs were prescribed which are supposed to be avoided in renal failure patients. Similarly in non-antibiotic group, 62.9% drug don’t required dose adjustment (they are safer in renal failure), dose adjustment was done in 22.9 %. The mortality rate of the renal failure at TUTH was found to be 15.3%. Kidney diseases, diabetes and hypertension were found to be the common causes of renal failure accounting for 29.5 %, 24.8% and 22.9% respectively. Conclusions: Most of the patients with renal failure had end stage renal disease at presentation. Though they were prescribed multiple drugs, only few had dose adjustment done and some were even prescribed nephrotoxic drugs. Keywords: Acute renal failure, chronic renal failure, creatinine clearance, end stage renal diseasesPublication Prevalence and types of cutaneous drug reactions intwo institutes(Institute of Medicine, 2011) Shrestha, A; Regmi, B M; Pokhrel, D B; Jha, A K; Jha, N; Bharati, LAbstract Introduction: Adverse drug reaction is one of the growing concerns of today!s health practice. Thepurpose of the study was to find out the prevalence and types of cutaneous drug reactions at TribhuvanUniversity Teaching Hospital (TUTH) and DI Skin Hospital and Research Centre. Methods: It was a prospective, cross sectional study conducted at Department of Dermatology of TUTHand DI Skin Hospital and Research Centre from 14th April 2010 to 14th October 2010. All the suspectedcases of cutaneous drug reaction above 14 years were included. Naranjo Algorithm was used to establishthe causality and Modified Hartwig and Siegel Scale was used to access the severity of the cutaneousdrug reaction. Clear purpose of the study was described and a patient consent form was produced beforethem while collecting the data and ethically approved from Institutional Review Board, Institute ofMedicine. Results: Prevalence of cutaneous drug reaction was found to be 0.258%. The male: female ratio was2.1:1. The highest percentage of CDR was seen in 15-34 years age group. Antibiotics were the group ofdrug involved in most CDR followed by anticonvulsant. Phenytoin, ibuprofen+paracetamol combinationand betamethasone were mostly associated with CDR. 51.61% of the cases were of moderate III rdlevel which was followed by moderate IV (b) level. 51.62% were assessed to be probable and 48.38%were possible. Out of 13 admitted cases, 6 cases were admitted for 7-9 days. Maculopapular rash wasthe most common clinical presentation observed followed by Steven!s Johnson Syndrome. Conclusion: The study estimated the average rate of cutaneous drug reaction in two major hospitals ofNepal. It also determined the most common type of manifestation of the cutaneous drug reaction. Key words: Cutaneous drug reaction, DI Skin Hospital, prevalence, Tribhuvan University TeachingHospitalPublication Side effects and efficacy of oral mifepristone plus sublingual misoprostol regimen in early medical abortion (gestation up to 63 days)(Institute of Medicine, 2018) Kshetri, R; Bharati, L; Pandey, S; Sapkota, B; Pandey, SAbstract Introduction: Medical abortion with mifepristone and misoprostol has few side effects that cannot be avoided. Efficacy of medical abortion varies with the routes of administration and the doses of mifepristone and misoprostol. This study aimed to investigate the side effects and abortifacient efficacy of 200 mg oral mifepristone and 800 mcg sublingual misoprostol regimen in termination of early pregnancy. Methods: A descriptive cross-sectional study was carried out at Marie Stopes Clinic, Gongabu, Kathmandu. Altogether 103 women with a period of gestation (POG) up to 63 days were selected by purposive sampling technique and were interviewed using two sets of the semi-structured questionnaire. Each woman received 200 mg mifepristone at the clinic. Then 800 mcg misoprostol was taken sublingually at home after 48 hours. Confirmation of abortion was done by ultrasonography. Association between efficacy and POG was calculated by using Chi-square and/or Fisher’s exact test. Results: Side effects reported were nausea, vomiting, diarrhoea, dizziness, fever, chills/shivering, headache, lower abdominal pain, anorexia, lower back pain. The overall efficacy of the regimen was 98.1%. Rates of complete abortion were 98.8% in ≤49 days’ POG and 95.0% in >49days’ POG. The differences were not statistically significant (p-value >0.05). Conclusion: Medical abortion done by using this regimen had few side effects, but no serious side effects or complications were reported. Efficacy of this regimen was high. This study will help to estimate the possible side effects, complications and effectiveness of the given regimen required for proper counselling to the women who opt for medical abortion. Keywords: Efficacy, Medical abortion, Mifepristone, Misoprostol, Side effects, SublingualPublication Study on hypoglycemic effect of Berberis aristata on type 2 diabetic model rats(Institute of Medicine, 2013) Bharati, L; Amatya, S; Bhoumik, A; Gharti, KP; Rokeya, BAbstract Introduction: Berberis aristata is one of the herbs mentioned in all ancient scriptures of Ayurveda. It is a well-known medicinal plant in hilly areas of Nepal and its occurrence is reported from middle altitude areas. It is used traditionally for treating various disorders including diabetes mellitus. Methods: The experiment was carried out for duration of 28 days on a total of 27 rats. The rats were divided into 4 groups – type 2 water control, type 2 glibenclamide treated, type 2 extract treated and normal treated group. Blood glucose, lipid profile and serum insulin level of all groups were compared at 0 day and 28 day. The renal function, liver function liver glycogen, MDA and GSH concentration value of all groups were compared on 28 day. Results: The study revealed that type 2 rats treated with extract showed decrease in blood glucose level at 120 mins. The significant decrease was found in normal rat treated with extract in comparison to water control, glibenclamide and type 2 rats extract treated group when fed simultaneously with glucose on the 15 day. There was significant decrease in fasting glucose level in both type 2 and normal rat treated with extract on 28 day in comparison to 0 day. Conclusion: Berberis aristata dry stem powder 80% ethanolic extract possesses significant hypoglycemic activity in Type 2 diabetic model rats and normal rats. Keywords: berberis aristata, ethanolic extract, hypoglycemia, hyperglycemia