Browsing by Author "Manandhar, T"
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Publication Assessing Drug Utilization in the Emergency Medicine Department at a Tertiary Care Teaching Hospital Using WHO Drug Use Indicators(Kathmandu University, 2024) Jha, N; Manandhar, T; Oli, E; KC, P; Jha, AK; Karki, PS; Hada Batajoo, K; Shankar, PRABSTRACT Background Patients might need urgent care in critical cases. Limited resources and limited manpower are limitations seen in developing countries. Very few studies have been conducted on drug utilization in the emergency department in Nepal. Objective To find out the drug utilization pattern and the cost of medicines in emergency medicine department as per WHO drug use indicators. Method The study design was a hospital based retrospective cross-sectional study done at the emergency department of KIST Medical College and Teaching Hospital, Lalitpur, Nepal. The study population were patients visiting the emergency department. The data was collected during the period from April to June 2023. Data was collected for one month from each quarter for the year 2023 from the medical records of the patients from the medical records section. A structured proforma was used for the data collection process. Census sampling method was used. Result Maximum patients, 257 (25.1%) were from age group 21-30 years. Females were slightly more than males, 537 (50.5%). The top three diagnosis among the admitted patients were soft tissue injury, 148 (13.9%), dengue fever, 138 (12.9%) and viral fever, 51 (4.7%). Maximum patients, 346 (32.5%) were given two therapeutic classes of drugs, followed by only one therapeutic class of drug for 251 (23.6%) patients. The common classes of drugs prescribed for the patients were analgesics, 639 (60.1%) followed by intravenous fluids, 410 (38.5%) and antiulcer drugs, 377 (35.4%). The total cost of drugs used was calculated as Rs. 305126.4 (2280.99 USD) and the average cost per patient was Rs. 297.97 NPR; 2.23 USD. The WHO drug prescribing indicators showed maximum percentage, (85.4%) of encounters with injection prescribed followed by the percentage of drugs prescribed from the Nepalese National List of Essential Medicines 81.71%. Conclusion On the basis of the findings from this study injection prescribing, and the number of drugs prescribed per encounter showed considerable deviation from the standards recommended by the WHO. Hence, it is important for the hospital to design and implement a system to promote judicious prescribing and injection medication administration. KEY WORDS Drug utilization, Emergency department, WHO core drug use indicators, NepalPublication Clinical Profile of Patients Presenting with Breast Cancer in Nepal(Kathmandu University, 2012) Acharya, SC; Jha, AK; Manandhar, TABSTRACT Background Breast cancer is the second most common cancer in women in Nepal. Even though the evaluation and treatment of patients is done as per western guidelines, there are considerable variations in risk factors, presenting stage and prognostic factors such as receptor status. Objective To evaluate the clinical profile of patients presenting with breast cancer in Nepal. Method The study was conducted at Department of Radiotherapy and Oncology, Bir Hospital and Department of Radiation Oncology, BP Koirala Memorial Cancer Hospital, Bharatpur from 16th July 2007 to 15th June 2008 for a period of one year and 114 patients were enrolled. Detailed history, clinical examination and necessary investigations performed. Histological features including receptor status were recorded. Tumor Node Metastasis (TNM) staging system was as per American Joint Committee on Cancer (AJCC), fifth edition. Data was collected in preformed case report form and was managed using SPSS version 13. Results The incidence was high (34.2%) among perimenopausal women age ranging from 41 to 50. The majority of women presented with lump (98.2%) and others with pain (21.9%), nipple retraction (16.7%), ulceration (7.9%), discharge (7%), or symptoms of metastasis (6.1%). Regarding receptor status, the majority (64.0%) were Estrogen receptor (ER) and Progesterone receptor (PR) negative with 21.9 percent. ER+PR+, Younger women were more likely to be both ER and PR negative. Where available, Her- 2 immunohistochemistry showed that 45.0 % of post menopausal women were Her-2 neative, compared to 64.0 % of premenopausal women. Incidence of Triple negative disease was 41.3 %. The most common stage at presentation was stage III (26.3%). Conclusion Majority of patients were perimenopausal, presenting with locally advanced disease (Stage III and Stage II) and with average tumor size two to five cm and were hormonal receptor negative. These findings are similar to other South Asian population but is inverse than profile reported in Western populations. KEY WORDS Breast Cancer, Estrogen Recepter (ER), Progesterone Recepter (PR), Human Epidermal Growth Factor Receptor - 2 (Her-2/neu)