Browsing by Author "Nepal, Richa"
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Publication Amitriptyline, Pregabalin and Duloxetine for Treatment of Painful Diabetic Peripheral Neuropathy(Nepal Health Research Council, 2024) Nepal, Richa; Bajracharya, Manil Ratna; Karki, Budda Bahadur; Mall, Dipak; Shrestha, Prajaya Shikhar; Wasti, Kushal Prasad; Bisht, AnjalBackground: Painful diabetic peripheral neuropathy is one of the frequent presenting complaints in diabetes and endocrine clinics. Our main objective was to compare effectiveness of three commonly prescribed drugs: amitriptyline, pregabalin and duloxetine for treatment of painful diabetic peripheral neuropathy. Methods: This was a comparative, prospective, observational study conducted among 99 diabetic patients with painful diabetic peripheral neuropathy having numeric rating pain scale ? 4. Thirty-three patients in each group were consecutively prescribed amitriptyline, pregabalin and duloxetine in lower dose (10mg/75mg/20mg) for first two weeks to gradually up titrate to higher dose (25mg/150mg/30mg) as per pain response for total duration of eight weeks. Results: At the end of eight weeks, 84.9% in amitriptyline, 78.7% in pregabalin and 60.6% in duloxetine group had adequate pain reduction in form of mild or no pain. Among total patients, 42.5% patients had severe pain at baseline that decreased to 5% by the end of our study. Out of three drugs, 45.5% patients in amitriptyline group had complete resolution of pain as compared to 24.2% in pregabalin and 18.2% in duloxetine group (p value 0.05). Drowsiness (42.4%), dizziness (21.2%) and dry mouth (21.2%) were the commonest side effects among total participants in our study. Conclusions: Amitriptyline, pregabalin and duloxetine were all associated with adequate pain reduction among patients of painful diabetic peripheral neuropathy in our study, however, amitriptyline had more favorable findings with tolerable side effects. Keywords: Amitriptyline; duloxetine; Nepal; painful diabetic peripheral neuropathy; pregabalin.Publication Community-Level Screening and Referral Guidelines for Major Non-Communicable Diseases at Primary Healthcare Settings: From Development to Application at the Multi-site ‘NCDs Mega-Campaign 2024’ in Kathmandu Metropolitan City, Nepal(Nepal Medical Association, 2025) Malla, Milan; Nepal, Richa; Regmi, Sushant; Neupane, Deewash; Shrestha, Dhanendra; Bhandari, Saugat; Subedi, MadhusudanAbstract Non-communicable diseases (NCDs), mainly cardiovascular conditions like hypertension, diabetes, and chronic kidney disease (CKD) are the major causes of morbidities and mortalities worldwide, with lower- and middle-income countries (LMICs) bearing the highest burden. As the UN 25*25 targets near their final year and the Sustainable Development Goals approach their last trimester, NCD cases continue to rise, leaving a significant undiagnosed population submerged in the communities and households. In Nepal, a few initiatives have been made at the health-facility level over the past decade. However, they lack people-centric strategies and community-focused intervention with appropriate working guidelines. This article outlines the three-phase development of a community-level screening program in Kathmandu Metropolitan City, providing structured guidelines for health workers to screen and appropriately refer cases of hypertension, diabetes, and CKD, implemented during the large-scale community-based campaigns across 256 sites in Kathmandu Metropolitan in 2024.