Browsing by Author "Shakya, Shrestha S"
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Publication A Prospective Study of Commonly Prescribed Drugs in the Management of Neuropathic Pain and its Medication Adherence Pattern(Kathmandu University, 2016) Shrestha, R; Silwal, P; Basnet, N; Shakya, Shrestha S; Shrestha, R; Pokharel, BRABSTRACT Background Neuropathic pain is one of the common complains of patients visiting neurology and orthopedic departments in hospitals. Management of neuropathic pain is difficult and is often symptomatic rather than being curative. Adherence to medication is necessary for pain management to be effective. However, there are various factors related to patient, physician, drug regimen and other socio-economic affecting adherence. Objective To study commonly prescribed drugs in neuropathic pain management and the medication adherence pattern including its associated factors. Method Patients already diagnosed as neuropathic pain were interviewed using structured questionnaire and data entered in Microsoft Office Excel 2007. Informed consent was taken from the patients. Result Among the 84 patients in the study, 69% were females. Majority 53.6% of patients had low back pain as cause of neuropathic pain. Anticonvulsants were mostly prescribed (75%) followed by non-steroidal anti-inflammatory drugs (52.4%) and Methylcobalamin (47.6%). More than 50% (n=49) patients were not adherent to the prescribed medication and majority (61.2%) of them were housewives. Significant association was observed between patient’s adherence to gender, occupation, polypharmacy, drug regimen, cost and availability of medicine. Conclusion Anticonvulsants were commonly prescribed drugs in patients with neuropathic pain. Neuropathic pain was seen more in females with low back pain. Majority of patients were non-adherent and forgetfulness was the major reason for missing dose in them. KEY WORDS Low back pain, medication adherence, neuropathic pain, non-adherencePublication Immune Responses in Neurodegenerative Diseases(Kathmandu University, 2014) Shrestha, R; Shakya, Shrestha S; Millington, O; Brewer, J; Bushell, TABSTRACT Neurodegenerative disease is a progressive loss of neurons from central nervous system and has a huge impact on health care system. Various causes have been proposed of which inflammation has been suggested to be a probable key factor in the most of such conditions. The involvement of immune cells including lymphocytes in such diseased condition of the CNS supports this notion. The effective therapy for these diseases has been sought for more than a half century but still lacking such therapy. On such basis this review article has mainly focussed on evidence of the involvement of immune cells in various neurodegenerative diseases including Alzheimer’s disease, Parkinson’s diseases and Multiple sclerosis and suggests a possible therapy of such diseased conditions of the CNS by the modulation of immune system. KEYWORDS Alzheimer’s disease, lymphocytes, multiple sclerosis, neurodegenerative diseases, parkinson’s disease, stroke, t cellsPublication Medication Adherence Pattern and Factors affecting Adherence in Helicobacter Pylori Eradication Therapy(Kathmandu University, 2016) Shakya, Shrestha S; Bhandari, M; Thapa, SR; Shrestha, R; Poudyal, R; Purbey, B; Gurung, RBABSTRACT Background Helicobacter pylori (H. pylori) infection is the most common chronic bacterial infection worldwide affecting approximately half of the world’s population. A number of screening tests as well as complex multi-drug therapies are available for the detection and treatment of H. pylori infection. However, the optimum eradication rates of H. pylori infection can only be achieved if adherence to drug therapy is higher. Therefore, it is of utmost importance to determine the factors leading to poor adherence to obtain successful treatment outcomes. Objective To determine the medication adherence pattern in patients with H. pylori infection and assess the factors associated with non-adherence to the prescribed drug therapy. Method Patients meeting the inclusion criteria who were confirmed as H. pylori positive by rapid urease test (histopathology) and/ or stool antigen test and those under H. pylori eradication therapy were considered. Informed consent was taken from the patients or from the patient party in incapacitated patients. They were then interviewed using structured questionnaire. Statistical analysis was done using SPSS version 20 and a p-value < 0.05 was considered as statistically significant. Result Among the 70 participants included in this study, 57.10% (n=40) of them were males. The mean (±SD) age of the patients was 42.36 years (±17.93). Higher number (85.70% (n=60)) of the patients were adherent to the recommended medication. Forgetfulness was the reason for missing dose in a majority (80% (n=8)) of the non- adherent patients. A highly significant association (p<0.05) was observed between adherence and absence of symptomatic relief. However, there was no statistically significant association (p>0.05) between patients’ adherence to gender, age, literacy, and the prescribed treatment regimen. Conclusion Majority of the patients with H. pylori infection were adherent to medication. Forgetfulness was the major reason for missing dose in the non-adherent patients. KEY WORDS Adherence, Helicobacter pylori, H. pylori eradication therapyPublication Medication Adherence to Levothyroxine Therapy among Hypothyroid Patients and their Clinical Outcomes with Special Reference to Thyroid Function Parameters(Kathmandu University, 2018) Shakya, Shrestha S; Risal, K; Shrestha, R; Bhatta, RDABSTRACT Background Non-adherence to medication in hypothyroid patients leads to poor clinical outcome and increased health care costs. Study related to adherence to levothyroxine in hypothyroid patients is limited worldwide. Objective To determine the adherence pattern and factors affecting adherence in hypothyroid patients and compare the clinical outcomes among adherent and non-adherent patients. Method A cross-sectional study was conducted in Dhulikhel hospital, Kathmandu University hospital. Patients with hypothyroidism on levothyroxine fulfilling the inclusion criteria were enrolled in this study. After obtaining the informed consent from the patients, structured questionnaire was used to interview the patients. Statistical analysis was performed by using SPSS 23.0. P-value < 0.05 was considered as statistically significant. Result Among 113 patients enrolled in this study, 85.8% of them were females. Majority (76.10%) of them belonged to the age group of 31-40 years. More than half (51.3%) of the patients were adherent to medication. Non-adherence was significantly associated with literate people following medication (p=0.003, OR=0.305), missed appointment to follow-up (p=0.007, OR=0.346) and longer duration of medication (p=0.019, OR=4.385). However, there was no statistically significant association of clinical outcomes with reference to TSH, fT4, fT3 and patients’ age, adherence to medication and concomitant use of other drugs. Conclusion More than half of the patients were adhered to the Levothyroxine therapy. Forgetfulness was the main reason for missing the dose and non-specific reasons attributed to discontinuation of medication for these patients. Good adherence was seen among illiterate people. Treatment related factor, patient-provider relationship and patient related factor were determined as the major barrier to medication adherence. Most of the non-adherent patients had uncontrolled TSH. KEY WORDS Adherence, Dhulikhel Hospital, Hypothyroidism, LevothyroxinePublication Study of Prescription Pattern and Factors Associated with Clinical Outcomes in Type 2 Diabetes Mellitus with Reference to Short Term Glycemic Control(Kathmandu University, 2019) Shakya, Shrestha S; Palanchoke, S; Shrestha, R; Bhatta, RDABSTRACT Background Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Though oral hypoglycemic agents (OHAs) or/and insulin are prescribed to control the hyperglycemia, still glycemic control is not seen in most of the cases. Evaluating the treatment pattern including the glycemic control and associated factors are of utmost importance for better patient care. Objective To investigate the treatment pattern and short term glycemic control among Type 2 Diabetes Mellitus (DM2) patients and study the factors associated with it. Method Patients meeting the inclusion criteria with DM2 attending laboratory or Out-Patient Department or Emergency Department in Dhulikhel Hospital and patients who were admitted to the ward taking various OHAs and/or insulin at the time of data collection were considered. Informed consent was taken prior to the interview. The collected data was entered as well as analyzed using the SPSS (Statistical Package for Social Sciences) version 21.0 and the p-value <0.05 was considered statistically significant. Result Among the 118 patients, 50.8% of them were males. Majority (28%) of the patients belonged to the age group of 51-60 years. Out of the 118 patients, 22% had their fasting blood glucose (FBG) level under control whereas 78% had uncontrolled FBG level. Metformin was the most (28%) commonly prescribed drug. Significant association was found between gender; knowledge about disease and medication with short term glycemic control (p=0.034, p=0.004 ans p=0.039 respectively). Conclusion All the patients enrolled in this study were under various anti-diabetic medications, however, majority of them didn’t have their glycemia under control. Significant association was found between FBG level and gender, knowledge about disease and knowledge about medication. KEY WORDS Diabetes, Glycemic control, Insulin, Oral hypoglycemic agents