NepMed Repository :: Browsing by Author "Shakya Shrestha, S"

Browsing by Author "Shakya Shrestha, S"

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A Cross-Sectional Study of Medication Adherence Pattern and Factors Affecting the Adherence in Chronic Obstructive Pulmonary Disease
(Kathmandu University, 2015) Shrestha, R; Pant, A; Shakya Shrestha, S; Shrestha, B; Gurung, RB; Karmacharya, BM
ABSTRACT Background Chronic obstructive pulmonary disease (COPD) is considered as a major health problem, associated with mortality and morbidities. Various disease management strategies have been established to optimize patient’s longevity and functional status where patient adherence to the prescribed treatment plays a key role. Poor adherence to medication is common among COPD patients and is affected by number of factors like number of medicines, delivery devices and patient-related factors. Objective This study aims to investigate the adherence pattern in the management of COPD and factors affecting patient adherence to the prescribed treatment. Method This study is a cross-sectional study which was conducted in a tertiary care hospital. Those patients suffering from COPD of all age were enrolled in this study and prior informed consent was obtained from patients. The structured questionnaire was used to interview those patients. Result Total 100 patients were enrolled in this study, among which most patients (45%) were of age groups 60-70 years. Unintentional non-adherence to medication attributed for 65% of patients and the major reason was forgetfulness (52.3%). Most patients had discontinued the medication due to experience of side effects (63.3%). The result showed significant association between adherence and polypharmacy (p=0.00). However, there was no significant association between adherence and age, sex, mode of administration of drugs, technics to use delivery devices etc. Conclusion Majority of COPD patients were elderly (mean age= 68.4 years). Forgetfulness was associated with medication non-adherence. Most of the patients had discontinued medication because of side effects. Polypharmacy is one of the major factors associated with non-adherence to medication in COPD. KEY WORDS Adherence, COPD, Dhulikhel Hospital, non-adherence, polypharmacy
Analysis of Antimicrobial Drugs Usage Pattern and it’s Cost Analysis in the Pediatric Department of a Tertiary Care Hospital
(Kathmandu University, 2020) Shrestha, R; Koju, P; Silwal, S; Karmacharya, BM; Shakya Shrestha, S
ABSTRACT Background Antimicrobials agents are the most widely and often imprudently used therapeutic drugs globally. The pediatric population comprises 20-25% of the total world population, and various acute and chronic diseases are prone to this group. It is also estimated that 50% to 85% of children are prescribed with antimicrobials in developed and developing countries. The misuse of antimicrobials not only contributes not only to the development of antimicrobial resistance but also results in economic burden on the health care system. Objective To analyze the antimicrobial usage and its cost analysis in the Pediatric department of a tertiary care hospital at sub-urban area. Method A hospital based retrospective study was conducted among patient (aged 1 to 18 years) admitted in pediatric ward and intensive care unit for at least 24 hours and dispensed at least one antimicrobial drug from January 2018 to December 2019. Data were collected from electronic medical record using a structured data collection form. The data was entered and analyzed using Microsoft Excel. A descriptive analysis was presented as mean ± (standard deviation) for the continuous variables and frequencies and proportions for categorical variables. Result Among the 1,281 patients, the antimicrobials were prescribed mostly in the respiratory tract infection (39.6%), followed by sepsis (19.75%), enteric fever (11.94%), seizure (10.07%), urinary tract infection (4.29%). Penicillins (1238 times) were highly prescribed followed by Cephalosporin (733 times), Nitro-imidazole (292 times), Aminoglycosides (180 times) and Fluoroquinolones (144 times). During study period in the Pediatric Department, approximately NRs. 1,619,121.11 was spent in the antimicrobial drugs and the highest expenditure was found to be in the Cephalosporin group of antimicrobials (NRs. 530,988.6), followed by Penicillin group of drug (NRs. 3,81,842.2). Conclusion The study concludes that the Penicillin groups of drugs were the most commonly prescribed drug and the highest cost was found to be in Cephalosporin group drugs followed by Penicillin group of drugs. KEY WORDS Antimicrobial drugs, Antimicrobial usage pattern, Cost analysis, Tertiary care hospital
Comparative Efficacy and Safety of Diacerein in Patients with Knee Osteoarthritis: A Pilot Study
(Kathmandu University, 2021) Shakya Shrestha, S; Tamrakar, S; Shrestha, R; Shrestha, R; Basi, A; Malla, M; Khadka, SK
ABSTRACT Background Osteoarthritis (OA) is the most common chronic rheumatic disease. The prevalence of OA is skyrocketing with time. Providing a proper treatment regimen for OA is also growing as a major public health challenge. Conventional pharmacological treatments are mainly for alleviating pain and have some severe adverse effects. Diacerein is a new oral anti-inflammatory drug especially developed for the management of OA having only mild to moderate adverse effects. However, the evidence of efficacy and safety of Diacerein in OA is not well documented and yet to be explored. Objective To compare the efficacy and safety of Diacerein in knee OA with conventional non- steroidal anti-inflammatory drugs (NSAIDs). Method A comparative study was conducted among knee OA patients attending Out- Patient Orthopedic department in Dhulikhel Hospital, Nepal from December 2019 to September 2020, using self-structured and standard questionnaire. The patients were randomized to receive either a conventional standard treatment (Treatment Group I: NSAIDs) or alternative treatment regimen (Treatment Group II: NSAIDS+ Diacerein). Patients were followed-up after two months and data were analyzed using SPSS 21.0. Result Among 72 patients enrolled in this study, majority (44.44%) were between 51-60 years of age in which 81.94% of the patients were female. Post treatment data was collected from 15 participants. The mean KOOS-PS score of the participants in Treatment Group I decreased from 35.56 ± 14.33 to 35.14 ± 12.65 while that of the Treatment Group II participants reduced from 63.31 ± 12.08 to 49.99 ± 13.10 in two months. Similarly, the mean WOMAC score decreased from 46.87 ± 17.80 to 34.37 ± 16.83 in Treatment Group I and from 54.23 ± 14.66 to 46.22 ± 12.16 in Treatment Group II. The mean Lysholm score in Treatment Group I increased from 55.57 ± 8.16 to 60.86 ± 15.01 and in Treatment Group II, it increased from 46.62 ± 13.01 to 60.25 ± 17.598. Conclusion Diacerein treatment group had better functional outcome compared to the patients in the treatment group with conventionally used drugs. Also, the adverse effects faced by the patients were minor. The current study are suggestive of better efficacy and safety of Diacerein compared to other drugs. KEY WORDS Adverse effects, Diacerein, Efficacy, Osteoarthritis, Safety
Drug Utilization Study in Outpatient Department of Ophthalmology in Tertiary Care Hospital
(Kathmandu University, 2022) Shrestha, U; Shakya Shrestha, S; Shrestha, A; Poudel, U; Manandhar Shrestha, JT
ABSTRACT Background The advancement in drug development and availability of newer drugs has improved overall health services including decrease in mortality and hospital stay. Along, it has brought negative impacts such as polypharmacy and associated adverse drug reactions and antimicrobial resistance. Drug utilization research is an essential approach to understand the drug use pattern, identify the early signs of such irrational drug use and to improve quality of drug use. Objective To study the drug utilization pattern in the Ophthalmology Outpatient department (OPD) of Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH). Method A descriptive, cross sectional study was conducted from March 2019 to August 2019 in patients attending OPD of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital. Prescriptions of 311 patients were analyzed using World Health Organization (WHO) International Network of Rational Use of Drug (INRUD) and additional other indices. The descriptive data was presented in mean and standard deviation. Result The average number of drugs per prescription was 2.10±1.35. Out of total 311 prescriptions, drugs prescribed in generic name were 152 (23.30%). Total antibiotics encountered were 247 (37.90%) and total drugs prescribed from National Essential Medicine List (NEML) were 371 (56.90%). Antibiotics 247 (37.90%) were the most commonly prescribed drugs followed by lubricants 146 (22.40%). Conclusion Practice of polypharmacy was very high. Most of the drugs were prescribed in brand names and antibiotics were the most frequently used drugs. KEY WORDS Drug utilization, Ophthalmology OPD, Rational drug use, WHO-INRUD
Hormonal Contraceptives Use and Their Adverse Effects: A Cross-sectional Study among the Women Visiting Tertiary Care Center
(Kathmandu University, 2020) Shakya Shrestha, S; Shrestha, R; Shrestha, S; Koju, P; Shrestha, A
ABSTRACT Background Hormonal contraceptives are one of the most commonly used means of contraception. Lack of contraception may lead to large family size, increased preexisting illness on pregnancy, social and economic instability, risk of unsafe abortion and so on. This may also lead to unintended pregnancies which may alter the outcomes of pregnancies as well. However, improper uses are associated with several serious adverse effects. Therefore, to achieve the optimum benefit with the least adverse effects, safe and effective use of these agents with monitoring of their pattern of use and patient compliance is very essential. Objective To investigate the usage of hormonal contraceptives and the adverse effects associated with them. Method A cross-sectional study was conducted in a family planning center of a tertiary care hospital. All women of reproductive age using hormonal contraceptives for at least 1 month were included in this study. Informed consent was taken from the patients and interviewed using a structured questionnaire. Statistical analysis was performed by using SPSS 20. Result Among the 105 participants under this study, the mean (±SD) age was 29.08 (± 6.12) years. A majority (42, 40.0%) of them were using injectables. The average duration of use of hormonal contraceptives was 25.1 months ± 31.8 while a majority (60, 57.1%) were using contraceptives from < 3 months. Less chance of missed dose was the major reason (26.8%) for choosing injectable. Adverse effects were reported by 75.2% of the patients. The most common adverse effect was menstrual abnormalities (21.7%). Conclusion Among various hormonal contraceptives, injectables were more commonly used. The majority of the participants responded to use injectables because of the least chance of missing the dose. The most common adverse effect reported was menstrual abnormalities. KEY WORDS Adverse effect, Family planning, Hormonal contraceptives, Implants, Injectables
Knowledge and Attitude of Undergraduate Students on Use of Topical Corticosteroids in a Medical School in Nepal: A cross-sectional study
(Kathmandu University, 2025) Shrestha, U; Shakya Shrestha, S; Shrestha Manandhar, JT; Shrestha, R
ABSTRACT Background Topical corticosteroids are widely used for their anti-inflammatory and immunosuppressive properties. However, proper knowledge of health professionals is key to appropriate and rational use of such topical corticosteroids to minimize multitude of their adverse effects. Objective To study knowledge and attitude of medical students regarding use of topical corticosteroid use. Method A cross-sectional study was conducted from September 2024 - November 2024, among the undergraduate students of Kathmandu University, School of Medical Sciences. A total of 387 students were included in the study. The students were surveyed using a structured questionnaire. Statistical analysis was performed using Statistical Package for Social Science version 21. Result Among 387 participants 217 (44.2%) were male and 171 (55.8%) were female. The mean (± SD) age of the patients was 21.73 years (± 2.06). The highest number of participants - 258 (66.7%) - were aware about atopic dermatitis as the most common indication of topical corticosteroids. Majority of the participants - 350 (90.4%) agreed that topical corticosteroids can cause cutaneous adverse effects. Similarly most of the participants 324 (83.7%) agreed that topical corticosteroids can produce systemic adverse effects as well. Likewise, most of the participants, 287 (74.2%), were aware of the fact that treatment with topical corticosteroids should not be stopped abruptly or without medical guidance. Conclusion Majority of the students had reasonable knowledge and attitude towards the use of Topical corticosteroids. However more than half were unaware of some topical adverse effects of Topical corticosteroids. Adequate educational training should be provided to future doctors regarding proper prescribing and usage of topical corticosteroids. KEY WORDS Adverse effects, Attitude, Knowledge, Medical students, Topical corticosteroids
Study of Pre-disposing Factors of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Antibiotic Prescribing Pattern with Reference to Antibiotic Sensitivity Test
(Kathmandu University, 2015) Shrestha, R; Shrestha, B; Shakya Shrestha, S; Pant, A; Prajapati, B; Karmacharya, BM
ABSTRACT Background Chronic Obstructive Pulmonary Disease (COPD) affects about 329 million people worldwide, which is nearly 5% of the entire global population. In the context of Nepal, COPD accounts for 43% of the non-communicable disease burden and 2.56% of hospitalizations. Various pre-disposing factors like bacterial, viral, fungal, smoking, occupational exposures and genetic factors have been proposed to precipitate COPD and its exacerbation though, the definitive pre-disposing factors and factors related to acute exacerbation have not been determined in the context of Nepal. Objective To find out the pre-disposing factors and the related causative agents for COPD. Method A cross sectional study was conducted in a tertiary care hospital. Patients of all age group who were diagnosed as COPD and admitted in the hospital were included in this study. Patients were interviewed using structured questionnaire. The socio- demographic data including personal and medical history were recorded from those participants. In addition, sputum from those patients was sent for culture to investigate the possible responsible pathogens as well as its antibiotic sensitivity pattern. Result A total of 150 patients having Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) who have admitted from either emergency or out-patient department of the hospital were included in this study. Among the total number of patients, more than half of them were female (n=82). In addition, analysis of occupations shows that most of them were either farmer (36.0%) or housewife (30.7%). In total studied patients (n=150), most of them were using traditional firewood (83%) for cooking purpose and majority of patients (91%) were smokers. Most of the sputum samples show growth of gram-positive cocci (26.7%) and gram negative bacilli (27.5%). Considering the overall sensitivity pattern, the higher sensitivity was recorded for Co-trimoxazole and Ciprofloxacin while higher rate of resistance was noted for Penicillin group of drugs. The most widely used antibiotics were found to be Cephalosporin group of drugs (68%). Conclusion The present study revealed that the case of COPD is more in female and the commonest pre-disposing factor is found to be smoke/firewood. Cephalosporin group of drugs is the most commonly prescribed drug. KEY WORDS AECOPD, firewood, pre-disposing factor and therapy of COPD
Study on Corticosteroids use Pattern in Dermatological Practice and Investigating Adverse Effect of Corticosteroids Including its Associated Factors
(Kathmandu University, 2015) Shakya Shrestha, S; Bhandari, M; Shrestha, R; Thapa, SR; Karki, A; Prajapati, M; Shrestha, S; KC, S; Karna, D
ABSTRACT Background Corticosteroids are highly effective drugs with anti-inflammatory and immunosuppressive properties. Due to this, they have become a mainstay of pharmacotherapy in dermatology. However, improper and long term uses are associated with a number of serious adverse effects. Objective To investigate the corticosteroids use pattern, adverse effects and various factors associated with adverse effects in dermatological practice. Method A cross-sectional study was conducted in a dermatology department of tertiary care hospital. All patients using at least one corticosteroids, either topically or systemically or the combination were included in this study. Informed consent was taken from the patients and interviewed using structured questionnaire. Statistical analysis was performed by using SPSS 20. p-value < 0.05 was considered as statistically significant. Result Among the 60 participants under this study, 81.67% of them were females. The mean (±SD) age of the patients was 31.03 years (±15.0). A majority (58.30%) of the patients was prescribed with topical corticosteroids with low potency (25%). Most of them had used corticosteroids for urticaria. Adverse effects were reported by 33.30% of the patients. The most common adverse effect reported was the shedding of skin. Adverse effects was significantly associated with gender; use of systemic corticosteroids; regular use of corticosteroids; discontinuation of dose abruptly; and missed dose. However, there was no significant association between adverse effects and the duration of use of corticosteroids. Conclusion In conclusion, the present study suggested that the proper counselling and clear instruction regarding the use of corticosteroid should be provided to the patients for avoiding the abrupt discontinuation of the prescribed medication leading to treatment failure. KEY WORDS Adverse effect, corticosteroid, dermatology, treatment failure.
Study on Patient’s Perception on Medication Counseling at Community Pharmacy in Sub-urban Area of Nepal
(Kathmandu University, 2022) Shrestha, U; Koju Shrestha, R; Biswokarma, AK; Koju, P; Shrestha, S; Shakya Shrestha, S
ABSTRACT Background Community pharmacists are the primary contact point in a healthcare system who provide medication information to the patients and enable them to make appropriate decision regarding their therapy. Hence, this study explored patients’ perception of community pharmacist based on medication counseling. Objective To study patient’s perception on medication counseling by community pharmacist at Manohara Municipality, Kathmandu, Nepal Method A cross sectional study was conducted from November 2020 to April 2021 in population visiting pharmacies of Kageshwori Manohara Municipality of Kathmandu valley. A total of 384 participants included in the study were surveyed using a structured questionnaire exploring the content of medication counseling, level of satisfaction on counseling and use of various means of counseling. Descriptive data were presented in frequencies and percentages using EXCEL 2016. Result This study enrolled 384 participants out of which 354, 92.19% received medication counseling. The main reason of pharmacy visit was to obtain over the counter medicines, 262, 68.23%. Majority of the participants rated satisfied with informations provided on use of medication 218, 56.77%, duration of therapy 261, 67.97%, about side effects 211, 54.95% and on action to be taken following side effects 246, 64.06%. Most of the participants rated satisfied with counseling on storage 189, 49.22% and for referral 250, 65.10% while 201, 52.34% participants rated highly satisfied with advice on lifestyle and dietary changes required. Conclusion This study concludes that the patients’ perception regarding the medication counseling by community pharmacist was acceptable. Thus pharmacists should be encouraged to support patients with their medication to promote patient care. KEY WORDS Community pharmacy, Medication counseling, Patient perception

Browsing by Author "Shakya Shrestha, S"

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