Journal Issue: No 2, Issue 14, APRIL-JUNE, 2006
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1812-2027
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Articles
Solid biomass fuel: Indoor air pollution and health effects
(Kathmandu University, 2006) SK, Joshi
NA
Prescribing patterns in the orthopaedics outpatient department in a teaching hospital in Pokhara, western Nepal
(Kathmandu University, 2006) PR, Shankar; R, Pai; AK, Dubey; DK, Upadhyay
Objectives: Information on the utilization patterns of drugs in the orthopaedics outpatient department (OPD) are
lacking in hospitals in western Nepal. The present study was carried out to obtain demographic information about
the respondents selected for analysis, information on the average number of drugs prescribed and the average cost of
drugs per prescription. The prescriptions were critically analyzed using predetermined criteria.
Methods: The study was carried out over a four-month period (01.09.2002 to 31.12.2002) at the Manipal Teaching
hospital, Pokhara, Nepal. The percentage of encounters with an injection or an antibiotic prescribed was noted. The
percentage of drugs prescribed from the Essential drug list of Nepal and the mean cost of drugs per prescription was
calculated.
Results: 1238 patients attended the orthopaedics OPD during the study period. 186 prescriptions were randomly
selected for analysis. The mean number of drugs per prescription was 1.9. Low backache was the most common
reason for attending the OPD. Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most commonly prescribed
drug group. Diclofenac and meloxicam were the most commonly prescribed drugs. Mean ± SD cost of drugs was
166.2 Nepalese rupees. Injections and antibiotics were prescribed in 16 (8.6%) and 7 (3.8%) encounters
respectively. 51 prescriptions (27.4%) had various problems. Absence of diagnosis on the prescriptions and the
duration of treatment were most commonly observed.
Conclusions: Percentage of prescribing by generic name was low. Educational sessions for the doctors at different
levels to encourage prescribing by generic names and on correct writing of prescriptions are required. Studies
covering a larger number of patients and for a longer time period are required. A greater number of patients can be
studied, seasonal variations can be overcome and drug utilization can be measured quantitatively.
Key words: Drug use patterns, Drug utilization studies, NSAIDs, Prescription audit, Tertiary care hospital
Evaluation of endometrial changes and p53 expression in tamoxifen treated women: Comparison of various methods
(Kathmandu University, 2006) HP, Pokharel; N, Bhatla; A, Kriplani; A, Mukhopadhyay; A, Srivastava; R, Ralhan
Objective: To compare transvaginal sonography (TVS), sonohysterography (SHG), hysteroscopy and endometrial
aspiration (EA) and p53 expression in assessing endometrial abnormalities in women on tamoxifen.
Methods: In a cross sectional study of 50 pre- and post-menopausal women receiving tamoxifen for > 2 years, all
participants underwent TVS and EA. Those with endometrial thickness > 4 mm on TVS underwent hysteroscopy
and SHG. Serum p53 antibody and p53 immunohistochemistry were tested in all women.
Results: The sensitivity and specificity when compared with histopathology as the reference standard were as
follows: TVS 100% and 33.3%, SHG 85.7% and 50%, hysteroscopy 92.8% and 80.8%, serum p53 50% and 83.3%,
and p53 immunohistochemistry 57.1% and 61.1%. Prevalence of endometrial abnormalities was not significantly
different in asymptomatic and symptomatic women.
Conclusion: Tamoxifen-users require routine testing for endometrial evaluation. TVS followed by hysteroscopy and
biopsy is an effective option. p53 expression correlates with histological abnormalities.
Key words: Tamoxifen, Sonography, Sonohysterography, Hysteroscopy, Endometrium, p53
An open, randomized, comparative study of efficacy and safety of risperidone and haloperidol in schizophrenia
(Kathmandu University, 2006) SM, Tamrakar,; MK, Nepal; NR, Koirala; VD, Sharma; CK, Gurung; SR, Adhikari
Objectives: In the last decade there have been numerous randomized controlled trials comparing the efficacy and
safety of second generation antipsychotics and conventional antipsychotics in the treatment of schizophrenia, but
most of them have been conducted in the western population. This study compared the efficacy and safety of
risperidone versus haloperidol in the Nepalese context, in order to add on to the very few literatures available on this
topic in the South East Asia region and compare them.
Methods: Patients with the diagnosis of schizophrenia were randomly assigned to receive risperidone 4-6
milligrams (mg) per day and haloperidol 10-20 mg per day, and were followed up for 6 weeks. Assessment were
done on the day of the diagnostic interview and days 7, 14, 28 and 42 (end point). During the assessment periods
Positive and Negative Syndrome Scale (PANSS) was administered to monitor the progress in psychopathology and
Udvalg for Kliniske Undersogelser (UKU) side effects rating scale was applied to rate the treatment emergent
adverse effects.
Results: Both risperidone and haloperidol were associated with substantial baseline- to- endpoint reduction in
symptom severity. After one week of treatment, the improvement in schizophrenia with risperidone was
significantly better than haloperidol in terms of PANSS- total Score (-45.4 versus –29.5), negative subscale score
(-14.3 versus -6.68) and general psychopathology subscale score (-20.9 versus –13.7). At the end point of the study,
the benefit was maintained in total score (-52.1 versus –43.1), though the negative subscale score still showed
tendency for greater improvement in psychopathology with risperidone. The side effects profile did not show
significant differences except in extrapyramidal symptoms. Thirty-eight percent of risperidone treated patients had
to resort to anti-parkinsonian treatment compared to 78% in haloperidol treatment group.
Conclusion: Similar to the studies in the western countries, Asia and Indian subcontinent, both risperidone and
haloperidol were effective in the reduction of psychopathological symptoms in this group of Nepalese population
with the diagnosis of schizophrenia. However, risperidone was quicker and better then haloperidol and risperidone
had a better safety profile. This is important, because extrapyramidal side effects of neuroleptics are responsible for
non-compliance and increased cost in terms of us of anti-parkinsonian medication.
Key words: schizophrenia, antipsychotic, risperidone, haloperidol, positive and negative syndrome scale (PANSS).