Journal Issue: Volume: 17, No 3, Issue 67, JULY-SEPT, 2019
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Volume
Number
Issue Date
2019
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Community Pharmacy Practice in Nepal- An Underexploited Healthcare Domain
(Kathmandu University, 2019) Sapkota, S; Shrestha, A
NA
Therapeutic Drug Monitoring of Antiepileptic Drugs at a Tertiary Care Hospital of Eastern Nepal
(Kathmandu University, 2019) Mandal, NK; Rauniar, GP; Rai, DS; Pradhan, B; Poudel, P; Sapkota, N
ABSTRACT
Background
Therapeutic drug monitoring (TDM) is the process of measuring drug level in body
fluids. It is done to maintain plasma concentration of the drug under therapy within
a specific target range for maximum therapeutic efficacy without unnecessary
exposure to adverse effects.
Objective
This study aims to evaluate necessity of therapeutic drug monitoring in Phenytoin,
Carbamazepine and Lamotrigine therapy among epileptic patients.
Method
A prospective, cross-sectional study was conducted for a period of one year at BP
Koirala Institute of Health Sciences, Dharan, Nepal. After taking detailed history,
blood samples were collected from epileptic patients on monotherapy with the
selected drugs. Plasma levels of these drugs were analyzed using High Performance
Liquid Chromatography technique (HPLC). Out of total 42 selected patients, 21 were
tested for phenytoin, 17 for carbamazepine and four for lamotrigine. The result was
categorized into therapeutic, sub-therapeutic and above-therapeutic groups based
on reference range.
Result
Out of total 21 samples tested for phenytoin, 15(71.4%) had plasma drug level within
therapeutic range, 5(23.8%) had within subtherapeutic range and 1(4.8%) had above
therapeutic range. Analysis of carbamazepine plasma level showed 14(82.3%) at
therapeutic level, 1(5.9%) at sub-therapeutic level and 2(11.8%) at above-therapeutic
level. Lamotrigine testing in four samples showed 2(50% in) both within therapeutic
range and above-therapeutic range.
Conclusion
Therapeutic drug monitoring of phenytoin, carbamazepine and lamotrigine showed
variation in plasma level irrespective of the therapeutic dose. It is suggested that
dose adjustment of antiepileptic drugs should be done after establishing ‘individual
therapeutic range’ following regular plasma monitoring.
KEY WORDS
Anti-epileptic, High performance liquid chromatography, Therapeutic drug monitoring
Clinical Profile and Outcome of Surgery of Patients with Hydatid Cysts at the National Referral Hospital, Bhutan: An Observational Study
(Kathmandu University, 2019) Kelzang, S; Dorji, T; Tenzin, T
ABSTRACT
Background
Hydatid disease a zoonosis caused by tapeworms (cestodes) of genus Echinococcus.
Humans acquire this infection by ingestion of eggs of Echinococcus from infected
dogs, sheep, goat, cattle or pigs. Hydatid cyst causes significant morbidity, mortality
and socioeconomic loss.
Objective
The objective of this study was to describe the clinical profile and short-term outcome
of surgical treatment of hydatidosis at Bhutan’s largest hospital.
Method
This was a descriptive study conducted among patients ≥ 18 years at the National
Referral Hospital, Thimphu, Bhutan from 01 January to 31 December 2017. Data
on pre-surgery treatment, type and outcome of surgery and histopathology were
collected. Data was entered analysed in EpiData. All variables are presented using
descriptive statistics. Ethics approval was obtained from the Research Ethics Board of
Health, Ministry of Health, Bhutan.
Result
There were 38 patients who underwent surgeries. The mean age of the sample was
36 (±17) years; cases were reported from almost all districts in the country. The most
common symptoms at presentation was abdominal pain (27, 71.4%), nausea (21,
55.3%), abdominal distension (16, 41.1%). The median duration of symptoms was
6.0 months (IQR 3.0, 12.0). Liver was involved in 36 patients (94.7%). All underwent
de-roofing and drainage through laparotomy (35; 92.1%), laparoscopy (2, 5.3%) or
throracotomy (1, 2.6%). Histopathologic confirmation was obtained in 28 patients
(73.7%). Twenty-three patients (60.5%) suffered from minor post-operative
complications.
Conclusion
Patients with hydatid cyst present with abdominal pain, nausea abdominal distension.
They suffer with symptoms for long periods till surgical treatment. The majority had
favourable outcomes of surgery.
KEY WORDS
Infection, Neglected tropical disease, Parasites, Surgery Bhutan
Prevalence of Nonalcoholic Fatty Liver Disease in a Tertiary Care Teaching Hospital: A Cross Sectional Study in Province 4 of Nepal
(Kathmandu University, 2019) Shrestha, MK; Ghartimagar, D; Jhunjhunwala, AK; Thapa, M
ABSTRACT
Background
Nonalcoholic fatty liver disease (NAFLD) is collection of lipids in hepatic tissues
excluding other hepatic diseases and chronic alcohol intake. It may advance to
nonalcoholic steatohepatitis or cirrhosis. Ultrasonography has high sensitivity and
specificity for detecting nonalcoholic fatty liver disease.
Objective
Lack of sufficient information in this region on sonological prevalence of nonalcoholic
fatty liver disease, lead us to design the survey and may also serve as reference for
further researches.
Method
This is a cross sectional study with 600 participants, conducted at Gandaki Medical
College Teaching Hospital, Province 4 of Nepal, from September to October 2017.
Ethical approval is taken from the Institutional review board. The study group includes
the participants referred for abdominal sonography from outpatient department.
Result
In present survey, 367 (61.2%) are female and 233 (38.8%) are male participants. The
mean age is 41.6 years and median age is 38 years. The prevalence of nonalcoholic
fatty liver in our observation is 229 cases (38.2%) of which, 102 cases (44.5%) are
male and 127 cases (55.4%) are female participants. Normal liver was seen in 61.8%,
Grade one fatty liver was discovered in 24.8%, Grade one in 12.6% and Grade three
in 0.6%. The mean liver size in those with fatty liver was 14.1 cm.
Conclusion
Province 4 of Nepal is not exempt from the growing epidemic of nonalcoholic fatty
liver disease with prevalence of 38.2%. The study shows that with higher grades of
fatty liver, the size of liver is also increased and the mean age of the participants
involved is also in the higher side of the spectrum.
KEY WORDS
Fatty liver, Nonalcoholic, Prevalence, Ultrasonography
Factors Affecting Recanalisation after Optimal Management of Deep Vein Thrombosis; A single institution based study
(Kathmandu University, 2019) Karmacharya, RM; Shrestha, B; Devbhandari, M; Tuladhar, SM; Pradhan, A
ABSTRACT
Background
Presence of recanalisation will favour for better physiological recovery after medical
management of Deep Vein Thrombosis (DVT) along with lesser chances of post
thrombotic syndrome. Rate of recanalisation is varied and can range from 43-57%
and the factors that affect recanalisation are still a dilemma.
Objective
To know the factors for recanalisation following Deep Vein Thrombosis.
Method
This is a single institution based retrospective-prospective analytical study
encompassing all ultrasonologically diagnosed cases of Deep Vein Thrombosis in
adults from January 2015 to November 2017. All the cases were admitted with oral
warfarin bridged by Heparin/ Enoxaparin and were discharged once International
Normalization Ratio was in therapeutic range. The patients were followed up for
three months with minimal of three outpatient followup. Best finding in the doppler
ultrasonography (done by Acuson P500, Seimens) in relation to recanalisation was
taken for the study.
Result
There were 67 cases of Deep Vein Thrombosis. Of these cases male to female ratio
was 0.91. The mean age was 48.07. Most common extent was up to common femoral
vein (47.8%) followed by upto popliteal vein (40.3%). Remaining 11.9% had extension
upto iliac veins. There was no recanalisation in 2 cases (3%). Partial recanalisation
was seen in 23 cases (34.3%) while complete recanalisation was seen in 42 cases
(62.7%). Recanalisation is more in DVT involving popliteal vein while it decreases as
the extension goes up. In contrast to 79.4% complete recanalisation in popliteal vein,
that in common femoral vein is 62.5% while in iliac vein is only 37.5%. Mean age in no
recanalisation group is much younger than partial or complete recanalisation groups.
Conclusion
Recanalisation following Deep Vein Thrombosis distal to popliteal vein is more than
that in proximal Deep Vein Thrombosis. The information on recanalization can be
considered to use to decide upon the duration of medical management of Deep
Vein Thrombosis.
KEY WORDS
Deep vein thrombosis, Doppler ultrasonography, Recanalisation