Care Teaching Hospital In Nepal Research Articles

2439. Excess Length of Stay and Mortality among the Critically Ill Adult Patients with Catheter-Associated Urinary Tract Infections in a Tertiary Care Teaching Hospital in Nepal

Abstract Background Patients in the Intensive Care Units (ICU) with Catheter-associated Urinary tract infections (CAUTI) stay longer in the hospital and have excess mortality. Conventional techniques like matching designs or regression analyses to obtain these estimates are prone to time-dependent bias and bias due to competing events. Instead, a survival analysis technique called multistate modeling that describes the occurrence of events as transitions between multiple states over time, has been recommended. Reliable estimates of excess length of stay and mortality among patients with CAUTIs, using appropriate methodologies, have not been reported from Nepal. In this study, we examined the mortality and length of stay that could be attributed to CAUTIs in the ICU of our center. Methods We conducted this prospective cohort study in the 8-bedded medical ICU of a 458 bedded tertiary care teaching hospital in Kathmandu, Nepal. We included all the patients aged ≥ 16 years admitted to the medical ICU and with an indwelling urinary catheter for more than two calendar days during the one-year study period from June 2021 to July 2022. We diagnosed CAUTI using US CDC definitions and determined the antibiotic susceptibility of the bacteria when isolated. We summarized the categorical variables with frequency and numerical variables with median (interquartile range [IQR]). With the assumption of a constant hazard model, we used multistate models to calculate the transitional probabilities and estimate the excess length of stay and mortality. Results Of the 209 patients receiving urinary catheterization, more than half of them (120, 57.42%) were males and the median age was 50 (IQR 38 – 67.25) years. There were 32 (15.3%) CAUTI events identified. The urine samples of 25 patients yielded 27 microorganisms; 20 isolates among them were multi-drug resistant isolates. Escherichia coli was the most common microorganism. Overall, the patients with CAUTI stayed 2.5 days longer in the ICU and had 13% higher mortality than those without CAUTI. Conclusion The high burden of CAUTIs and the associated excess length of stay and mortality provide an approximation of the number of lives that could be saved and the number of bed days that could be gained by the appropriate CAUTI preventive and management strategies and should be reinforced. Disclosures All Authors: No reported disclosures

Antibiotic Prescribing Pattern in Paediatric Emergency Department at Tertiary Care Teaching Hospital in Nepal

Background and Objectives: The indiscriminate use of antibiotics often results in an increased incidence of adverse drug reactions (ADR), suboptimal therapy, treatment failure, polypharmacy and most importantly, the emergence of antibiotic resistance. Thus, the objective of this study was to assess the paediatric emergency department, antibiotic prescribing pattern at a tertiary care teaching hospital, Universal College of Medical Sciences (UCMS), Bhairahawa, Rupandehi, Nepal.
 Material and methods: A prospective, cross-sectional, observational study was carried out on 152 paediatric patients of ages between 2 months to 12 years at the paediatric emergency department of UCMS. The data were collected by reviewing the prescription paper, and the required information was recorded using a structured data collection sheet prepared for study. The prescribing pattern was assessed through the World Health Organization (WHO) prescription indicators using the WHO Children Formulary 1993 AD.
 Results: This study revealed that out of 152 patients, average number of drugs prescribed was 5.13 and antibiotic per patient was 2.10±.540. Antibiotics were prescribed at least once for 93.4% of patients. Drugs prescribed from Essential drug list (EDL) was 46.46% and that encountered with injectable was 92.1%. There was a significant difference between the patients age group and the number of drugs prescribed (χ2 = 21.553, p = 0.010). The mean duration of antibiotic treatment was 6.95±3.145. Cephalosporin’s (36.6%) followed by aminoglycosides (28.8%) were most frequently prescribed antibiotics.
 Conclusion: Multiple courses of antibiotics are most frequently prescribed, which could increase antibiotic resistance in future. Continuous audits, training and new treatment protocols should be developed for prescribing and using antibiotics in paediatric patients.

Epidemiology and Risk Factors of Healthcare-Associated Infections in Critically Ill Patients in a Tertiary Care Teaching Hospital in Nepal: A Prospective Cohort Study

Background:Healthcare-associated infection (HAI) is an important public health problem, particularly in intensive care units (ICUs). We aimed to examine the epidemiology and risk factors of HAIs in our ICUs and study their microbiological profile.Methods:We evaluated 100 consecutive patients in 3 medical and surgical ICUs of a tertiary care teaching hospital daily starting in January 2016 using the Centers for Disease Control and Prevention definitions and methods. We determined the incidence and sites of HAIs, identified the causative microorganism, and studied their antibiotic sensitivity profiles. We investigated risk factors for the development of an HAI using a multiple logistic regression model.Results:Of 300 patients, 129 patients (43%) developed HAIs (55.96 HAI events per 1000 ICU-days). Pneumonia was the most common type of HAI (57, 41%). Escherichia coli was the most frequently isolated microorganism (20, 29%) and 74% of the pathogens isolated were multi-drug resistant. The presence of an invasive device (Odds Ratio, 4.29; 95% Confidence Interval, 2.52-7.51) and use of sedation (Odds Ratio, 2.24; 95% Confidence Interval, 1.31-3.87) were the statistically significant risk factors for HAIs.Conclusions:We found a high incidence of HAIs in our ICUs and a high burden of multidrug-resistant microorganisms highlighting the importance of infection control and antibiotic stewardship.

Does teaching medical ethics ensure good knowledge, attitude, and reported practice? An ethical vignette-based cross-sectional survey among doctors in a tertiary teaching hospital in Nepal

BackgroundImportance of awareness of medical ethics and its integration into medical curriculum has been frequently highlighted. Study 1 aimed to assess the knowledge, attitude, and reported practices of medical ethics among clinicians at Patan Academy of Health Sciences, a tertiary care teaching hospital in Nepal. Study 2 was conducted to assess whether there was a difference in knowledge, attitude, and reported practices of medical ethics among doctors who received formal medical ethics education during undergraduate studies and those who did not.MethodsTwo cross-sectional surveys using self-administered questionnaires were conducted. Study 1 included 72 participants; interns, medical officers, and consultants working at Patan Academy of Health Sciences. Study 2 was a comparative study conducted among 54 medical officers who had received formal medical ethics education (Group 1) and 60 medical officers who did not (Group 2).ResultsParticipants who had completed post-graduate education had higher knowledge (p = 0.050), practice (p < 0.001), and overall combined scores (p = 0.011). Participants with ethics education had higher knowledge (p < 0.001), attitude (p = 0.001), practice (p < 0.001), and overall score (p < 0.001). Most participants preferred consulting colleagues if an ethical dilemma arose. Fewer participants had heard of the Declaration of Helsinki. Most participants thought doctors to be most capable of judging what is best for the patient (Study 1: 70.42%, Study 2 Group 1: 42.59%, Group 2: 80%). Case scenarios in which participants demonstrated poor practice were ethical issues concerning truth-telling, end-of-life decisions, treating HIV/AIDS patients, treating a minor, and reporting colleague’s errors.ConclusionsThis study found that participants who have received medical ethics education have higher knowledge, attitude, and practice scores. The results further justify the need for medical ethics education to be a part of the core medical curriculum. A blame-free environment where seniors can be approached for advice should be created. Research ethics should also be given attention. During medical ethics training, ethical issues where doctors perform poorly should be given more priority and should be discussed in a country-specific context.

Prescribing pattern of proton pump inhibitors among patients visiting the outpatient general medicine clinic in a tertiary care teaching hospital in Nepal

PurposeThe purpose of this study is to evaluate the prescribing pattern of proton pump inhibitors (PPIs) in patients visiting the outpatient general medical clinic in a Tertiary Care Teaching Hospital.Design/methodology/approachA hospital-based cross-sectional study was conducted in 419 patients aged ≥18 years, visiting the outpatient general medicine clinic of a tertiary hospital and prescribed with at least one PPI, from July to September 2016 using a purposive sampling technique. Descriptive statistics were performed using IBM-SPSS 20.0 (IBM Corporation, Armonk, NY, USA).FindingsPatients were mostly less than 30 years (30.78%) and female (58.95%). Pantoprazole was the most frequently prescribed PPIs (57.04%). The majority of PPIs were prescribed for acid peptic disorder (APD) (33.65%), followed by non-steroidal anti-inflammatory drugs (NSAIDs) prophylaxis (30.79%). Most of the PPIs were prescribed for twice-daily administration (68.26%). Nearly one-fourth (21.72%) of the patients presented with at least one additional medical condition, and almost all (99%) patients were receiving at least one additional drug along with PPIs.Originality/valueThe study suggests that PPIs are frequently prescribed and their use has been extended to other conditions that in fact do not require acid anti-secretory therapy. Result has highlighted the need for an interdisciplinary collaboration between pharmacists and medical professionals for the rational use of PPIs and promotion of PPIs prescription from the National List of Essential Medicines.

Antibiotic utilization, sensitivity, and cost in the medical intensive care unit of a tertiary care teaching hospital in Nepal.

Background:High utilization and irrational use of antibiotics in an intensive care unit increases microbial resistance, morbidity, mortality, and costs.Objective:This study aimed to evaluate the utilization, sensitivity and cost analysis of antibiotics used in the medical intensive care unit of a tertiary care teaching hospital of Nepal.Methods:A prospective cohort study was conducted on patients admitted to the medical intensive care unit at a tertiary care teaching hospital in central Nepal from July to September 2016. Antibiotic utilization, defined daily dose per 100 bed-days and the cost of antibiotics per patient were calculated. Descriptive statistics were performed using IBM-SPSS 20.0.Results:A total of 365 antibiotics were prescribed in 157 patients during the study period, with an average of 2.34 prescriptions per patient. Total antibiotic utilization in terms of defined daily dose per 100 bed-days was 49.5. Piperacillin/tazobactam (45.2%) was the most commonly prescribed antibiotic, and meropenem was the most expensive antibiotics (US$4440.70). The median (interquartile range) cost of antibiotics used per patient was US$47.67 (US$63.73). Escherichia coli, Acinetobacter, and Pseudomonas sp. were the common organisms isolated and were found to be resistant to some of the commonly used antibiotics.Conclusion:This study suggests that the utilization and cost of antibiotics are high in medical intensive care unit of the hospital and E. coli was resistant to multiple antibiotics. The findings highlight an urgent need for the implementation of antibiotic stewardship program in order to improve antibiotic utilization in such hospital settings.

Pattern of Injury among Orthopaedic Inpatients in a Teaching Hospital in Central Nepal

Introduction: Injury is a major cause of morbidity and mortality globally with the majority of them being orthopaedic in nature and are the resultants of fall, road traffic accidents (RTA), physical assault amongst others. The aim of this study was to determine the patterns of musculoskeletal injury among orthopaedic inpatients in a tertiary care teaching hospital in Nepal.&#x0D; Methods: It was a cross-sectional study conducted in the department of orthopaedic surgery at College of Medical Sciences and Teaching Hospital (COMS-TH), Bharatpur from January to December 2019. Patients presenting with orthopaedic injury and admitted and treated as inpatients were assessed for their demographic details, mode of injury and other patterns of injury and descriptive analysis was done.&#x0D; Results: In a total of 1027 patients, the mean age was 33.4 years (range: 1.0 - 95.0). Most of them (74.5%) were male. Right side was the most predominant side of injury (53.8%). Students were most commonly affected groups (34.8%). RTA was the most common mode of injury (66.9%). The commonest pattern of injury was fracture (70.1%). Closed bony injuries were sustained by 74.1%. Head injury was the most commonly associated injury.&#x0D; Conclusions: The commonest mode of injury was RTA. Closed fracture was the most common type of fracture. Extremity injury was the most common site and head injury was the commonest associated injury. These patterns can serve as valuable tools in clinical decision making and further research studies.

Drug therapy and cost analysis of urinary tract infections in a tertiary care teaching hospital in Nepal

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Urinary tract infection (UTI) is the most common infection caused by the presence and growth of pathogenic microorganisms within the human urinary system into the lower and upper genito-urinary tract. UTI continues to be major health problems in developing countries like Nepal.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective observational study was conducted from June 2019 to November 2019 in the outpatient and inpatient department of Manipal teaching hospital. The face-to-face interview was adopted in 137 UTI patients with the census sampling technique. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 137 patients (121 out-patients and 16 in-patients), 82 (59.85%) female, and 55 (40.15%) males were enrolled in which UTI was observed in more than half of the sample in the aged group of 25-54. &lt;em&gt;Escherichia coli&lt;/em&gt; was the most common uropathogens isolated whereas dysuria was the most common presenting symptom among the patients. Cefixime 200 mg followed by nitrofurantoin 100 mg was the most commonly prescribed medicine for UTI. Disodium hydrogen 1.40 g oral liquid, pantoprazole 40 mg tablet, and multivitamins were commonly prescribed supportive medications. The empirically prescribed average cost was Nepalese rupee (NRs.) 820.44 whereas the total definitive average cost was NRs. 305.54. The average cost of medical management for in-patients was NRs. 2316.55 including registration, urine analysis, investigation bed charge, and other consumable charges as well as discharge medicine cost.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; With lower cost, higher sensitivity, and high prescription, cefixime, and nitrofurantoin could be better drugs for the management of UTI among outpatient department (OPD) patients while ceftriaxone could be better for in-patients.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Study of Self-medication among First and Seventh Semester Medical and Dental Undergraduate Students of Tertiary Care Teaching Hospital in Nepal: A Descriptive Cross-sectional Study.

Although appropriate self-medication can ease minor illness and is time and costeffective, it can lead to irrational drug use and increased resistance, leading to prolonged morbidity. Inclined towards medical information and drug indices, medical students have an open arena for self-medication practice. This study was conducted to find the prevalence of self-medication among first and seventh semester medical and dental students in a tertiary care hospital. A descriptive cross-sectional study was conducted among medical and dental undergraduates from July 2020 to August 2020 after receiving ethical clearance from the Institutional Review Committee of Kathmandu University School of Medical Sciences (IRC Approval Number:35/20). A questionnaire was responded to by participants through a google form. Participants were enrolled through the convenience sampling method. Data were collected and entered in Microsoft Excel and analyzed using Statistical Package for Social Sciences version 25. Out of 199 respondents, the prevalence of self-medication was 100 (50.3%) (46.76-53.84 at 95% Confidence Interval). First semester medical 36 (73.5%) and dental undergraduates 24 (80%) had higher practice. Seventh-semester medical students 14 (51.9%) usually self-medicated within one day of onset of symptoms. Headache 47 (47%) was the most common indication. Analgesics 62 (62%) were most commonly used drugs procured most commonly from pharmacies 114 (57.3%). Dosage form was drug selection criteria for 120 (60.3%) students. Since self-medication is crammed with serious health hazards, proper exposure to the topic should be given to medical, dental students, and pharmacists. The implication of selfmedication into the pharmacology syllabus is a must.

Prevalence of Smoking among Medical Students in a Tertiary Care Teaching Hospital.

Tobacco smoking is one of the most important preventable risk factors for noncommunicable diseases. It has been seen that medical students have a higher frequency of smoking compared to the general population. This study aims to determine the prevalence of smoking among third-year medical students in a tertiary care teaching hospital in Nepal. This descriptive cross-sectional study was conducted among the hospital's third-year undergraduate medical students over a four-month period (October 2019 to January 2020). Ethical clearance was received from the Institutional Review Committee of Kathmandu Medical College and Teaching Hospital. The whole sampling technique was used to collect data. The Global Health Professional Students Survey questionnaire was used to collect data. Data analysis was done in the statistical package for social sciences. The prevalence of current smoking among selected medical students of Kathmandu Medical College and Teaching Hospital is 34 (30.1%), majority male 26 (23%). Fifty-six (49.4%) of them had ever smoked cigarettes in their life, and 27 (23.9%) had their first cigarette in late adolescence. The number of students who used other forms of tobacco was comparatively lower i.e. 6 (5.3%). Many of the students 53 (46.9%) were exposed to second-hand smoke both at home and in public, while 18(15.9) exposed only at public places, and 6 (5.3%) only at home. Our study has concluded that there is a notable prevalence of smoking among the participants. This points to the need for specific training sessions in their clinical years about smoking cessation for themselves and regarding counseling for patients.

2472. Point Prevalence of Healthcare-Associated Infections and Antibiotic Use in a Tertiary Care Teaching Hospital in Nepal: A Cross-Sectional Study

BackgroundHealthcare-associated infections (HAIs) are a growing threat to patient safety, particularly in resource-limited settings. Information on the burden of HAIs will help in surveillance and prevention efforts. This study aims to estimate the prevalence of HAIs and antibiotics use in a tertiary care teaching hospital in Nepal.MethodsWe conducted a descriptive cross-sectional point prevalence survey in a 350 bedded acute care teaching hospital at Kathmandu, Nepal on April 2019 in a single day for every ward. We studied all the patients aged ≥ 18 years admitted for at least two calendar days on the day of the survey to collect data on patient characteristics, hospital stay, and invasive devices and antibiotics used. We evaluated for the three common HAIs – pneumonia, urinary tract infection and surgical site infection, active on the day of data collection using the clinical criteria by European Center for Disease Prevention and Control protocol version 5.3. We summarized continuous variables with median and interquartile range (IQR) and categorical variables with proportions. We reported the prevalence of HAIs as a proportion of the number of HAIs by the number of patients studied.ResultsOf 213 inpatients, 160 were eligible, 25 (15.6%) among them were from critical care units. The median age was 50 years (IQR 34–65). The median duration of hospital stay was 6 days (IQR 4–9). There were 18 HAIs for the prevalence of 11.25%. Urinary tract infection was the most common HAI (13 HAIs, 72.2% of all HAIs). We found invasive devices used in 42 patients (26.2%), the most common was urinary catheter (37 patients, 23.1%). The number of patients with any antibiotic used was 114 (71.25%) with 61 (38%) patients receiving two or more antibiotics. Third-generation Cephalosporins were the most common antibiotics (74, 64.9%) used. We found 91 (79.8%) patients being treated for community-acquired infections.ConclusionThis study provides an estimate of the burden of HAIs in our center that is comparable to that of the reports from other resource-limited settings. However, we believe a higher burden will be revealed when we add microbiological criteria as well to diagnose HAIs. This highlights an urgent need for HAI surveillance system, infection prevention and control, and antibiotics stewardship programs in our center. Disclosures All authors: No reported disclosures.

Presentation Number ASR-02 - Epidemiology and Risk Factors of Healthcare Associated Infections in Critically Ill Patients in a Tertiary Care Teaching Hospital in Nepal

Presentation Number ASR-02 - Epidemiology and Risk Factors of Healthcare Associated Infections in Critically Ill Patients in a Tertiary Care Teaching Hospital in Nepal

Premenstrual Syndrome and Premenstrual Dysphoric Disorder in Medical and Nursing Students of a Tertiary Care Teaching Hospital in Nepal

Aims: To determine the prevalence of premenstrual syndrome and premenstrual dysphoric disorder and their association with psychiatric cases and dysmenorrhea in students of Lumbini Medical College, Palpa, Nepal.Methods: This is a cross-sectional study where self-report questionnaires based on American College of Obstetrics and Gynecology and Diagnostic and Statistical Manual of Mental Disorders-V criteria for PMS and PMDD and the General Health Questionnaire-12 for psychiatric caseness were filled by the students. The results were calculated using SPSS 16.0 as frequencies, mean, standard deviation and chi square with a p-value of &lt; 0.05 as significant. Results: There were 382 participants out of which 113 (61.1%) medical and 126 (64%) nursing students met the ACOG criteria for PMS. PMDD was diagnosed in 78 (39.6%) nursing students and 72(38.9%) medical students. The most common somatic symptom was headache 256(77%) and behavioral symptom was irritability 310(81.2%). A significant relation (p value &lt;0.05) was seen between psychiatric caseness, dysmenorrhoea and PMS/PMDD.Conclusion: PMS and PMDD are common in young medical and nursing students. A significant relation was present between PMS and psychiatric caseness and dysmenorrhea therefore comprehensive efforts should be made by healthcare providers to screen and manage symptoms including dysmenorrhea efficiently, thereby improving daily functioning, academic performance and professional skills of the students.

Antepartum hemorrhage at a tertiary care teaching hospital in Nepal

Introductions: Antepartum hemorrhage (APH) is a serious obstetrical emergency and is a leading cause of maternal and perinatal morbidity and mortality. Incidence varies from 2-5% of all deliveries. The maternal and perinatal complications of APH are anemia, postpartum hemorrhage, shock, low birth weight, intrauterine fetal death and birth asphyxia.&#x0D; Methods: This descriptive study was conducted at Department of Obstetrics and Gynaecology of Patan Hospital, a tertiary care teaching hospital of Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. All patients who were admitted after 22 weeks of gestation with diagnosis of antepartum hemorrhage from April 2012 to April 2016 were included.&#x0D; Results: The incidence of APH was 0.23% in the present study. Out of 84 patients, 39.3% were in age group of 25-29 years, 63% were multigravidae, 63% had placenta previa, 92.3% lower segment caesarean section done in new onset APH and 53.1% done in previous admitted cases of APH, 23.8% developed hypovolemic shock, 14.3% needed blood transfusion, 9.5% had postpartum hemorrhage, 1.2% had caesarean hysterectomy, 54.8% had preterm delivery, 9.5% were admitted in neonatal intensive care unit and perinatal mortality was 10.7%.&#x0D; Conclusions: APH is a major cause of maternal and perinatal morbidity and mortality. In our study, the most common cause of APH was placenta previa. The commonest mode of delivery was caesarean section. The major maternal complication was hypovolemic shock with consequent high blood transfusion rate and fetal complication in prematurity.

Comparative evaluation of effect of Olanzapine and Quetiapine on body weight and body mass index (BMI) in psychotic patients at a tertiary care teaching hospital in Nepal

Background: Atypical antipsychotics are currently the most frequently prescribed class of drugs for psychotic illness. Weight gain and obesity are more problematic with atypical antipsychotics than with typical antipsychotics. Since weight gain contributes to non-compliance with treatment and may lead to medical morbidity, it is important to know and compare the weight gain associated with the use of most commonly prescribed atypical antipsychotics olanzapine and quetiapine at our set up. Objective: Comparative evaluation of changes in body weight and body mass index (BMI) of psychotic patients treated with olanzapine and quetiapine in a tertiary care teaching hospital in Nepal. Materials and Methods: This study was conducted in the Department of Neuropsychiatry, Nepalgunj Medical College & Teaching Hospital, Nepalgunj, for a period of 6 months between July to December 2014. A total of 40 patients suffering from psychotic disorders were included in the study and randomly allocated in two groups: Group-I (20 patients) received tablet olanzapine (10–15 mg/day) and Group-II (20 patients) received tablet quetiapine (200–600 mg/day). Patients were followed upto 6 weeks. All values were expressed in mean ± SD. The changes in body weight and BMI were measured at 0 and 6 weeks. Statistical analysis was done by using paired and unpaired T-test. p value < 0.05 was considered significant. Result: Mean weight in group receiving olanzapine at 0 and 6 weeks was 54.59±6.72 kg and 58.75±6.76 kg, respectively and in quetiapine group was 55.37±5.63 kg and 57.18±5.93 kg, respectively (p 0.05). Conclusion: Both olanzapine and quetiapine showed increase in body weight and BMI in psychotic illness patients during the study period. But intergroup comparison revealed no significant difference between the groups.

Recent scenario on psychotropic drug usage pattern among patients attending psychiatric outpatient department of a tertiary care teaching hospital in Nepal

Background: Due to increasing burden of psychiatric illnesses, it is essential to study the psychotropic drug utilization pattern in actual clinical practice. The objective of the study was to study the psychotropic drug usage pattern among patients attending psychiatric OPD of a tertiary care teaching hospital in Nepal. Methods: This observational retrospective study was conducted in Nepal Gunj Medical College, Nepal for a period of 6 months from January 2016 to June 2016. A total of 282 prescriptions from Psychiatric OPD were analysed for drug usage pattern. Prescriptions containing at least one psychotropic drug were included. Data was measured for number and percentage of prescriptions or drugs, using selected World Health Organization (WHO) drug use indicators. Results: A total of 282 prescriptions from Psychiatric OPD were analysed. Patients had a mean age of 35.01±1.17 years. Male and Female %age was 41.49% and 58.51% respectively. Majority of the patients (47.52%) were in 31-45 years age group. 70.57% patients were literate. Depression was the leading psychiatric illness seen in 144 (51.06%) patients followed by Anxiety disorders which were seen in 60 (21.28%) patients. A total of 2463 drugs were prescribed which included 591 (23.99%) antipsychotic drugs followed by 462 (18.76%) antidepressants, 390 (15.83%) antiepileptics, 312 (12.67%) supplements, 276 (11.21%) antianxiety, 171 (6.94%) antacids, 165 (6.7%) anticholinergics, 96 (3.9%) drugs in miscellaneous category. Drugs prescribed per prescription were 8.73 and psychotropic drugs per prescription were 6.09. Number of oral and injectable drugs were 2313 (93.91%) and 150 (6.09%) respectively. 87 fixed dose combinations (FDCs) of psychotropic drugs were prescribed. 903 (36.66%) drugs were prescribed from WHO’s 18th List of Essential Medicines. Conclusions: Depression was the most common psychiatric illness and antipsychotics were the most commonly prescribed medicines in psychiatry OPD. Majority of the prescriptions revealed polypharmacy.

Near-miss Obstetric Events in a Tertiary Care Teaching Hospital in Nepal: An Audit

Aims: This study aims to determine the frequency of near-miss obstetric events and analyze its nature such as reasons for near-miss, organ dysfunction associated and critical management required among pregnant women managed over a 3-year period in a Tertiary Care Teaching Hospital in Nepal. Methods: This hospital based prospective, descriptive study was done from August 2011 to February 2015. Case eligibility was defined by WHO Near-Miss Guidelines. Medical records of the patients and the interview with the patient, accompanying family members and health workers from referral centres were used to generate the data which were filled in the pre-designed questionnaire. The data generated and analyzed included age and gestation weeks, parity, mode of intervention, associated organ dysfunctions, reasons for near-miss and critical intervention accompanied to manage the near-miss cases. Results were presented in mean ± SD and percentages, wherever applicable. Results: There were 4617 deliveries with 28 near-miss cases. The major factors contributing near-miss events were obstetric haemorrhage followed by hypertensive disorder. Three fourth (n=21) of cases required blood transfusion and almost all cases (n=26) required ICU management. Coagulation disorder was observed in majority of cases (n=23) followed by cardiovascular, respiratory and uterine atony. Conclusions: In this study, maternal near-miss event was mainly attributable to obstetric haemorrhage followed by hypertension and sepsis. Major organ-system disorders observed were coagulation disorder, cardiovascular, respiratory and uterine disorders. Almost all the cases were managed in ICU and majority of them required blood transfusion.

Clinico-epidemiological study of near-hanging cases – An investigation from Nepal

Hanging is one of the commonest methods of suicide. Epidemiological data of near-hanging patients from Nepal is limited. The present research from Nepal attempts to review the clinico-epidemiological profile of near-hanging patients. A retrospective review of case records was done for the near hanging patients admitted to a tertiary care teaching hospital in Nepal, between August 2012 and August 2014. Details regarding socio-demographic profile, circumstances of hanging, clinical details, and outcome etc. were obtained and examined. During the study period, 10 near hanging patients were admitted to the hospital. The majority of the patients were below 30 years. Mean age of the study group was 28.8 years. The GCS on arrival ranged between 5/15 and 15/15 with the mean GCS being 9.5/15. Hypoxic encephalopathy and cerebral edema were the only noted complications. None of the patient had a cervical spinal injury. All the patients survived the near hanging episode. The mean ICU and hospital stay were 3.9 days and 6.2 days respectively. Prompt resuscitation, active interventions and intensive care support favors a good prognosis. Psychiatric evaluation and support to the patients and their relatives is the key to preventing such attempts in future.

A non-clinical randomised controlled trial to assess the impact of pharmaceutical care intervention on satisfaction level of newly diagnosed diabetes mellitus patients in a tertiary care teaching hospital in Nepal.

BackgroundPatient satisfaction is the ultimate goal of healthcare system which can be achieved from good patient-healthcare professional relationship and quality of healthcare services provided.Study was conducted to determine the baseline satisfaction level of newly diagnosed diabetics and to explore the impact of pharmaceutical care intervention on patients’ satisfaction during their follow-ups in a tertiary care teaching hospital in Nepal.MethodsAn interventional, pre-post non-clinical randomised controlled study was designed among randomly distributed 162 [control group (n = 54), test 1 group (n = 54) and test 2 group (n = 54)] newly diagnosed diabetes mellitus patients by consecutive sampling method for 18 months. Diabetes Patient Satisfaction Questionnaire was used to evaluate patient’s satisfaction scores at baseline, three, six, nine and, twelve months’ follow-ups. Test groups patients were provided pharmaceutical care whereas control group patients only received their usual care from physician/nurses. The responses were entered in SPSS version 16. Data distribution was not normal on Kolmogorov-Smirnov test. Non-parametric tests i.e. Friedman test, Mann-Whitney U test and Wilcoxon signed rank test were used to find the differences among the groups before and after the intervention (p ≤0.05).ResultsThere were significant (p < 0.001) improvements in patients’ satisfaction scores in the test groups on Friedman test. Mann-Whitney U test identified the significant differences in satisfaction scores between test 1 and test 2 groups, control and test 1 groups and, control and test 2 groups at 3-months (p = 0.008), (p < 0.001) and (p < 0.001), 6-months (p = 0.010), (p < 0.001) and (p < 0.001), 9-months (p < 0.001), (p < 0.001) and (p < 0.001) and, 12-months (p < 0.001), (p < 0.001) and (p < 0.001) follow-ups respectively.ConclusionPharmaceutical care intervention significantly improved the satisfaction level of diabetics in the test groups compare to the control group. Diabetic kit demonstration strengthened the satisfaction level among the test 2 group patients. Therefore, pharmacist can act as a counsellor through pharmaceutical care program and assist the patients in managing their disease. This will not only modify the patients’ related outcomes and their level of satisfaction but also improve the healthcare system.

Comparative evaluation of Amisulpride and Escitalopram on Hamilton Anxiety Rating Scale among depression patients in a tertiary care teaching hospital in Nepal

Background: Depression is an important global public health problem and is a major cause of disability and premature death. The present study was conducted to compare efficacy and safety of amisulpride and escitalopram on Hamilton anxiety rating scale (HAM-A) among depression patients in a tertiary care teaching hospital in Nepal. Methods: The study was conducted in patients for 1-year in the Department of Neuropsychiatry, Nepalgunj Medical College and Teaching Hospital. A total of 117 depression patients were divided into two groups. Group I (58 patients) received amisulpride tablet at a dose of 50 mg/day and Group II (59 patients) were given escitalopram at a dose of 10 mg/day. The patients were required to follow-up at 4, 8 and 15 weeks. The efficacy of the drugs was calculated by HAM-A. Adverse drug reactions (ADRs) were monitored at every follow-up. Appropriate statistical tools using Graphpad instat 3.0 were used for analysis p<0.05 was considered significant. Results: HAM-A score in group receiving amisulpride at 0 and 15 weeks was 19.83±0.33 and 8.17±0.32 (p<0.0001). HAM-A score in group receiving escitalopram at 0 and 15 weeks was 20.76±0.28 and 8.98±0.24 (p<0.0001). Gastrointestinal disturbances, sexual disturbances, amenorrhea, lactation, agitation, and insomnia were the commonly encountered ADRs. Conclusion: Both amisulpride and escitalopram were highly effective in the treatment of anxiety in depression patients during the study period. Further, more clinical studies with longer follow-up duration are needed to substantiate the therapeutic effects of amisulpride.