Background: Geriatric people particularly those with multiple co-morbid condition may result in polypharmacy which can be associated with use of potentially inappropriate medication. This study aims to understand about prescription pattern and to find out inappropriate medication used in geriatric patients using Beer’s criteria 2012.Methods: A cross sectional study was conducted from May 2018 to Aug 2018 in Koshi Zonal Hospital in Biratnagar. Data of all elderly patients greater above or equal to 60 years those were admitted to General Medical Ward during this period was analyzed.Results: Eighty-six percent of the prescriptions were appropriate and 14% were inappropriate. Seventy-seven percent of drugs belong to Group I of Beer’s criteria (Potentially inappropriate medication use in older adults), 23% of drugs belong to Group III (Potentially inappropriate medication to be used with caution in older adults) and no drugs fall under Group II (Potentially inappropriate medication use in older adults due to Drug-Disease or Drug-Syndrome interactions that may exacerbate the disease or syndrome) of Beer’s criteria.Conclusions: Potentially inappropriate medication was found out to be 14%. The use of inappropriate medications can be avoided using Beer’s criteria 2012 which is important clinical tool that can be used by physicians, pharmacist and other health care professionals. Keywords: Beer’s criteria; geriatric; potentially inappropriate medication; prescribing pattern.
The global problem of acute poisoning has constantly increased over the last few years. It is a major cause of morbidity and mortality in developing countries. Appropriate preventive and management strategies can be developed if the incidence and pattern of acute poisoning is known. This study aimed to determine the profile and outcomes of acute poisoning patients admited to the hospital through emergency department of a tertiary care hospital. Material and Methods: A hospital based retrospective study was performed in the patients admitted to tertiary hospital with the history of poisoning for the period of one year. Several parameters were analyzed and compared with other studies. Results: Seventy-nine patients were presented with acute poisoning during our study period. The age of the patient varied from 11 to 63 years. The mean age was 27.76±15.5%. Females (53.2%) were dominant over males (46.8%). Patients aged between 21 to 30 years were the most common age group involved with poisoning. Subjects were most commonly affected by organophosphorous poisoning followed by chemical poisoning. Conclusion: Poisoning by agents like drugs (pesticides) and organophosphorus compounds are alarming situation and these occur mostly during adolescent period. Government regulations, educational awareness and poison information centres will help to decrease the growth of this public health problem
Oral morphine is extracted from a naturally occurring opium plant. It has been reviewed as a potent analgesic and according to the World Health Organization (WHO) its use is recommended as the drug of choice for the treatment of severe pain, including cancer pains and various other types of pains. However, a large proportion of doctors are hesitant to prescribe morphine because of the unfounded fear of addiction. The main aim of this study was to assess the morphine prescribing pattern of doctors in conformity with the international guidelines. Material and Methods: The present study was a descriptive analysis of oral morphine prescriptions made within a 6 months period, between 2016 and 2017. All the prescriptions for the patients with pain under oral morphine in the hospital records were reviewed. Results: The results showed that (53.6%) of all morphine prescriptions were from the Oncology Department/OPD, while the newly created Day Care Unit accounted for 43.9% of the prescriptions. Almost nil prescriptions were seen from the Labour ward. Only 1.2% of all the prescriptions conformed to international guideline Conclusion: The results reflected that there was a need for more education and advocacy programmes to increase awareness among doctors about morphine prescriptions. The cancer study revealed the useful information related to epidemiology of cancer among both the genders in Nepal which will prove to be useful in health planning and future research.
Introduction: Epistaxis is a common otolaryngological emergency condition. It occurs due to local and systemic cause. Local cause lies within the nose bleeding either anterior or posterior. Commonest site of bleeding anterior epistaxis is kiesselbach’s plexus. In posterior epistaxis, it is difficult to locate bleeding site. Epistaxis is controlled by simply pinching of nose, decongested nasal drop and abgel packing. Some cases become more challenging required nasal packing and arterial ligation. Objectives: To study the epidemiological pattern and management of epistaxis. Methods: This was a retrospective study on pattern of epistaxis managed at Gandaki Medical College Teaching Hospital over a period from April 2015 to April 2016. Information regarding demographic profile, presentation and management of epistaxis was obtained from the Hospital records, ENT Outpatient clinic, Emergency Department, ENT ward and operation theatre. Results: A total of 78 cases were managed during study period. There was a significant male preponderance with male to female ratio 1.78:1. Patients’ age varied from eight to 80 years with mean age 40.7 years. The peak age of incidence was 21 - 30 years group. Idiopathic nasal bleeding 27 (34.6%) was commonest followed by nasal trauma 23 (29.5%) cases and hypertension 16 (20.5%) cases. Seventeen (21.8%) cases managed in day care basis with decongested nasal drop, chemical cautery and abgel packing. Remaining cases required nasal packing and bipolar cautery and other specific form of treatment. Five (6.4%) cases required sphenopalatine artery ligation with no recurrence of bleeding. Conclusions: Epistaxis is common ENT emergency. Most common causes are idiopathic followed by nasal trauma and hypertension. Prompt management is instituted according to cases. Most of the cases are managed by non-surgical method.
Introduction: Idiopathic frozen shoulder (IFS) is a common chronic and disabling condition of shoulder pain characterized by progressive loss of active and passive range of motion (ROM) with unclear pathogenesis. The ideal treatment protocol is still controversial but commonly used treatment includes single agent or combination of oral non-steroid anti- inflammatory drugs (NSAIDS), oral steroids, intra-articular steroid injection and physiotherapy. Objective: The objective of this study was to evaluate the effectiveness of intra-articular methylprednisolone injection for pain and ROM in patients suffering from idiopathic frozen shoulder who did not respond to oral NSAIDS with or without oral steroid. Methodology: A total of 70 patients suffering from IFS were enrolled in this cross sectional study from May 2017–October 2018 from outpatient department of orthopaedic and physiotherapy of Koshi Zonal Hospital. All the patients underwent treatment protocol that comprised of Intra-articular steroid injection followed by five days of oral NSAIDS along with five days regime of physical therapy at the physiotherapy centre, followed by home exercise program. Each patient was followed up at every two weeks interval from intra-articular injection till 6th week. Each patient was evaluated for range of motion (ROM), Numerical Pain Rating Scale (NPRS) and Shoulder Pain and Disability Index (SPADI) before the treatment protocol and at every follow up visit. Data was analyzed using Microsoft Excel Program. Results: All patients enrolled for the study had satisfactory response. The mean age of the patient was 51.8 years (range 40-65 years). The mean age of the 26 male patients was 54 years (range 45-65), whereas the mean age of 44 female patients was 50.5 years (range 45-60). Mean duration of illness was 26.5 weeks (range 18-32 weeks), SPADI before medication was 83.14, at 2nd week was 50.92, at 4th week was 38.63 and at 6th week was 27.22. Conclusion: Combination of intra-articular methylprednisolone injection, physiotherapy and home exercise program is effective in IFS for rapid improvement in pain and ROM.
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