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105. Development and Evaluation of a Pharmacovigilance Education Module for Medical Students in Nepal.

Author

Palaian, Subish, Mohamed Izham Mohamed Ibrahim, Mishra, Pranaya, and Shankar, Pathiyil Ravi

Subjects
*MEDICAL students, *MEDICAL education, *ASSESSMENT of education, *DRUG side effects, *EDUCATIONAL intervention
Abstract

This study evaluated the impact of a pharmacovigilance educational module on the Knowledge, Attitude and Practice (KAP) of pharmacovigilance among students in a medical college in Nepal and obtained their feedback on the module. A pre-post study design was used. First to fourth semester (basic sciences) undergraduate medical students (n = 229) were included. Their baseline KAP towards adverse drug reactions (ADRs) and pharmacovigilance was evaluated using a pretested KAP questionnaire. The students were grouped into "control" (1st and 4th semester) and "test" (2nd and 3rd semester) groups. The test group received an educational intervention, which included the basic, technical and operational aspects of pharmacovigilance. The improvements in the KAP scores following the intervention was compared using Wilcoxon signed rank test; student feedback on the sessions was obtained using a feedback questionnaire' (maximum score = 100). Nearly, all students (n = 227; 99.1%) believed undergraduate medical students should be taught about ADRs and 224 (97.8%) felt ADRs reporting to be important. A statistically significant association was found between the baseline KAP scores and gender (p = 0.044), respondents' age (p = 0.017), method of financing of education (p < 0.001), nationality (p = 0.009) and the respondents' semester of study (p = 0.001). After the intervention, the median interquartile range (IQR) KAP scores improved from 32 (30-33) to 34 (32-36), (p < 0.001). Overall, the students' perception regarding the module was positive. This was reflected by a high median IQR feedback scores [83 (78.0-87.0)]. Post intervention, the knowledge scores improved significantly suggesting the effectiveness of the educational modules. Student feedbacks about the modules were positive. Findings also suggest the feasibility of conducting pharmacovigilance education modules for medical students in resource limited settings. [ABSTRACT FROM AUTHOR]

Published
2019
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106. Can clinical pharmacists bridge a gap between medical oncologists and patients in resource-limited oncology settings? An experience in Nepal.

Author

Shrestha, Sunil, Shrestha, Sudip, and Palaian, Subish

Subjects
CANCER patients, COMBINED modality therapy, DRUG side effects, HOSPITAL pharmacies, HOSPITAL wards, MEDICAL care, ONCOLOGISTS, ONCOLOGY, PATIENTS, PHARMACISTS, OCCUPATIONAL roles
Abstract

The clinical pharmacist's part is emerging as a key extension to the human services care team bringing about enhanced patient care in the world. The main objective of this article is to highlight the role of clinical pharmacist in an oncology setting of Nepal. An enrollment of clinical pharmacist in an oncology hospital or in oncology settings can work as a bridge between medical oncologist and patients. [ABSTRACT FROM AUTHOR]

Published
2019
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107. Assessment of utilization pattern of fixed dose drug combinations in primary, secondary and tertiary healthcare centers in Nepal: a cross-sectional study

Author

Poudel, Arjun, Izham Mohamed Ibrahim, Mohamed, Mishra, Pranaya, Palaian, Subish, Poudel, Arjun, Izham Mohamed Ibrahim, Mohamed, Mishra, Pranaya, and Palaian, Subish

Abstract

Background Prescription practices, especially in South Asian countries, have come under investigation for quality. Although there have been no studies in Nepal that have analyzed the prescription pattern of FDCs for different levels of health care centers, several studies from Nepal and other countries in the region have revealed poor medicine use practices, including irrational use of fixed-dose drug combinations (FDCs). This research aimed at assessing the utilization pattern of FDCs among primary (PHC), secondary (SHC) and tertiary health care (THC) centers in Western region of Nepal. Methods A cross-sectional descriptive study was conducted at primary, secondary and tertiary health care centers in Western Nepal. One hundred prescriptions from each health care center were chosen through systematic random sampling. The International Network for Rational Use of Drug (INRUD) indicators were used to assess the rationality of prescribing. Both descriptive and inferential statistics were applied. The alpha level used was 0.05. Results At the PHC center, 206 medicines were prescribed, of which 20.0% were FDCs. Antimicrobials were the most prescribed FDCs (57.1%). The unit prices of all FDCs were below 100 Nepalese Price Rupees (NPRs). At the SHC center, 309 medicines were prescribed, and 30% were FDCs. Vitamins, minerals and dietary supplements were the most prescribed FDCs (25.8%). The costs of 63.5% of FDCs were below 100 NPRs. At the THC center, 33.5% of 270 medicines were FDCs. As at the SHC center, vitamins, minerals and dietary supplements were the most prescribed FDCs (40.6%). The costs of 50.5% of FDCs were below 100 NPRs. Conclusions FDCs were used extensively at different health care centers. The number of prescription in private centers, following established guidelines and the essential drug list (EDL), was much lower. The cost associated with the utilization of FDCs was higher in private sectors compared to public health care centers. In certain cases, the

Published
2017

108. Assessment of the availability and rationality of unregistered fixed dose drug combinations in Nepal: a multicenter cross-sectional study

Author

Poudel, Arjun, Izham Mohamed Ibrahim, Mohamed, Mishra, Pranaya, Palaian, Subish, Poudel, Arjun, Izham Mohamed Ibrahim, Mohamed, Mishra, Pranaya, and Palaian, Subish

Abstract

The medications that are registered and available in a country are meant for the prevention and treatment of ailments and diseases. However, a lack of effective regulatory bodies and operative control mechanisms, especially in developing countries, promotes irrational and inappropriate use of medicines. This study aims to evaluate the availability and rationality of unregistered fixed-dose drug combinations (FDCs) in Nepal. A snowball sampling method with visits to 20 retail pharmacies in each of five major cities in Nepal was used to assess the availability of unregistered FDCs. To justify the rationality of the FDCs obtained from these five cities, the toolkit developed by Health Action International Asia-Pacific (HAI-AP) was used. Altogether, 41 unregistered FDCs were obtained from the five cities. Among the total 41 FDCs, a majority were anti-inflammatory/analgesic/antipyretics. A maximum of eight drugs and a minimum of two drugs per combination were present among the total 41 FDCs, with a majority in the form of tablets followed by suspensions. The cost ranges from a minimum of 3.7 Nepalese Rupees (NRs) (= USD 0.05) to a maximum of 240 NRs (= USD 3.15). None of the FDCs fulfilled all the fundamental requirements as stated in the toolkit; thus, they were categorized as ‘irrational’. Unregistered FDCs are available in the Nepalese pharmaceutical market. All the unregistered FDCs found in our study were ‘irrational’ as per the HAI-AP toolkit. Regulatory authorities should initiate strict monitoring and appropriate regulatory mechanisms to prohibit the use of unregistered and irrational FDCs.

Published
2017

109. Drug and therapeutics committee in Manipal Teaching Hospital, Pokhara, Nepal

Author

Alam, Kadir and Palaian, Subish

Subjects
Nonprescription drugs -- Complications and side effects, Nonprescription drugs -- Laws, regulations and rules, Generic drugs -- Complications and side effects, Generic drugs -- Laws, regulations and rules, Medical societies -- Laws, regulations and rules, Government regulation, Health
Abstract

Drug use problems are common worldwide. Nepal is a developing country with several drug use problems. The Drug and Therapeutics committee (DTC) in Manipal Teaching Hospital (MTH) has been playing a vital role in promoting rational use of medicines in the hospital. The DTC has banned several irrational fixed dose combinations and formulated several guidance regarding safe and effective use of medicines. The DTC in MTH has proven the importance of DTCs in developing countries like Nepal in improving rational use of medicines in hospitals settings., Introduction Irrational drug use is a common problem worldwide. In Nepal there are several drug use problems. Some of them include unavailability of essential medicines, irrational prescribing and dispensing, adverse [...]

Published
2010

110. Clinical profile and management pattern of melasma patients in Western Nepal: a hospital based study

Author

Dwari, Binayak Chandra, Palaian, Subish, Poude, Arjun, and Prabhu, Smitha

Subjects
Melanosis -- Diagnosis, Melanosis -- Care and treatment, Melanosis -- Demographic aspects, Pregnant women -- Physiological aspects, Pregnant women -- Health aspects, Health
Abstract

Introduction: Melasma is an acquired hypermelanosis of sun-exposed areas. Melasma is much more common in women than in men. Women are affected in 90% of cases. The patient usually presents with tan to brown patches. Multiple factors have been postulated to involve in the etiology and pathogenesis of melasma including pregnancy, oral contraceptives, genetics, sun exposure, cosmetics and race. Objectives: The objectives of the present studies are to study the demographic details of the melasma patients visiting the Manipal Teaching Hospital (MTH), to study the drugs used in management of melasma and to estimate the treatment cost to the patients. Materials and methods: We went through the records of the patient at MTH and found out the number of patients suffering from melasma and other related data from 25th November 2005 to 30th November 2007. The data obtained were analyzed as per the study objectives. Results: Altogether 107 patient files were included in the study. There were 75 (70.09%) females and 32 (29.90%) males (the total is 107). More than 50% of the patients were above the age 20 years. Most common site of occurrence of pigmentation was forehead accounting for 56.45% (n = 70) of the total case followed by cheeks 12.09% (n = 15). Altogether 290 drugs were used in the patients with a Mean [] SD of 2.71 [] 0.89 drugs per patient. The Mean [] SD cost of medications was NRs 458 [] 251.36. Conclusion: The present study analyzed the clinical profile and treatment pattern of the melasma patients visiting MTH. Majority of the patients were of child bearing age. Sun screens were the most commonly employed medications followed by antioxidants 20 (6.89%) and antibiotics 18 (6.2%). Keywords: Clinical profile | Melasma | Nepal, Introduction Melasma is an acquired hypermelanosis of sun-exposed areas. It presents as symmetrical hyperpigmented macules and patches, which can be confluent or punctate. The cheeks, the upper lip, the chin, [...]

Published
2009

111. Diagnosing abdominal tuberculosis: a retrospective study from Nepal

Author

Kishore, P.V., Chandrsekhar, T.S., and Palaian, Subish

Subjects
Tuberculosis -- Diagnosis, Health
Abstract

Table of Contents Abstract Introduction Methodology Results Discussion Conclusion References Abstract Introduction: Tuberculosis (TB) is a common problem in developing countries including Nepal. Abdominal TB accounts for nearly 2% of [...]

Published
2008

112. Preliminary evaluation of use pattern of pneumococcal vaccine in a developing country: a study of 24 cases in a tertiary care hospital in Nepal

Author

Kishore, P.V., Palaian, Subish, and Shankar, P. Ravi

Subjects
Developing countries -- Health aspects, Pneumococcal vaccine -- Dosage and administration, Health promotion -- Evaluation, Health
Abstract

Table of Contents Abstract Introduction Results Discussion Limitation Conclusion References Abstract Background: Respiratory diseases are a common problem in Nepal. Pneumococcal infections are a common cause of respiratory infection in [...]

Published
2007

113. Drug induced macucopapular rash with the commonly used first line antitubercular drug, pyrazinamide

Author

Kishore, P.V., Palaian, Subish, Prabhu, Smitha, Prabhu, Mukhyaprana, and Mishra, Pranaya

Subjects
Pyrazinamide -- Complications and side effects, Rash (Dermatology) -- Risk factors, Drugs -- Adverse and side effects, Drugs -- Research, Health
Abstract

Table of Contents Abstract Introduction Case report Discussion Conclusion References Abstract Pyrazinamide is a commonly used first line antitubercular drug. Gastric related adverse drug reactions are common with pyrazinamide. Dermatological [...]

Published
2007

119. Safety profile of antiretroviral therapy: An urgent need for monitoring

Author

Bhandari, Dhaka Ram, Palaian, Subish, Poudel, Arjun, Mohamed Ibrahim, Mohamed Izham B., Aljadhey, Hisham, Bhandari, Dhaka Ram, Palaian, Subish, Poudel, Arjun, Mohamed Ibrahim, Mohamed Izham B., and Aljadhey, Hisham

Abstract

The diminution of CD4 lymphocytes is the diagnostic characteristic of human immunodeficiency virus (HIV) infection. Since the discovery of the disease 35 years ago, the infection has become one of the greatest menaces for the modern civilization. There are many individual drug toxicities and a number of class-specific or therapy-related toxicities of anti-HIV agents. Hepatotoxicity is a well-recognized side effect developing asymptomatic mild elevation of transaminases. It is known that the incidence of adverse reactions is high in long-term reactions such as lipodystrophy, paresthesia, and neuromotor disorders. Antiretroviral (ARV) therapy is not only effective but also complex. There are many adverse effects of the therapy, which affect varieties of the organ system. To optimize the treatment, health professionals should focus on preventing the adverse effect of ARV agents.

Published
2016

120. Evaluating community pharmacy practice in Qatar using simulated patient method: acute gastroenteritis management

Author

Ibrahim, Mohamed Izham, Palaian, Subish, Al Sulaiti, Fatima, El Shami, Somia, Ibrahim, Mohamed Izham, Palaian, Subish, Al Sulaiti, Fatima, and El Shami, Somia

Abstract

Objective: To evaluate Qatari pharmacists’ prescribing, labeling, dispensing and counseling practices in response to acute community-acquired gastroenteritis.Methods: The simulated patient method was used in this study. Thirty pharmacies in Doha were randomly selected and further randomized into two groups: Face-to-Face (n=15) vs. Telephone-call (n=15) per simulated patient; 2 simulated patients were involved. Prescribing, labeling, dispensing and counseling practices were assessed. Data analysis was performed using Mann-Whitney and chi square tests at alpha=0.05.Results: Most pharmacists prescribed and dispensed medicines (96%), including antimicrobials (43.9%), antidiarrheals (36%), antiemetics (5.1%) and antipyretics (3%). Counseling practices were poor (62.1% in the face-to-face group vs 70% in the telephone-call group did not counsel simulated patients about the dispensed medicines; p-value=0.50). In more than one-third of the encounters, at least one labeling parameter was missing. The duration of each interaction in minutes was not significantly different between the groups [median (IQR); 3(4.25) in the face-to-face group versus 2(0.25) in the telephone-call group; p-value=0.77]. No significant differences in prescribing or dispensing behaviors were present between groups (p-value>0.05).Conclusion: Qatar community pharmacists’ labeling, dispensing, and counseling practices were below expectation, thus urging the need for continuous professional development.

Published
2016

126. Role of pharmacist in counseling diabetes patients

Author

Palaian, Subish, Chhetri, Anupa K., Prabhu, Mukhyaprana, Rajan, Surulivel, and Shankar, P. Ravi

Subjects
Diabetes -- Complications and side effects, Diabetes -- Physiological aspects, Hyperglycemia -- Complications and side effects, Hyperglycemia -- Physiological aspects, Diabetes therapy -- Physiological aspects, Pharmacists -- Physiological aspects, Health
Abstract

Table of Contents Abstract Introduction Diabetes: A Major Global Burden Conclusion References Abstract In the last three decades role of pharmacist has changed dramatically. Presently, the pharmacists are becoming more [...]

Published
2006

127. Valproic acid induced pancreatitis in an Arab Male.

Author

Imam, Ethar, Idrees, Abdulrhman, Ibrahim, Mohamed, and Palaian, Subish

Subjects
VALPROIC acid, DRUG side effects, DRUG monitoring, PANCREATITIS, THERAPEUTICS, PHENOBARBITAL
Abstract

Valproate, a commonly used antiepileptic, is known to cause pancreatitis, which may present days to years after initiation of therapy. A 20-year-old Arab male patient with electroencephalogram (EEG) confirmed epileptiform activity over the left posterior head region was initiated with tablet carbamazepine 400 mg twice daily in the year 2015 and based on subsequent EEG findings (suggestive of more of generalized myoclonic seizure) carbamazepine was withdrawn gradually and started with sodium valproate 500 mg twice daily and levetiracetam 1 g twice daily. During treatment, the patient had status epileptics, treated with diazepam and lamotrigine 50 mg was added. Laboratory data indicated low valproate level, 47 μg/mL (normal range: 50–125 μg/mL) resulting in two episodes of myoclonic jerks necessitating lamotrigine dose escalation (100 mg twice daily). A month later, the patient developed nystagmus and tremors, and lamotrigine dose was deescalated to 75 mg twice daily. Patient was brought to the emergency with severe abdominal pain and vomiting since the day before and valproate level was 179 μg/mL (>150 μg/mL μg/mL is considered toxic), a diagnosis of acute pancreatitis due to valproate was made and the patient was treated in the intensive care unit. The causality assessment of the adverse drug reaction was "probable" (Naranjo score 8), and severity was "Severe" (Level 5; Modified Hartwig and Siegel scale), and the adverse reaction was "Not preventable" (Modified Schumock and Thornton scale). This report suggests the need for constant clinical monitoring and the need for therapeutic drug monitoring for patients undergoing valproate therapy. [ABSTRACT FROM AUTHOR]

Published
2019
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134. Medication storage and self-medication behaviour amongst female students in Malaysia

Author

Ali, Sohair E., Ibrahim, Mohamed I.M., and Palaian, Subish

Subjects
Practice, Conocimiento, Health Knowledge, Attitudes, Malaysia, Self Medication, actitudes y práctica en salud, Auto-medicación, Malasia
Abstract

Objectives: The aims of this study are to determine the prevalence, attitudes and behaviours of medication storage and self-medication amongst female students at Universiti Sains Malaysia (USM). Methods: A cross-sectional survey was conducted and cluster random sampling technique was used for respondent selection. A pre-piloted questionnaire was administered to female respondents so as to collect the data. Data was analyzed using SPSS version 12 and analysis was conducted using descriptive analysis procedures. Results: Of the 481 participants (mean age; SD was 22.1; 3.3), 93.1% (n=448) students stated that they stored medicine in their rooms, while 70.7% (n=340) stated that they stopped taking a prescribed medicine without consulting a doctor. The prevalence of self-medication was 80.9% (n=389). The most common reasons for self-medication were related to their knowledge of their ailment and its treatment (58.0%), 14.4% thought it saved time and 8.5% mentioned that medication given by provider was not effective. The most common symptoms were otorhinolaryngology problems (22.5%), followed by respiratory disease (19.6%), Gastro Intestinal Tract (GIT) disease (18.1%) and headache/fever (16.8%). Commonly used medicines were analgesics & antipyretics (30.2%), ear, nose & throat drugs (10.8%), vitamins & minerals (10.8%), GIT drugs (8.5%), anti-infections (7.3%) and herbal medicines (3.5%). Prevalence of medicine storage and self-medication practice is high among educated female students in USM. Conclusions: There is a need to educate the students to ensure safe practice by increasing their awareness. Strict policies need to be implemented on the unrestricted availability of medicines so as to prevent the wastage of medicines. Objetivos: Los objetivos de este estudio son determinar la prevalencia, actitudes y comportamiento en el almacenamiento de medicamentos y la auto-medicación entre mujeres jóvenes estudiantes en la Universiti Sains Malaysia (USM). Métodos: Se realizó un estudio transversal y se utilizó una técnica de muestreo por cluster para la selección de respondentes. Para recoger los datos, se administró un cuestionario pre-pilotado a las mujeres que respondieron. Los datos fueron analizados utilizando el SPSS versión 12 y el análisis se realizó utilizando procedimientos descriptivos. Resultados: De los 481 participantes (edad media; DE era 22,1; 3,3), el 93,1% (n=448) afirmaron que almacenaban medicamentos en sus habitaciones, mientras que el 70,7% (n=340) afirmó que pararon de tomar un medicamento prescrito sin consultar al médico. La prevalencia de auto-medicación era del 80,9% (n=389). Entre las razones más frecuentes para auto-medicación estaban relacionadas con sus conocimientos de su enfermedad y su tratamiento (58,0%), el 14,4% pensaba que ahorraba tiempo y el 8,5% mencionó que la medicación proporcionada no era efectiva. Los síntomas más frecuentes fueron problemas otorrinolaringológicos (22,5%), seguidos de enfermedades respiratorias (19,6%), del tracto gastrointestinal (TGI) (18,1% y dolor de cabeza/fiebre (16,8%). Los medicamentos frecuentemente utilizados eran analgésicos y antipiréticos (30,2%), medicamentos para nariz, garganta y oídos (10,8%), vitaminas y minerales (10,8%) y plantas medicinales (3,5%). La prevalencia del hábito de almacenar medicamentos y de auto-medicación es alta entre las mujeres estudiantes de la USM. Conclusiones: Existe la necesidad de educar a los estudiantes para garantizar la práctica segura aumentando sus conocimientos. Se necesita implantar políticas estrictas sobre la disponibilidad irrestricta de medicamentos así como para prevenir el desperdicio de medicamentos.

Published
2010

135. Pattern of adverse drug reactions reported by the community pharmacists in Nepal

Author

Palaian, Subish, Ibrahim, Mohamed I.M., and Mishra, Pranaya

Subjects
Farmacéuticos, Nepal, Sistemas de comunicación de reacciones adversas de medicamentos, Servicios de farmacias comunitarias, Adverse Drug Reaction Reporting Systems, Community Pharmacy Services, Pharmacists
Abstract

The pharmacovigilance program in Nepal is less than a decade old, and is hospital centered. This study highlights the findings of a community based pharmacovigilance program involving the community pharmacists. Objectives: To collect the demographic details of the patients experiencing adverse drug reactions (ADR) reported by the community pharmacists; to identify the common drugs causing the ADRs, the common types of ADRs; and to carry out the causality, severity and preventability assessments of the reported ADRs. Methods: The baseline Knowledge-Attitude-Practices (KAP) of 116 community pharmacists from Pokhara valley towards drug safety was evaluated using a validated (Cronbach alpha=0.61) KAP questionnaire having 20 questions [(knowledge 11, attitude 5 and practice 4) maximum possible score 40]. Thirty community pharmacists with high scores were selected for three training sessions, each session lasting for one to two hours, covering the basic knowledge required for the community pharmacists for ADR reporting. Pharmacist from the regional pharmacovigilance center visited the trained community pharmacists every alternate day and collected the filled ADR reporting forms. Results: Altogether 71 ADRs, from 71 patients (37 males) were reported. Antibiotics/ antibacterials caused 42% (n=37) of the total ADRs followed by non steroidal anti-inflammatory drugs [25% (n=22)]. Ibuprofen/paracetamol combination accounted for ten ADRs. The most common type of ADR was itching [17.2 % (n=20), followed by generalized edema [8.6 % (n=10)]. In order to manage the ADRs, the patients needed medical treatment in 69% (n=49) of the cases. Over two third (69%) of the ADRs had a "possible" association with the suspected drugs and a high percentage (70.4%) were of "mild (level 2)" type. Nearly two third [64.7 % (n=46)] of the ADRs were "definitely preventable". Conclusion: The common class of drugs known to cause ADRs was antibacterial/ antibiotics. Ibuprofen/ Paracetamol combination use of the drug was responsible for more number of ADRs and the most common ADRs were related to dermatological system. Strengthening this program might improve safe use of medicines in the community. El programa de farmacovigilancia de Nepal tiene menos de una década de antigüedad, y está centrado en los hospitales. Este estudio muestra los resultados de un programa de farmacovigilancia comunitario, que involucra a farmacéuticos comunitarios. Objetivos: Recoger detalles demográficos del número de pacientes que sufren reacciones adversas a medicamentos (RAM) comunicadas por farmacéuticos comunitarios; identificar los medicamentos que causan las RAM y los tipos comunes de RAM; y realizar las evaluaciones de causalidad, gravedad y preventabilidad de las RAM reportadas. Métodos: Se evaluó, mediante un cuestionario validado (Cronbach alfa=0.61) 20 preguntas [(conocimiento 11, actitud 5 and práctica 4) máxima puntuación posible score 40], el valor inicial de Conocimiento-Actitudes-Práctica (KAP) de 116 farmacéuticos comunitarios del valle de Pokhara. Se selección a los 30 farmacéuticos comunitarios con puntuaciones más altas para realizar 3 sesiones formativas, cada sesión duraba de una a dos horas, que cubrían los conocimientos básicos que requerían los farmacéuticos para comunicar RAM. Los farmacéuticos del centro regional de farmacovigilancia visitaron a los farmacéuticos comunitarios formados en días alternos y recogieron las comunicaciones rellenas. Resultados: Se comunicaron 71 RAM de 71 pacientes (37 hombres). Los antibióticos/antibacterianos causaron el 42% (n=37) del total de RAM, seguidos de los antiinflamatorios no esteroidicos [25% (n=22)]. La combinación ibuprofeno/paracetamol totalizó 10 RAM. El tipo de RAM más frecuente fue el picor [17.2 % (n=20)], seguido del edema generalizado [8.6 % (n=10)]. Para resolver las RAM, el 69% del total de los pacientes (n=49) requirió tratamiento médico. Mas de 2 tercios de las RAM (69%) tenia una "posible" asociación con el medicamento sospechoso, y un alto porcentaje (70.4%) eran de tipo "suave (nivel 2)". Cerca de 2 tercios de las RAM [64.7 % (n=46)] eran "claramente prevenibles". Conclusión: El grupo más común que causo RAM fueron los antibacterianos/antibióticos. La combinación ibuprofeno/paracetamol fue responsable del mayor numero de RAM y las RAM más frecuentes estaban relacionadas con el sistema dermatológico. Reforzar este programa podría mejorar el uso seguro de medicamentos en la comunidad.

Published
2010

136. Pattern and quality of scientific communications on drug safety produced by a regional pharmacovigilance center in Nepal

Author

Palaian, Subish, Ibrahim, Mohamed I., and Mishra, Pranaya

Subjects
Nepal, Adverse Drug Reaction Reporting Systems, Revistas como tema, Periodicals as Topic, Sistemas de comunicación de reacciones adversas medicamentosas
Abstract

Analyzing the pattern and quality of scientific communications on pharmacovigilance can help the regional centers in Nepal and other developing countries to develop approaches for communicating effectively medicine safety issues. This kind of research is lacking in developing countries. Objectives: To analyze the pattern and quality of scientific communications on drug safety produced by the regional pharmacovigilance center at western Nepal. Methods: Various conference abstracts and journal publications produced by the center during its initial four years of establishment (14th September 2004 till 13th September 2008) were identified. These communications were categorized in to case reports, review articles, conference presentations, short communications, newsletter and bulletin articles, original research and case series. In addition, the quality of the case reports were evaluated as per International Society of Pharmacovigilance/International Society of Pharmacoepidemiology (ISoP/ISPE) guidelines on the requirements for submitting case reports on adverse event reports in biomedical journals. Results: During the study period, 53 scientific communications were produced by the staff of the regional pharmacovigilance center in relation with drug safety. Among these, 18 (34%) were related to case reports and letters. The median (interquartile range) age of the patients described in the case reports was 46.5 (21.7-51.2) years. Among the total 18 ADRs, four were fixed drug eruptions, followed by contact dermatitis (n=2). Majority of the published case reports were related to skin (n=13; 72.2%). Antimicrobials were responsible for 27.8% (n=5) of the case reports. Among the 18 case reports published by the pharmacovigilance center, a majority followed the ISoP/ISPE guidelines. Few parameters like physical examination of the patient experiencing ADR, patient disposition, dosage and administration of the suspected drugs, and drug-reaction interface were missing in few of the cases. Conclusion: A high percentage of the scientific communications were "case reports". A high proportion of the case reports produced by the center were of international standards. There were lacunae in "patient disposition" in few of the reports. Analizar el patrón y la calidad de las comunicaciones científicas en farmacovigilancia puede ayudar a los centros regionales de Nepal y de otros países en desarrollo a desarrollar abordajes de comunicación efectiva de los problemas de seguridad de los medicamentos. Este tipo de investigación no existe en los países en desarrollo. Objetivos: Analizar el patrón y la calidad de las comunicaciones científicas sobre seguridad de medicamentos producidas por el centro regional de farmacovigilancia de Nepal oriental. Métodos: Se identificaron los resúmenes de conferencias y las publicaciones en revistas producidas pro el centro durante sus cuatro años iniciales desde el establecimiento (14 de septiembre de 2004 a 13 de septiembre de 2008). Estas comunicaciones fueron clasificadas en reporte de casos, artículos de revisión, presentaciones en conferencias, comunicaciones breves, newsletter y artículos de boletín, investigaciones originales y series de casos. Además, se evaluó la calidad de los reportes de casos según las guías requisitos para enviar a revistas biomédicas los reportes de casos sobre comunicaciones de eventos adversos de la International Society of Pharmacovigilance / International Society of Pharmaepidemiology (ISoP/ISPE). Resultados: Durante el periodo de estudio, se produjeron 53 comunicaciones científicas por el personal del centro regional de farmacovigilancia sobre seguridad de medicamentos. De estas, 18 (34%) estaban relacionadas con reportes de casos y cartas. La media (rango inter-cuartilico) de edad de los pacientes descritos en los reportes de casos fue de 46,5 (21,7 - 51,2) años. Del total de 18 RAM, 4 fueron erupciones de medicamentos, seguidas de dermatitis de contacto (n=2). La mayoría de los reportes de casos publicados estaban relacionados con la piel (n=13; 72,2%). Los antimicrobianos fueron responsables por el 27,8% (n=5) de los reportes de casos. Entre los 18 reportes publicados por el centro de farmacovigilancia, la mayoría siguió las guías de la ISoP/ISPE. En unos pocos casos faltaban algunos elementos como examen físico del paciente que sufrió la RAM, disposición del paciente, dosis y administración del medicamento sospechoso, y medio de la reacción medicamentosa. Conclusión: Un elevado porcentaje de las comunicaciones científicas eran reportes de casos. Una alta proporción de los reportes producidos por el centro seguían los estándares internacionales. Existe una laguna en "la disposición del paciente" en algunos de los reportes.

Published
2010

137. Parent’s knowledge and management of their children’s ailments in Malaysia

Author

Dawood, Omar T., Ibrahim, Mohamed I.M., and Palaian, Subish

Subjects
Parents, Practice, Conocimientos, práctica sobre salud, Health Knowledge, Attitudes, Malaysia, Padres, Malasia, actitudes
Abstract

Minor ailments like sore throat, fever, cough and diarrhea can be relieved with over-the-counter (OTC) medications such as paracetamol or other traditional remedies, without seeking for consultation from general practitioners. Parents usually take the responsibility to come up with some kind of treatment for their children. Objective: (1) to evaluate the parents´ medical knowledge about OTC medicines which are usually used by the parents to treat their children and (2) to evaluate the parents´ management in dealing with their children´s ailments, and (3) to evaluate the association between medical knowledge and the management of children´s ailments related to medicine use among the parents. Methods: A cross-sectional survey was conducted to measure the parents´ knowledge about their children´s ailments. Subjects were selected and information was obtained in September 2008. Non-probability convenient sampling method was used. Parents were recruited from the general public to answer the questionnaires. Results: 197 parents filled in the questionnaires. From the total respondents, 48.2% of them were male. This study showed that most respondents have medium knowledge (6.11 SD=3.6) and a moderate management (4.39 SD=2.7). The results showed that there is a significant difference between the knowledge and the management level of ailments (P=0.033). Regarding the education level of the parents and the socioeconomic status, the p-value showed there was a significant difference between parents´ knowledge and their education level (P=0.012). Conclusion: This study showed that parents have inadequate knowledge and some misconception about how to go about treating their children when they are unwell. It is hoped that by identifying weak areas in parents´ management to their children´s ailments, better planned educational and behavioral modification efforts can be made to elevate the knowledge level among the parents when they medically treat their children. Las dolencias menores como irritación de garganta, fiebre, tos y diarrea pueden aliviarse con medicamentos over-the-counter (OTC) como el paracetamol u otros remedios tradicionales, sin posterior consulta al médico general. Los padres, generalmente, toman la responsabilidad de identificar algún tipo de tratamiento para sus hijos. Objetivo: (1) evaluar los conocimientos médicos de los padres sobre los medicamentos OTC que usan habitualmente para tratar a sus hijos; (2) evaluar el manejo de los pares al tratar las dolencias menores de sus hijos; y (3) evaluar la asociación entre los conocimientos médicos y el manejo de las dolencias menores de los niños en relación al uso de medicamentos entre los padres. Métodos: Se realizó un estudio transversal para medir los conocimientos de los padres sobre las dolencias de sus hijos. Se seleccionó a los individuos y se obtuvo la información en septiembre de 2008. Se utilizó un muestreo no probabilístico de conveniencia. Se reclutó a los padres para responder los cuestionarios entre el público general. Resultados: 197 padres rellenaron el cuestionario. Del total de respondentes, el 48,2% eran hombres. Este estudio mostró que la mayoría de los respondentes tenían un conocimiento medio (6,11; DE=3,6) y un manejo moderado (4,39; DE=2,7). Los resultados mostraron que hay una diferencia significativa entre nivel de conocimiento y manejo de las dolencias (P=0,033). En relación al nivel educativo de los padres y el estado socio-económico, los valores p mostraron que había una diferencia significativa entre el conocimiento de los padres y su nivel educativo (P=0,012). Conclusión: Este estudio mostró que los padres tienen un conocimiento inadecuado y algunos malos entendidos sobre cómo tratar a sus hijos cuando no se encuentran bien. Se espera que identificando los puntos débiles del manejo de los padres de las dolencias de sus hijos, se puedan realizar planes educativos y esfuerzos de modificaciones actitudinales para elevar el nivel de conocimiento entre los padres cuando tratan médicamente a sus hijos.

Published
2010

138. Fairness creams in South Asia--a case of disease mongering?

Author

Shankar, P. Ravi, Giri, Bishnu Rath, and Palaian, Subish

Abstract

We read with interest the article by Moynihan and Henry on disease mongering [1]. The authors argued that disease mongering is the opportunistic exploitation of a widespread anxiety about frailty [...]

Published
2006

140. Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal

Author

Bista,Durga, Saha,Archana, Mishra,Pranaya, Palaian,Subish, and Shankar,Pathiyil R.

Subjects
Inpatients, Nepal, Drug Interactions, Continuing, Education
Abstract

Objective: To study the impact of educational intervention on the pattern and incidence of potential drug-drug interactions (DDIs). Method: All patients admitted to Internal Medicine wards of Manipal Teaching Hospital during the study period were included. Patient details were collected using a patient profile form and the datum from the filled forms was analyzed using Micromedex electronic database. An intervention was carried out through a presentation during clinical meeting and personal discussion. The target groups for the intervention included doctors and the nurses. Results: Altogether 435 patients during preintervention and 445 during postintervention were studied. The incidence of potential DDIs was 53% (preintervention) and 41% (postintervention) [chi-square =11.27, p=0.001]. The average number of drugs per patient was 8.53 (pre-intervention) and 7.32 (post-intervention) [t=3.493, p=0.001]. Sixty-four percent of the potential DDIs were of "Moderate" type and 58% had a "Delayed" onset in both the phases. Seventy percent of the potential DDIs during the pre-intervention phase and 61% during post-intervention phase had a "Good" documentation status. Pharmacokinetic mechanism accounted for 45% of the potential DDIs during pre-intervention and 36% in the post-intervention phase. Cardiovascular drugs accounted for 36% of the potential DDIs during pre-intervention and 33.2% during post-intervention phase. Furosemide was the high risk drug responsible for DDIs in both phases. The most common potential DDIs observed were between amlodipine and atenolol (4.82%) (preintervention) and frusemide and aspirin (5.20%) (postintervention). Conclusion: There was an association between potential DDIs and age, sex, and polypharmacy.

Published
2009

141. Health professionals´ knowledge, attitude and practices towards pharmacovigilance in Nepal

Author

Palaian, Subish, Ibrahim, Mohamed Izham, Mishra, Pranaya, Palaian, Subish, Ibrahim, Mohamed Izham, and Mishra, Pranaya

Abstract

Pharmacovigilance can be helpful in protecting consumers from harmful effects of medicines. Healthcare professionals should consider Adverse Drug Reaction (ADR) reporting as their professional obligation and should be aware of the existing pharmacovigilance mechanisms in their countries. In Nepal, pharmacovigilance activities were initiated in 2004. Objectives: The present study evaluated the knowledge, attitude and practices (KAP) of the healthcare professionals towards ADRs and pharmacovigilance in Manipal Teaching Hospital (MTH), a tertiary care teaching hospital attached to the regional pharmacovigilance center in western Nepal. Methods: A cross-sectional study was carried out in 2007 using a pretested (Cronbach alpha=0.72) questionnaire having 25 questions (15 questions on knowledge, 5 on attitude and 5 on practice). The correct/positive responses were given a score of 2 and the wrong/negative responses 1, maximum possible score of 50. Results: A total of 131 responses were obtained among which 42 were incomplete and remaining 89 [females 49 (55.1%)] were analyzed. Of the 89 professionals, 29 (32.6%) were doctors, 46 (51.8) nurses and 14 (15.7%) pharmacists. The mean age was 28.32 (SD=8.46) years and the median (interquartile range) of duration of the service 14.5 (6-36) months. The total KAP scores was 40.06 (SD=3.51) for doctors, 38.92 (SD=4.83) for pharmacists, and 35.82 (SD=3.75) for nurses. Among the 89 professionals, 59 (62.3%) had not reported even a single ADR to the pharmacovigilance center. Conclusion: The healthcare professionals at the MTH had a poor KAP towards ADRs and pharmacovigilance and there is a need for educational and awareness intervention for these professionals., La farmacovigilancia puede ser útil para proteger a los consumidores de los efectos dañinos de los medicamentos. Los profesionales de la salud deberían considerar la comunicación de reacciones adversas de medicamentos (RAM) como una obligación profesional y deberían conocer los mecanismos de farmacovigilancia que existen en sus países. En Nepal, las actividades de farmacovigilancia comenzaron en 2004. Objetivos: El presente estudio evaluó el conocimiento, actitudes y prácticas (KAP) de los profesionales de la salud hacia las RAM y la farmacovigilancia en el Hospital Universitario de Manipal (MTH), un hospital universitario terciario ligado al centro regional de farmacovigilancia del Oeste de Nepal. Métodos: Se realizó un estudio transversal en 2007 usando un cuestionario pre-evaluado (alfa de Cronbach=0,72) que tenía 25 preguntas (15 sobre conocimiento, 5 sobre actitudes y 5 sobre práctica). A las preguntas correctas se les dio una puntuación de 2 y a las respuestas incorrectas/negativas se les dio un 1, con una puntuación máxima de 50. Resultados: Se obtuvieron un total de 131 respuestas de las que 42 estaban incompletas y las restantes 89 se analizaron [49 mujeres (55,1%)]. De los 89 profesionales, 29 (33,6%) eran médicos, 46 (51,8%= enfermeras y 14 (15,7%) farmacéuticos. La media de edad era de 28,32 años (DE=8,46) y la media (rango intercuartílico) de la duración en el servicio fue 14,5 meses (6-36). Las puntuaciones totales de KAP fueron 40,06 (DE=3,51) para médicos, 39,92 (DE=4,83) para farmacéuticos y 35,82 (DE=3,75) para enfermeras. Entre los 89 profesionales, 59 (62,3%) no comunicaron ni una sola RAM al centro de farmacovigilancia. Conclusión: Los profesionales de la saludo del MTH tienen pobre KAP sobre las RAM y la farmacovigilancia, y se necesita una intervención educativa y sobre el conocimiento para estos profesionales.

Published
2011

142. Oncology pharmacy practice in a teaching hospital in Nepal

Author

Khanal, Saval, Poudel, Arjun, Sharan, Krishna, Palaian, Subish, Khanal, Saval, Poudel, Arjun, Sharan, Krishna, and Palaian, Subish

Abstract

Objective. To highlight the patient care activities performed by pharmacists during their ward rounds in medical oncology ward of a tertiary care hospital in western region of Nepal. Methods. The study was conducted for 3 months. Two pharmacists joined the clinicians and nurses in the ward rounds every morning as a member of healthcare team. The data used in this study was obtained from different documented files in hospital and were analyzed as per study objectives. Results. During 3 months (May 20, 2008 to August 20, 2008), pharmacists provided answers to eight queries asked by clinicians and nurses for the patient care purpose. During the same period pharmacists detected four cases of medication errors and provided suggestions on them. A total of 30 adverse drug reaction (ADR) reports were reported to the regional pharmacovigilance center during the study time. Altogether there were 84 types of adverse drug reaction seen on those patients. Most of them were related to hematological system. Conclusion. The study evaluated the drug information provided by pharmacists, spontaneous reporting of ADRs by the pharmacists, and their intervention on treatment plan of patients during ward round. This suggests pharmacists can play a significant role on patient care when he or she joins round with other healthcare personnel in the oncology ward

Published
2010

143. Fixed dose combination antimicrobials practices in Nepal - review of literature

Author

Alam, Kadir, Poudel, Arjun, Palaian, Subish, Alam, Kadir, Poudel, Arjun, and Palaian, Subish

Abstract

Antibacterial drugs are one used commonly as fixed dose combination. The use of fixed dose combination antimicrobials is more common in developing countries. There are several studies which suggest extensive use of fixed dose combination antimicrobials drugs in Nepal. Although thousands of fixed dose combination are available in world market, WHO has approved only 25 fixed dose combination in 15th edition of WHO essential drug list. Even if some of the fixed dose antimicrobial offer some benefit in treatment of disease like Tuberculosis, Leprosy etc., majority of irrational fixed dose antimicrobials has major contribution in resistance development, decrease the flexibility of prescriber and increase the misuse by selfmedication. To minimize the extensive use of fixed dose combination of antimicrobials certain measure like developing guideline for preparing of combination product, evaluation of product before registration, banning of irrational IFDC antimicrobials, strict monitoring, strict antibiotic policy, hospital antibiotic policy etc., will be helpful. In the developing world where resistance to antimicrobials is increasing, minimizing the use of irrational fixed dose combination antimicrobials can be better tool to combat with the resistance.

Published
2010

144. Introducing pharmacovigilance to postgraduate pharmacy students in Nepal (Letter)

Author

Palaian, Subish, Khanal, Saval, Alam, Kadir, Poudel, Arjun, Palaian, Subish, Khanal, Saval, Alam, Kadir, and Poudel, Arjun

Abstract

Pharmacovigilance is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. Pharmacovigilance programs can play an important role in early detection and prevention of adverse drug reactions (ADRs). Healthcare professionals should be aware of the existing pharmacovigilance programs in their country and should report (ADRs) as a part of their professional obligation. The pharmacist can promote the development, maintenance, and ongoing evaluation of a program to reduce the risks of ADRs by detecting, reporting, and assessing any suspected ADRs. A pharmacist can educate the staff (physicians, nurses, etc.) and encourage compliance with the ADR reporting program. Studies from both developed and developing countries document a poor knowledge of, attitude toward, and practice of pharmacovigilance among pharmacists.

Published
2009

145. Irrational fixed dose combinations in Nepal: Need for intervention

Author

Poudel, Arjun, Palaian, Subish, Shankar, P. Ravi, Jayasekera, Jinani, Izham Mohamed Ibrahim, Mohamed, Poudel, Arjun, Palaian, Subish, Shankar, P. Ravi, Jayasekera, Jinani, and Izham Mohamed Ibrahim, Mohamed

Abstract

A large proportion of drugs available are of little importance in terms of fulfilling primary healthcare needs. Combination drugs increase the risk of side effects, lead to an ineffective dosage and liability to abuse and may also needlessly increase the cost. Drug combinations make it more difficult to find the causative agent responsible for the adverse reactions. In many cases their stability is doubtful, reducing the efficacy of many preparations. The Fifteenth WHO model list of essential medicines (March 2007) contains only 25 approved fixed dose combinations, whereas in Nepal, there are innumerable examples of irrational drug combinations, which are easily available and can be bought even without a prescription. A system of screening the drug combinations that are already licensed and available in the market is implemented in many developed and developing countries. Rational combinations can be of immense help to the health care system. These combinations may improve the quality of life for many and increase compliance. But irrational fixed dose combination products can be equally harmful.

Published
2008

147. Prevalence of vincristine induced-peripheral neuropathy among Sudanese cancer patients.

Author

Imam, Ethar Abdelmageed, Ibrahim, Alnada, Palaian, Subish, and Ibrahim, Mohamed Izham Mohamed

Subjects
VINCRISTINE, VINCAMINE, ALKALOIDS, ANTINEOPLASTIC agents, NERVOUS system abnormalities
Abstract

Background: Increasing clinical evidence suggests treatment of cancer with neurotoxic agents results in some degree of peripheral neuropathy. Objective: The main objective of the study was to evaluate vincristine induced peripheral neuropathy among Sudanese cancer patients. Methods: A descriptive cross-sectional study was carried out at Radiation and Isotopes Center, Khartoum State, Sudan. All patients suffering from cancer with an age of 18 to 65 years were reviewed. A self-developed data collection form was used to collect the demographic data; drug use history; medical diseases; and vincristine cycles. The World Health Organization criteria were used to grade the side-effects. Data was collected for a period of two months and were analyzed descriptively. Results: Out of 78 patients reviewed, majority were females (n=47, 60.3%). Most of the patients were in the age group of 18-30 (n=27, 34.6%) and 51-60 (n=27, 34.6%) years. Twenty six (33.3%) of the patients took analgesic and 15.3% (n=12) experienced hypertension. Most of the patients went through more than 6 cycles of therapy with vincristine (n=24, 30.9%). Our study showed that 'altered bowel function (i.e constipation)' was the most important neuropathic change, which occurred in 62 (79.5%) of the patients who received vincristine. The second common neuropathic change was the 'lack of ability to go upstairs un-aided', which occurred in 37 (47.4%) of patients receiving vincristine. Majority of the patients (n=37, 47.5%) showed mild paresthesia as graded by the 'WHO grading scale'. Conclusion: More than three-fourth of the cancer patients experienced vincristine induced peripheral neuropathy. Healthcare professionals need some understanding regarding medical management that may decrease occurrence of neuropathy and a better planning and implementing special care for patients at risk. [ABSTRACT FROM AUTHOR]

Published
2016
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150. Letters to the Editor

Author

Malik, Madeeha, primary, Hassali, Mohamed AA, additional, Shafie, Asrul A, additional, Hussain, Azhar, additional, Sandhu, Geeta, additional, Dionysopoulos, Dion, additional, Phillips, Cameron J, additional, Tomlin, Angela C, additional, Doherty, Paula, additional, Whitfield, Karen, additional, Polasek, Thomas M, additional, Lin, Frank PY, additional, Doogue, Mathew P, additional, Amir, Muhammad, additional, Ellis, David P, additional, Hassali, Mohamed Azmi Ahmad, additional, Shafie, Asrul Akmal, additional, and Palaian, Subish, additional

Published
2011
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