As a chronic illness, tuberculosis is known to negatively affect patients' day-to-day functioning. Therefore, evaluating all aspects of their health is imperative to improve their quality of life. The current study was conducted to assess the quality of life of patients receiving tuberculosis therapy and to identify the associated risk factors. A prospective, cross-sectional study of six months was planned and conducted in 66 Mycobacterium tuberculosis-infected patients who justified the pre-defined inclusion criteria. All pertinent data about the patients were collected in a precisely created data collection form. Further, the brief version of the World Health Organization Quality of Life Questionnaire was used to evaluate the patients’ quality of life. Of the 66 patients who were enrolled, 42 (63.6%) were male, and 14 (21.2%) belonged to the age group of 61-70 years. The domains of physical, psychological, social relationships, and environment had mean scores of 46.76±20.15 standard deviation (SD), 55.02±16.12 SD, 54.83±13.91 SD, and 64.92±14.59 SD, respectively. All four quality-of-life domains were found to have statistically significant associations with a variety of sociodemographic and treatment-related variables. This study gives healthcare practitioners an insight into the need to evaluate patients' health-related quality of life, particularly for individuals with chronic illnesses.

Poor sleep quality in older adults can lead to poorer quality of life. To identify the predominant factors that best predict sleep quality amongst older adults. A prospective cross-sectional study was carried out among 310 older adults (≥ 60 years) in the Department of General Medicine of a tertiary care hospital for a duration of 6 months. The Pittsburgh Sleep Quality Index (PSQI) questionnaire and a validated data collection form were used to gather the data and assessed using Statistical Package for Social Sciences (SPSS) version 20. Out of 310 older adults, 71.3

Background Anxiety is widely prevalent among patients planned for surgery in orthopedics department and it continues to go unnoticed and undertreated. Aim and objectives The present study was carried out to assess the pre-operative anxiety among patients scheduled for surgery in the department of orthopedics and find out the factors associated with it. Materials and methods A prospective cross-sectional study of eight months duration was carried out among 384 subjects proposed to undergo surgery in the department of orthopedics. The socio-demographic details and other relevant information pertaining to the subjects were collected in a well-designed data collection form. The level of anxiety of the subjects was assessed using GAD-7 scale. Chi-square test was performed to analyse the categorical variables and ordinal logistic regression was used to identify the related factors. p-value <0.05 was considered as statistically significant. Results Among the total subjects enrolled in the present study, 95 (24.7%) were found to have mild level of anxiety, 223 (24.7%) with moderate level and 66 (17.2%) with severe anxiety. Various factors of fear including the fear of surgical procedure (p<0.001), result of surgery (p<0.001), post-operative pain (p=0.001), hospital environment (p=0.004) and anaesthesia (p=0.012) were found to be the factors associated with severe anxiety. Conclusion The present study provides an insight to the healthcare professional on the essentiality of assessing anxiety and adopting appropriate interventions to address the issue among patients proposed with surgical interventions in department of orthopedics.

Background/Purpose: Drug related problems (DRPs) are common and geriatric patients living with psychiatric disorders are at a greater risk of DRPs due to many factors including polypharmacy which contributes to drug-drug interactions and alterations in pharmacokinetics that occur with age. The present study aims to identify and assess the different drug-related problems among geriatric inpatients of the psychiatry department using the APS-DoC classification system. Methods: A retrospective observational study was conducted over 6 months among the geriatric inpatients, aged 60 years and above, in the psychiatric department. All the deteils pertaining to the patients were collected from their case files in the Medical Records Department at the study site. The data was sampled from a two year period between January 2017 to December 2019. Data analysis was carried out using a statistical analysis package for social sciences (SPSS) 26.0. Results: Out of 180 patients enrolled in the study, 149 (82.77%) were identified to be present with a total of 236 DRPs. Using the APS-Doc classification system, it was found that the most frequent DRP was potential drug-drug interaction, 121 (51.27%), followed by Adverse Drug Reactions (ADRs), 63 (26.69%). Quetiapine and Risperidone were found to be the drugs causing a majority of the DRPs, followed by clonazepam. Presence of co-morbidities (p=0.001) was found to have statistically significant association with the occurrence of DRPs. Conclusion: Clinical pharmacists play a crucial role in the timely identification of DRPs and further help other members of the multidisciplinary healthcare team to address the issue and prevent its future occurrence. ISSN 2663-8851/Copyright (c) 2023, Asian Association for Frailty and Sarcopenia and Taiwan Association for Integrated Care. Published by Full Universe Integrated Marketing Limited.

Background: Adequate knowledge, attitude and practices about the use of antibiotics are essential for effective treatment and the cure of diseases. Objective: To assess the knowledge, attitude and practice towards the use of antibiotics among the outpatients of the general medicine department and to find the factors that are significantly associated with it. Materials and methods: A prospective cross-sectional study of eight months duration was carried out among 263 outpatients, in the department of general medicine. The socio-demographic details pertaining to the patients were collected in a well-designed data collection form. The knowledge, attitude and practice of the subjects were assessed by using previously validated KAP questionnaire. Results: The highest number of subjects were found to be females, 135 (51.3%), and most of the subjects belonged to the age category of 18–34 years, 107 (40.7%). The mean score of knowledge, attitude and practice were found to be 62.74 ± 23.28, 76.96 ± 17.73, and 52.55 ± 14.06 respectively. Age, domiciliary status, educational qualification, occupation, and socio-economic class were found to be the factors significantly associated with knowledge. Factors significantly associated with attitude were found to be age, educational qualification and socio-economic class whereas only educational qualification and occupation were found associated with practice. Conclusion: The results of the current study will serve as the foundation for future implications to enhance public knowledge and perceptions regarding antibiotic usage.

Background/Purpose: The main purpose of this study is to analyse the prescription pattern among geriatrics by using Beers and the START/STOPP criteria and to assess the frequency of poly-pharmacy in geriatric patients. Methods: A prospective study of eight months was conducted among the elderly in- patients aged above 65 years old. Patient's demographics, diagnosis, and details on drug therapy were documented. Inappropriateness of prescription were analysed using AGS 2015 Beer's and STOPP/ START criteria and further comparison was done between both criteria. The frequency of polypharmacy was documented and analysed. Results: A total of 385 patients were enrolled as per the inclusion criteria. While analysing 385 prescriptions, it was found that 73 (19.0%), 16 (4.2%) and 52 ( 13.5%) prescriptions were inappropriate according to STOPP criteria, START criteria and Beer's criteria respectively. 34.0% of the total prescriptions had major polypharmacy, 46.5% with minor polypharmacy and no polypharmacy was observed in 19.5% of the prescriptions. Majority of the patients were diagnosed with hypertension (n (%) = 228(59.2%)), followed by diabetes (n (%) = 150 ( 39%), COPD ( n (%) = 92 (23.9%) and the most inappropriately prescribed drugs were clonidine (n (%) = 16 (4.2%)), followed by prazosin (n (%) = 11 (2.9%)) and lorazepam (n (%) = 7 (1.8%)). Conclusion: The inappropriateness of medication was directly proportional to the number of medications. It vividly states that polypharmacy can be one of the main reasons to bring forth inappropriateness in prescription.

Aims: The present study was conducted to assess the level of medication adherence and factors affecting adherence among Type-2 Diabetes Mellitus (T2DM) patients. Methods: A prospective cross-sectional study was carried out among T2DM patients who were presented to the outpatient department of general medicine. A well-designed data collection form was used to gather information pertaining to various socio-demographic and medical variables. A previously validated and translated 8-item self-reported questionnaire was used to assess the level of medication adherence. Data was analysed using SPSS Version 29.0. Results: Among the total 369 subjects enrolled, a majority were found to be males, and the mean age of the population was observed as 56.84 11.32. A total of 125 (33.8%) subjects were found to be within the cate-gory of high adherence, 161 (43.6%) subjects were found to have moderate level of adherence and 83 (22.4%) had low level of adherence. On analysis, various medical variables were found to have a statistically signifi-cant association with medication adherence. Conclusion: The findings of the present study would form the basis for all the future implications including education intervention programmes to improve the level of adherence towards anti-diabetic medications, which ultimately results in better health outcomes. (c) 2023 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Objective. - To assess the impact of education among pharmacy students on their level of knowledge, attitude and practices in the disposal of expired and unused medications. Materials and methods. - A pre-test post-test study without control group was conducted in which a total of 573 students pursuing Bachelor of Pharmacy and Doctor of Pharmacy programmes were enrolled. The impact of education provided was analysed with the aid of a previously validated KAP questionnaire. Data on KAP was analysed using SPSS software 24.0. Results and discussion. - The knowledge, attitude and practice of the total students improved from 74.17 +/- 17.063 to 91.06 +/- 11.87, 75.92 +/- 19.26 to 91.73 +/- 12.318 and 43.11 +/- 22.77 to 82.06 +/- 16.149 respectively. The improvement with respect to knowledge and attitude was significantly high among Doctor of Pharmacy students when compared to Bachelor of Pharmacy, with P value< 0.001 for both domains. Conclusion. - The present study concludes on the effectiveness of educational intervention in generating a positive impact on the student population with respective to adequate disposal practices to be followed for unused and expired medications. (c) 2022 Academie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Background/Purpose: Elderly patients are at a high risk of developing drug related problems. Hence, the current study was carried out to analyze various drug related problems (DRPs) among the geriatric inpatients of the general medicine department using APS-Doc classification system as well as to find out the factors significantly associated with them. Methods: A retrospective cross-sectional study of six months duration was conducted among 360 inpatients. Patient data collection form and DRP documentation form was prepared as per the need for the study. The relevant socio-demographic as well as the drug therapy details of the patients satisfying the inclusion criteria were recorded. Once a DRP was identified, it was categorized based on APS-Doc classification system and further analyzed using statistical package for the social sciences (Statistical Product and Service Solutions, SPSS) 26.0. Results: Among 360 patients enrolled, 254 presented a total of 681 DRPs. Majority of the DRPs were found among the males 150 (58.8%), and patients belonging to the age category of 65-69 years, 85 (33.3%). Among the various categories of DRPs, the highest identified were drug-drug interactions as indicated by literature 452 (66.5%), followed by incorrect spelling of the trade names 133 (19.5%), and adverse drug reactions (ADRs) 48 (7.0%). Aspirin was identified as the drug associated with highest number of DRPs, 47 (4.4%). Presence of co-morbidities (p=0.038), including hypertension (p=0.025), was found to have statistically significant association with DRPs. Conclusion: The study concluded drug-drug interactions as the major type of DRPs and presence of co-morbidities had significant association with their incidence. Copyright (c) 2021, Asian Association for Frailty and Sarcopenia and Taiwan Association for Integrated Care. Published by Full Universe Integrated Marketing Limited.

BackgroundDrug-drug interaction alters the efficacy of the drugs. Early identification can reduce unintended therapeutic outcomes.ObjectiveThe main objective of the present study was to assess the drug-drug interactions among patients with psychiatric disorders.MethodologyA prospective observational study was conducted for a period of eight months. A total of 112 psychiatric inpatients were enrolled in the study. The patients were monitored regularly to identify the incidence of potential and actual drug-drug interactions. The identified interactions were analyzed for their severity by using various standard references which included published scientific articles, online databases (e.g., UpToDate) and standard textbooks.Results and DiscussionThe mean age of the study population in years was found to be 37.93 ± 12.21 standard deviation. It was observed that the incidence of potential drug-drug interactions was 66.96%. A total of 201 potential drug-drug interactions were identified from 75 patients. Based on the severity assessment of the identified interactions, 52.73% were major, 37.31% were moderate, and 19.82% were minor. About 7.46% were contraindicated drug combinations. The data on the onset of interaction revealed that 34.82% were of delayed onset and 14.92% with rapid onset and 50.24% were not specified. The drug that was responsible for the majority of the interactions in the study was found to be olanzapine.ConclusionThe study revealed a high incidence of drug-drug interaction. Drug-drug interactions most frequently encountered among psychiatric patients were found to be major in terms of severity. The study concluded on the higher event of drug-drug interactions among the patients prescribed with olanzapine.

Objectives: The study mainly aims to assess the knowledge, attitude, and practice of subjects who attend the smoking cessation clinic and thereby, study and document the drug management in smoking cessation.Material and Methods: This was an observational study conducted among 160 patients for 8 months. A knowledge, attitude, and practice questionnaire was prepared and validated. All the details and directions for filling out the questionnaire were explained to the patients by the investigator. The questionnaire was given to the patients and all the required data were collected and analyzed. Results: A total of 160 male patients were enrolled in the study. Majority of the participants had a good knowledge of the harmful effects of tobacco consumption. Around 96% knew that smoking could heighten their risk for different types of cancer and 93.8% were aware that smoking was a leading cause of many serious diseases. Majority of the patients (98.1%) had an attitude that quitting smoking was an individual choice and 96.3% were supportive of the fact that smoking in public places is an offense. Concerning their practice, 89.4% have attempted to quit smoking in the past and 78.8% have received advice from physicians earlier to cease smoking. Conclusion: The study revealed the good knowledge of patients and the majority of them tried to quit smoking as advised by their physician.

Introduction: Gastroprotective agents are prescribed in the department of orthopaedics to prevent and to treat gastric toxicity due to analgesics including NSAIDs. Objective: The present study aimed to analyze the prescribing pattern of gastroprotective agents among patients prescribed with NSAIDs in the department of orthopaedics and to identify the most common gastroprotective agent co-administered. The study also aims to estimate the average cost of gastroprotective agents. Methods: A prospective observational study was conducted for six months among 370 inpatients of the orthopaedics department. Relevant details on the usage pattern of gastroprotective agents were collected from the case sheets of the patients and were analyzed by descriptive statistics. Results: Out of 370 subjects enrolled, 257 (69.5%) were males and 113 (30.5%) were females. The most frequently prescribed single NSAID agent was diclofenac 82 (71.3%) and the fixed-dose combination was found to be diclofenac + chymotrypsin 88 (32.1%). Among the various proton pump inhibitors and H2 receptor antagonists prescribed, pantoprazole was found to be the most commonly prescribed agent 205 (61.4%), followed by rabeprazole 96 (28.7%). The average cost spent by a patient on the gastroprotective agent during their hospital stay was found to be 65.85±52.45 INR. Conclusion: The present study concluded that the majority of patients were prescribed with gastroprotective agents along with NSAIDs. The present study provides an insight into various healthcare professionals on the importance of rational use of medications among subjects.

The drugs used to treat psychiatric illnesses are known as antipsychotics. Antipsychotics have a higher incidence of adverse drug reactions including extrapyramidal side effects and several other metabolic disorders. The main objective of the study is to assess the changes in anthropometric parameters of metabolic risk in patients with severe mental disorders initiated with antipsychotic drug therapy. A prospective observational study was carried out in the psychiatric inpatient unit of a tertiary care teaching hospital for eight months. Eligible patients were enrolled and their baseline and follow-up anthropometric measurements such as body weight, body mass index (BMI), fat index, and waist-hip ratio were taken before and after six weeks of therapy. The changes were documented and analyzed. The most commonly prescribed antipsychotics were olanzapine, clozapine, risperidone and quetiapine. A considerable mean increase in the body weight of 4.5 kg with a mean increase in body mass index of 1.7 kg/m2, percentage body fat of 1.84% and the waist-hip ratio of 0.027 was observed among patients treated with olanzapine. Similarly, patients who were prescribed with clozapine also revealed a significant increase in the mean body weight of 4.7 kg, an increase in BMI of 1.75 kg/m2, 0.07 of waist-hip ratio and a percentage body fat of 1.4%. On analysis, patients treated with quetiapine and risperidone also showed significant changes in the anthropometric parameters. The overall comparison and statistical analysis of different anthropometric parameters suggest that the changes observed within the parameters were a result of antipsychotic drug therapy. Les médicaments utilisés pour traiter les maladies psychiatriques sont appelés antipsychotiques. Les antipsychotiques ont une incidence plus élevée de réactions indésirables aux médicaments, y compris des effets secondaires extrapyramidaux et plusieurs autres troubles métaboliques. L’objectif principal de cette étude est d’évaluer les changements des paramètres anthropométriques du risque métabolique chez les patients atteints de troubles mentaux sévères initiant un traitement médicamenteux antipsychotique. Une étude observationnelle prospective a été menée dans l’unité d’hospitalisation psychiatrique d’un hôpital universitaire de soins tertiaires pendant huit mois. Les patients éligibles ont été recrutés et leurs mesures anthropométriques de base et de suivi telles que le poids corporel, l’indice de masse corporelle (IMC), l’indice de graisse et le rapport taille-hanches ont été prises avant et après six semaines de traitement. Les changements ont été documentés et analysés. Les antipsychotiques les plus couramment prescrits étaient l’olanzapine, la clozapine, la rispéridone et la quétiapine. Une augmentation moyenne considérable du poids corporel de 4,5 kg avec une augmentation moyenne de l’indice de masse corporelle de 1,7 kg/m2, un pourcentage de graisse corporelle de 1,84 % et un rapport taille-hanches de 0,027 a été observée chez les patients traités par olanzapine. De même, les patients à qui on a prescrit de la clozapine ont également révélé une augmentation significative du poids corporel moyen de 4,7 kg, une augmentation de l’IMC de 1,75 kg/m2, 0,07 du rapport taille-hanches et un pourcentage de graisse corporelle de 1,4 %. Lors de l’analyse, les patients traités par la quétiapine et la rispéridone ont également montré des changements significatifs dans les paramètres anthropométriques. La comparaison globale et l’analyse statistique de différents paramètres anthropométriques suggèrent que les changements observés dans les paramètres étaient le résultat d’un traitement médicamenteux antipsychotique.

Summary Introduction Patient information leaflet contains specific information regarding the medical conditions, medications as well as the lifestyle modifications required to be followed by the patients. The information collected for the leaflet should be in the simplest form possible so that it can be easily interpreted by the targeted population. Objective The present study aims to develop and validate patient information leaflet for cancer patients. Materials and methods The information for the leaflet was gathered from various primary, secondary and tertiary resources. The content of the leaflet was validated by 10 members including general physicians, medical oncologists, academic pharmacists and clinical pharmacists. Readability of the patient information leaflets was assessed using Flesch Reading Ease test, Flesch-Kincaid Grade Level test and user readability method. User opinion on the content, layout and design was also obtained from the enrolled patients. Results and discussion The FRE and FK-GL scores of English version of patient information leaflet were 61.2 and 7.9 respectively. The overall user readability score of English, Kannada and Malayalam versions of PIL improved significantly from a pre-test score of 41.80 ± 23.18 to a post-test score of 70.40 ± 23.03. Ninety percent of the total patients enrolled in the study recorded good opinion about the leaflet in terms of its content, layout and design. Conclusion Patient information leaflet based education had a significant impact in improving the knowledge level of cancer patients.

The current study was undertaken to analyze the bacteriological profile among diabetic foot ulcer patients and to determine the antibiotic susceptibility and resistance pattern of the organisms isolated. This was a prospective observational study conducted among 102 patients for six months. All patients, aged above 18 years diagnosed with diabetic foot ulcers and performed with culture and sensitivity tests in the department of general surgery, were enrolled in the study. All the relevant details of the study were collected and analyzed. Out of 102 patients enrolled, 72 were males and 30 were females. The majority of the bacteria that were isolated from the culture samples were found to be gram-negative, 119 (79.33%) and 31 (20.97%) were found to be gram-positive. Methicillin-resistant coagulase-negative Staphylococcus was the most frequently isolated gram-positive micro-organism. It was found to have more sensitivity to both vancomycin and teicoplanin (100%) whereas it showed high resistance to benzylpenicillin (84.6%). Among various gram-negative organisms, Pseudomonas aeruginosa was the most commonly isolated. It showed high sensitivity to doripenem (70.9%) and was found to be more resistant to levofloxacin (51.6%). Our study concluded on the predominance of gram-negative bacteria among the enrolled patients. Among the 22 different types of bacteria identified, Pseudomonas aeruginosa was the most frequently isolated species.

Purpose of the Study The primary objective of the study is to develop, validate, translate and to assess the user readability of PIL for patients diagnosed with breast cancer. Methods The leaflet on breast cancer was prepared by referring various primary, secondary and tertiary resources of information. The prepared PIL was validated by the expert committee of eight members including academic and clinical pharmacists, general physician and medical oncologist. User readability testing was conducted. The opinion of the subjects on the content, layout and design of the PIL was also attained. Results A total of 50 patients were enrolled for user readability testing. The overall user readability score was significantly increased from 39.20 ± 17.12 to 73.20 ± 13.76. A good opinion on the content, layout and design of the PIL was reported by ninety two percent of the study patients. Conclusion The study concluded the significant impact of validated PIL on the level of knowledge of study subjects. Trial Registration The study was prospectively registered in Clinical Trial Registry of India (Ref No: CTRI/2020/07/026688).

: The novel coronavirus was renamed as coronavirus disease 2019 (COVID-19) by the world health organization, began its spread in December 2019, in the city of Wuhan, China. Global bodies and governments weren't prepared to handle the impact of the virus on society. Nepal's landlocked nation encountered its incident confirmed case of COVID-19 during the first week of January, with the primary host being a student with a travel history from its place of inception. The nation is deficient in its health resources. The country mainly focused on the stringent implementation of washing of hands, wearing masks, restricting general movement, and maintaining social distancing in public. The disease transmission reached to the third stage, which began within three months after the confirmation of the first case of COVID-19. The lack of tropical hospitals, laboratory and diagnostic facilities added to the challenges faced by the country. This paper is a comprehensive review of the overall preparation and steps taken by the federal system of Nepal to combat the virus's effects till the third stage of transmission. It concludes with the practical limitations faced by the governing authorities of the nation while implementing these measures.Key words: Nepal, COVID-19, Preparedness, Lockdown, Migrant labor.

This study aimed to analyse the price variation between various prescribed brands of anti-hypertensives and the direct medical costs involved in the treatment of hypertension. A retrospective study was conducted at a super specialty hospital over a period of eight months from September 2019-April 2020. Ethical approval was obtained from the institutional ethics committee before initiating the study. A total of 400 hypertensive patients of either gender, aged above 18 years, prescribed with at least one antihypertensive agent were enrolled in the study. All relevant information was collected from the concerned patient treatment charts and patient hospital bills. Patient details such as age, gender, occupation, body mass index, domiciliary status, social habits (smoking and alcohol), family history of hypertension, co-morbid conditions and duration of hypertension were collected. All the data obtained were then analysed using SPSS (version 20.0). The majority of the patients were males, n=234 (58.5%) and n=166(45.5%) were females. A total of n=285 (71.25) were prescribed with more than one antihypertensive agent and only n=115(28.75%) patients were on monotherapy. In monotherapy, prazosin 25 mg was found to have the maximum price variation of 7.76, followed by spironolactone 50 mg with a price variation of 7.73. The least variation was observed with telmisartan 80 mg. In case of multiple drug therapy, maximum variation was seen with metoprolol 50 mg. Lab charges, being the highest median medical cost has resulted in the maximum burden for the patients. The average lab charges were found to be 4997.33 INR (64.46USD). The least median direct medical cost was accounted to antihypertensives. The cost of antihypertensives was found to be 134.48 INR (1.96 USD).

Objectives: To analyze the pattern of drugs prescribed to treat irritable bowel syndrome among patients admitted in a tertiary care teaching hospital. Materials and Methods: A retrospective study was carried out among 120 inpatients of the general medicine department for a period of eight months from August 2019 to April 2020. The data of the patients admitted to the hospital over a period of five years was collected from the medical records department in a specially designed data collection form. The prescription pattern of the drugs used in the management of irritable bowel syndrome was analyzed using descriptive statistics. Results: Among 120 patients, n=68 were diagnosed with inflammatory bowel syndrome (IBS)-D, n=30 with IBS-M and n=22 diagnosed with IBS-C. The occurrence of irritable bowel syndrome was higher in males (55%) than in females (45%). The most common clinical presentation was found to be abdominal pain, reported among 63.33% of the total patients. Probiotics were the most widely prescribed medications n=73(14.39%), followed by pantoprazole n=65(12.82%). Conclusion: In the study, movement modulators followed by adjunctive gastrointestinal agents, psychoactive substances and antibiotics were commonly prescribed for the management of irritable bowel syndrome. Key words: IBS, Pharmacotherapy, Abdominal pain, Colonoscopy, Probiotics.