An overview of over the counter drugs in pregnancy and lactation

Over the counter (OTC) drugs are commonly used by pregnant women. Most OTC drugs are safe in pregnancy but some have unproven safety and may adversely affect the growing foetus. The safety profile of some of the medication may change according to the gestational age of the foetus. Because an estimated 10% or more of the birth defects results from maternal drug exposure, the US Food and Drug Administration (FDA) has assigned a risk category to each drugs. Among the commonly used OTC drugs Acetaminophen, Chlorpheniramine, Kaolin and Pectin preparations and most antacids have a good safety record. The drugs like H2 blockers; Pseudoephedrine and Atropine/Diphenoxylate should be used with caution. The risk and benefit while using OTC drugs in pregnancy has to be assessed.

Recent trends and directions in the rationalization of pharmacotherapy of bronchial asthma: probing for alternatives

Although tremendous progress has been made in the understanding of Bronchial Asthma (BA) over the past decade, asthma remains a frequently encountered challenging condition for the physicians in the health care locale. Inflammation is distinguished as the most important event in the pathogenesis and the knowledge that asthma is an inflammatory disorder has become elementary to our explanation of asthma; this has broadened the perspective for the treatment of BA. However, bronchodilators and corticosteroids are still the mainstay of asthma treatment over the decades. The introduction of superior derivatives of corticosteroids and beta agonists, the choice, safety, duration of action and ease of delivery have enhanced progressively. Surrogated anti-inflammatory agents have been used in severe disease, but have been limited by adverse effects. The introduction of new agents affecting leukotrienes synthesis and action provides an alternative strategy but it needs to be confirmed on a large subset of population of asthmatics. In fact, the past decade has been witnessed by a proliferation of scientific information and a widespread addition of anti-inflammatory therapy to improve asthma outcomes along with the recommended therapies. In this context, there has been much advancement in the available pharmacologic panorama for both chronic and acute therapy and the development and approval of novel medications. Yet, many controversies abound this disorder, and further fundamental developments in novel therapeutics are imminent. This review of asthma for the practicing clinician will summarize these developments and their implications in treatment of BA.

Electric quadrupole moments of the D states of alkaline-earth-metal ions

The electric quadrupole moment for the 4d(2)D(5/2) state of (88)Sr(+); one of the most important candidates for an optical clock, has been calculated using the relativistic coupled-cluster theory. This is the first application of this theory to determine atomic electric quadrupole moments. The result of the calculation is presented and the important many-body contributions are highlighted. The calculated electric quadrupole moment is (2.94 +/- 0.07)ea(2)(0), where a(o) is the Bohr radius and the electronic charge while the measured value is (2.6 +/- 0.3) ea(2)(0). This is so far the most accurate determination of the electric quadrupole moment for the above mentioned state. We have also calculated the electric quadrupole moments for the metastable 4d(2)D(3/2) state of 88(Sr(+) and for the 3d(2)D(3/2.5/2) and 5d(2)D(3/2.5/2) states of (43)Ca(+) and (138)Ba(+), respectively.

Relativistic coupled-cluster theory of atomic parity nonconservation: application to 137Ba+

We report the result of our ab initio calculation of the 6s2S1/2-->5d2D3/2 parity nonconserving electric dipole transition amplitude in 137Ba+ based on relativistic coupled-cluster theory. Considering single, double, and partial triple excitations, we have achieved an accuracy of less than 1%. If the accuracy of our calculation can be matched by the proposed parity nonconservation experiment in Ba+ for the above transition, then the combination of the two results would provide an independent nonaccelerator test of the standard model of particle physics.

Medical errors challenges for the health professionals: need of Pharmacovigilance to prevent

The incidence of different aspects of iatrogenic problems due to drugs is Adverse Events (AEs) 3.7%, Adverse Drug Events (ADEs) 2.4-6.5%, Adverse Drug Reactions (ADRs) is 6.7%. Negligence in serious ADEs and death is 34% and 51% respectively, preventable ADEs is 25-50%. Medication Errors (MEs) occur most often in perscribing (29-56%). The most common cause of MEs is lack of knowledge about the drug (29%) and the patient about 18%. MEs result malpractice claims in 13-25% of cases which occur due to mistakes and slips of action & lapses of memory. The MEs can be prevented by establishing effective Pharmacovigilance control center, which frequently gives proper guidance to the prescribers. Use of computerized decision for prescription writing, effective communication with patient, families, pharmacists and nurses and continuing medical education on information of new drugs and new information on current drugs can be effective tolls to prevent the errors.

Knowledge, attitudes and practices (KAP) regarding the management of diarrhea by pharmacists and licensed drug sellers in eastern Nepal

Diarrhea constitutes a major cause of morbidity and mortality in developing countries. Inappropriate drug prescribing is common in diarrhea, resulting in an increase in cost and adverse drug reactions. In Nepal, drug sellers often act as the first contact persons for the underprivileged. No information has been available regarding their knowledge, attitudes and practices (KAP) regarding diarrhea management. Using a structured questionnaire, between the 1st of January and the 31st of December 2003, 109 drug sellers in eastern Nepal were interviewed about their educational status, patient/attendant presentation at the outlet and their advice to patients/attendants. Only 2.7% of drug sellers were qualified in health education. Eighty percent of the patients/attendants sought advice from the drug sellers, only 20% presented to the outlet with prescriptions. The data reveals that about half of them were taking note of the nature of the diarrhea. Although 62 (56.8%) of them were aware of dehydration, only 2 (1.8%) of them knew all three signs of dehydration (dry tongue, non-elastic skin and sunken eyes). Sixty-six (60.5%) of them knew about oral rehydration solution (ORS), its principle and the required period of administration. About 50 to 60% of them were aware of the implications resulting from dehydration from uncontrolled diarrhea and of the importance of ORS in its management. Only 20% of the drug sellers advised ORS alone, otherwise it was dispensed along with drugs, such as antimotility agents (AMA) or metronidazole. As a result of the above findings, it is important to educate the drug sellers by conferring knowledge about the ethical aspects of drugs in the management of diarrhea.

Pattern of intraocular pressure changes following manual small incision cataract surgery

OBJECTIVES

To find out the pattern of changes in intraocular pressure after manual small incision cataract surgery.

METHODS

Consecutive patients (291 eyes of 291 patients) undergoing manual small incision cataract surgery were prospectively evaluated for change in IOP. Patients were further divided into two groups based on whether or not sutures were used to close the scleral tunnel. IOP was serially measured at day 1, 1st, 2nd, 4th, 6th, 8th and 12th week.

RESULTS

The mean post operative IOP in eyes where sutures were not applied (12.59+/- 3.02 mmHg, 12.59+/-2.34mmHg, 12.54+/-2.19mmHg and 12.40+/-2.99 mm Hg at day1, 2week and 4weeks respectively) was lower than that where sutures were used to close the wound (15.57+/- 3.86mmHg, 14.05+/-2.52mmHg, 14.43+/-3.39mmHg at day1, 2weeks and 4 weeks respectively). There was a drop of IOP from the preoperative IOP in both suture (1.15+/-3.29mm Hg) and non suture (3.29+/-3.07mm Hg) group at 3 months of follow up.

CONCLUSION

There is a small drop of IOP following sutureless MSICS during long term follow up. Eyes where sutures are applied are more likely to have higher IOP than those without sutures at the initial post operative period.

Antimicrobial utilization pattern in out patient services of ENT department of tertiary care hospital of Eastern Nepal

OBJECTIVE

The objective of this study was to monitor the antimicrobial utilization in ENT out patient services in a tertiary care hospital of Nepal.

MATERIALS & METHODS

A total of 191 prescriptions were randomly audited at varying time interval from the department of ENT in the year 2003. The data was collected in customized Performa in the form of antibacterial audit questionnaires. It also contained Patient particulars, diagnosis, investigations, drug details and information from the prescriber regarding the indication for prescribing antimicrobial agent, suspecting organism underlying infection, duration of therapy and details of any concomitant medications.

RESULTS

The incidence of use of antimicrobial agents (AMA) in 191 prescriptions was analyzed from the enrolled prescriptions, a total of 218 antimicrobials i.e.1.4 antimicrobial agent per patient were prescribed. . The AMAs were indicated therapeutically in 73.29% of patients & 19.37% patients for prophylaxis. The AMAs were advised for more than 72 hours for prophylaxis in 86.48%. In the concomitant medications antihistaminic were prescribed in 32.62% and NSAIDS in 21.98% cases. Most of patients reported with upper respiratory tract infections (URTI-32.56%), Chronic Suppurative otitis Media (CSOM-18.3%), sinusitis (6.28%), tonsillitis (5.75%),. Pharyngitis (3.66%), Acute Suppurative Otitis Media (ASOM-2.61%) and others. The diagnosis was established clinically in 42.40% and confirmative in 35.60%. In 21.46% the diagnosis was not disclosed. Out of 191 patients, culture sensitivity tests were performed for only 31 patients and 13 patients depicted a positive culture sensitivity tests. The common microbes isolated from the culture were staphylococcus aureus (69.2%). Streptococcus (7.7%), Enterobacteriacae (7.7%), Pseudomonas auroginosa (7.7%) & psendomanas mirabilis (7.7%). Clinically suspected organism were mentioned in only 32 prescriptions and most prescriber presumed the infections due to staphylococci & pseudomonas (43.75%), streptococci (21.8%),Gram negative organisms (12.5%) and H influenza (9.3%). The use of a single drug was abundant (89.52%), two drugs (9.94%), and three drugs (0.52% )prescriptions. Ciprofloxacin (23.85%) was preferred, followed by amoxycillin (20.06%), combination of ampicillin + cloxacillin( 9.17%), doxycyclin (5.96%). Erythromycin (4.58%) and cotimoxazole (4.58%). Expensive drugs i.e azithromycin (2.75%), roxithromycin (1.37%) and cephalosporins (3.21%) were also prescribed. The causative microbes were sensitive to amoxycillin (53.84%), cloxacillin (53.84%) ciprofloxacin (46.15%), gentamicin (46.15%), and cephalosporin (46.15%). But resistant to erythromycin, tetracycline, cotrimoxazole and norfloxacin)

CONCLUSIONS

Majority of patients were prescribed drugs irrationally with misleading indications without confirming the bacteriological culture and sensitivity.

Teaching exercise of drug utilization by medical students

The prescription is a vital written document communicating between the physician, the patient and the pharmacist. The audit of prescribing pattern is a component of medical audit, which seeks monitoring, evaluation and necessary modifications in the prescribing practices of prescribers to achieve rational and cost effective medical care for the patients, The present drug utilization study was conducted by fourth year MBBs students during their research posting in the department of Pharmacology at B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan. The prescriptions were randomly collected from BPKIHS pharmacy over a period of 3 weeks. The auditing was done in the form of a semi structured performa containing the patients particulars with regard to age, sex, and residence, the details of the illness and prescribed drug information. The data was analyzed at the end of the study. The study points out that the maximum (27.5%) prescriptions were from General Outpatient Department (GOPD) followed by ENT (16.5%), Internal medicine (15.5%) and General surgery (10%). This indicates the distribution of patient load in hospital and the dominant areas to be targeted for intervention. Further, the proportion of antimicrobial agents (AMAs) i.e. 26.03% use was low and was prescribed empirically in most of the cases. There was use of expensive AMAs and irrational prescribing of combinations of AMAs in some prescriptions. Other prevailing drugs which were prescribed were analgesics. The usage of nimesulide and rofecoxib. withdrawn by FDA were used recurrently in this setup. There was greater use of dubious drugs of unproven benefit like vitamins, calcium etc. The diagnosis of the disease were not mentioned in 32.5% of prescriptions, The dose, frequency and duration of drugs were unascertained in majority of prescriptions that might lead to health hazards. This exercise might change the behavior of existing prescribers and also of the future doctors.

Recent advances in the management of epilepsy: a review

Epilepsy is a complex disorder affecting brain function having a variety of contributing factors. The genetic predisposition plays a key role in the genesis of epilepsy. The already existing antiepileptic drugs (AEDs) provide effective control of majority of patents with different types of seizures. In some refractory cases and in those patients who can not tolerate the conventional AEDs, there is an urgent need to provide relief by controlling the seizures adequately. Various newer approaches in the rational management of seizures have been evolved during the recent years, based on different mechanisms of action and side effects profile. A brief account of these newer treatment modalities have been incorporated in this review in order to enlighten the readers about the possible beneficial effect of this regimen vis a vis the limitations of such use.

Entomological indices of Aedes aegypti at some international airports and seaports of southern India--a report

Entomological surveys were undertaken at some of the international airports/seaports (Bangalore, Calicut, Chennai, Cochin, Thiruvanathapuram and Vishakapatnam) to find out the breeding prevalence of dengue vector mosquito in diverse breeding containers from 1998 to 2004. Three vector indices (House index, Container index and Breateu index) were used to assess the breeding potential at each airport/seaport. International Health Regulations urged national governments to keep all the international airports/seaports and peripheral areas up to 400 meters free from Aedes aegypti mosquitoes. However, surveys revealed high vector indices at all the airports and seaports. Health authorities of airports/seaports need to take cognizance of these facts and develop action plan for appropriate control measures with emphasis on vector surveillance.

Distribution of Plasmodium falciparum genotypes in clinically mild and severe malaria cases in Orissa, India

A cross-sectional study was conducted in a malaria hyperendemic state of India to ascertain the distribution of Plasmodium falciparum genotypes in patients with mild (n=40) and severe (n=35) malaria. PCR and nested PCR were used to determine the glutamate-rich protein (GLURP), merozoite surface proteins 1 and 2 (MSP1 and MSP2) and knob-associated histidine-rich protein (KAHRP) for characterization of the parasite. The results indicate that (i) the 200bp allele of the MAD20 family of MSP1 and the 550bp allele of the 3D7 family of MSP2 show over-representation in severe malaria cases; (ii) the multiplicity of infection with respect to MSP2 alleles is significantly higher (P<0.001) in severe cases than in mild cases; and (iii) comparison with the findings of other studies leads to the conclusion that the distribution of P. falciparum genotypes between different clinical groups differs geographically.

First time detection of Japanese encephalitis virus antigen in dry and unpreserved mosquito Culex tritaeniorhynchus Giles, 1901, from Karnal district of Haryana state of India

Japanese encephalitis virus (JEV) antigen has been detected by antigen capture enzyme linked immunosorbentassay (ELISA) in dry specimens of the mosquito Culex tritaeniorhynchus Giles, 1901, collected from Karnal district of Haryana state in northern India. These mosquitoes were stored in dry condition for 20 months, at room temperature, before processing. The procedure of detecting JEV infection in long time stored, dry vector mosquitoes, has important application in the surveillance of Japanese encephalitis.

Cytological diagnosis of rhinosporidiosis with skeletal involvement--a case report

A young Hindu male presented with painful swelling of left lower thigh for 6 months. The provisional diagnosis both clinically and radiologically was osteosarcoma. FNAC and biopsy proved the lesion to be a case of rhinosporidiosis. The present case is reported due to rare incidence of skeletal rhinosporidiosis.

The PfCRT (K76T) point mutation favours clone multiplicity and disease severity in Plasmodium falciparum infection

In Orissa, a malaria-hyperendemic area of India, we assessed the relationship between the PfCRT (K76T) point mutation of Plasmodium falciparum and the clinical severity of malaria. Forty uncomplicated and 36 severe malaria cases were selected, and parasite species, density and schizontaemia determined by examination of Giemsa-stained thick or thin blood films. The PfCRT point mutation was analysed by PCR-RFLP and genotypes of the parasite isolates investigated by nested PCR using the polymorphic region of the merozoite surface protein-2. We found that (i) the prevalence of the PfCRT point mutation was significantly higher (P < 0.01) in severe malaria cases and that (ii) heavy parasitaemia along with clone multiplicity was statistically more common (P < 0.01) in severe cases. These associations may be due to progression of uncomplicated to severe disease after chloroquine treatment failure and/or increased virulence of chloroquine-resistant parasites. The implications for antimalarial treatment policy are discussed.

ANTIMICROBIAL UTILIZATION PATTERN IN A TEACHING DISTRICT HOSPITAL OF NEPAL

The objective of this study was to monitor the antimicrobial utilization in a teaching district hospital and tocompare it against the rational antimicrobial use guidelines.Total 106 data sheet of indoor patients admitted in year 2001 were randomly chosen and analyzed. Thenumber of antimicrobials prescribed in every prescription was taken into account to calculate the incidenceof use of more than one antimicrobial agent. The Patient sheet included patient information, drug information(name, indication, dose, frequency and duration of antimicrobial use), diagnosis or provisional diagnosisand investigations. Prescription auditing was done on the selected prescriptions.Male: female ratio was 40:65. In 90.57% diagnosis was established empirically and in only 4.7 % patientsconfirmatory diagnosis was made using relevant investigations. The antimicrobials were prescribed chieflyfor respiratory tract infections (RTI -26.41%), gastrointestinal infections (GIT -22.64%), genital tractinfection (13.20%), wound infections (8.48%), urinary tract infections (UTI-6.6%), bone & joint infections(4.71%) and miscellaneous (Typhoid, Malaria, meningitis etc-17.92%). The causative organism wasconfirmed using culture & sensitivity tests in only one patient (0.94%) out of 106 patients. In 77 (69.8%)patient prescriptions suspected pathogenic organisms were mentioned. These were streptococcus (29.58%),Chlamydia (11.27%), mycoplasma (18.30%), staphylococcus (23.94%), E. coli (32.39%) and S. typhi(15.49%). In 35 prescriptions (33.01) no causative organism was mentioned. It was further observed that atotal 452 drugs (i.e. 4.26 drugs per patient), out of this only 165 antimicrobials (1.55 antimicrobials perpatient) were prescribed in the 106 enrolled prescriptions. On further analysis of antimicrobials use, it wasobserved that most patients were prescribed a single antimicrobial agent (58.49%), two AMAs (24.52%),three AMAs (13.20%) and least was four AMAs (3.77%).The antimicrobials were given prophylacticallyin 14 (13.10%) and therapeutically in 85 (80.18%) prescriptions. The use of antimicrobials were not indicatedin 7(6.60%) prescriptions.. In 91 cases (85.85%) duration for which AMAs were considered was notmentioned. Ampicillin + cloxacillin (12.12%), ciprofloxacin (10.30%), metronidazole (10.30%), amoxycillin(10.30%) and cephalosporins (25.47%) were the most frequently prescribed AMAs. A fixed dose combinationof ampicillin & cloxacillin, ciprofloxacin and metronidazole were recurrently prescribed while gentamicin,cotrimoxazole and crystalline penicillin were relatively least prescribed antimicrobials agents.Inappropriate and irrationality in the Antimicrobial prescribing pattern was observed.Das B P*, Sethi A*, Rauniar G P*Key Words: Antimicrobial agent, Respiratory tract infection (RTI), urinary tract infection (UTI),gastrointestinal infection, prophylaxis, therapeutic.

Students’ perceptions of the pre-clinical integrated medical curriculum in a Health University in Nepal

Abstract

AN OVERVIEW OF INTEGRATED MEDICAL AND DENTAL UNDERGRADUATE PRE-CLINICAL CURRICULA AT B. P. KOIRALA INSTITUTE OF HEALTH SCIENCES, NEPAL: A MULTIPROFESSIONAL APPROACH

Curricular innovations such as multiprofessional education (MPE) sensitise healthprofessionals towards the role of other health professionals and inculcate team spirit.This is a preliminary report on MPE in practice in the preclinical phase of dental andmedical undergraduate courses at B.P. Koirala Institute of Health Sciences, Nepal.The preclinical curriculum of the undergraduate courseis integrated, organ systembased and partially problem based. There is an emphasis on early exposure of studentsto patients and to community. The undergraduate course in medicine started in 1994and in dental surgery in 1999 based on the core curriculum developed at variousworkshops. The course duration and structure is similar in bot

Effect of nimodipine, a dihydropyridine calcium channel antagonist on the pharmacokinetics of carbamazepine in rhesus monkeys

Calcium channel antagonists have been shown to have an anticonvulsant activity in a variety of seizure models and also to potentiate the anticonvulsant activity of other standard antiepileptic drugs like carbamazepine, phenytoin and valporoate. A pharmacokinetic interaction may be involved in such potentiation. This cross over single dose study was carried out to find out if there was a pharmacokinetic interaction between carbamazepine, a commonly used antiepileptic drug and nimodipine, a dihydropyridine calcium channel antagonist in rhesus moneys. Carbamazepine 46 mg/kg and nimodipine 9.6 mg/kg was administered through a nasogastric tube and blood samples were collected at 0.5, 1, 2, 3, 6, 9, 12, 24, 48, 72 and 96 hours after drug administration and were assayed for carbamazepine. Nimodipine caused a significant increase in peak plasma concentration (C(max)) of carbamazepine and a decrease in plasma absorption half life (t1/2 alpha). There was no significant change in other pharmacokinetic parameters between the two groups. The results of the study suggest that concurrent administration of carbamazepine and nimodipine may cause a significant rise in carbamazepine concentration as may contribute to a potentiation of anticonvulsant effect of carbamazepine and an increase in the incidence of adverse effects warranting that nimodipine should be prescribed cautiously in epileptic patients receiving carbamazepine and it might be very appropriate to do therapeutic drug monitoring of carbamazepine in such patients.

A PROSPECTIVE STUDY OF DENTAL DISEASE PATTERN AND DRUG UTILIZATION AT THE DENTAL DEPARTMENT OF A TERTIARY CARE TEACHING HOSPITAL IN EASTERN NEPAL

To find out the pattern of dental diseases and drug utilization at dental out patientdepartment (OPD) of B.P. Koirala Institute of Health Sciences (BPKIHS), a tertiarycare hospital. A prospective prescription audit was conducted for a period of 10 daysin the dental OPD and the data was analyzed using WHO drug indicators. The totalnumber of prescriptions analyzed were 279. Dental caries (37%), Periodontitis (14%)and chronic gingivitis (11%) were the most common diseases with a maximum incidencebetween the age groups of 9 to 40 years. Mean number of drugs per prescription was2.79. Of the total prescriptions, 223 (79.9%) had 314 antimicrobial agents (AMA)constituting 40.3% of total drugs prescribed. The mean number of antimicrobial agentsper prescription was 1.13. The most commonly prescribed antimicrobial agents wasamoxycillin (33.1%) followed by metronidazole (24.9%), doxycycline (17.2%) andtinidazole (12.7%). Fixed dose drug combination of amoxycillin + cloxacillin (26) andampicillin + cloxacillin (10) were prescribed in 36 of the prescriptions. Povidone iodinegargle (41.2%) was the most commonly prescribed oropharyngeal preparation followedby Chlorhexidine gluconate mouthwash (32.4%). Non- steroidal anti-inflammatoryagents (20.66%), multi-vitamins (19.51%) and oropharyngeal preparations (17.45%)constituted the rest of the drugs prescribed. Diclofenac (60.86%) was the mostcommonly prescribed among NSAIDs and fixed dose drug combination of ibuprofenand paracetamol was prescribed in 19 of the prescriptions. All drugs were given byoral route (except for gentamicin in one prescription) and were prescribed underbrand names. None of the prescriptions had instructions whether the drug should betaken before or after food. The results indicate that dental caries was the most commondental disease, anti-microbial agents were prescribed to majority of the patients andconstituted a little less than half of the total drugs prescribed. Commonly used anti-microbial agent was amoxycillin which in two thirds of the cases was prescribed as anfixed dose drug combination. The high incidence of anti-microbial agent prescribingmay be modified by a feedback to the prescribers.Key words: Dental morbidity, prescribing pattern, drug utilization, dental OPD,antimicrobial agents.

ANALGESIC UTILIZATION IN POSTOPERATIVE CARE AT A TERTIARY CARE TEACHING HOSPITAL IN NEPAL

ABSTRACTA retrospective analysis of analgesics used in postoperative pain in abdominal surgery was done to developbase line data. Appendectomy and cholecystectomy each formed 38.63% while hernia repair constituted22.74% of all the abdominal surgeries (422). NSAIDs were the most commonly prescribed group of analgesicsboth during the hospital stay (99.52%) and at the time of discharge (86.01%). Opioid analgesics (4.73%)was used in the immediate postoperative period mainly to supplement the NSAIDs. Diclofenac (88.86%)was the most commonly prescribed analgesic to in-patients and either diclofenac (47.63) or a fixed dosecombination of ibuprofen and paracetamol (32.46%) was the most commonly prescribed at the time ofdischarge. The administered dose of diclofenac was higher than the recommended dose. Utilization ofanalgesics during postoperative period may be rationalised by pain assessment charts and regular feedbackto the precribers.Key Words: Analgesic utilization, post operative, abdominal surgery.

HOW COST EFFECTIVE IS THE TREATMENT? ARE PRESCRIBERS CONCERNED ?

ABSTRACTCost-effective treatment should be of primary concern to prescribers in poor countries like Nepal. Thepresent study was carried out at a tertiary care hospital in Nepal to find out the perception of prices ofcommonly prescribed drugs among prescribers. The participants selected randomly were directed to writein 10 minutes on a proforma, the generic name(s) and price of the brand preparation of 18 most commonlyused drugs listed under their brand name.The price of the drug was considered correct if the price mentioned was within a range of 20% above orbelow the brand price. Results indicated that the participants were aware of the composition of majority(80%) of the drugs, but were not aware of the prices of 81.80% of the drugs. No single participant mentionedthe correct prices of all the drugs. Among the drug groups studied, the most accurate data was providedabout composition (90.43%) and price (24.47%) of non steroidal anti-inflammatory drugs (NSAIDs). Onlyin 9.22% of brand preparations of antimicrobial agents (AMA), the prices were mentioned correctly. Hence,sensitisation of physicians about cost-effective treatment is of immense importance and to facilitate this,hospital authorities could provide prescribers with regularly updated price lists of commonly prescribeddrugs and competitive prices of various brand preparations. Pharmacoeconomics may be introduced in the undergraduate curriculum which can be reinforced by continuing medical education.Key Words: Cost-effective, Pharmacoeconomics.

MANAGEMENT OF SNAKEBITE – CURRENT CONCEPT

Abstract

Clinical evaluation of human placental extract (placentrex) in radiation-induced oral mucositis

To evaluate human placental extract in the treatment of radiation mucositis involving the oral/oropharyngeal region, a prospective randomized study was carried out in 120 patients with squamous cell carcinoma of the head and neck from August 1997 to March 1999. The study was conducted in patients receiving radical external radiation therapy, planned for = > 60 Gy/30 F/6 weeks, who developed grade 2 radiation mucositis (patchy mucositis) during radiation treatment. The patients were randomized in two groups of 60 patients each to receive either placentrex treatment (placentrex group) or conventional treatment (control group). Placentrex treatment was given as Inj Placentrex 2 ml by deep intramuscular injection 5 days a week for 15 injections. Conventional treatment given in the control group was disprin gargles and betamethasone oral drops. A subjective decrease in pain was observed in 48/60 (80%) of patients in the placentrex group compared with 22/60 (36.7%) in the control group. The progression to grade 3 radiation mucositis was 24/60 (40%) in the placentrex group compared with 52/60 (86.7%) in the control group. The subjective improvement in difficulty in swallowing was seen in 56/60 (93%) of patients in the placentrex group compared with 9/60 (15%) of patients in the control group. Only one patient in the placentrex group compared with three in the control group required interruption of radiation therapy because of severe radiation reactions. Human placental extract appears to be effective in the management of radiation-induced oral/oropharyngeal mucositis and especially in controlling subjective symptoms.