A Brief Review of Analytical Methods for the Estimation of Allopurinol in Pharmaceutical Formulation and Biological Matrices.

This review article represents the collection and discussion of various analytical methods available in the literature for the determination of allopurinol (ALLP) in pharmaceutical and biological samples consisting of HPLC, UV-visible method, near-IR spectroscopy, spectrofluorometry, capillary electrophoresis, polarography, voltammetry, and hyphenated techniques such as LC-MS, LC-MS/MS, UPLC-MS/MS, and GC-MS. The anticipated review provides details about the comparative utilization of various analytical techniques for the determination of ALLP. The present review article can be effectively explored to conduct future analytical investigation for the estimation of ALLP.

Use of Antidepressants among Patients Diagnosed with Depression: A Scoping Review.

INTRODUCTION: Depression is a major global health problem with a relatively high lifetime prevalence and significant disability. Antidepressants are the most effective medications used for the treatment of depression. Hence, this study is aimed at summarizing the studies on antidepressant use among patients diagnosed with depression. METHOD: PubMed, Embase, Web of Science, Scopus, and Google Scholar were searched for literature (2000-2019) using keywords such as depression, drug utilization, antidepressants, prescription, serotonin reuptake inhibitor, serotonin and norepinephrine reuptake inhibitor, tricyclic antidepressants, and atypical antidepressants. RESULTS: Antidepressant users were mostly females, married people, housewives, lower-income people, employees, and highly educated people, as they were found to be more prone to develop depression than their counterparts. Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, were most commonly prescribed among depressive patients. CONCLUSION: Our study suggested that out of five major antidepressant drugs available for the treatment of depression, selective serotonin reuptake inhibitors are preferred over others because of their better side effects and tolerability profile.

Medical abortion kit dispensing practices of community pharmacies in Pokhara Metropolitan, Nepal.

BACKGROUND: Medical abortion (MA) refers to the use of medicines to terminate the pregnancy. There is an urgent need to spread safe abortion services in the community. This study assessed the MA kit dispensing practices of community pharmacies in Pokhara Valley, Nepal. METHODS: A cross-sectional descriptive study was conducted in Pokhara Valley, Nepal from December 2017 to November 2018. Among the community pharmacies of Pokhara Valley, 115 community pharmacies were selected using a consecutive sampling method. A semi-structured questionnaire was used to collect data. MA kit and related information were requested by simulated male clients visiting the community pharmacies. The information obtained from the pharmacy workers was recorded in the data collection sheet. RESULTS: Nine brands of MA kit from eight manufacturing companies were found in practice in Pokhara Valley, out of those only five (56%) were registered in Nepal. Seven brands were sold at more than the labeled price. The pharmacy workers asked about the gestational age and confirmation of pregnancy in all the cases. Most of them counseled the clients on the frequency, duration, and direction of use. Dispensing practice and level of counseling were found to be significantly correlated (r = 0.40, p value = 0.01). CONCLUSION: Despite the awareness of the pharmacy workers on the MA kit, most of them provided limited information to the clients. Nearly half unregistered MA kits were found in practice at the community pharmacies. Thus, the Department of Drugs Administration and other concerned authorities must provide relevant training and awareness programs to the pharmacy workers of the community pharmacies for preventing the malpractice of MA kit. The Government of Nepal must restrict the illegal entry of unregistered brands and assure the standards of MA kit by regulating drug acts and policies effectively.

Anticoagulant Utilization and Cost Analysis among Cardiology Inpatients in a Tertiary Care Teaching Hospital of Western Nepal.

INTRODUCTION: Anticoagulants have a wide spectrum of use and risks associated with their therapy due to their narrow therapeutic range. This study aimed to evaluate the anticoagulant utilization and cost analysis in patients admitted to the cardiology ward of a tertiary care hospital in western Nepal. METHODS: A prospective cohort study was conducted in patients admitted to the cardiology ward of Manipal Teaching Hospital (MTH), Pokhara, Kaski, Nepal, from August to November 2019. All patients (n = 132) aged ≥18 years of either gender receiving anticoagulants for any indication in the cardiology ward were included in the study. Anticoagulant utilization, the average prescribed daily dose (PDD/DDD) and the cost of anticoagulant per patient were calculated. Descriptive statistics were performed using IBM-SPSS 20.0. RESULTS: Acute coronary syndrome (66.67%) was a common indication, unfractionated heparin + enoxaparin (45.45%) and enoxaparin (27.3%) were the most frequently prescribed anticoagulants. The performance of monitoring parameters such as international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (aPTT), and renal function test were consistent with the American College of Chest Physician (ACCP) guidelines. The average prescribed daily dose of anticoagulants was 1.3 (unfractionated heparin), 2.25 (enoxaparin), 0.5 (warfarin), and 1.0 (dabigatran). Heparin was associated with the majority of cases of drug interactions (52 cases). Enoxaparin was the most expensive of all the anticoagulant drug classes. The median (IQR) cost of anticoagulants used per patient was US$79.92 ($46.32). CONCLUSION: Our study suggests that the utilization of unfractionated heparin and enoxaparin and the cost of anticoagulants per patient were higher in the patients admitted to the cardiology ward of the hospital.

Self-Reported Antidepressant Drug Side Effects, Medication Adherence, and Its Associated Factors among Patients Diagnosed with Depression at the Psychiatric Hospital of Nepal.

OBJECTIVE: The present study is aimed at evaluating the side effects of antidepressant drugs, medication adherence (MA), and associated factors among patients diagnosed with depression at a psychiatric hospital in western Nepal. METHODS: A prospective cross-sectional study was conducted among 174 patients visiting the outpatient clinic of a psychiatric hospital. The antidepressant side effect checklist (ASEC) was used to classify the reported antidepressant drug side effects into mild, moderate, and severe types. The Naranjo adverse drug reaction (ADR) probability scale was employed to assess the ADRs, and the Morisky Green Levine Adherence (MGLA) score was employed to determine the rate of medication adherence. Descriptive statistics and bivariate analysis were used, and a P value < 0.05 was taken as statistically significant in the multivariate analysis. RESULTS: The patients were mostly female (55.74%), with a median (IQR) age of 32 (20) years. Approximately 74.13% of the patients experienced antidepressant side effects, where insomnia (17.05%) and anxiety (17.05%) were the most common. More than half of the patients (52.29%) had a low level of adherence. Females were 1.01 times more likely to be nonadherent to their antidepressant medications compared to males, adjusted odds ratio (AOR): 1.001 (0.31-1.63). Similarly, illiterate patients tended to be more nonadherent compared to literates, AOR: 1.342 (0. 93-2.82), and unemployed individuals were 1.5 times more likely to be nonadherent to their medications compared to employed individuals, AOR: 1.46 (1.16-4.13). Likewise, patients with severe side effects were more prone to develop nonadherence than those with moderate side effects, AOR: 1.173 (0.42-3.25). A significant association was found between the Naranjo score and medication adherence. CONCLUSIONS: This study suggests that antidepressant drug side effects were more prevalent and medication adherence was extremely poor among depressive patients in psychiatric hospitals. Factors such as gender, occupation, education, side effects, and ADRs attributed to poor medication adherence in patients.

Prevalence of Hypertension in a Community.

INTRODUCTION: Hypertension is one of the leading risk factors for the global burden of disease and is of rising public health concerns in the developing world including Nepal. However, few studies have focused on awareness, treatment, and control of hypertension among people living with this condition. In this scenario, this study aimed to find out the prevalence of hypertension and its awareness, treatment, and control among hypertensive patients residing in different parts of Kaski district, Nepal. METHODS: A descriptive cross-sectional study was performed among 977 family members of 290 households from August to December 2017. Ethical approval was taken from the Institutional Review Committee (reference number:73/074/75) of the Pokhara University Research Center. Simple random sampling was done. Hypertension screening was performed through averaging three values obtained by standardized aneroid sphygmomanometer in three observations. Primary data was collected through self-administered questionnaires and face-to-face interviews based on the participant's preferences. Collected data were analyzed using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out Of total 997 family members screened, 294 (29.49%) (26.66-32.32 at 95% confidence interval) had hypertension whereas only 127 (43.2%) were completely aware of their disease condition. 279 (94.9%) were taking antihypertensive medication and 201 (68.4%) had their blood pressure controlled. CONCLUSIONS: We found that almost one-fourth of the adult population in the community suffered from hypertension but less than half of the hypertensive patients are aware of their conditions.

Evaluation of Antinociceptive and Anti-inflammatory Activity of Phytosterol Present in Chloroform Extract of Phyllanthus Maderaspatensis.

Inflammation and pain is a common cause of medical consultation which generally occurs when a tissue is injured. In recent scenario, attention has been paid for screening new drugs with analgesic activity from plant sources, to reduce or treat pain with less adverse effects than allopathic drugs. The objectives of this research work was to evaluate the antinociceptive and anti-inflammatory activity of phytosterol present in chloroform extract of Phyllanthus maderaspatensis (CEPM) through carrageenan-induced hind paw oedema and hot plate method in male wistar rats. The test groups received CEPM (suspended in 1% caboxymethylcellulose, CMC) at doses 400 mg/kg, p.o.; the reference group received indomethacin (10 mg/ kg, in 1% CMC, p.o.) as positive control and the negative control animals received the vehicle only (1% CMC, 10 mL/kg, p.o.). Oral administration of CEPM or indomethacin showed significant (P<0.001) effect in the reduction of the paw oedema induced by 0.1 mL of 1% carrageenan (in 1% CMC) solution into the subplantar region. CEPM showed the highest inhibition 71.42% at 3rd hr. CEPM extract and pentazocin significantly (P<0.001) increases the basal reaction time when compare to control group. The present study demonstrates the potential anti-inflammatory and analgesic effect of the CEPM which supports the claims by the traditional medicine practitioners.