Drug utilization pattern and effectiveness analysis in diabetes mellitus at a tertiary care centre in eastern Nepal.

An observational follow up study conducted for one year at a tertiary care centre in 154 newly diagnosed diabetes mellitus patients is presented. The aims of the study were to determine the demographics, prescribing patterns, drug cost and analyze effectiveness of different therapies. Effectiveness of therapies were analyzed in patients achieving glycemic control by Wilcoxon signed- rank test. Majority of patients (n = 114) fell into the middle age strata of 35-64 years and 97% were type 2 diabetics. A total of 282 prescriptions were screened that included antidiabetics and other drug categories. Mean number of drugs per prescription sheet was 1.83±1.31. Oral hypoglycemic agents were advised to 64% of the patients. The prescribing frequency of biguanides (24.5 %) was more than sulphonylureas (19.9 %). Only 67 patients followed up for 3 months±15 days, of which 46 achieved glycemic control. The biguanides only group (p=0.002) and combination therapy of biguanides and sulphonylureas group (p=0.005) were the highly effective therapies, as their p values of fasting blood glucose levels on follow up were the lowest. Nearly 90% of patients on combination therapy achieved glycemic control. In conclusion, this study reflects the therapeutic approach followed in diabetes mellitus as optimal. Future research on a larger patient population is warranted to evaluate existing patterns of therapy for sound practice and quality of care.

An evaluation of training of teachers in medical education in four medical schools of Nepal.

Effective teaching is a concern of all teachers. Therefore, regular teachers' training is emphasized globally. B. P. Koirala Institute of Health Sciences (BPKIHS), a health science deemed university situated in eastern region of Nepal has an established Medical Education unit which attempts to improve teaching-learning skills by training faculty members through organizing regular medical education training programs. The aim of the present study was to assess the effectiveness of 3-day training workshop on "Teaching-learning methodology and Evaluation" held in four different medical colleges of Nepal. The workshop was targeted at middle and entry level of health profession teachers who had not been previously exposed to any teacher's training program. The various components, such as teaching-learning principles, writing educational objectives, organizing and sequencing education materials, teaching-learning methods, microteaching and assessment techniques, were incorporated in the workshop. A team of resource persons from BPKIHS were involved in all the four medical institutions. The collection data had two categories of responses: (1) a questionnaire survey of participants at the beginning and end of the workshop to determine their gain in knowledge and (2) a semi-structured questionnaire survey of participants at the end of workshop to evaluate their perception on usefulness of the workshop. The later category had items with three-point likert scale (very useful, useful and not useful) and responses to open-ended questions/ statements to document participants general views. The response was entered into a spreadsheet and analyzed using SPSS. The result showed that all participants (n = 92) improved their scores after attending the workshop (p < 0.001). Majority of respondents expressed that the teaching-learning methods, media, microteaching and evaluation techniques were useful in teaching-learning. The workshop was perceived as an acceptable way of acquiring teaching-learning skills but 39.4% participants expressed that the duration of the workshop was too short. The overall impression about trainers was very positive. Therefore, regular organization of such workshops with addition of new advances in medical education would be highly beneficial to improve teaching learning skill of medical teachers.

Polymorphonuclear leukocyte function in type-2 diabetes mellitus patients and its correlation with glycaemic control.

Infection is an important cause of morbidity and mortality in diabetic patients. Chronic hyperglycaemia impairs host defense mechanism such as cell mediated immunity, polymorphonuclear leukocyte (PMNL) function, antibody formation etc. PMNL serves as bodies first line of defense against various infections. The present study was undertaken to establish a correlation between impaired PMNL function, blood glucose levels and its improvement with good glycaemic control with glibenclamide and glimepiride, with special reference to parameters such as respiratory burst and O2(-) and H2O2 production by diabetic neutrophils.

Antinociceptive effect of amitriptyline in mice of acute pain models.

Tricyclic antidepressant drugs induce antinociceptive effect and suggest that their analgesic action could be related to the monoaminergic activity of the drugs. The analgesic activity of amitriptyline was observed in mouse models of acute pain. Mice were divided into different groups and were given amitriptyline in different doses alone and in combination with morphine. Reaction time in Hot-Plate and Tail-Flick tests was observed. Results showed that amitriptyline had antinociceptive effect in acute pain state in experimental models. Amitriptyline in combination with morphine had better analgesic effect than the morphine alone in Hot-Plate test.

Student's critical appraisal on the evaluation of analgesics in laboratory animal verses simulated clinical trail.

Effective feedback is an integral part of medical education in helping the medical students to reach their maximum potential. Without feedback mistakes may go uncorrected which results poor performances of learners as well as tutors. At present teaching learning methodology used in many medical colleges includes lectures, tutorials, practical and occasionally small groups teaching and case discussions. The curriculum of undergraduate medical and dental students of BP Koirala Institute of Health Sciences, Dharan, Nepal is need based, integrated, co mmunity oriented, partially problem based. The practical lessons are an important part of Pharmacology curricula of undergraduate courses. So the aim of this study was to evaluate the student opinion towards animal experimentation as well as simulated clinical trial (SCT) on analgesics in terms of understanding the objectives. To conduct the study a semistructure questionnaire were provided to 2nd years MBBS and BDS students to obtain their view. Of the 164 questionnaires 154 students submitted completed questionnaire. On analysis of the feedback, it was observed that 77.9% students liked animal experiments and most of them wee happy with simulated clinical trial. The majority of the students 74.1% favoured both exercises for improved understanding of the subject and 66.2% agreed the sequential sessions. So the study concludes with the view that sequential sessions of laboratory experiments as well as SCT are required for a rectified learning of Pharmacology.

Drug dose calculation need to be drilled.

A study was conducted to establish the knowledge of correct dose calculations and conversion between mass concentration, dilution and percentage concentrations amongst medical and paramedical personnel handling patient, with life saving support system. A questionnaire was prepared having five standard questions to be answered in ten minutes by medical house officers and nurses. Results of the study suggested that the knowledge of correct dose calculations of both the medical and paramedical personnel needs to be improved to impart best possible management to the critically ill patients.