Care Centre In Kerala Research Articles

Maternal obesity affecting immediate neonatal outcomes in infants of diabetic mothers: A case–control study

Introduction: The association between maternal obesity and increased neonatal morbidity in infants of diabetic mothers needs to be evaluated. Aims: The objective of the study is to compare the immediate neonatal complications of obese and nonobese gestational diabetic mothers (GDM). Settings and Design: This prospective case–control study was conducted in a tertiary care center in Kerala, South India, between July 1, 2019 and January 1, 2020. Methods: Six hundred and seventy-seven obstetric patient records of deliveries conducted between July 1, 2019 and January 1, 2020 were reviewed. Neonatal outcomes of infants of obese and nonobese diabetic mothers (categorization based on prepregnancy body mass index [BMI]) were compared with the healthy neonatal controls born during the study period. Outcomes studied were neonatal intensive care unit (NICU) admission, NICU stay more than 7 days, hypoglycemia, respiratory distress, phototherapy, and proportion of small for gestational age in infants of diabetic mothers. Statistical Analysis Used: Statistical analysis used odds ratio and Chi-square tests. Results: One hundred and sixty-eight were found to be eligible to be included in the study. Eighty-four GDM cases were matched with 84 healthy control mothers. Hypoglycemia (P = 0.001), respiratory distress (P = 0.002), NICU admission (P = 0.001), prolonged NICU stay, and phototherapy were significantly associated with those mothers who had high BMI. Conclusions: Compared to infants of nonobese GDMs, infants of obese GDMs are at higher risk of hypoglycemia, respiratory distress, phototherapy, and NICU stay more than 7 days.

Seroprevalence of Hepatitis A among Medical Students of a Tertiary Care Centre in Kerala, Southern India

Introduction: Hepatitis A Virus (HAV) is a major cause of acute viral hepatitis caused by a Ribonucleic Acid (RNA) virus. The mode of transmission is fecal-oral route and the risk factors include unsafe water, poor personal hygiene and sanitation. Even though seroprevalence rate is high in low socio-economic regions, it is low in urban areas and the need of vaccination is looked for. Aim: To estimate the seroprevalence of hepatitis A in medical students of Southern India. Materials and Methods: The present study was a cross-sectional study conducted in the medical students of Government Medical College, Manjeri, Kerala, India. Blood samples of 377 students during the year 2015-2018 were taken. These students were in their 1st, 2nd, 3rd and 4th year MBBS course who admitted in the years 2018, 2017, 2016 and 2015, respectively. Commercially available Enzyme-Linked Immunoassay (ELISA) kits for anti HAV IgG antibodies were used. Chi-square test was used for statistical analysis. Results: Out of 377 participants 238 (63.2%) were females and 139 (36.8%) were males. A total of 51 (13.5%) were positive for IgG antibodies. A total of 43 were in 21-22 age group with a p-value >0.05. An association of seropositivity and seronegativity with frequency of dining out pattern was there with a p-value <0.05. Conclusion: The seroprevalence of hepatitis A was found in a declining stage hence, vaccination against hepatitis A should be included in the National Immunisation Schedule.

Erythroderma: a clinico etiological study of 77 patients in a tertiary care centre in Kerala

<p class="abstract"><strong>Background:</strong> Erythroderma is defined as generalized erythema and scaling of the skin affecting more than 90% of body surface area. Identification of the underlying disease process represents one of the most complex challenges in proper patient care.</p><p class="abstract"><strong>Methods:</strong> A retrospective study was done in Department of Dermatology in a Tertiary Care Centre. History, clinical findings and investigations of erythroderma patients were recorded and clinic-histopathological correlation was analyzed by kappa coefficient (К).<strong></strong></p><p class="abstract"><strong>Results:</strong> Erythroderma was more prevalent in elderly males with a mean age of 64.56 years and a male to female ratio of 3:1. A clinical evidence of pre-existing dermatoses was found in 65 patients, commonest being eczema (41.3%) followed by psoriasis (40.3%). Evidence of a trigger was seen in 54.54% patients, commonest being the use of ayurvedic medications (42.8%). Clinico-histopathological correlation was seen in 53.9% cases.</p><p class="abstract"><strong>Conclusions:</strong> Although the clinical presentation of erythroderma is similar, etiological factors are varied and it depends largely on the population studied. Most commonly, erythroderma is due to generalization of pre-existing dermatoses as seen in our study. Hence careful evaluation of clinical clues and histopathological correlation plays a pivotal role in diagnosis of the primary cause and the effective management of erythroderma.</p>

Effectiveness of underlay myringoplasty in inactive mucosal chronic otitis media; a prospective study

Introduction: Patients with a mucosal type of chronic otitis media (COM) usually have recurrent ear discharge and conductive hearing loss. It is characterized by the central perforation of the tympanic membrane. Myringoplasty is an operation performed to repair tympanic membrane perforation when there is no ossicular damage. It helps to prevent ear discharge and improves hearing. Different techniques used for myringoplasty are underlay and overlay. Underlay technique is an effective procedure for tympanic membrane repair. Methods: 125 patients who underwent underlay myringoplasty over two years in a tertiary care center in Kerala were included in the study. Patients with actively discharging ears were excluded from the study. Results: The majority of the patients were in the age group of 20-29 years (49.6%). There were 47 males (37.6%) and 78 females (62.4%). In 63 patients the surgery was done on the right side (50.4%) and in 62 patients on the left side (49.6%). Maximum preoperative hearing loss was in the range of 30-34 dB (39.2%). 100 patients (80%) showed successful graft uptake with the improvement of hearing in the range of 10-15 dB. Eight patients (6.4%) showed small residual perforation with the improvement of hearing. In 17 patients (13.6%) there was a complete rejection of graft with continuous ear discharge and no improvement in hearing. Conclusion: Underlay myringoplasty is an effective surgical technique for the repair of tympanic membrane perforations in terms of graft take up and improvement of hearing.

Multidrug Resistant Gram Negative Bacterial Isolates from Intensive Care Unit in a Tertiary Care Centre in Kerala with Special Reference to Molecular Detection of BLA NDM1 Gene

Multidrug Resistant Gram Negative Bacterial Isolates from Intensive Care Unit in a Tertiary Care Centre in Kerala with Special Reference to Molecular Detection of BLA NDM1 Gene

CLINICAL PROFILE OF INTUSSUSCEPTION IN CHILDREN ADMITTED TO A TERTIARY CARE CENTRE IN KERALA

Background and objectives: Intussusception is the commonest cause of bowel obstruction and is one of the common abdominal emergencies in children younger than 2 years of age.The objective of the study was to assess the clinical profile of intussusception in children and the management and the outcome and to assess whether the characteristics mentioned in clinical profile are predictive of subsequent management and outcome of the disease.
 Methods: A hospital based descriptive study conducted in a tertiary care centre in Kerala, using purposive sampling technique. 120 children admitted with diagnosis of intussusception fulfilling inclusion criteria and whose parents consented for study were included in the study population, during the study period from November 2018 to June 2020. Detailed history, clinical examination including per rectal examination and USG was done to make diagnosis of intussusception in suspected cases. Follow up is done at 72 hours,1 week after the admission and 1month later. To assess the clinical profile and outcome of patients, frequency and percentage is used. To obtain the association of clinical profile with outcome chi square test is applied.
 Results: Outcome of the problem was correlated with age, sex, symptoms, risk factors sonological findings treatment protocol and duration of hospital stay. Out of the 120 children in study population, majority were males(65.8%) with male to female ratio 1.9:1 and majority was in the age group 7- 12 months, which is similar to many other similar studies. Maximum number of cases were in the month of February(14.2%) and November(15%). Majority of the patients(57.5%) presented to healthcare facility within 24 hours of onset of first symptom.Irritability was the most common clinical symptom(62.5%) followed by vomiting(58.3%) and abdominal pain(49.2%). Ileocolic intussusception (96.7%) was the commonest type. Majority of the cases could be managed with hydrostatic saline reduction(73.3%) and significantly lesser number of patient went for surgical intervention(7.5%) and spontaneous resolution(19.2%).
 Conclusions: Incidence of intussusception is more common among males and more in the 7-12 month age group. Majority of the cases presented to health care facility within 24 hours of onset of symptom and could be managed with hydrostatic reduction technique and had a shorter duration of hospital stay compared to surgical reduction technique. Even recurrent cases could be managed with hydrostatic saline reduction.
 Keywords: Intussusception; Intestinal obstruction; Hydrostatic reduction; Spontaneous resolution

The Chronicles of Myelodysplastic/ Myeloproliferative Legacy - Chronic Myelomonocytic Leukemia

Chronic myelomonocytic leukemia is a heterogeneous syndrome with features of both myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN). The varied clinical presentations add to the distinctiveness of the disease. This heterogeneity should invigorate the search for reliable predictors of evolution and progression of disease. We report a case series from a tertiary care centre in Kerala, South India. This was a retrospective observational study of all cases of CMML, which was diagnosed in the departments of Pathology and Clinical Haematology & Haemato- oncology of our institution between January 2017 to May 2020. The clinical presentation, laboratory investigations, and treatment details were noted. Nine cases of CMML were encountered during the study period. The mean age of study subjects was 70.4 years with a female predilection. Fever and weight loss were the most common clinical presentations. Four patients were classified as CMML- 2, three patients as CMML- 1, and two as CMML- 0. Based on the WBC count, five patients were classified as dysplastic and four as proliferative subtypes. Two patients had grade 1/3 (one case each of CMML- 2 and CMML- 1) and one patient had grade 2/3 fibrosis (a case of CMML- 1) in the bone marrow. Thirty-three percentage patients had clonal cytogenetic abnormalities, the commonest being trisomy 8. Renal function was deranged in three patients and two patients had a deranged liver function and hepatomegaly. Four patients underwent treatment with hypomethylating agents or cytoreduction with hydroxyurea. One of the patients (CMML- 2 with marked leucocytosis) succumbed to disease.

English

BACKGROUND Immune Thrombocytopenic Purpura (ITP) is one of the most commonly encountered disease in paediatric practice. Thorough clinical and morphological study of peripheral blood and bone marrow is required for confirming ITP. Clinicomorphological aspects of paediatric ITP is a less studied topic especially in developing countries like India. The objective was to study the clinical and morphological profile of paediatric cases of ITP. METHODS This is a 5-year record based retrospective study conducted in a paediatric tertiary health care centre in Kerala, South India. Data of all paediatric cases diagnosed as ITP including clinical presentation, clinical findings, blood counts, peripheral blood morphology, bone marrow morphology, and treatment response was collected and entered in SPSS software version 16.0 and analysed. For assessing correlation, chi-square test was used. RESULTS The age of children ranged from 3 months to 15 years. H/o viral fever was noted in 53 % cases. Cases which had moderate and severe thrombocytopenia were 74 % and 21 % respectively. Isolated thrombocytopenia was the most common peripheral blood picture observed with few cases showing coexisting eosinophilia and anaemia. All cases showed megakaryocyte proliferation in marrow with 9 % cases showing coexisting iron deficiency anaemia. Majority of cases showed rapid response to steroid / IVIG therapy and the response had no correlation with grade of thrombocytopenia (p value < 0.05). CONCLUSIONS Paediatric cases of ITP usually present following viral infections or vaccination, with worrisome bleeding episodes, petechiae, ecchymosis or purpura. KEYWORDS ITP, Paediatrics, Platelet Count, Thrombocytopenia, Vaccination

Clinical and functional profile of 6-12-year-old children with attention deficit hyperactivity disorder referred to a tertiary care center in South India

Objective: To describe the clinical, socio-demographic, and functional profile of children with Attention Deficit Hyperactivity Disorder (ADHD) referred to a tertiary care center in Kerala, India. Methods: A retrospective descriptive study was conducted from records of developmental evaluation clinic over a period of one year. All-consecutive cases the first time diagnosed as ADHD were enrolled. Autism Spectrum Disorder, genetic disorders, and children with sensory impairments were excluded. Clinical profile was based on presenting symptoms, gender, and socio-demographic characteristics; functional status assessed by Conner’s 3 Parent Scale and cognitive status by Intelligence Quotient. Results: ADHD prevalence in a clinically referred sample was 12.7%. Boy to girl ratio was 6:1. The mean age of presentation was 8.2 years (SD 6.09). The most common presenting symptom was hyperactivity and behavioral problems followed by poor scholastic performance and poor memory. The functional status assessment showed major concerns in all six domains - Inattention, Hyperactivity, Learning Problem, Executive Functioning, Aggression, and Peer relation, in the majority of children. Children presenting with ADHD symptoms at a later age (9-12 years) had lower IQ scores than those diagnosed at a younger age. Conclusion: Course of childhood ADHD shows a consistent clinical and functional pattern. Early diagnosis and quantification of difficulties at the outset is suggested, which can help in providing early intervention and is likely to improve long-term outcome in these children.

880-P: Is Time-in-Range Independent of A1C? A Study in Asian Indian Population

Time-in-Range (TIR) has been recently established as a treatment target in diabetes to complement the time-tested A1c. Studies in the Caucasian population have shown that every 10% increase in TIR corresponds to 0.8% reduction in A1c. To study the relationship between TIR with A1c in the Asian-Indian population, CGM data from EMR of patients with type 1 and type 2 diabetes (n=424) followed up by a telemedicine program (DTMS) at our comprehensive diabetes care center in Kerala was obtained. Mann Whitney U test, t-test, ANOVA, and Pearson correlation coefficient were used for univariate analysis. Baseline characteristics were age 54 + 14 years, Gender frequency: F/M 127/297, diabetes duration 10.83+8.24 years, A1c 7.44+1.17 (%), eA1c 6.74+1.24 (%), and Average Blood Glucose (ABG) 146.96 + 35.62 (mg/dL). All the patients were eligible for a reduction of A1C <7.5%. In this subset of Asian-Indian population, our statistical analysis revealed that a TIR of >70% corresponds to an A1c level of <7.5% in agreement with the previous studies. In our telemedicine-based chronic care model, an A1c of <7.5% was achieved in 67.5% of the subjects. However only 36% achieved a TIR >70% and 66% achieved a TIR >60%; a finding which underscores the significance of TIR independent of A1c levels. The study suggests that TIR should evolve as a powerful target and predictor of diabetes complications and should be a routine measure in diabetes care. Disclosure J. Kesavadev: Speaker’s Bureau; Self; Biocon, Novo Nordisk Inc., Sanofi-Aventis. A. Shankar: None. G. Krishnan: None. B.D. Saboo: None. G. Sanal: None. M. Krishna B: None. S. Ts: None. S. Jothydev: None.

A study on seroprevalence of Rubella IgG antibodies among antenatal women in a tertiary care centre in Kerala

A study on seroprevalence of Rubella IgG antibodies among antenatal women in a tertiary care centre in Kerala

Change in trends in incidence and histopathology of lung carcinoma in a tertiary care centre in Kerala

Change in trends in incidence and histopathology of lung carcinoma in a tertiary care centre in Kerala

P140 Validation of EULAR/ACR 2019 classification criteria for SLE in a south Indian juvenile SLE cohort

Abstract Background To date there is no specific classification criteria for juvenile systemic lupus erythematosus (jSLE). Our aim is to compare the real world performance of EULAR/ACR 2019 criteria when applied to a known cohort of jSLE cases in Kerala, India. Methods We retrospectively reviewed the electronic medical record of all patients (n = 735), admitted under the Pediatric Rheumatology Department, Amrita Institute of Medical Sciences, Kochi, a tertiary care center in Kerala, India, during the period January 2012 to June 2019. 107 patients were diagnosed with jSLE by a qualified experienced pediatric rheumatologist and were independently assessed by an adult rheumatologist. Every sixth patient of the remaining 628 patients were selected as the control (n = 105). Patients were excluded if the diagnosis was uncertain or, if there was an overlap with jSLE. Each patient was evaluated to see if he or she satisfied the ACR-1997, SLICC-2012, or EULAR/ACR- 2019 criteria. Results Female: male ratio in cases and controls was 4.1:1 and 2.4 :1 respectively. Mean age for cases and controls was 12.6 +/-2.9 and 11.8 +/-3.5 respectively. The comparison of performance of each criterion is shown in table 1. Table 1: Validation of the EULAR/ACR 2019 SLE classification criteria using clinically diagnosed 107 jSLE cases. ACR- American College of Rheumatology; EULAR- European League Against Rheumatism; SLICC-Systemic Lupus International Collaborating Clinics; PPV- positive predictive value; NPV- negative predictive value Conclusion The new EULAR/ACR 2019 criteria achieved sensitivity, specificity, PPV, NPV and accuracy greater than SLICC 2012 criteria. It also achieved sensitivity, NPV and accuracy greater than 1997 ACR criteria. Disclosures H. Bhaskaran Nair None. S. Balan None.

Prescription pattern of antiepileptic drugs in a tertiary care hospital

Background: Epilepsy is a chronic neurological disorder which affects about 0.5% to 1% of the population. The older antiepileptic drugs like carbamazepine and phenytoin are the mainstay of treatment of epilepsy. With the development of newer drugs for various type of epilepsy, the prescribing pattern for epilepsy has changed over the last decade. The objective of this study was to evaluate the prescription pattern of antiepileptic drugs in outpatient department of a tertiary care health care centre in Kerala and to assess how adherent they are to the available treatment guidelines of epilepsy.Methods: Data was collected from patients attending the outpatient department of Neurology in Government Medical College, Kozhikode for 2 months from January 2018 to February 2018. A total of 442 patients were enrolled in the study and data regarding the type of epilepsy, the antiepileptic drug prescribed, and the demographic profile were recorded and analysed.Results: Among the study participants, 237 were males (53.6%) and 205 females (46.2%). The study showed that among the 442 participants enrolled, the most common type of epilepsy was focal seizures (64.5%) and the most commonly prescribed drug was carbamazepine (28%), followed by levetiracetam (22%) and valproate (20%). Majority of the patients were treated with a single drug (79.2%).Conclusions: Newer drugs have been increasingly added to the list of antiepileptic drugs, but most of them serve as adjuvant to older ones and the important drugs used as monotherapy are still the older ones.

Histopathological profile of ovarian tumors in a tertiary care centre in Kerala: a retrospective two year study

Histopathological profile of ovarian tumors in a tertiary care centre in Kerala: a retrospective two year study

Self-perception on oral health and related behaviours among antenatal mothers attending a public antenatal clinic - Kerala.

Background and Aims:Antenatal oral care has been given least priority on a global scale. The study assesses self-perception of oral health knowledge and related behaviors among antenatal mothers.Method:A cross-sectional study was done among 400 pregnant women attending antenatal care clinic of a tertiary care center in Kerala, India. Details regarding knowledge, attitude, and practice were obtained, after getting an informed consent. The dental caries experience and gingival status were measured. To test the significance (p ≤ 0.05) between variables, Chi-square test was used.Results:Poor oral health knowledge was observed among 75.5% of the pregnant mothers. Oral health problems were reported by 63.2% of them. Low priority for oral health (59.4%) and fear for fetal safety (17.5%) were the reasons for delaying dental services. Oral examination showed that more than half of the study subjects had a high prevalence of dental caries (67.5%) and low gingival bleeding status (26.2%). The study highlights that more than half of the study population (60.8%) were influenced by the elderly in the family to avoid certain food items. A better oral health knowledge was observed among the upper middle class (OR - 2.8) who had visited dentists within the last six months (OR - 3.6) and child bearing mothers (OR- 0.46) (p ≤ 0.05).

Prediction of outcomes in stroke patients from radiological findings – A hospital-based retrospective cohort study from a comprehensive stroke care center in Kerala, India

Introduction: Functional outcome after stroke can be improved by early and accurate diagnosis with the help of imaging techniques such as computed tomography (CT) and magnetic resonance imaging. Alberta Stroke Program Early CT Score (ASPECTS) calculated from the CT image infarct areas of middle cerebral artery (MCA) circulation is supposed to be a reliable outcome predictor. Methodology: A retrospective cohort study was conducted in the Comprehensive Stroke Care Center for a period of 6 months. All adult patients (18–90 years) who had visited the hospital from January 2014 to December 2017 were enrolled for the study. Patients with MCA strokes were only included in the study since the ASPECTS is defined for this territory. The data were gathered from the electronic format of the patient information system in the institution and were entered in a structured proforma specifically designed for the study. ASPECTS was calculated from the CT findings of the patient. The modified Rankin Scale (mRS) scores were calculated for every patient at four different time points. The collected data were compiled in a Microsoft Excel sheet and were analyzed using IBM Statistical Package for Social Sciences (SPSS version 21). The summary statistics for categorical variables were reported using frequency and percentage and continuous variables as mean (standard deviation). We reported the association of the ASPECTS with mRS at different time points using the Chi-Square test. Results: A total of 132 adult patients were enrolled in the study. The mean age of the study population was 60.72 (±13.99) years, and among them, 93 (70.45%) were males. Majority of the patients were nonvegetarians (99.92%). The most prevalent risk factor found was hypertension (62.1%). The most common symptom presented by the patients was facial palsy (28%). When the ASPECTS was calculated for 132 patients, 62 patients fell in the high ASPECTS category (8–10), 45 patients had a moderate ASPECTS (5–7), and 25 had low ASPECTS (0–4). mRS scores calculated for four different time points showed a decline in disability in most of the patients. ASPECT and mRS had a negative association signifying, as the ASPECTS increases the number of functional disability decreases. Conclusions: Our study results show that ASPECTS can be a definite outcome predictor in MCA stroke patients.

A study on correlation between cytological and histopathological diagnosis of thyroid lesions at a tertiary care centre of Kerala

A study on correlation between cytological and histopathological diagnosis of thyroid lesions at a tertiary care centre of Kerala

First episode depression in women- a study of clinical characteristics through the female reproductive stages in a rural tertiary care center in Kerala

Background: The lifetime prevalence of major depressive disorders is 10-25% for women and 5-12% for men. Women are more prone to develop depressive episode from the period of menarche to the perimenopausal period. Relatively little research has been done on this. Materials and methods: Female patients between the ages of 12 years to 55 years presenting in the outpatient department with first episode depressive symptoms are selected (ICD 10) and the number of patients presenting in different stages of the reproductive cycle – perimenarche, pregnancy, post-partum, post abortion and perimenopausal are noted. Age at onset, severity of the illness, positive family history, presence of somatic and hypochondriac symptoms, and suicidal intent (Beck suicidal intent scale, Hamilton rating scale for depression) were noted. Results and discussion: Out of the total 120 patients, 53 were in the perimenopause state, 23 in the perimenarche, 5 in pregnancy, 14 in the post-partum, and 7 as post abortion. The mean age of onset of depressive disorders is 36.7 years (SD- 13.67). The severity of the depressive episode is significantly higher towards the younger age group (<30years) and number of patients presenting with somatic symptoms are much higher towards the older age group (41-55years). There is no significant difference in presence of positive family history, hypochondriasis and suicidal intent among various age groups. Conclusion: Perimenopausal and perimenarche periods show higher prevalence of depressive disorders during female reproductive cycle. Biological changes in reproductive cycle can cause increase prevalence of depression in women.

Incidence of Metabolic Syndrome in patients treated with Clozapine in a tertiary care center in central Kerala

Background: Clozapine is widely used for the treatment of resistant Schizophrenia (Sz). Metabolic syndrome (MetS) is its recognized side effect. Reports on the side effects of Clozapine are scanty from Kerala. Hence a prospective observational study was conducted. Aim: The aim of the present study was to find the incidence of Metabolic syndrome in patients with psychosis, after 12 weeks of treatment with clozapine in a tertiary care centre in Kerala. Methods: Patients diagnosed as Schizophrenia or Delusional disorder based on International Classification of Diseases (ICD)-10 and not meeting the threshold criteria for MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and on Clozapine treatment were recruited and followed up for at least 12 weeks. Augmentation, when needed, was limited to Amisulpride, Aripiprazole, and/or Modified Electroconvulsive Therapy (MECT). Bodyweight, waist circumference, blood pressure, fasting blood sugar, and triglycerides levels were measured at the enrolment and after 12 weeks. Seventy-five patients completing follow up for 12 weeks were considered as study subjects. Patients who fulfilled NCEP ATP III criteria at 12 weeks were diagnosed as having MetS. Results: Study sample of 75 had not met the threshold criteria of NCEP ATP III based MetS diagnosis at the study entry. But among them, 23 met no criteria, 23 met one criterion and 29 met two criteria. Out of 75 patients, 32 (42.7%) developed Metabolic Syndrome at three months. Among 23 who met no criteria at intake, 3 (13%) developed MetS, while it was 9 (39%) in 23 who met 1 criterion and 20 (69%) in 29 who met 2 criteria. The mean Clozapine dose at discharge was 514±148 mg in those who developed MetS while it was 428±164 mg in those who did not. This difference was statistically significant (p<0.05). Conclusion: Incidence of MetS is high in Clozapine receiving Psychotic patients. The present study showed that in the study population, risk factors have a cumulative effect on the development of this side effect, and the risk is high when the dose of clozapine is higher.