Clinic Of Tertiary Care Hospital Research Articles

An Observational Study of Maternal and Perinatal Outcome in Preeclampsia Cases in a Tertiary Care Center.

Preeclampsia, a hypertensive disorder in pregnancy, is a multisystem disease of unknown etiology and is associated with an increased risk of maternal mortality and morbidity.Infants from preeclampsia mothers have significantly higher incidence of prematurity, somatic growth retardation, thrombocytopenia, low birth weight, respiratory distress syndrome, and long duration of admission to neonatal intensive care (NICU). This study was done to study the maternal mortality and morbidity and foetal outcome in pregnant women with severe preeclampsia. This observational study was done in the Department of Obstetrics and Gynaecology, of a tertiary care centre, from the period October 2015 to October 2017.Data was collected from all 130 women attending the antenatal clinic of tertiary care hospital and ward admission and all details such as demographic details, obstetrics examination, and all clinical findings were noted and from that made results. Result: After applying inclusion and exclusion criteria all 130 women were observed in this study.Among 130 women 47 were diagnosed with preeclampsia. Mainly primigravida women were diagnosed with preeclampsia in the 21-25 years group. Among 47 preeclampsia women, 39 women had a BMI of 19-25 kg/m2. Thirty-two of 47 (68.09%) women were diagnosed with preeclampsia around 36-39 weeks. Among all preeclampsia, 28 women out of 47 (59.5%) women delivered babies vaginally, 18 of 47 (38.3%) women delivered through cesarean section, and one of 47 (2.13%) underwent preterm vaginal delivery. In preeclampsia, women's babies were delivered mostly (25/47, 53.19%) ≤2.5 kg weight and only one baby was shifted to NICU because of low birth weight. Preeclampsia increases maternal mortality and morbidity but in this study mortality was not done because our hospital is a tertiary care center with all ICU (intensive care unit) and NICU setup. Preterm births and cesarean deliveries were the mild to severe outcomes that were noted. ICU and NICUhospitalizations as a result of severe complications place a heavy demand on medical facilities. There are firm guidelines for the management of pregnancy-induced hypertension and its complications. For appropriate management, there is careful consideration of various factors, and individual case studies are required.

Birth Preparedness and Complication Readiness among Pregnant Women Attending Antenatal Clinic in Tertiary Care Hospital

Birth Preparedness and Complication Readiness among Pregnant Women Attending Antenatal Clinic in Tertiary Care Hospital

A study of functional outcome of medial open wedge verses lateral closed wedge high tibial osteotomy

The treatment of unicompartmental osteoarthritis with high tibial osteotomy using medial open wedge verses lateral closed wedge osteotomy. It is a choice of surgery in young age osteoarthritis. In this study we analyse the functional outcome of medial open wedge osteotomy the tom fix plate and lateral closed wedge osteotomy using staple in patients having unicompartmental osteoarthritis with genu varum.Material and Methods: This is a prospective study of patients who attended the orthopaedic outpatient clinic in tertiary care hospital between July 2021 to December 2022. The patients were evaluated by clinical examination and weight bearing radiographs. The patients who were found to have unicompartmental osteoarthritis with knee pain not relieved by conservative management and who satisfy the inclusion criteria were selected. During this period 30 patients were selected and were included in study.Results: In both groups a significant improvement of both scores were achieved. Both methods obtained safe and reproducible results for the correction considering the different operation techniques. There were no differences in outcome between the two methods. Satisfactory results were also achieved for early arthrosis of the femoropatellar and the lateral compartment.Conclusion: Open and closed wedge HTOs obtain significant improvement in patients with medial osteoarthritis of the knee. Using the right technique is very important for good results. For stabilization of the medial ligament we recommend the open wedge osteotomy. The patient should be informed about the routine removal of the metal plate.

C-peptide as an investigatory tool for endogenous insulin secretion in Type 2 diabetes mellitus patients of Mahakaushal region

Background: Type 2 diabetes mellitus (T2DM) is a disease state of chronic hyperglycemia that occurs due to decrease insulin secretion or attenuated insulin response or both. Insulin resistance with relative insulin deficiency is a peculiar feature of T2DM. Proinsulin is synthesized by the beta cell of the pancreas. Before secretion into the portal vein, proinsulin cleaves into equal quantities of insulin and C-peptide. The secreted insulin gets extensively metabolized by the liver and has a shorter half-life than C-peptide. Thus, C-peptide levels more accurately perceive the endogenous insulin secretion of the pancreas. Hence, C-peptide can be used to interpret the significant pathophysiology behind T2DM. Aims and Objectives: The aim of the study was to perceive endogenous insulin secretion or beta cell functioning of the pancreas by measuring C-peptide levels in T2DM patients. Materials and Methods: The cross-sectional study were conducted on 120 random T2DM patients attending the outpatient clinic of tertiary care hospital (Netaji Subash Chandra Bose Medical College, Jabalpur) from January 2021 to August 2022. All T2DM patients were evaluated with fasting C-peptide levels. Results: Among 120 cases,25 (20.8%) have low C-peptide levels of <1.1 ng/dL, indicating poor insulin reserve.33 (27.5%) have normal C-peptide levels, and approximately half −62 (51.6%) have high C-peptide levels of more than 3.3 ng/dL, indicating adequate endogenous insulin secretion and insulin resistance is the significant pathophysiology behind T2DM. Conclusion: C-peptide level is a useful investigation to perceive endogenous insulin secretion and beta cell function of the pancreas. Insulin resistance rather than insulin deficiency is the significant pathophysiology behind T2DM.

Spectrum of Neurological Disorders in Neurology Outpatients Clinic in Tertiary Care Hospital: A Cross Sectional Study

Background: Neurological disorders are one of the most noticeable causes of morbidity and mortality that have a negative impact on patient’s lifestyle. A significant rate of these diseases exists in developing populations. However, there is lack and shortage of literature on neurological illnesses in Pakistan. This study was therefore carried out to determine the pattern of neurological diseases in this setting which can also provide a benchmark for planning and care for neurological illnesses at tertiary care level. Methodology: This is a Descriptive cross-sectional review conducted at the neurology outpatient clinic of the Lahore General Hospital, Lahore over the duration of 9 months between April, 2021 and December, 2021. Data was gathered through a predesigned questionnaire from the patients which included data regarding gender, age, marital status, occupation, residential status and affected disease. Results: Among all patients (140) who visited the neurology clinic over this duration, the most frequent neurological disorder was migraine (40%), followed by stroke (25%) and seizures (20%). The major age group that visited the neurology clinics was between 51 and 60 years (30%) and among them, most were males (60%). Conclusion: Stroke, migraine, and Parkinson's disease were the most common neurological disorders among participants of present study. Neurological diseases outnumber other diseases in Pakistan, affecting all age groups and genders. Headache, migraine, stroke, and seizure were found to be more common than AD and other dementias in Western countries and as significant reasons of morbidity. Keywords: Neurological disorders, neurology clinic, outpatients

Prevalence of cardiovascular diseases and risk factors in adult patients with haemophilia: a cross-sectional study in a tertiary care hospital clinic in Sri Lanka

BackgroundManagement of cardiovascular disease (CVD) in patients with haemophilia is extremely challenging. Therefore, knowing the prevalence of CVD and risk factors in this population is imperative.MethodsAll consented patients ≥ 18 years of age attending the haemophilia clinic at a tertiary care centre were recruited to the study. Data were collected using a pretested, investigator administered questionnaire. Seated blood pressure, anthropometric measurements and blood samples were obtained using standard techniques. Lipid profile and fasting plasma glucose were estimated. Prevalence of risk factors for CVD was compared with those of age matched males in the general population. P values < 0.05 were considered significant.ResultsOf the total 109 participants, 92 (84.4%) had haemophilia A. The median age of the study group was 36 years. Three (2.8%) had at least one cardiovascular disease. There were 10 (9.2%), 30 (27.5%), 13 (11.9%) and 4 (3.7%) participants with diabetes, hypertension, current smoking and obesity (Body Mass Index (BMI) ≥ 30 kg/m2) respectively. 32 (29.4%) and 37 (33.9%) participants had waist circumference ≥ 90 cm and waist hip ratio ≥ 0.9 respectively. 38 (34.9%) had total cholesterol ≥ 200 mg/dl, 43 (39.5%) had low density lipoprotein (LDL) cholesterol ≥ 130 mg/dl, 25 (22.9%) had triglycerides (TG) ≥ 150 mg/dl and 58 (53.2%) had High density lipoprotein (HDL) cholesterol < 40 mg/dl. Diabetes was significantly associated with factor levels below 5% (p = 0.038). BMI, waist circumference and dyslipidaemia in the study were significantly higher compared to the general population.ConclusionThe study signifies an increased prevalence of risk factors for CVD among patients with haemophilia and the need for preventive measures.

EFFECT OF YOGA BREATHING EXERCISE ON THE PULMONARY FUNCTION PARAMETER (PEAK EXPIRATORY FLOW RATE) AND SYMPTOM CONTROL OF CHILDREN WITH MODERATE PERSISTENT BRONCHIAL ASTHMA ATTENDING TERTIARY CARE CENTRE-A QUASI EXPERIMENTAL STUDY

Objectives: The study was undertaken with the objective of assessing the effect of breathing exercise ( Alternate Nostril Breathing Exercise with deep breathing and controlled relaxation, pranayama a form of yoga breathing technique) on the pulmonary function parameter as well as symptom control of children with moderate persistent bronchial asthma. Background: Childhood asthma is a chronic health condition that affects more than 1 million school-aged children and their families. Nonpharmacological therapy includes yoga breathing techniques such as Alternative Nostril Breathing techniques significantly reduces the stress and improves better asthma control in children with bronchial asthma. Design &amp;Methods: Quasi-Experimental, two group pretest- post-test design were adopted. Sixty children with moderate persistent bronchial asthma attending asthma clinic of tertiary care hospital were selected for the study. Simple random sampling with a comparison group was used for selection of the sample. TREND checklist for quasi-experimental design used as guidelines for the current study. Results: Breathing exercise significantly changed the Peak Expiratory Flow Rate as evidenced by the significant change in the mean percentage of PEFR value from the predicted value in the experimental group. Comparison of mean percentage PEFR value from age wise predicted value in the experimental group showed that 69.5%/ 82.4% , t= 8.275, p= o.ooo (p&lt; 0.05) and in the control group was 66.0%/ 66.2% , t= 1.326 , p = 0.195 ( p&gt; 0.05). There was statistically significant change in asthma control parameters in the experimental group. Breathing exercise significantly improved the level of symptom control in the experimental group. No such significant improvement in Symptomcontrol was noted in the control group.(McNamer 0.000/ 0.063), (p&lt; 0.05). Conclusion: Based on the above findings, the present study concluded that breathing exercise has an effect on improving the pulmonary functions and symptom control of children with bronchial asthma.Relevance to clinical practice:The practice of yogabreathing exercises improves asthma symptoms and helps children to achieve better control over asthma along with pharmacological management.

Depression in adults with epilepsy attending epilepsy clinic in tertiary care hospital: an observational study

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Epilepsy is a chronic neurological disorder characterized by recurrent unprovoked seizures. Depressive disorders are the most common psychiatric co-morbidity in patients with epilepsy. Early detection and treatment improve overall health related quality in these patients.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A prospective cross sectional observational study was conducted across 6 months (December 2018-May 2019) in a tertiary care hospital. The present study included 50 registered patients and various socio-demographic factors like age, sex, marital status, literacy, drug compliance and status of seizure control etc. were evaluated in regards to prevalence and severity of depression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 50 patients, 27 patients (54%) showed signs of depression. Out of which 10 patients (20%) showed signs of mild depression, 6 patients (12%) showed signs of moderate depression, 7 patients (14%) showed signs of moderately severe depression whereas 4 patients (8%) showed signs of severe depression and there was a strong association of drug compliance, current epilepsy status and last seizure episode with various degree of depression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Depression is an illness with a significant morbidity and mortality. Its association with epilepsy is very strong. Various factors contribute to depression which include compliance of drugs, last seizure episode, current status of epilepsy, etc. Unfortunately, depression among epileptics is very much under diagnosed and therefore untreated. A through psychiatric assessment should be done in these patients with epilepsy for depression and appropriate treatment should be instituted.&lt;/p&gt;

Epidemiological Pattern and Trend Analysis of Animal Bite Cases of Anti-Rabies Clinic of Tertiary Care Hospital of Delhi.

Background:Animal bites to humans are a public health problem. Rabies is caused by rhabdovirus which is present in the saliva of rabid animals like dogs, cats, monkeys, and wild animals like fox and jackals.Objective:To find the epidemiological pattern and trend analysis of animal bite cases registered in Anti-rabies clinic of tertiary care hospital of Delhi.Materials and Methods:A retrospective cross-sectional study was planned in Anti-rabies clinic of Hindu Rao Hospital, Delhi, and data from January 2010 to December 2018 was taken. Data were analyzed by SPSS software version 21.0.Results:After interpretation of data from 2010 to 2018, it was found that maximum number of animal bite cases belonged to category 3 (91.0%) and majority (93.6%) were due to dog bite. On analysis of year and season wise trend, it was found that the frequency of cases showed a rising trend from the year 2010, with highest number of cases in the year 2014, while animal bite cases were maximum with arrival of spring season (month of April).Conclusion:This study concludes that animal bite cases are rising over the years and dog bites are most common animal bite cases in Delhi. Most of the animal bite cases occurred during spring season followed by autumn season of the year. So, there is dire need of strengthening the preventive measures for controlling animal bites in the study area.

Evaluation of Cognitive Functions in Type 2 Diabetes Mellitus Patients Attending Diabetic Clinic of Tertiary Care Hospital in India

&#x0D; Background: The incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide and has become a significant public health problem. Diabetes can lead to many secondary complications affecting multiple organs in the body. There is an association between diabetes mellitus and cognitive impairment, rapid decline in cognitive function, and dementia.&#x0D; The purpose of this study was to determine the effect of diabetes on cognitive functions of male and female patients and to assess whether cognitive functions of diabetic patients differentially vary between male and female patients.&#x0D; Methods: 94 [Male (n=52) and female (n=42)] patients suffering from diabetes for more than five years attending diabetes clinic were selected for study and subjected to blood sugar tests and various cognitive function tests like MMSC, CDT, TRIAL A&amp;B, WMS 1&amp;2 tests.&#x0D; Results: The results from the tests showed significant alteration in the cognitive function of both male and female patients although patients are on treatment for diabetes.&#x0D; Conclusion: The elucidation of the mechanism of T2DM-associated cognitive dysfunction and dementia may lead to the development of therapeutics for this specific condition as well as for dementia.&#x0D; Key Words: T2DM, Cognitive function tests, Cognitive dysfunctions,&#x0D;

Annual Cost of Care of Parkinson's Disease and Its Determinants in North India - A Cost of Illness Study with Patient Perspective.

Background:Parkinson's disease (PD) is a slowly progressive and disabling disorder, so the cost of illness may change with time. We aimed this study to know the annual cost of care of PD in India.Methods:After ethics approval, a prospective cohort study was conducted at the movement disorder clinic of tertiary care hospital for 2 years (2014–2016). The outcomes were a description of the total annual direct cost of Parkinson's disease including health care as well as non-health care cost. We also did correlation analysis to know the determinants of the total cost.Results:A total of 200 consecutive patients of PD with 141 (70.50%) males and 59 (29.50%) females with a mean age of 56.84 ± 10.51 years were enrolled. The annual Median Direct cost of care was INR 27,315.0 (IQR 13636.6–44908.4), whereas the Indirect cost was INR 21,400 (IQR 9800 – 96800). Cost on drugs (Direct health care) formed 68.50% (Median) of the total Direct cost. Total direct cost formed 11.38% of the Median total yearly income of our patients. Of the direct cost, the Median expenditure on drugs was INR 18,712.8 (8064.0 -30696.0). Only 5% of patients had health care insurance. The total direct cost was determined by the stage of Parkinson's disease and duration of disease (P = < 0.01) but not predicted by age, gender, age at onset, and the yearly income of patients.Conclusion:Annual cost of care of Parkinson's disease is high and increases with the duration of the disease as well as the progression of the disease.

Study of evaluation of functional outcome of medial opening wedge high tibial osteotomy in unicompartmental osteoarthritis knee

Introduction: Osteoarthritis is a multifactorial disease but abnormal stress produced by biomechanical alteration is one of the major accelerating factors. Medial compartment osteoarthritis refers to the excessive loading of weight onto the medial femoral condyle and medial tibial plateau. If mechanical axis is realigned in correcting varus in open wedge high tibial osteotomy to unload the medial compartment, patient gets significant pain relief and surgery adds life to the knees. Material and Methods: This is a prospective study of patients who attended the Orthopaedics outpatient clinic in tertiary care hospital. The patients were evaluated by clinical examination and weight bearing radiographs. The patients who were found to have unicompartmental osteoarthritis with knee pain not relieved by conservative management and who satisfy the inclusion criteria were selected. During this period 21 patients were selected and were included in study. Results: Major group of patients in our study belong to age group 46-50 years (62%). The mean age of patients in our study is 48.38 years, the mean time of union is 4.04 months. As far as complications are concerned there were 3 complications we encountered 1 among them was superficial infection 1 had lateral tibial condyle involvement due to higher correction angle 1 patient had under correction noted on post operative HKA axis scanogram. The average JOA Knee score preoperatively was 52.6 which improved postoperatively with average score of 82.9.average. Functional knee society score was 70.80 preoperatively which improved postoperatively to 90.57. VAS score preoperatively was 6.95 which reduced considerably to an average score of 2.09 postoperatively. We got excellent results in 18 patients (86%), good results in 2 patients (9.5%) and fair results in 1 patient (4.5%). Conclusion: In our study medial opening wedge high tibial osteotomy with osteosynthesis is a physiologically better surgery in medial compartmental primary osteoarthritis knee in early stages. Early results are gratifying for Indian patients, who cannot afford the costlier surgery and implant and also are reluctant to change squatting habits & job profile. Though complications are there but they are avoidable & treatable.

Investigating the experience of receiving podiatry care in a tertiary care hospital clinic for people with diabetes related foot ulcers

BackgroundDiabetes related foot ulcers can have physical, social, emotional, and financial impacts on the daily life and wellbeing of many people living with diabetes. Effective treatment of diabetes related foot ulcers requires a multi-faceted, multi-disciplinary approach involving a podiatrist, other healthcare professionals, and the person with diabetes however, limited research has been conducted on the lived experience of podiatric treatment for diabetes related foot ulcers to understand how people are engaged in their ulcer management. Therefore, this study aimed to explore the lived experience of receiving podiatric treatment for diabetes related foot ulcers in a tertiary care outpatient setting.MethodsTen participants were interviewed. All were male, with mean age of 69 (SD 15) years and currently undergoing podiatric treatment for a diabetes related foot ulcer in a tertiary care setting. Participants with diabetes related foot ulcers were purposively recruited from the outpatient podiatry clinic at a tertiary hospital in a metropolitan region of South Australia. Semi-structured interviews were conducted to gain insight into the lived experience of people receiving podiatric treatment for their foot ulcer and understand how this experience impacts their regular lifestyle. Data were analysed using a thematic analysis method.ResultsFour themes were identified that add an understanding of the lived experience of participants: ‘Trusting the podiatrists with the right expertise’, ‘Personalised care’, ‘Happy with the service, but not always with prescribed care’, and ‘It’s a long journey’. Participants described professional behaviour including high organisation and hygiene practices and demonstrated expertise as key factors influencing their trust of a podiatrist’s care. Information tailored to individual needs was helpful for participants. Offloading devices and ulcer dressings were often burdensome. Podiatric treatment for foot ulcers was a lengthy and onerous experience for all participants.ConclusionsThe findings of this study suggest podiatrists can use practical strategies of maintaining consistency in who provides podiatry care for the person, demonstration of high organisational and hygiene standards, and using innovation to adapt information and equipment to suit an individual’s lifestyle to support positive experiences of podiatric ulcer care. There is a need for further research to understand how a person’s experience of podiatric ulcer care differs amongst genders, cultural groups, and healthcare settings to facilitate positive care experiences and reduce treatment burden for all people with diabetes requiring podiatric ulcer treatment.

Presentations and Psychiatric Diagnosis in A Psychiatric Out-Patient Clinic of Tertiary Care Hospital in Eastern Nepal

INTRODUCTION This study aimed to see common presenting complaints and psychiatric diagnoses among the patients visiting for the first time to the Psychiatric Out-patient Department (OPD) of a tertiary care hospital in Eastern Nepal. METHODOLOGY A cross-sectional study was conducted in the OPD of B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal during the study period of 3 weeks after the institute ethical approval. Patients were selected via convenience sampling technique. Face to face interview was conducted to collect socio-demographic data and the presenting complains (up to 5) according to the patients and their attendants. Psychiatric diagnoses were recorded as per the clinician. RESULT Among the first contact psychiatry out-patients; various physical/ somatic, anxiety and mood related symptoms were the commonest presenting complaints, as per the patients, attendants and clinicians. Behavioural symptoms were others mostly observed and reported. The commonest diagnoses were: Depression, Recurrent Depressive Disorder, Dysthymia (18.6%); Phobia, Other Anxiety and Obsessive Compulsive Disorder (17.9%); Schizophrenia, schizotypal and delusional disorders (13.8%) and Mental and Behavioural disorders due to Substance use (8.3%). Deliberate self harm and seizures were present in 7% each. CONCLUSION The commonest presenting complaint in psychiatry outpatient clinic was related to physical and somatic symptoms, followed by anxiety and mood related ones. Common diagnoses were Depression, Anxiety, Schizophrenia and Substance use/ related disorders.

AACE2021-A-1084: Impact of Sodium Glucose Co-Transporter Type 2 Inhibitors on Alanine Amino-Transferase Levels of Patients with Type 2 Diabetes Having Nonalcoholic Fatty Liver Disease in Pakistani Population: A Retrospective Cohort Study

To determine the changes in ALT levels after initiation of SGLT2-i in T2DM patients aged 30 – 60 years having NAFLD over a period of one year presenting to an Endocrine outpatient clinic of tertiary care hospital in Karachi, accounting for dietary intake and physical activity level.

Reduced oral intake is the primary cause of referral of patients with dementia to the internists in Turkey

AbstractBackgroundDuring acute care admissions of dementia patients, an internist consultation is ordered in the first step due to the complexity of these patients. In this study, to determine what types of care are expected in the internal medicine wards, we examined the causes of referral of patients with dementia to an internal medicine clinic.MethodIn this single center study, we retrospectively enrolled patients with dementia who were consulted and admitted to the internal medicine clinic of tertiary care hospital between April 2018 and December 2020. The causes of admission were identified from the medical records. Patients consulted but not hospitalized were excluded. Patients with a history of neurodegenerative disorders other than Alzheimer’s dementia, vascular dementia, dementia with Lewy bodies and Parkinson’s dementia were excluded.ResultThe analysis included 71 patients [mean (SD) age: 85.0 (9.1) years, female 54.9%]). Lower education (&lt;5 years, 87.3%), low estimated glomerular filtration rate (&lt;60 ml/min, 84.5%), hypertension (80.3%), composite CVD (CAD, stroke or peripheral arterial disease, 56.3%), coronary heart disease (46.5%), diabetes mellitus (32.4%), stroke history (22.5%), anemia 45.1%, polypharmacy (&gt;4 drugs, 39.4%), and overall multimorbidity (4 or more comorbidities, 70.4%) were prevalent. The most common cause of referral resulting hospitalization was reduced oral intake by 57.7%. Acute kidney failure (9.9%), glycemic disturbances (7.0%), blood pressure disturbances (2.8%), cancer related problems (2.8%), urinary infection (2.8%), and other disorders (2.8%). In 14.1% of patients the cause of neither referral nor admission was identified by the referring physician and the internist. Men vs. women (71.9 vs. 46.2%, p=0.029) and patients with BMI&lt;30 vs. &gt;30 (62.5% vs. 14.3%, p=0.037) were more frequently, whereas patients with diabetes vs. without diabetes (30.4 vs. 70.8, p=0.001), and composite CVD (47.5 vs. 71.0, p=0.047) were less frequently admitted with reduced oral intake.ConclusionThe present study showed reduced oral intake as the leading cause of admissions of dementia patients to the internal medicine ward. Given the well‐known complexity of these patients, this finding may justify the recent efforts by the international societies to increase the involvement of internists in the management of undernutrition in acute and chronic care.

DETERMINANTS OF ADHERENCE TO ANTIHYPERTENSIVE MEDICATIONS AMONG PATIENTS ATTENDING TERTIARY CARE HOSPITALS IN ISLAMABAD

Objective: Hypertension is one of the non-communicable diseases which reduces life expectancy and decreases productive years, accounting for almost 9·4 million deaths annually and 7·0% of global DALYs. The economic burden associated with NCD deaths will rise from $152 million in the year 2010 to $296 million in 2025. Nonadherence to medications leads to poor health outcomes. The annual cost of nonadherence was estimated to be at 100 million US dollars in 2011 or 70% of healthcare expenditure on drugs worldwide. We conducted this study to have an insight into our patient's behavior towards their treatment regimes. Design and method: A hospital-based analytical cross-sectional study involving adult hypertensive patients attending the cardiology clinic of tertiary care hospital in Islamabad Capital Territory (ICT), conducted from July 2019 to October 2019. The data was collected using a semi-structured pretested questionnaire. Proportionate to target population sample was calculated and 418 subjects were enrolled through systematic random sampling technique. Data analysis was done as descriptive statistics Bivariate analysis was carried out and a p-value of less than 0.05 considered as significant. Logistic regression was done to identify independent predictors of adherence Results: The mean age of respondents was 54.4 years SD ± 10.61. Participants were predominately male (56.2%). 327 (72.7%) of the respondents had High Bp Grade I, uncontrolled blood pressure. 218 (48.44%) were not able to afford to buy monthly medication, Average monthly cost of the medication was 7.42 USD (1150 PKR) ± 1136 Pak Rupees, with 28.89% were not able to buy the medications on their own. Multivariate logistic regression analysis revealed non-affordability of treatment (OR 2.2 p-value 0.0002) and testing, uncontrolled hypertension (OR 3.1 p-value 0.0001), as statistically significant determinants for being nonadherent, whereas being educated (OR O.6 p-value 0.02))and adequate counseling by a health practitioner (OR 0.2 p-value 0.000) were protective factors. Conclusions: For improving adherence to antihypertensive therapy, we concluded the prevalent paradigm of healthcare is nonsupportive in terms of enhanced and non-affordable treatment regimes, long waiting hours, non-availability of universal health coverage. Further, education and better counseling had a positive impact on the patient's altered attitude towards medications.

Illness Representations of Hypertension among Nepali Patients at a Tertiary Care Hospital Clinic: An exploratory survey.

The prevalence of stage 2 hypertension approaches one-third in adult Nepalis and despite inexpensive effective treatment, long-term compliance is poor. World-wide, a major impediment is the incongruity between hypertension and patients' symptom-based illness representations. The Common-Sense Model of Self-regulation was used to investigate Nepali illness representations through open-ended interviews of patients with hypertension. In a tertiary hospital setting, 50 self-identified hypertensive patients were interviewed about their representations of health, hypertension, and hypertensive treatment. Responses were analyzed with a modified Interpretative Phenomenological Analysis. An Ayurvedic-influenced health model appeared in illness identity and coping responses. Hypertension was identified as a serious disease having observable, wide-ranging symptoms with chronic and intermittent timelines. Concerns included side-effects and barriers to treatment. Further confirmation and investigation of Nepali common-sense hypertension models in a sample size sufficient for factor analysis is warranted for effective adherence interventions.

Pattern of Anemia among Primigravida Attending the Antenatal Clinic of Tertiary Care Hospital

Objectives: To determine the frequency of anemia, severity, its various types and determinants among primigravida attending the antenatal clinic of tertiary care hospital. Methods: It was cross sectional study conducted in Antenatal clinic, Gynecology and Obstetrics department, Services Hospital Lahore for duration of one year from 01-07-2017 to 30-06-2018. All primigravida presenting to antenatal clinic for their first antenatal visit uptil 24 weeks were included in study. Blood samples of the patients was sent in complete blood count vial to pathology laboratory. Patients having hemoglobin level less than 11 gm/dl were labelled as anemia and typing was done according to RBC indices, S. Ferritin and hemoglobin electrophoresis if required. Characteristics of patients anemic and nonanemic patients were compared. Severity of anemia was also noted. Results: Total 210 primigravida were screened and 53 (25.2%) patients were found to be anemic. Iron deficiency anemia was noted in 40(75.5%) patients, beta thalassemia in 9(17.0%) patients and megaloblastic anemia in 4(1.9%) patients. Mild anemia was seen in 28(52.8%), moderate anemia in 19(35.8%) and severe anemia in 6(11.3%) primigravida. The mean age of the patients was 25.68±4.68 years in patients without anemia and 26.47±4.76 in patients with anemia. The mean gestational age at booking was 16.15±4.87 weeks for non anemic patients and 22.23±3.67 weeks for anemic patients (p&lt;0.05). Mean hemoglobin in anemic patients was 9.2+0.8 mg/dl while 11.1+0.6mg/dl in nonanemic patients (p&lt;0.05). Illiteracy, low socio- economic status and no intake of iron supplementation had significant association with anemia (p&lt;0.05). Conclusion: The frequency of anemia among primigravida attending the antenatal clinic of tertiary care hospital was 25.2% and the most common type was iron deficiency anemia. Poverty, illiteracy, late booking and no iron and folic acid intake were significant determinants of anemia. Key Words: Anemia, Primigravidas, Iron deficiency anemia How to Cite: Bushra N, Wasim A.Z, Feroze J, Masood M. Pattern of anemia among primigravida attending the antenatal clinic of tertiary care hospital. Esculapio.2020;16(04):92-96.

Does malnutrition in clubfoot patients affect Ponseti technique and its outcome?

Malnutrition is a crucial health problem predominantly in the developing countries. Malnutrition in children is one of the main risk factors for diseases and mortality. Club foot or congenital talipes equinovarus (CTEV) is the most common form of congenital orthopaedic abnormality. Over the past 20years, the Ponseti method is considered the gold standard for the treatment of clubfoot. Our objective is to determine the prevalence of malnutrition in clubfoot patients, and its effects on the outcome of Ponseti technique in patients presenting to the Orthopaedic Clinic of tertiary care Hospital in Karachi, Pakistan. The cross-sectional study was conducted from January to December 2018. Total 153 clubfoot patients were treated and the World Health Organization (WHO) classification of weight-for-age index was used to assess the nutritional status of patients, and its impact on outcome of Ponseti technique was recorded and analysed with a P value≤.05 as significant. Of the 153 patients, 112 (79.7%) were found in good nutritional status and 42 (20.6%) were malnourished. The average number of casts per patient and patients requiring 6+casts in the undernutrition group was higher compared with good nutrition group (45.5% vs 21.42%, respectively). The number of Achilles tenotomy performed in the undernutrition group was also higher (76.4% vs 51.8%). A significant correlation between patients' nutritional status and outcome of the Ponseti technique is found as it influences the number of casts, possible relapse and failure of treatment.