General Medicine Department Research Articles

A Pilot Study on Medication Adherence, Patient Satisfaction, KAP and Quality of Life of Hypertensive Patients

Aim: The present study was designed as a pilot study to assess the prevalence and reasons for occurrence of hypertension and identify the various treatment options prescribed and to determine the patients’ awareness and adherence to the treatment. Materials and Methods: An institution based cross-sectional study for a period of one month was conducted among the patients of Department of General Medicine, DM WIMS Multispecialty Hospital, Wayanad, Kerala by using standard questionnaires. 51 patients who meet the inclusion criteria were enrolled in the study. Well-structured questionnaires and standard tools such as Patient Satisfaction Scale (SAPS), Hill-Bone medication adherence scale (HB-MAS), WHOQOL-BREF were utilized to collect the data. Collected data was scrutinized by using Statistical Package for Social Sciences (SPSS version 15.0). Student t-test and one-way ANOVA were employed to test for associations at 95% confidence interval. P<0.05 were considered significant. Results: The Results indicated rise of prevalence of hypertension in rural regions. Middle ged male group was mostly affected. Majority of the participants were affected with Grade III hypertension for more than five years and also affected with other chronic illness. All the study subjects were treated with multi-therapy regimen with dose frequency of BID. Results showed a lesser level of treatment satisfaction, medication adherence, KAP and quality of life of study population. Conclusion: The results strongly supported the need of the patient counselling by clinical pharmacists to improve the analysed parameters. Hopefully, future study with larger sample size with proper patient counselling could provide a significant outcome.

Correlation of Anemia with Glycated Hemoglobin among Euglycemic Type 2 Diabetic Patients.

Diabetes mellitus (DM) and anemia are both prevalent in India. Glycated hemoglobin (HbA1c) is the gold standard test for the diagnosis of DM and monitoring of glycemic status. Hemoglobin (Hb) being the integral component of HbA1c, there is a possibility that anemia can also affect the level of HbA1c apart from the various other factorsObjectives: To study the prevalence, type of anemia, and correlation between HbA1c and anemia, including red blood cell (RBC) indices in euglycemic type 2 DM patients. The study was conducted with the objective of studying the correlation between HbA1c and anemia in euglycemic diabetic patients having controlled blood glucose over a period of 3 monthsMethodology: This cross-sectional study was conducted between May 2020 and May 2021 at the Department of General Medicine, Government Medical College, Kota, Rajasthan, India. All euglycemic diabetic patients with controlled blood glucose over a period of 3 months attending the outpatient department and fulfilling inclusion and exclusion criteria were enrolled in the studyInclusion criteria: All euglycemic type 2 DM patients with controlled blood glucose having three consecutive normal blood glucose levels [fasting blood sugar (FBS)-80-130 mg/dL and postprandial blood sugar (PP2BS) test-<180 mg/dL] over a period of 3 months from the outpatient departmentExclusion criteria: Type 1 DM and latent autoimmune diabetes of adults, patients with hemolytic anemia, pregnancy, chronic alcoholism, chronic kidney disease, chronic liver disease, combined deficiency anemia, patients with increased FBS and PP2BS, acute and chronic inflammatory state, malignancy, anemia of chronic disease, and vitamin B12 deficiency were excluded from our studyDetailed investigations of diabetes and anemia were conducted. The effect of anemia on HbA1c was assessed, and the correlation of anemia with mean HbA1c was analyzed statistically Results: The prevalence of anemia in diabetic patients is 56.8%. Normocytic normochromic anemia is the most common, which was observed among 48.86% of diabetic patients. The median HbA1c of anemic patients is higher than nonanemic patients (p < 0.01). There is a negative correlation between Hb and HbA1c (p < 0.01). The correlation of RBC indices, that is, mean corpuscular Hb (MCH), mean corpuscular volume (MCV), and MCH with HbA1c, is also negative (p < 0.01). There is a negative correlation between HbA1c and serum ferritin level, as indicated by the Pearson correlation test (p-value of <0.01)Conclusion: Anemia is prevalent in type 2 DM patients without renal involvement, and also normocytic normochromic type is the most common, followed by iron deficiency anemia (IDA). HbA1c levels are significantly affected by the presence of moderate anemia in spite of controlled glycemia.

EVALUATION OF SERUM FERRITIN AS A PROGNOSTIC MARKER IN ACUTE HEMORRHAGIC STROKE

Background - The term stroke or apoplexy refers to acute neurological injury,especially the type caused by cerebrovascular disease. Stroke is classied into two major types: 1. Infarction is due to thrombosis, embolism or systemic hypoperfusion. 2.Hemorrhage is through rupture of small arteries, arteriolar, aneurysms or capillaries. Methods - All patients who were admitted with stroke in medical ward and ICU from January 2021 to July 2022 in the department of General Medicine, Mamata Medical College and Hospital, Khammam.This is a hospital based observational study in group of 50 subjects. Results - Among 50 subjects of 30-80 age group most patients are 60s to 70s Ÿ Most frequent site of hematoma in study population is capsulogangionic region consistent with hypertensive hemorrhage (64%) , least affected thalamus (14%) . Ÿ HTN is main risk factor (98%) for patients with ICH. Ÿ Most common symptom FND Ÿ Maximum mortality in age group is among 51-70years Ÿ Serum ferritin levels are increased in mortality group Ÿ Patients < 40 years, DM, Thalamic bleed have good prognosis. Conclusions -The most common risk factor connected with ICH is hypertension. The volume of ICH and admitting GCS have no effect on serum ferritin levels.Increased baseline serum ferritin can be used as an independent prognostic marker and is associated with clinical deterioration. 1. Gangliocapsular region is the most common site of bleed. 2. The absence of diabetes, younger age and absence of IVH and midline shift are associated with good prognosis. 3. Low GCS and higher volume of hematoma is associated with poor prognosis. 4. The initial volume of hematoma as evaluated by ABC/2 is a reliable predictor of prognosis.

A STUDY OF NON ALCOHOLIC FATTY LIVER DISEASE PATIENTS WITH METABOLIC SYNDROME

Background: Non-alcoholic fatty liver disease (NAFLD) has been rising in incidence in the past two decades in developing nations like India as well as in many western nations and is being taking over the position of most common liver disease in the world. To study ultrasonographically diagnosed NAFLD with va Aims & objectives: rious grades and its association with metabolic syndrome and its components. The study was cross sectional descri Material and Methods: ptive study of patients with NAFLD, attending OPD and in patients of the Department of general Medicine, tertiary care hospital. All patients with as NAFLD were investigated for metabolic syndrome according to the NCEP ATP 3 Criteria and association between NAFLD and metabolic syndrome was studied. Results: There was a signicance association between fasting blood sugar level and USG grading of NAFLD. Age, HDL, VLDL & SBP were close to the statistical signicant level . NAFLD found to be in higher degree in all Conclusions: the components of metabolic syndrome. Its early screening will help in modifying the disease course, delaying complications and will also play a major role in preventive complication.

Assessment of antibiotics utilization in respiratory tract infections in teaching hospital

Background: Antibiotics are the main key drugs for treatment of respiratory tract infections (RTI) of both in upper respiratory tract infections (URTI) and lower respiratory tract infections (LRTI), and are among the most commonly prescribed drugs in adults. The caution use for anti-microbial agents (AMAs) is very important as their serious side effects, drug resistance and cost effectiveness can be life threatening. “In general drug utilization studies are carried out to identify appropriate usage of drugs in terms of medical, social and economical aspects. Objectives: A prospective observational study was carried out for a period of nine months between Januarys to September 2018. The information was collected from the Department of General Medicine and Pulmonology Basaveshwara general and teaching hospital Kalaburgi (India). Materials and methods: The prescription is chosen based on the inclusion criteria and the treatment follow-up until the patient discharge. During the study period the inpatient case records will be reviewed, which include antibiotics used and their dosage schedule, route of administration, dosage frequency & strength, date of discontinuation, generic name & bacteriological investigation. The information will document in the patient profile form. The data were analyzed by using online drug information like microdex, mediscap and data were present percentage calculation. Results: The results showed that out of 80 patients enrolled in the study 39 (48%) were given both IV route and oral route, 38 (47%) were given only IV route, 3 (4%) were given by oral route of antibiotics. In our study found that the combination of antibiotics Ceftriaxone, Amoxicillin with Clavunate, Pipericillin with Tozabactum were found to be commonly prescribed. In 42 patients (52%) are prescribed on diagnostic report were as in 38 patients (47%) prescribed without diagnosis of RTIs. Conclusion: The 20% of studied prescriptions founded prophylactic use of antibiotics combination. Thus special measures are imperative for their rational usage to prevent emergence of antibiotic resistance, serious side effects and cost effective treatment of poor economical patients. It can be concluded that it is mandatory to prepare suitable clinical guidelines for antibiotic prescriptions and usage rather than prescribing multiple and combination antibiotics.

Stressors and stress management strategies among young doctors amidst COVID-19 pandemic- Cross-sectional study

Introduction and Aim: The COVID-19 pandemic has caused a huge economic burden and impacted physical and mental health of the people. The young medical graduates are facing a lot of disappointments with regard to career, higher studies, personal life etc. The current research aims to assess the various stressors and their coping strategies among the young medical graduates during the COVID-19 pandemic. Materials and Methods: The cross-sectional study was conducted in the Department of General Medicine at a tertiary care teaching hospital in South India. Undergraduate medical students of 228 in number of both genders who completed their residency training just before and during the COVID-19 pandemic were enrolled in the study. The data was collected through a preformed questionnaire. Ethics clearance was obtained from the Institutional Ethics Committee. Informed consent was obtained. Statistical analysis was done by SPSS software version 18.0. P value < 0.05 was considered statically significant. Results: The mean scores obtained in PSS-10 were found to be higher among males than females. Around 79.4% showed moderate stress while 20.6% showed high stress (P=0.001). Males showed more stress compared to females in general as well as academic stressors. Male doctors and female doctors had differing stress coping skills. Conclusion: The study highlighted the vulnerable state of mind of the young medical doctors. The best way to overcome stress is by providing adequate resources, training to cope stress and ambient conditions for study and work, social support and relaxation techniques at both individual and organisational levels to help them to achieve a reasonable work-family interface.

Chronic Kidney Disease of Unknown Etiology in a Tertiary Care Teaching Hospital.

Background Several primary studies have looked at the burden of chronic kidney disease among diabetic patients, but their results have shown significant variance in India. In order to determine the combined prevalence of chronic kidney disease and associated risk factors among patients with diabetes, this study used a combination of methods. Methods Over the course of two years, a cross-sectional observational study was undertaken in the Tertiary Care Teaching Hospital's Department of General Medicine including all chronic kidney disease patients of 18 years of age and above of either gender. People not suffering from the disease were chosen as controls. Kidney Injury Molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin-ELISA (NGAL-ELISA) sample analysis by the kit method was done. The study was carried out in accordance with Schedule Y, ICH GCP principles, and the Helsinki Declaration after receiving approval from the institutional ethics committee. Results In our study, the urinary mean KIM-1 was 49.75±4.35 μg/g Cr in theChronic Kidney Disease of Unknown etiology (CKDu) group and 1.43±0.15 μg/g Crin the controls group. The mean NGAL levels of the CKDu Group and the controls group were 8.94±1.31 μg/g and 0.41±0.05 μg/g, respectively. In CKDu and the controls group, the mean eGFR (ml/min/1.73m2) was 69.83±7.91 and 108±3.7, respectively. The mean serum creatinine (mg/dL) was reported 3.79 in theCKDu group and 1.0 in the controls group. Conclusion Despite the urban centers previously being thought of as a non-endemic location, for the first time in the city, 60 CKDu patients are reported in this study. This is the first study to use the urinary biomarkers KIM-1 and NGAL to find suspected cases of CKDu and early kidney damage in local communities in the urban centers.

Clinical Presentations of Teenage Outpatients Encountered by General Internists in Japanese Hospitals: A Cross-Sectional Study.

Introduction General internists in Japanese hospitals sometimes consult on adolescents. Our university hospital encounters more adolescents with mental health complaints than other city hospitals. Consequently, based on our experience, we hypothesized that psychiatric disorders are significantly more common among teenagers who visit general internists. Therefore, we retrospectively analyzed the clinical profiles of teenage outpatients who visited general internists at three hospitals to test this hypothesis. Methods This study included 342 patients aged 13-19 years who visited the Departments of General Internal Medicine at Toyama University Hospital, Nanto Municipal Hospital, and Kamicichi General Hospital between January 2019 and December 2021. Data on age, sex, chief complaint, the period from onset to visit, referral status, and final diagnosis were collected from medical records. We also identified the final diagnoses of 1,375 outpatients from the university hospital during the same period, stratifying them by age. Multiple comparison analyses, Chi-squared tests, and residual analyses were performed to analyze the data. Results The number of psychiatric teen patients was significantly higher in the university hospital group than in the other city hospital groups (p<0.01). The incidence of psychiatric disorders, such as stress-related mental disorders, including adjustment and eating disorders (p<0.001), was also significantly higher in the teenage group (13-19 years) than in other age groups. Most psychiatric disorders lead to complaints of physical symptoms. Conclusions The potential onset of clinical episodes during consultations with teenage patients can make treating this age group more challenging; thus, they may require care at university hospitals. Furthermore, Japanese general internists in university hospitals encounter patients in their late teens with physical signs more often than in other hospitals. This trend may be unique to general medicine departments ("Sogo-Shinryo") in Japanese university hospitals. However, if general internists act under primary care principles, they can adequately assist adolescent patients.

Association of Hyperuricemia with Hypertension in Patients Presenting in the Outpatient Department for Regular Follow–Up

Objective: To determine the association of hyperuricemia with hypertension in patients presenting in the Outpatient Department for regular follow-up.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of General Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun 2019 to 2020.&#x0D; Methodology: Three-hundred patients suffering from hypertension for more than years were recruited in this study. They were evaluated for hyperuricemia during a routine follow-up visit by performing serum uric acid levels. &#x0D; Results: Out of 300 hypertension patients included in the study, 187(62.3%) had no hyperuricemia, while 113(37.7%) showed the presence of hyperuricemia on routine analysis. The mean age of the study participants was 41.72±6.98 years. The mean duration of hypertension in our patients was 6.61±2.75 years. Polypharmacy and long duration of illness had a significant association with the presence of hyperuricemia among the study participants (p-value&lt;0.001).&#x0D; Conclusion: Patients with hypertension showed a high frequency of hyperuricemia in our study. The long duration of hypertension and the use of multiple pharmacological agents to achieve adequate control of hypertension predicted raised levels of uric acid among hypertensive attending the routine outpatient clinic in our study.

Appropriateness of antibiotic prescribing for upper respiratory tract infection in a tertiary care teaching hospital: a cross sectional study

Background: Overuse of antibiotics among the patients with upper respiratory tract infection (URTI) is a worldwide problem, leading to antimicrobial resistance. This study is aimed to evaluate the appropriateness of the antimicrobial prescribing for upper respiratory tract infections in a tertiary care teaching hospital. Methods: This was a cross-sectional, observational study. Data was collected from outdoor adult patients who were clinically diagnosed to have URTIs from General Medicine and Otorhinolaryngology Department of a tertiary care teaching hospital. The appropriateness of antibiotics used in URTI was assessed. The data was analyzed using descriptive statistics. Results: Total 100 cases, clinically diagnosed to have URTI were included in the study. Among these, common cold (46%) and acute otitis media (23%) were the most frequent encounters. 75% of the prescriptions contained at least one antibiotic. In fact, antibiotics were the most commonly prescribed agents (21.2%) followed by antihistaminic (19.8%) and NSAIDs. 57% of the antibiotics were prescribed inappropriately, either in terms of inappropriate choice (37%) or over use (20%) of antibiotic. Conclusions: Inappropriate prescription of antibiotics for otherwise self-limiting URTI cases is a common practice even in a tertiary care teaching hospital. Implementation of multifaceted approach is needed to curtail the same.

Frequency of Difficult Patient Encounters in a Japanese University Hospital and Community Hospitals: A Cross-sectional Study.

Objective Difficult patient encounters (DPEs) are defined as encounters with patients causing strong negative feelings in physicians. In primary care settings, DPEs account for approximately 15% of visits among outpatients. To our knowledge, this is the first epidemiological study of DPEs in Japan. Methods We conducted a survey of 8 physicians (5.0±2 years of clinical experience) who examined first-visit patients ≥15 years old with clinical symptoms at the Department of General Medicine in Chiba University Hospital and 4 community hospitals over a 2-month period since December 2015. Materials We evaluated 10-Item Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) scores (DPE ≥31 points; non-DPE ≤30 points) and patient age, sex, and presence of psychological or social problems. Results The valid response rate was 98.9% (94/95) and 98.4% (189/192) in the university and community hospitals, respectively. The percentage of DPEs was 39.8% (37/93) and 15.0% (26/173) in the university and community hospitals, respectively; the percentage of DPEs was significantly higher at the university hospital than at the community hospitals (p<0.001). The proportion of patients with psychosocial problems was significantly higher in the DPE group than in the non-DPE group (93.7% vs. 40.4%, p<0.001). Conclusion Our findings were similar to those reported in primary care settings in other countries in community hospital outpatient and general internal medicine departments, where patients are mostly non-referrals, although the values were higher in university hospital general medicine departments, where patients were mostly referrals. Patients involved in DPEs have a high rate of psychological and social problems.

SERUM URIC ACID IN TYPE 2 DIABETES MELLITUS AND ITS ASSOCIATION WITH CARDIOVASCULAR RISK FACTORS

BACKGROUND: Prevalence of Type 2 Diabetes mellitus is rapidly increasing and is already as epidemic in India. Diabetes mellitus is an important risk factor associated with increased incidence of cardiovascular disease (CVD) Prevalence of CVD has rapidly increased in past few years. The four major risk factors for CVD are hypertension, dyslipidemia, diabetes mellitus and cigarette smoking.The Morbidity and mortality due to noncommunicable diseases specially attributed to diabetes mellitus and coronary heart disease is rising rapidly in India, causing nearly 5.8 million deaths per year annually. Insulin resistance state is associated with diabetes mellitus and metabolic syndrome. AIM To study the effect of serum uric acid levels in type 2 diabetes mellitus and its association with cardiovascular risk factors. OBJECTIVES :To compare serum uric acid levels with other CVD risk factors (hypertension, dyslipidemia, obesity, smoking) among type 2 diabetic subjects.To compare duration of diabetes and serum uric acid levels STUDY DESIGN: Cross sectional , observational study. PLACE OF STUDY: Department of General Medicine, Kamineni institute of medical sciences, Narketpally. DURATION OF STUDY : October 2020 to September 2022

A Study on the Risk Factors associated with Stroke in young adults and its Management Practices

The various risk factors causing premature stroke and cardiovascular diseases in young adults and their management are increasing problems in both developed and developing countries. Cardiovascular diseases include heart conditions that involve diseased vessels, structural problems, and blood clots. This is a prospective observational study which was conducted for 6 months in the general medicine department of Gandhi Hospital, Hyderabad. The study was initiated after the approval by Institutional Ethical Committee. During the study period a total number of 80 cases were collected. Out of these cases (55 cases, 69%) were of ischemic stroke and (25 cases, 31%) of hemorrhagic stroke. It was observed that males were more prone to strokes and females are more prone to cardiovascular diseases. The most common risk factor associated with stroke was hypertension. The age group of 41–50 years was mostly affected by stroke and cardiovascular diseases. Therefore, from our study we observe that timely treatment and patient counselling on disease, disease management and medications are important parameters for better patient care and improving quality of life.&#x0D; Keywords: Stroke, cardiovascular diseases, hypertension.

Relationship Between Vitamin D Deficiency and Non-alcoholic Fatty Liver Disease: A Cross-Sectional Study From a Tertiary Care Center in Northern India.

Background Vitamin D levels are strongly associated with myocardial infarction, coronary artery disease, heart dysfunction, and even mortality. Non-alcoholic fatty liver disease (NAFLD) is a prevalent hepatic illness whose incidence has grown dramatically over the past several decades. Methodology This observational, cross-sectional study was conducted over 1.5 years (January 2019 to June 2020) at the Department of General Medicine of a tertiary care hospital in northern India on 100 adult patients with NAFLD admitted to the emergency ward, intensive care unit, and medical ward. Results In our study, of the 100 patients, 45.0%, 16.0%, and 39.0% of patients exhibited vitamin D deficiency, insufficiency, and sufficiency, respectively. Vitamin D deficiency was the highest among those aged 41-50 (54.2%) and lowest among those aged 30-40 (29.0%). We observed that vitamin D deficiency was less prevalent in people with a normal body mass index (39.1%) than in those who were overweight (91.7%). There was a significant (p < 0.05) association between the severity of vitamin D deficiency and the presence of hepatomegaly, splenomegaly, and ascites. Overall, the incidence of fatty liver was 49% among patients. There was a significant (p = 0.0001) correlation between fatty liver and serum vitamin D levels. The association between the proportion of patients with fatty liver and the degree of vitamin D deficiency was found to be significant (p = 0.04). The relationship between the distribution of patients according to insulin resistance and the degree of vitamin D deficiency was also statistically significant (p < 0.001). Conclusions Vitamin D deficiency is associated with an increased risk of NAFLD, as well as with the severity of NAFLD.

Utilization of Hypolipidemic Drugs, Patterns, and Factors Affecting Dyslipidemia Among Type 2 Diabetes Mellitus at a Tertiary Care Teaching Hospital in South India.

Background The prevalence of dyslipidemia is higher in type 2 diabetes mellitus (T2DM) and hypolipidemic drugs like statins are effective for the primary and secondary prevention of cardiovascular events. Most of the patients with type 2 diabetes have a mixed type of dyslipidemia. This study aimed to evaluate the utilization of hypolipidemic drugs, patterns, and factors affecting dyslipidemia in T2DM participants. Methods This cross-sectional observational study was approved by the institutional ethics committee (IEC) of the Vydehi Institute of Medical Sciences and Research Center. It was conducted for a period of one year from July 2021 to June 2022. Participants with T2DM visiting the Department of General Medicine and Endocrinology were enrolled after obtaining informed consent. Demographic details, medication history, and laboratory data were recorded in case report form and statistical measures were applied. Results Out of 237 participants enrolled in the study,the predominance (n=133, 56%) was males. The mean age of the study population was 47.92±9.17 years, and the mean duration of diabetes was 6.8±5.3 years. Out of the total participants, 164 (69%) had deranged lipid profiles. Out of them, 129 (78.65%) were on hypolipidemic drugs. Regarding drug utilization, 122 (94.6%) received statins either rosuvastatin (54%) or atorvastatin (40%). In the deranged lipid profilespattern, 24% (58) participants had oneabnormal lipid parameter and the majority 70% (166) had combined lipid profile abnormality. Factors like increased BMI were significantly associated with dyslipidemia(p=0.004). Utilization of hypolipidemic drugs was also significantly associated with the control of dyslipidemia (p<0.001). It was observed that participants who were not on lipid-lowering drugs had 5.38 times more chance ofdyslipidemia (OR=5.38; CI=2.82-10.28; p<0.001). Conclusion A high prevalence of dyslipidemia was observed among diabetic patients. Statins were the most prescribed drug in the study.BMI and lack of pharmacotherapy were found to have a statistically significant association with dyslipidemia in diabetic patients.

CLINICAL PROFILE OF PATIENTS WITH RODENTICIDE POISONING IN A TERTIARY CARE CENTER

Background: Poisoning is one of the leading cause for admission in emergency department and rodenticides are one of the major poisons used. It is highly toxic substance where morbidity and mortality are signicant. After Methods: obtaining informed consent 100 patients admitted with rodenticide poisoning in Department of General Medicine, Siddhartha medical college is enrolled into the study after fullling inclusion and exclusion criteria, data is collected and appropriate treatment is given. Out of 100 Results: patients included in the study, 55patients (55%) consumed zinc phosphide. 27patients(27%) consumed warfarin derivatives. 18patients(18%) consumed yellow phosphorous. Female preponderance(54%) was seen in this study. Poisoning is more common below 29years of age. Total of 77patients(77%) recovered without complications, most common symptom is vomiting and complication is acute hepatitis(23%). Conclusion: This study shows Yellow phosphorous has the worst outcome. Zinc phosphide is the most common poison consumed and low mortality is seen in zinc phosphide and warfarin compounds

Engagement of Healthcare Professionals in Voluntary Activities During COVID-19: A Cross-Sectional Study

Background: The coming various disasters, especially probable pandemics, will need a large number of volunteers with different capabilities. Motivation of volunteers, as a driving force, will be very important for future pandemic disaster planning. The aim of this study was to determine the enablers and barriers to the engagement of healthcare professionals in voluntary activities during the COVID-19 pandemic.&#x0D; Methods: This cross-sectional study was conducted at the General Internal Medicine Departments of Imam Khomeini Hospital Complex in Tehran, Iran. A 44-item questionnaire was designed based on the Literature Review and Experts Panel. Items were scored on a 5-point Likert scale, ranging from “strongly disagree (1)” to “strongly agree (5)”. Content validity and face validity of the questionnaire were checked by 10 experts and 10 respondents, respectively. Cronbach’s alpha of the items of stimulating and inhibitory factors’ section was calculated 0.83 and 0.92, respectively. A self-administrated paper-based questionnaire has been distributed among healthcare team members. &#x0D; Results: Out of 105 health care professionals, 80 (76.2%) were female and 41 (39%) were married. The most significant demographic predictor of willingness to volunteering was having no child (p-value=0.001). History of infection, admission, or death of family members or friends in the current pandemic was an important factor to reduce the desire to voluntary activities significantly (p-value=0.019). Depressive disorders and using antidepressants had no relation with the attraction to volunteering, but anxiety disorders had a significant relation with the willingness to be a volunteer (p-value=0.04).&#x0D; Conclusion: The most important demographic variables influencing the unwillingness to participate in voluntary activities during the COVID-19 crisis are parenting role, history of anxiety disorders, and history of hospitalization or death of relatives or friends. Furthermore, the voluntary participation of healthcare professionals is influenced by facilitating factors such as giving rewards, reducing the period of obligatory military service, having a sense of altruism, and helping others.

A CLINICAL PROFILE OF HYPERTENSIVE EMERGENCIES WITH RESPECT TO TARGET ORGAN DAMAGE

Background: Hypertension is one of most common non-communicable disease affecting all age groups . Hypertensive emergency is characterized by an acute increase in blood pressure with systolic blood pressure greater than 180 or diastolic blood pressure greater than 110 . There is evidence of an acute target organ damage in hypertensive emergencies . The purpose of this study is to evaluate the clinical prole , and spectrum of target organ injury , as well as their prediction in patients with hypertensive crises. This is a hospital based prospective study done on 100 Methods: patients presenting with hypertensive emergencies to Department of General Medicine over a period of two years. The patients clinical and laboratory prole were evaluated. The results have shown that males have high Results: incidence of development of hypertensive emergencies and the average age of developing hypertensive emergencies is 62 years .Majority of population included are previously hypertensive .The most common presenting features include neurological decits , dyspnoea , chest pain , seizures , visual impairment .Type 2 Diabetes Mellitus and hyperlipidemia is associated with patients with hypertensive emergencies. Among the 100 patients , 93 were discharged and there were 7 mortalities. Hypertensive emergencies are associated with target or Conclusion: gan damage which can be life threatening , thus early idencation and strict control of blood pressure is must for all individuals

STUDY OF CLINICAL PROFILE OF PATIENTS OF NON ALCOHOLIC FATTY LIVER DISEASE AND ITS ASSOCIATION WITH METABOLIC SYNDROME

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver problems in the western world. It is known to be associated with various metabolic abnormalities, but not much information regarding association between the metabolic disease and the severity of fatty liver is available. We conducted a study on 100 consecutive patients aged &gt;18 years attending the outpatient and inpatient Department of General Medicine, Rajarajeswari Medical College and Hospital according to the inclusion and exclusion criteria. The study was an observational and analytical study of patients diagnosed as NAFLD. All patients diagnosed as NAFLD were investigated for metabolic syndrome according to the NCEP ATP III criteria and a relationship between NAFLD and metabolic syndrome was studied. We found that 53% of the patients of NAFLD had metabolic syndrome and statistical signicance was found in waist circumference, blood pressure, triglycerides, and fasting glucose. Its early detection will help CONCLUSION: in modifying the disease course, delaying complications and will also play a major role in preventive cardiology. It has been observed that there is high prevalence of all the components of metabolic syndrome in cases of NAFLD

A STUDY OF THYROID PROFILE AND FASTING LIPID PROFILE IN CHRONIC KIDNEY DISEASE

Background: Chronic kidney disease [CKD] is associated with specific abnormalities in the thyroid and lipoprotein metabolism both in the early and in the advanced stages of chronic renal failure. Regardless of age, heart disease is a major cause of morbidity and mortality among patients with renal failure.Our study aimed at to estimate thyroid profile and dyslipidemia in CKD patients on conservative management,on haemodialysisand to compare with healthy controls. Methods: This was a prospective study conducted among the 100 CKD patients and controls over 18 months admitted in the department of general medicine at our hospital. Results: Hundred CKD cases with 70 male and 30 female in a M: F ratio of 2.3:1 were found to be in different stages CKD (12, 29 and 59 in stage-3 to stage-5 respectively). In 59 cases of stage-5 CKD, 32 were on HD and 27 on conservative management. In each grade of CKD, the mean age, eGFR, urea, creatinine, thyroid profile, and lipid profile were computed individually. The levels of urea, creatinine, and eGFR differed significantly across CKD grades 3-5.The thyroid profile differed significantly across CKD grades 3-5. The lipid profile differed significantly across CKD grades 3-5, with p=0.000, &gt;0.05, 0.000, &gt;0.05, &gt;0.05 for total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) levels, respectively. Conclusions: The number of patients increases with decreasing T3 and T4 and increasing TSH proportionate to the severity of the renal failure, hypothyroidism is becoming more common in people with chronic renal disease.All lipid abnormalities found in CKD on HD have reduced HDL levels in serum along with significant rise in serum triglyceride, serum cholesterol serum LDL level and serum VLDL level.Dyslipidemia in CKD worsened as patientsprogresssed to severe stages with significant increase in TG, TC, VLDLc and TC/HDLc confirming presence of atherogenic lipid profile needing early intervention to prevent cardiovascular complications.