General Outpatient Department Research Articles

Human papillomavirus 16 specific immunoglobulin g antibodies and its correlates among women attendees of selected hospitals in Southern Kaduna, Kaduna State, Nigeria

Human papillomavirus type 16 (HPV-16) is one of the high-risk viruses that cause cervical cancers. Persistent infection with the virus leads to development of precancerous lesions of the cervix in infected women, which without medical intervention can progress to invasive cervical cancer. This study assessed HPV16-specific immunoglobulin G (IgG) antibodies in the serum of women attendees of General Outpatient Department (GOPD) at General Hospital Kafanchan and Kagarko in Kaduna State. This was a cross-sectional study. Structured, self-administered questionnaire was used to collect information and blood samples were also collected for testing. This was in addition to information collected from the laboratory analyzed. Five milliliters (5mls) of blood were aseptically collected from each of the 200 women, who had no history of HPV vaccination at the time of the study for the determination of HPV16-specific IgG antibodies using enzyme-linked immunosorbent assay method. The sero-positivity for HPV 16-specific IgG antibodies among the women was 24.5%. The sero-positivity among women who had their first sexual intercourse at age 13-19 years was 37.6%, and it was significantly different from those who had their sexual debut at ≥20 years (14.8 %) (p=0.001). Sero-positivity also increased from 9.2 % in women with one lifetime sexual partner to 60.0% in those with multiple sexual partners(p=0.001). The finding showed that the women in this study have been exposed to the HPV-16 virus. Further study with a larger population of women in this locality to determine the level of susceptibility or immunity to HPV-16 is strongly advocated, among others.

A Comparative Analysis of Healthcare Facilities: With and Without 24/7 Interventions.

Background: Maternal and neonatal mortality remains disproportionately high in low and middle-income countries, particularly in remote areas with limited healthcare accessibility. The Tharparkar district of Sindh, Pakistan, exemplifies such challenges, with basic utilities and healthcare services notably lacking. Objective: This study aimed to assess the impact of 24/7 availability of Maternal, Newborn, and Child Health (MNCH) services on healthcare delivery and patient outcomes in government healthcare facilities in the Tharparkar district. Methods: This action research followed a cross-sectional study design. Data collection commenced after receiving ethical approval and written consent from the Government District Health Officer of Tharparkar. Longitudinal data were collected using District Health Information tools from six healthcare facilities, three of which operated 24/7 and the remaining three for six hours daily. Data included indicators such as general outpatient department (OPD) visits, non-vaginal deliveries (NVD), antenatal, postnatal care, family planning, immunization, neonatal deaths, stillbirths, and live births. Statistical analysis was conducted using SPSS version 25, and results were visualized using Tableau 2024. Results: Facilities operating 24/7 reported a significant increase in healthcare utilization: general OPD attendance increased by 118.5% at THQ Kheeme Jo Par, 168.2% at GD Jese Jo Par, and 150.5% at GD Mehrna Vero. There were also notable improvements in NVD, antenatal, postnatal care, and family planning services. Immunization rates improved, stillbirths decreased, and there were zero neonatal deaths reported in these facilities following the intervention. Conclusion: The implementation of 24/7 MNCH services in Tharparkar significantly enhanced healthcare service delivery and improved maternal and child health outcomes. Continuous healthcare availability is crucial for improving health indicators and achieving global health targets in underserved populations.

Understanding Knowledge, Attitude, and Practices towards Sickle Cell Disease among Adult Outpatients: Insights from Lira Regional Referral Hospital, Northern Uganda

This study investigates the knowledge, attitude, and practices (KAP) regarding sickle cell disease (SCD) among adult outpatients at Lira Regional Referral Hospital (LRRH) in Northern Uganda. Employing a descriptive cross-sectional qualitative approach, data were collected from 100 adult patients aged 18 years and above attending the general outpatient department (OPD) at LRRH. Results revealed a substantial level of awareness of SCD among respondents, predominantly sourced from healthcare facilities and media outlets. While many recognized SCD as hereditary, misconceptions regarding its etiology and symptoms were evident. Notably, there was a knowledge gap regarding the treatability of SCD. Attitudes towards marrying individuals with SCD were predominantly negative, reflecting concerns about genetic transmission. However, there was a positive inclination towards premarital SCD testing. Regarding practices, reliance on medical facilities for SCD treatment was predominant, with minimal engagement with alternative therapies. Recommendations include sustained awareness campaigns, integration of SCD prevention and control initiatives, and further research to elucidate regional SCD prevalence determinants. Efforts to enhance male involvement in SCD advocacy and capacity building among healthcare providers are advocated to optimize SCD management and prevention strategies within the community. Keywords: Knowledge, Attitude, Practices, Sickle Cell Disease, Outpatients

Action Of Homoeopathy In Chronic Diseases – A Retrospective Analysis

Background: Homeopathy, as a holistic system of medicine, plays a pivotal role in the management of both acute and chronic diseases, offering a potential for permanent cure without causing harm to the patient. This retrospective analysis aims to underscore the advantages of homeopathy, focusing on common chronic ailments such as irritable bowel syndrome (IBS), polycystic ovarian syndrome (PCOD), bronchial asthma, allergic rhinitis, and low backache. Materials and Methods: The study was conducted retrospectively among patients attending the general Outpatient Department (OPD 2) at the National Homeopathy Research Institute in Mental Health, Kottayam, Kerala, every Tuesday from January 2023 to July 2023 (7 months). Analysis of data from 1677 patients revealed patterns of frequently indicated medicines. Results: A total of 1677 patients were included in the study, revealing distinct patterns in demographics and health conditions. The age distribution (Table 1, Figure1) indicated a higher prevalence among individuals aged 51-60 years (24%), while those in the 91-100 age group showed the least representation (1%). Notably, a predominant male presence was observed, constituting 51% of the patient population(Table2, Figure2). Among the patients, 197 were new attendees, while 1480 were returning patients, highlighting the sustained engagement of individuals with homeopathic care over time (Table 3, Figure3). The most prevalent disorders encountered during the study period (Table4, Figure4) were Bronchial Asthma (10%), Acid Peptic Disease (9%), and Diabetes Mellitus (9%). The most frequently used remedies were Sulphur, Pulsatilla, Nuxvomica, and RhusToxicodendron. Conclusion: In summary, this retrospective study involving 1677 patients at the National Homeopathy Research Institute in Mental Health revealed a predominant male demographic, with a concentration of cases in the 51-60 age group. Common disorders included Bronchial Asthma, Acid Peptic Disease, and Diabetes Mellitus, while Sulphur, Pulsatilla, Nuxvomica, and Rhustox emerged as frequently indicated remedies. Notably, the study showcased a remarkable improvement in all patients, affirming the efficacy and significance of homeopathy in achieving positive therapeutic outcomes.

Health care utilization and the associated costs attributable to cardiovascular disease in Ireland: a cross-sectional study.

Cardiovascular disease (CVD) is the leading cause of mortality and disability globally. We examined healthcare service utilization and costs attributable to CVD in Ireland in the period before the introduction of a major healthcare reform in 2016. Secondary analysis of data from 8113 participants of the first wave of The Irish Longitudinal Study on Ageing. CVD was defined as having a self-reported doctor's diagnosis of myocardial infarction, angina, heart failure, stroke, atrial fibrillation or transient ischaemic attack. Participants self-reported the utilization of healthcare services in the year preceding the interview. Negative binomial regression with average marginal effects (AME) was used to estimate the incremental number of general practitioner (GP) and outpatient department (OPD) visits, accident and emergency department attendances and hospitalisations in population with CVD relative to population without CVD. We calculated the corresponding costs at individual and population levels, by gender and age groups. The prevalence of CVD was 18.2% (95% CI: 17.3, 19.0) Participants with CVD reported higher utilization of all healthcare services. In adjusted models, having CVD was associated with incremental 1.19 (95% CI: 0.99, 1.39) GP and 0.79 (95% CI: 0.65, 0.93) OPD visits. There were twice as many incremental hospitalisations in males with CVD compared to females with CVD (AME (95% CI): 0.20 (0.16, 0.23) vs 0.10 (0.07, 0.14)). The incremental cost of healthcare service use in population with CVD was an estimated €352.2 million (95% CI: €272.8, €431.7), 93% of which was due to use of secondary care services. We identified substantially increased use of healthcare services attributable to CVD in Ireland. Continued efforts aimed at CVD primary prevention and management are required.

Prevalence of Dyslipidemia, Drug Therapy Problems, and Medication Adherence in Type 2 Diabetes Mellitus Patients in North Central Nigeria

Background Patients with diabetes mellitus have an increased risk of developing dyslipidemia, predisposing them to macro- and microvascular consequences such as coronary heart disease. Aim The aim of this study was to assess the prevalence of dyslipidemia, drug therapy problems (DTPs), and medication adherence in type 2 diabetes mellitus (T2DM) patients in a tertiary hospital in North Central Nigeria. Method This study was a cross-sectional convenient sampling of eligible patients conducted in the General Outpatient Department of General Hospital, Ilorin, from March to May 2022. A validated questionnaire was administered to obtain all relevant information on sociodemographic information, and blood samples were collected in a medium plain heparinized tube and sent to the laboratory where fasting blood sugar, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) values were calculated as appropriate. Morisky's Medication Adherence Scale 8 (MMAS-8) was used to capture patient's adherence level, and DTP was assessed using the Pharmaceutical Care Network Europe (PCNE) Criteria version 7. Ethical approval was obtained from the Ministry of Health, Ilorin. Statistical Package for Social Sciences was used to analyze the data collected for descriptive and inferential statistics. Results The mean age of the respondents was 60 ± 0.7 years. Of the 60 respondents, 25 (41.67%) were males and 35 (58.33%) were females. All the respondents had dyslipidemia, 30% respondents were identified with a DTP of nonadherence, 16.7% needed additional drug/monitoring, dosage was too low in 11.7%, and 11.6% could not afford their medication due to high cost. In all, 45 (75%) respondents had poor sugar control and 33 (55%) had poor blood pressure control. Using MMAS-8, the majority (41, [68.30%]) of the respondents were found to have poor adherence to their diabetic medications. Conclusion High prevalence of dyslipidemia, poor medication adherence, and DTPs were found in the T2DM patients in this study.

Clinical spectrum and management of pseudoexfoliation syndrome: A cross-sectional study

Background: Pseudoexfoliation is one of the most common causes of secondary open-angle glaucoma worldwide. The current investigation is being carried out to investigate the clinical characteristics associated with pseudoexfoliation syndrome. Aims and Objectives: The current study was conducted with the goal of documenting the prevalence of the ocular clinical profile of patterns in patients with pseudo-exfoliative material attending a tertiarycare hospital’s general ophthalmology outpatient department. Materials and Methods: In the current study, 100 individuals were explored who were diagnosed with pseudoexfoliation and attended the outpatient department of ophthalmology, medical college, and hospital. The Snellen chart for visual acuity was used to test visual acuity. Pseudoexfoliation glaucomawas identified based on slit lamp examination of pseudoexfoliative material, intraocular pressure (IOP) >21 mmHg, glaucomatous cupping on fundus examination, pigmentation of trabecular meshwork on gonioscopy, and glaucomatous field abnormalities on perimetry. Results: The age range of 61–70 years had the most cases of pseudoexfoliation, accounting for 23, followed by 51–60 years with 17 occurrences. The current study comprised 48 patients, 20 of whom had bilateral pseudoexfoliation and 28 of whom had unilateral pseudoexfoliation. Our findings revealed that 17 patients had high IOP. We discovered 15 cases of open-angle glaucoma and 2 cases of narrow-angle glaucoma after analyzing 48 patients. The sample of 15 individuals with open-angle glaucoma included 11 men and 4 women. Conclusion: Pseudoexfoliation becomes more common as people age, and it is often unilateral at first but progressively progresses to bilateral pseudoexfoliation, necessitating frequent follow-up in unilateral cases. Pseudoexfoliation is associated with an increased risk of glaucoma, and the majority of cases have open angles.

A Rare Case of Pleomorphic Adenoma in the Left Submandibular Salivary Gland

Pleomorphic adenomas, which are benign tumours of the salivary glands, are most commonly found in the parotid gland and comparatively infrequently seen in the submandibular gland. These benign mixed tumours, known as pleomorphic tumours, are composed of different types of myoepithelium, epithelium, and mesenchyme. Regardless of the histologic type, parotid gland neoplasms result in distinct swellings in front of and below the ear. With the exception of neglected malignant tumours, both benign and malignant lesions are normally palpable when they are first discovered. Malignancies are often discovered more quickly due to their rapid growth, even though benign tumours are known to exist for many months to years before gaining clinical attention. Ultimately, there are no reliable clinical criteria to distinguish between benign and malignant lesions. A 58-year-old female patient presented to the general surgery outpatient department with a six-month history of a firm, palpable, slow-growing, painless, freely mobile mass in the submandibular region that was not attached to the surrounding tissue, bone, or skin. There was no significant past history, and the patient was not on any medication. Axial and coronal views of the Computed Tomography (CT) scan showed a well-defined radiolucent mass in the medial aspect of the left submandibular gland. The patient underwent surgical exploration and excision of the mass under general anaesthesia, and the excised specimen was sent for histopathological examination. The entire gland was dissected freely and removed, with utmost care taken not to affect the nearby neurovascular structures. No enlarged lymph nodes were noted. The histopathological examination of the biopsy specimen revealed features of pleomorphic adenoma. Surgery is the treatment of choice for pleomorphic adenoma, and the tumour tissue must be completely removed because any residual tumour tissue has a high risk of recurrence or transformation into a malignant tumour. The patient was followed up for more than two years with no signs of recurrence.

Outcomes of non-surgical treatment of chronic anal fissure: A comparative study

Background and objective: Chronic anal fissure is a common health problem related to high morbidity. The chemical option for treating chronic anal fissures is highly preferred. Methods: A clinical prospective comparative study was carried out in the General Surgery Outpatient Department in Rizgary Teaching Hospital, Erbil, KRG, during the period from January 2019 to December 2021,on a sample of 100 patients randomly recruited patients with chronic anal fissures divided into two groups with 50 participants each: the DTZ group, who received 2% diltiazem ointment, and the GTN group, who used 0.2% glyceryl trinitrate ointment twice daily for 6 consecutive weeks. The aim of the study is to compare the efficacy and effects of topical Diltiazem (DTZ) and topical glyceryl trinitrate (GTN) in the management of chronic anal fissures. Results: There was a highly significant association between fissure healing at the 4th week and patients treated with DTZ (P <0.001). A highly significant association was observed at the 6th week between fissure healing and DTZ treatment (P <0.001), while there was later a highly significant association between fissure healing at the 8th week and patients treated with GTN (P <0.001). A significant association was observed between treatment adverse effects and patients treated with GTN (P = 0.05). DTZ was found to be more effective for symptomatic relief than GTN. Conclusion: Both DTZ and GTN are effective in the treatment of chronic anal fissures, but treatment with DTZ is accompanied by faster healing and lower side effects.

Assessment of Medication Prescribing Indicators Using the World Health Organization Standard Indices in a Tertiary Hospital in Ilorin, Nigeria

Background: Drug use is the most common option in treating disease conditions in clinical practice. Irrational prescription and use of medicine have become a major problem in Africa. The patterns of medication prescription in this environment have been under-studied. Evaluating these patterns is essential to provide information that may guide actions towards improving the prescription standards and mitigate the problems associated with irrational prescription and use of medicine. The study aimed to assess medication prescribing patterns by all cadres of doctors in the General Outpatient Department of the University of Ilorin Teaching Hospital (UITH) using the World Health Organization (WHO) prescribing indicators. Methods: It was a six-month retrospective study of medication prescription by all cadres of the doctors attending to outpatients in the General Outpatient Department of UITH between 1st July, 2022 – 31st December, 2022. A validated data capture form was used for the study following the WHO prescribing indicator guidelines. The results were displayed using the arithmetic means, frequencies, and percentages. Results were interpreted by the recommended ideal values by the WHO. Results: 1,650 prescriptions were reviewed, 914 were included in the study. This study found that all the analyzed prescription indices fell short of the WHO-recommended threshold. An average of 2.25 medications were prescribed per patient. The percentages of encounters with injections, antibiotics, and other medications by generic name were 87.2%, 66.9%, and 73.2%, respectively. 53.8% of the medications prescribed came from the essential medicine list. Conclusion: All medication prescribing indicators assessed were found to be below the ideal value recommended by WHO. Therefore, we advocated for the training of prescribers and the formulation of policies that will promote the prescription of medications in line with WHO guidelines.

Health care use and costs attributable to cardiovascular disease in Ireland: a cross-sectional study

Abstract Cardiovascular disease (CVD) is the leading cause of mortality and disability in Europe but the use of health services and costs associated with CVD are poorly quantified. We examined health service use attributable to CVD and corresponding costs in Ireland. Data on 8113 participants aged 50+ of the first wave of The Irish Longitudinal Study on Ageing was used. CVD was defined as having a self-reported doctor diagnosis of myocardial infarction, angina, heart failure, stroke, atrial fibrillation or transient ischaemic attack. Outcomes were the self-reported number of general practitioner (GP) and outpatient department (OPD) visits, accident and emergency department (A&E) attendances and hospitalisations over the 12 months preceding the interview. Negative binomial regression adjusted for socio-demographic confounders and other chronic conditions was used to study the effects of CVD on the outcomes. Average marginal effects (AME) were estimated to examine the additional use of health services attributable to CVD. We estimated the total additional costs attributable to CVD at the population level using Census 2022 data. Participants with CVD reported higher utilization of all health services. In adjusted models, having CVD was associated with additional 1.19 (95% CI: 0.99, 1.39) GP and 0.79 (95% CI: 0.65, 0.93) OPD visits over the past year. There were twice as many additional hospitalisations attributable to CVD in males compared to females (AME: 0.20 (95% CI: 0.16, 0.23) in males vs AME: 0.10 (95% CI: 0.07, 0.14) in females), with no difference observed in the additional use of other healthcare services by gender or age groups. The population-level costs of the additional healthcare service use attributable to CVD were an estimated €352.2 million (95% CI: €272.8, €431.7), 93% of which was due to use of secondary care services. There is a substantial additional use of health services due to CVD in Ireland, with hospital admissions being the biggest contributor to costs. Key messages • The vast majority of additional costs attributable to CVD in Ireland are generated through use of secondary care services. • While a shift is being implemented in Ireland to manage uncomplicated CVD cases in primary care, sustained efforts aimed at CVD primary prevention are required to contain health service costs.

Ten-Year Cardiovascular Risk as Predicted by the QRISK®3 Calculator in Diabetic Patients Attending a Tertiary Care Teaching Hospital in Central India and Its Application to Stratify Statin Over-Users and Under-Users.

Cardiovascular disease (CVD) is an important cause of morbidity and mortality in diabetic patients. As such, risk stratification is essential to identify the risk factors of CVD and provide early intervention. The QRISK®3 tool, recommended by the National Institute for Health and Care Excellence (NICE) guidelines, has the option to choose the patient's ethnicity, which is not available in other tools. However, there is a paucity of data regarding the use of this tool in the Indian population. Therefore, this study was planned to predict 10-year CVD risk using the QRISK®3 tool and to determine statin eligibility in diabetic patients. We enrolled diabetic patients visiting our general medicine outpatient department and diabetic clinic in the study. We collected data from clinical and prescription records, as well as through patient interviews. We analyzed the data to determine the 10-year CVD risk using the QRISK®3 risk tool, which is available online. A cut-off QRISK score of 10%, as recommended by the NICE guidelines (2014), was used to stratify patients as "over-users" and "under-users." We also analyzed the data to determine any correlation between other risk factors and QRISK scores. Of the 134 diabetic patients recruited in this study, 43 (32.09%) had a CVD risk score of <10%, of which 16 (37.21%) were categorized as "over-users." Of the patients,91 had a CVD risk score of ≥10%, of which 17 (18.68%) were categorized as "under-users." Risk factors showing a positive correlation with QRISK score included duration of diabetes, age, blood pressure treatment, waist circumference, and non-high-density lipoprotein cholesterol level. QRISK score can be useful to predict10-year CVD risk in the Indian population and to stratify patients as statin over-usersand under-users. This tool can be used in the Indian set-up to identify potential candidates for statin initiation.

Psychological Assessment and Treatment Effectiveness in Mastalgia: Developing a Treatment Algorithm.

Background Mastalgia often impairs the physical, social, and sexual lives of women. It may manifest in both cyclical or acyclical patterns. The psychoneurotic association of mastalgia has been claimed for a long time in various available literature. Several treatment options have been used and are available in the market for mastalgia, but no specific guidelines are currently in place at the global or local levels. This study aims to evaluate the psychological status and effectiveness of various treatment options in women presenting with mastalgia. Methods This study was conducted in the General Surgery outpatient department from February 1 to November 30, 2021,at King George's Medical University, Lucknow, India. Females of all age groups presenting to the General Surgery outpatient department with unilateral/bilateral breast pain and/or chest wall pain were considered for this study. Pregnant patients, those with a history of allergy to drugs, or those who were lost to follow-upwere excluded from the study. The psychological status of patients was assessed using the Depression Anxiety and Stress Scale(DASS-42) scale. Pain assessment was performed using a visual analog scale (VAS). Patients were divided into five categories: (i) isolated chest wall pain, (ii) isolated breast pain, (iii) both chest wall and breast pain, (iv) pain with an associated lump(s), and (v) pain and tenderness isolated over the lump, and two groups: Group-A: VAS≤4, and Group-B: VAS>4. Group B patients in Category iv were randomized into two groups: topical non-steroidal anti-inflammatory drugs (NSAIDs) or evening primrose oil+vitamin E. The next line of treatment was tamoxifen 10mg followed by danazol 100mg followed by ormeloxifene 30mg. Results The mean age of 106 participants enrolled was 31.59±10.52 years. The mean scores,using the DASS-42 scale, for depression, anxiety, and stress were 7.31±8.53, 7.08±6.57, and 11.15±8.07, respectively. The depression, anxiety, and stress scores had no significant correlation with pain scores (p =0.84, 0.99, and 0.97 for depression, anxiety, and stress, respectively), or duration (p=0.69, 0.66, and 0.85 for depression, anxiety, and stress, respectively). Twenty-nine of 43 patients (67.44%) responded to topical NSAIDs as first-line treatment, and out of the remaining, 6.98% responded to evening primrose oil + vitamin E, 18.60% to tamoxifen, and 4.65% to danazol. Twenty-nine of 32 patients (90.63%) responded to evening primrose oil+vitamin E as first-line treatment, while 6.25% and 3.12% responded to tamoxifen and danazol, respectively. Conclusions Both topical NSAIDs and evening primrose oil + vitamin E were found effective first-line treatment options in the majority of patients. Hence, it is always advisable to start such patients on topical NSAIDs, or evening primrose oil + vitamin E, before switching over (if no resolution of pain is reported with these drugs) to higher and more severe treatment options. The duration or severity of pain did not correlate with the psychological condition of the patient.

Family history of hypertension and its relation to other variables in hypertensive patients: a cross-sectional study from a tertiary care hospital

Background: Hypertension, a key determinant of cardiovascular disease, is one of the major public health burdens worldwide. Family history is a known nonmodifiable risk factor for hypertension. This study aims to identify the family history of hypertension in terms of its prevalence and its association with various risk factors. Methods: A descriptive cross-sectional study was conducted among 423 hypertensive patients visiting the general outpatient department of Shree Birendra Hospital using a simple random sampling method. The data were collected using a preformed questionnaire through a face-to-face interview approach. Data were entered into Microsoft Excel 2019 v16.0 and were analyzed using Statistical Packages for Social Sciences version 21. Results: Out of 423 hypertensive individuals, 131 (30.97%) had a family history of hypertension, with grandparents having the greatest frequency (56.49%). In the multivariable model, the participants with age 60 years or older [adjusted odds ratio (AOR): 2.54, 95% CI: 1.60–4.02, P &lt; 0.001], female (AOR: 2.11, 95% CI: 1.35–3.29, P = 0.001), and participants with government or private jobs, including farming (AOR: 2.63, 95% CI: 1.59–4.35, P &lt;0.001), were significantly associated with a family history of hypertension. Conclusions: Family history is an influencing factor in hypertension. Thus, it is possible to target people who have a family history of hypertension to identify undiagnosed hypertension cases in the community, as well as to modify risk factors and provide necessary interventions.

A prospective observational study of prescription pattern of antihypertensive drugs in general medicine outpatient department of associated hospital RUHS CMS, Jaipur

Background: The increasing prevalence of hypertension is attributed to population growth, ageing and behavioural risk factors, such as unhealthy diet, harmful use of alcohol, lack of physical activity, excess weight and exposure to persistent stress. The aim of study is the prescribing pattern and the consumption of antihypertensive drugs in isolated hypertensive patients and in hypertensive patients with different co-existing morbidities. Methods: The present study is a Prospective observational study. The study was conducted at Medicine Department of associated hospital of RUHS College of Medical Sciences, Jaipur. Results: A total of 965 patients having hypertension were analyzed, in that 556 patients were male and 409 patients were female. In hypertension patients, angiotensin receptor blockers ARB, diuretics and β- blockers (29.90%) were mostly used classes in three drug therapy. Whereas telmisartan, hydrochlorothiazide and metoprolol (35.05%) were mostly prescribed. Drugs. In hypertension patients, angiotensin receptor blockers ARB, diuretics, β- blockers and calcium channel blockers (56.67%) and calcium channel blockers, angiotensin converting enzyme inhibitors, β-blockers and diuretics (43.33%) were used classes in four drug therapy. Whereas Telmisartan, Hydrochlorothiazide, Nebivolol and Amlodipine (62.5%) were mostly prescribed drugs. Hypertensive Patients with Comorbidity were found in higher prevalence with 276 hypertensive patients (28.60%) along with Diabetes Mellitus most commonly found and 389 hypertensive patients (40.31%) were found to be with No Comorbidity. Conclusions: Present results reveal that antihypertensive medication adherence to JNC-8 recommendations is suboptimal. Therefore, physicians should follow JNC-8 guidelines to improve the patients care because suboptimal adherence leads to adverse clinical outcomes. The present study demonstrated that physicians are not completely adhering to standard guidelines while treating hypertension with co-morbid conditions.

A study to assess the efficacy of local applicants to prevent complications of diabetic foot

Background: Diabetes is one of the most common comorbid illnesses in our community. Diabetes is associated with numerous complications related to microvascular, macrovascular, and metabolic etiologies. One of its complications in long course is diabetic foot ulcer and the associated morbidity and mortality is a major health issue. Aims and Objectives: This study was conducted to describe the lesions we treat, study and compare outcomes and to identify measures to decrease morbidity and mortality due to diabetic foot disease. Materials and Methods: All patients who attended general surgery outpatient department at M.Y. Hospital (M.P.) India between July 1st 2021 and June 30th, 2022 were included in this study with nonhealing Diabetic foot Ulcer Wagners Stage 3 for more than 2 weeks without any other comorbidities. Results: Majority of the patients presented with higher grade and with poor glycemic control at the time of presentation. Conservative management with antibiotics was useful in a small subset of the patients. Majority of the patients needed surgical treatment in the form of debridement to amputations. Conclusion: Diabetic limb disease is more prevalent in male sex commonly in 51–60 years of age group. 74% of patients presented with foot ulcer and Staphylococcus aureus was found the most common microorganism in pus culture from wounds. Local applicants are effective in controlling ulcers. In our study, hydrogel with colloidal silver was most effective followed by silver nitrate. Early and aggressive treatment of these ulcers can prevent the rate of amputation.

AWARENESS AMONG PHYSICIANS OF A TERTIARY CARE HOSPITAL REGARDING RATIONAL USE OF MEDICINE: A QUESTIONNAIRE-BASED STUDY

Objectives: The current study was planned with the objectives of discovering awareness regarding the rational use of medicines (RUM) among the physicians, drug prescribing patterns, and verifying the quality of the prescriptions given to the patients. Methods: A pre-validated questionnaire was used for physicians and patients after the Institutional Ethics Committee’s permission and consenting the participants. Prescriptions of patients were photocopied. The study was conducted in dermatology, medicine, and general outpatient departments. The study duration was from June 2013 to April 2014, and a universal sampling was used. Thehe data were analyzed using descriptive statistics. Results: 70/105 physicians consented. The score for knowledge was 10.36±1.96 in this study. 73% were generic prescriptions. The score per physician for attitude and practice on the Likert scale was 67.47±5.75. Fifty-eight percent of physicians mentioned they prescribe on diagnosis, and first choice is preferred. 97% said fixed drug combinations are better for compliance. Of the 278, 385 patients consented. The average number of drugs prescribed per prescription was 3.545±1.45, and legible was 32.37%. Non-pharmacological therapy was mentioned in 11.87%, and 54% were complete in dose and duration. 40.64% of patients did not take the medications regularly, and 95.57% said the cost of medicines was the reason. 69% (120/174) purchased economical alternatives without informing the doctor. Conclusion: The awareness regarding RUM in physicians is low; the cost of medicines deters patients from regularly taking medicines.

Effect of Health Education on Posture Practices Towards Reduction of Low Back Pain Among Patients in Rivers State

This study investigated the effect of health education on posture practices in reducing low back pain among patients in Rivers state, Nigeria. To achieve this, pretest-posttest quasi-experimental design was employed, and the study targeted 170 patients at the University of Port Harcourt Teaching Hospital in Nigeria. Two objectives having corresponding research questions and hypotheses guided the study, while convenience and stratified sampling techniques were used to select 50 participants, comprising 35 patients from the general outpatient clinic department and 15 patients from the spine physiotherapy unit, with 20 male and 30 female participants. Data collection was done by administering a self-structured, self-administered questionnaire, titled health education effect on ergonomic practices and low back pain, which had a reliability coefficient of 0.75. Both descriptive and inferential statistics were used to answer the research questions and test the hypotheses. The research found that educating patients on various methods of preventing low back pain, including healthy weight maintenance, warm-up exercises, and proper postural habits while sitting and standing, had a noteworthy impact on reducing pain. Moreover, the study also revealed that health education programmes were successful in therapeutic posture practices and reducing low back pain in patients residing in Rivers state. Therefore, the study concluded and recommended that health education interventions for functional and therapeutic posture practices are effective strategies for reducing low back pain among patients in Rivers state, and healthcare providers should incorporate these interventions into their treatment plans for patients suffering from low back pain.

Effect of Prior Antibiotic Treatment on Blood Culture in an Outpatient Department of General Internal Medicine: A Retrospective Case-Control Analysis.

The effect of antibiotics administered before blood cultures performed in general internal medicine outpatient settings is not well known. We conducted a retrospective case-control study including adult patients who underwent blood cultures in the general internal medicine outpatient department of a Japanese university hospital between 2016 and 2022. Patients with positive blood cultures were included as cases and matched patients with negative blood cultures were included as controls. Univariable and multivariable logistic regression analyses were performed. A total of 200 patients and 200 controls were included. Antibiotics were administered prior to blood culture in 20% of patients (79/400). Oral antibiotics were prescribed to 69.6% of the prior antibiotics (55/79). Prior antibiotic use was significantly lower among patients with positive than negative blood cultures (13.5% vs 26.0%, p = 0.002) and was an independent predictive factor in univariable (odds ratio, 0.44; 95% confidence interval, 0.26-0.73; p = 0.002) and multivariable (adjusted odds ratio, 0.31; 95% confidence interval, 0.15-0.63; p = 0.002) logistic regression models for positive blood culture. The area under the receiver operating characteristic (AUROC) curve of the multivariable model for predicting positive blood cultures was 0.86. There was a negative correlation between prior antibiotic use and positive blood cultures in the general internal medicine outpatient department. Therefore, physicians should interpret the negative results of blood cultures performed after the administration of antibiotics with care.

Steroids in Headache: A Comprehensive Review of Recent Research.

Headache is an extremely common symptom of the general outpatient department and also the headache clinic, with prevalence of 48.9% in the general population. None has ever experienced headache in life time. Headache is seen in 1 patient out of 10 general practitioner (GP) consultations, 1 referral out of 3 is headache in neurology OPD, and 1 in 5 of all emergency medical admissions. Of all headaches, around 98% constitute primary headache: migraine without aura, tension headache, and cluster headache. With advancement in various drug modalities, certain headache forms respond less well to the regular approved medications, and some headaches are complicated by the analgesic itself. Steroids have been tried in many subtypes of headache, especially in primary forms of headache with dysautonomia, headache with trigeminal pathway activation and disinhibition, and in certain medication-culprit headaches. This subgroup of headaches is almost a challenge in an emergency for the headache expert as well. So, we need to assess the role of steroids in less well-responsive headaches. Current reviewed evidence on the role of steroids in primary headache suggests that steroids have a role in status migrainosus and medication overuse headache when used in the mentioned and monitored manner. Consideration and further exploration of its role in other primary headaches may reveal insight into steroid efficacy as a treatment modality in various subtypes of headache. Steroids, when used cautiously in specifically selected primary headaches under supervision, proved miraculous where other modalities failed.