Medical Outpatient Department Research Articles

Feasibility of Provision and Vaccine Hesitancy at a Central Hospital COVID-19 Vaccination Site in South Africa after Four Waves of the Pandemic.

As mortality declined significantly during the fourth and fifth waves compared to previous waves, the question of the future role of COVID-19 vaccination arose among both experts and the public in South Africa. Turning attention away from the general public, now considered to be at very low risk of severe COVID-19 disease, a commonly held view was that the vaccination campaign should focus only on those who remain highly vulnerable to severe disease and death from COVID-19. Primary amongst this group are patients with common chronic diseases attending hospital outpatient departments. We hypothesized that providing COVID-19 vaccinations on-site at a central hospital will increase uptake for the patients with co-morbid chronic conditions who need them most in the Omicron phase of the pandemic. Evaluate the acceptability, need, and uptake of a hospital-based vaccination site for patients attending the medical hospital outpatient departments. To assess vaccination uptake, coverage, and hesitancy in people attending a central hospital, to determine factors associated with and influencing vaccination uptake, and to document implementation and assess acceptability of the vaccination project among staff and persons attending the hospital. Mixed-methods study using quantitative and qualitative methods. Of the 317 participants enrolled in the study, 229 (72%) had already received at least one dose of the COVID-19 vaccine. A total of 296 participants were eligible for a first vaccination, additional vaccination, or booster vaccination according to the South African Department of Health guidelines. Of those previously vaccinated, 65% opted for an additional dose on the day it was offered (same day). Only 13 previously unvaccinated participants (15% of vaccine naïve participants) opted for vaccination, increasing vaccine coverage with at least one dose from 72% to 76%. Approximately 24% (n = 75) of all participants refused vaccination (vaccine hesitant). Variables tested for an association with vaccination status demonstrated that age reached statistical significance. Emerging themes in the qualitative analysis included perceptions of vulnerability, vaccine safety and efficacy concerns, information gaps regarding vaccinations, the value of convenience in the decision to vaccinate, and the role of health promoters. This study has shown that it is logistically acceptable to provide a vaccination site at a large hospital targeting patients attending outpatient services for chronic medical conditions. This service also benefits accompanying persons and hospital staff. Access and convenience of the vaccination site influence decision-making, increasing the opportunity to vaccinate. However, vaccine hesitancy is widespread with just under one-quarter of all those offered vaccinations remaining unvaccinated. Strengthening health education and patient-clinician engagement about the benefits of vaccination is essential to reach highly vulnerable populations routinely attending hospital outpatient departments with an appropriate vaccination program.

Role Of Cities in NCD Prevention and Management: A Qualitative Research Study among Doctors

Background: Noncommunicable diseases (NCDs) such as diabetes, hypertension, and cardiovascular diseases are major global health concerns, surpassing the mortality rates of communicable diseases. These conditions pose significant challenges to global development, particularly in low- and middle-income countries where two-thirds of NCD-related deaths occur. In Pakistan, NCDs account for nearly 25% of all fatalities. The prevention of NCDs requires continuous lifestyle modifications, and evidence suggests that the physical environment and urban design play crucial roles in influencing health behaviors and outcomes. Objective: This study aimed to assess doctors' perspectives on the role of cities in the prevention and management of NCDs in Pakistan, and to identify barriers and enablers to the development of healthy city policies. Methods: This descriptive exploratory study employed a qualitative approach, conducted at various private hospitals in the Twin Cities. A purposive sample of approximately 20 doctors from medical units and outpatient departments participated in focus group discussions (FGDs). Data were collected using a semi-structured interview guide, and the FGDs were audio-recorded with participants' consent. Thematic analysis was performed to identify major themes and subthemes related to the role of urban environments in NCD prevention and management. Results: Participants recognized the importance of physical activity, healthy environments, and lifestyle modifications in preventing NCDs. Key barriers to physical activity included socio-cultural norms, environmental limitations, and political/legislative challenges. Facilitators included individual willpower, health-seeking behavior, supportive policies, and perceived benefits. Poor air quality and the lack of green spaces were significant contributors to the increased prevalence of NCDs. Participants emphasized the need for government intervention to improve urban infrastructure, promote physical activity, and enhance public health initiatives. Conclusion: Well-planned cities can significantly reduce the burden of NCDs by addressing modifiable risk factors. Governments must prioritize the development of infrastructure that promotes physical activity, improves air quality, and increases access to green spaces. Comprehensive multisectoral strategies are essential to combat the rising threat of NCDs, particularly in rapidly urbanizing areas.

To study the efficacy of case based learning on prescription practices in post graduate students on geriatric patients attending medical OPD

BackgroundRationalizing drugs and deprescribing potentially inappropriate medicines in elderly patients is a major challenge faced by doctors in today’s era due to the ever-increasing number of diseases, drugs, changing guidelines, and indications. The objective of this study was to study the efficacy of case-based learning on prescription practices in postgraduate students on geriatric patients attending medical outpatient department (OPD). MethodsObservation cross-sectional study done on postgraduate medicine residents working in medicine/geriatric OPD. Prescriptions were analyzed for quality by prescription quality index (PQI) score. The baseline PQI score was generated. An interactive workshop and training session on case-based learning on appropriate prescribing for the elderly was conducted. The prescribing habits and PQI scores were reassessed and compared to assess the change in PQI scores along with satisfaction levels and faculty feedback. ResultsA total of 60 prescriptions from 24 medicine residents were initially assessed for baseline PQI. A total of 41 residents participated in the workshop. Sixty fresh prescriptions were reassessed after one month of the workshop. The mean baseline PQI was 27.15 (±3.70) which increased to 31.81 (±3.60) [p < 0.001. The majority of the faculty (10/12) felt improvement in prescribing practices. Two third of residents (28/41) had a very good and excellent level of satisfaction with the case-based learning. ConclusionCase-based learning is an effective tool for enhancing the prescribing skills of postgraduates, especially in geriatric patients. There was a significant improvement in PQI score after the case-based learning workshop in the prescriptions of the postgraduate students with a p-value of < 0.001.

Incidence of Plasmodium Vivax Malaria in Patients with Pancytopenia

Background: Malaria, caused by Plasmodium vivax, is prevalent in many tropical and subtropical regions of the world, notably in South Asia and Africa. The clinical manifestation of malaria, including pancytopenia, varies widely, leading to complex challenges in diagnosis and treatment. Understanding the association between Vivax malaria and hematological abnormalities like pancytopenia is critical for improving patient outcomes in endemic regions. Objective: This study aimed to investigate the incidence of Plasmodium vivax in patients presenting with pancytopenia and to assess the demographic and hematological profiles of these patients in a high-prevalence area. Methods: A prospective cohort study was conducted at the Hayatabad Medical Complex, Peshawar, from January 2021 to January 2023. A total of 350 patients who presented at the medical outpatient department were enrolled based on inclusion and exclusion criteria. Blood samples were collected using aseptic techniques, and peripheral blood smears were prepared for analysis. Demographic data were collected through questionnaires. Statistical analysis was performed using SPSS version 25, with categorical data analyzed using Chi-square tests and continuous variables using t-tests, setting statistical significance at p &lt; 0.05. Results: Of the 350 patients studied, 71.4% were male and 28.6% were female, with a mean age of 55.1 years. The hemoglobin levels averaged 8.86 g/dl (SD ± 1.77), and the leukocyte count was 2.84×10^3/Cmm (SD ± 3.31). Platelet counts averaged 77.25×10^9/Cmm (SD ± 2.90). Overall, 52.6% of patients tested positive for P. vivax. There were no significant differences in the incidence of P. vivax infection across age groups (p = 0.36) or between genders (p = 0.41). Conclusion: The study confirmed a significant prevalence of P. vivax in patients with pancytopenia, highlighting the need for routine screening in malaria-endemic regions. Early diagnosis and treatment are essential for managing pancytopenia in patients with malaria and can lead to substantial improvements in clinical outcomes.

Thyroid and Lipid Profile Dysfunction among Obese versus Non-Obese Individuals Study Design

Obesity, a complex disorder influenced by both genetic and environmental factors, manifests through intricate interactions. Objective: To assess thyroid function tests and serum lipid profiles in obese and non-obese individuals. Methods: This cross sectional observational study was conducted over six months from July to December 2023 at the medical outpatient department of Shahida Islam Medical College, after obtaining ethical approval (IRB Ref no. SIMC/H.R./7314/23, dated May 1, 2023). A sample size of 200 was calculated, divided equally into obese (BMI &gt; 30 kg/m²) and non-obese (BMI &lt; 25 kg/m²) groups. Data were analyzed using SPSS version 23.0, employing chi-square tests for significance (p &lt; 0.05). Results: Each group comprised 100 participants, with mean ages of 42.49 ± 9.0 years for the obese and 43.83 ± 6.2 years for the non-obese group. Females constituted 62% of the obese and 51% of the non-obese group. Mean BMI was 35.8 kg/m² and 26.6 kg/m² in the obese and non-obese groups, respectively. Obese individuals exhibited higher mean total cholesterol (173 ± 40.77 mg/dl vs. 134 ± 29.62 mg/dl, p = 0.05) and significant differences in HDL, LDL, triglycerides, TSH, T3, and T4 levels (p &lt; 0.05). Conclusions: Obesity is associated with adverse thyroid and lipid profiles, with a higher prevalence among females. These findings underscore the importance of addressing these metabolic factors in obesity management.

A Study was Conducted to Evaluate the Risk Factors Associated with Stroke among Hypertensive Patients Receiving Care at the Medical Outpatient Department (OPD) of HSK Hospital &amp; Research Centre in Navanagar, Bagalkot

BACKGROUND OF THE STUDY:* Hypertension, characterized by elevated blood pressure, is a major public health concern globally. It is a leading cause of cardiovascular diseases, including stroke. Stroke, a neurological condition, is a significant cause of mortality and disability, especially in low- and middle-income countries. Hypertension is a predominant risk factor for stroke both globally and in our country. Hence, there is a critical need to enhance stroke education, particularly targeting low-income individuals at high risk, through public health campaigns and targeted health education efforts. OBJECTIVES OF THE STUDY: 1. To assess the knowledge of hypertensive patients regarding stroke risk factors and prevention. 2. To determine the association between knowledge scores and selected socio-demographic variables. HYPOTHESIS: H1: There will be a significant association between the knowledge level of hypertensive patients and their socio-demographic variables. CONCEPTUAL FRAMEWORK: This study adopts the health belief model proposed by Becker as its conceptual framework. METHODOLOGY: The research employed a descriptive survey design to assess stroke risk factors among hypertensive patients attending the medical OPD of HSK Hospital &amp; Research Centre in Bagalkot. Non-probability convenient sampling was used to select 100 hypertensive patients for the study. Data collection utilized a structured questionnaire consisting of two sections: Section I focused on socio-demographic variables, while Section II assessed stroke risk factors. RESULTS: The study revealed that hypertensive patients exhibited varying levels of knowledge regarding stroke risk factors. On average, the overall knowledge score was 55.3%. The percentage distribution of hypertensive patients based on their knowledge level showed that 24% had poor knowledge, 50% had average knowledge, and 26% had good knowledge. CONCLUSION: The study identified a significant association between the knowledge level of hypertensive patients and certain socio-demographic characteristics, particularly the source of information. However, no significant associations were found with other variables such as age, gender, education, occupation, and health history. This underscores the importance of targeted health education interventions aimed at improving awareness of stroke risk factors among hypertensive patients.

A Retrospective Study on the Effectiveness of Sulphur in Lm Potency for Dermatitis in Paediatrics Age Group

Context: Children with dermatitis often complain of eczema, neurodermatitis, stasis dermatitis, atopic dermatitis, and seborrheic dermatitis, among other conditions. The purpose of the study is to determine the effectiveness of sulfur LM potency for dermatitis complaints in the pediatric age group and to emphasize the incidence of dermatitis in children. Thirty instances of dermatitis treated with sulfur LM potency were selected from the pediatric age category and gathered from Sarada Krishna Homoeopathic Medical College's in-patient and outpatient departments in Kulasekharam. According to this study, dermatitis is more common in children aged 1 to 5; 19 cases showed a significant improvement, and 22 cases improved during follow-up visits. Ten cases have impacted females and twenty cases have affected males. Kids more people with lower socioeconomic status have been impacted. Based on the study, homoeopathic drugs may be more effective in treating cases of dermatitis. With the right dosage of the medication, more over half of them 22 patients could feel better. Eight patients' conditions have persisted, and two patients' conditions have gotten worse. This outcome is consistent with a clinical investigation that found that, out of 30 instances, 10 patients were male and that homoeopathic drugs were effective in treating dermatitis in youngsters.

Effects of Galvanic Skin Resistance Biofeedback on Perceived Stress in Individuals with High Blood Pressure: A Quasi-experimental Study

Introduction: According to the World Health Organisation (WHO), hypertension is one of the leading causes of premature morbidity and mortality, both in industrialised and developing countries. Patients with arterial hypertension are advised to make lifestyle adjustments, such as increasing physical activity and reducing stress. Nowadays, a variety of relaxation techniques are used to reduce stress and tension. The practise of Biofeedback (BF) is regarded as a successful treatment for this purpose. Aim: To investigate the effect of Galvanic Skin Resistance Biofeedback (GSRBF) on perceived stress. Materials and Methods: In present quasi-experimental study, 53 individuals with high blood pressure, including prehypertensive and hypertensive individuals {Blood Pressure (BP)&gt; 120/80 mmHg}, were included. Participants were recruited from various Medical and Physiotherapy Outpatient Departments (OPD) of private and Government hospitals and clinics in Veraval, Gujarat, India, from March 2022 to September 2022. Basic demographic data was collected, Blood Pressure (BP) was measured, and the Perceived Stress Scale (PSS) was administered. Participants were then connected to the GSRBF instrument and instructed to relax using a relaxation response technique. After 12 sessions, BP was measured again, and the PSS was administered. As the data were not normally distributed, a t-test was performed at a significance level of 95% (p&lt;0.05). Results: The analysis revealed a significant decrease in PSS scores following GSRBF sessions, with a p-value of &lt;0.05. Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) also showed a significant reduction, with a p-value of &lt;0.05. Conclusion: The GSRBF demonstrated a significant reduction in perceived stress among individuals with high blood pressure, and it also showed a significant reduction in SBP and DBP. The present study provides valuable insights into the potential of GSRBF as an adjunct therapy for managing hypertension and promoting overall well-being.

Effect of Yoga Nidra on Perceived Stress Section in Individuals with High Blood Pressure: A Quasi-experimental Study

Introduction: A persistently high level of stress can lead to a variety of diseases, such as anxiety, depression, sleeplessness, muscle discomfort, high Blood Pressure (BP) and a compromised immune system. Although 15% of adults in India suffer from hypertension, significant progress has been made in preventing and managing this condition. One alternative form of treatment that may help with stress management and BP regulation is Yoga Nidra. Aim: To assess the effect of Yoga Nidra on perceived stress in Individuals with High Blood Pressure. Materials and Methods: The present quasi-experimental study was conducted at various medical and physiotherapy Outpatient Departments (OPDs) in Veraval, Gujarat, India, from June 2021 to September 2022. A total of 49 individuals diagnosed with high BP, including both prehypertensive and hypertensive individuals (with BP &gt;120/80 mmHg), were selected. Essential demographic information was gathered from the participants, who were also asked to complete the Perceived Stress Scale (PSS) questionnaire. Participants were introduced to the concept of Yoga Nidra and provided with instructions on how to perform the Yoga Nidra technique. They engaged in 12 sessions of this technique. After completing these 12 sessions, participants once again completed the PSS questionnaire. Since the collected data did not exhibit a normal distribution, a paired t-test was conducted at a significance level of 95%. Results: Out of 49 study participants, 22 (45%) were females and 27 (55%) were males, and mean±Standard Deviation (SD) age was 47.86±10.62 years. The analysis revealed a significant reduction in PSS scores following the Yoga Nidra sessions (p-value=0.0001). Additionally, both Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) showed decrease with a p-value of 0.0001. Conclusion: Yoga Nidra has a significant effect on reducing perceived stress in individuals with high blood pressure, along with a reduction in blood pressure. This research provides valuable findings regarding the potential of Yoga Nidra as an additional relaxation therapy to help manage hypertension and enhance overall well-being.

Situs inversus with levocardia in a 15-year-old male adolescent: a case report

BackgroundSitus inversus with levocardia is a rare anomaly in which the heart is present in the left chest but the abdominal viscera are transposed. It is caused by a single incomplete penetration of an autosomal recessive gene. It is unclear what exactly causes situs inversus with levocardia. Even if situs inversus can be identified following a comprehensive physical examination, it is now possible to validate the results and search for further information and pathologies since medical imaging is so widely accessible.CaseA 15-year-old Oromo male child from a remote area of Bale Zone presented to the Goba Referral Hospital’s medical emergency outpatient department complaining of periumbilical pain that had persisted for 4 months. He frequently came to our hospital and was admitted three times with the same problem. Objectively, there was tenderness over the left lower quadrant and periumbilical area. The sonographic evaluation discovered the transposition of the liver and spleen with cardiac apex on the left side. He received conservative treatment with ceftriaxone 1 g intravenous twice a day and metronidazole 500 mg intravenous for 5 days, and he went home improved.ConclusionIsolated levocardia is a rare form of situs inversus in which the heart is in the traditional levo position while the abdominal organs are in the dextro position. What causes situs inversus with levocardia is unknown. Despite the fact that situs inversus can be diagnosed after a thorough physical examination, medical imaging has allowed us to confirm the findings as well as understand more about diseases. Due to the severity of an underlying heart defect, situs inversus with levocardia has a dismal prognosis.

Access to healthcare services for people with non-communicable diseases during the COVID-19 pandemic in Ibadan, Nigeria: a qualitative study

BackgroundDesirable outcomes for people with non-communicable diseases (NCDs) are achieved when they access routine monitoring and care services. Expectedly, the COVID-19 pandemic severely impacted access to healthcare services, leading to poor health outcomes among people with NCDs. We aimed to [1] explore the delays in accessing healthcare services and [2] understand alternative actions adopted by people with NCDs to overcome these delays.MethodsWe conducted an exploratory qualitative research guided by the “Three Delays” model to unpack the barriers to healthcare access for people living with NCDs in Ibadan, Nigeria. The “Three Delays” model conceptualizes the reasons for negative/adverse healthcare outcomes related to the patient’s decision-making to seek healthcare, reaching an appropriate healthcare facility, and receiving adequate care at the healthcare facility. Twenty-five (25) people with NCDs were purposively selected from the University College Hospital’s medical outpatient department to participate in in-depth interviews. Interview recordings were transcribed verbatim and analyzed using a deductive-inductive hybrid thematic analysis.ResultsAt the level of individual decision-making, delays were related to fear of contracting COVID-19 in the hospital (considered a hotspot of the COVID-19 pandemic). Regarding reaching an appropriate healthcare facility, delays were mainly attributed to the intra- and inter-city lockdowns, limiting the movements of persons. For those who successfully arrived at the healthcare facilities, delays were related to the unavailability of healthcare professionals, prioritization of COVID-19 patients, and mandatory adherence to COVID-19 protocols, including COVID-19 testing. To overcome the delays mentioned above, people with NCDs resorted to (i) using private healthcare facilities, which were more costly, (ii) using virtual consultation through mobile phone Apps and (iii) self-management, usually by repeating previously prescribed prescriptions to obtain medication.ConclusionPandemic conditions provide unique challenges to people with chronic illnesses. Recognizing the need for continuous access to monitoring and care services under such conditions remains critical. Alternative health service provision approaches should be considered in pandemic situations, including remote healthcare services such as Mobile health apps (mHealth) that can help manage and prevent NCDs.

A Retrospective Study of Body Weight Changes in Patients Receiving Cyproheptadine in A Hospital-Based Outpatient Setting in Thailand

Cyproheptadine has been used as an appetite stimulant to increase body weight in various population. This study aimed to determine the effect of cyproheptadine on weight changes in Thai patients. A retrospective longitudinal study was conducted in adult patients who were prescribed with cyproheptadine, having body weight records at 2 times consecutively during 12-month period at the medical outpatient department, the Police General Hospital, Thailand. Of 125 participants, 69.6% were females and the mean age was 78.38 (SD ± 11.68) years. Hypertension, dyslipidemia and diabetes mellitus were the most common underlying conditions. The mean body mass index (BMI) at 1st visit was 21.16 (SD ± 3.64) kg/m2. The mean body weight at 1st and 2nd visit were 52.46 (SD ± 11.11) kg, and 52.61 (SD ± 10.98) kg, respectively. Overall, there was no significant change in body weight between two visits. In underweight patients (BMI &lt; 18.5 kg/m2), the mean BMI decreased significantly in the 2nd visit compared to 1st visit (p = 0.044). At the 2nd visit, older age and high-density lipoprotein cholesterol levels were negatively associated with body weight (p &lt; 0.05). The polypharmacy (odds ratio (OR), 0.778; 95% confidence interval (CI), 0.616 – 0.982), the presence of hypertension (OR, 0.022; 95%. CI, 0.001 – 0.390) and low-density lipoprotein cholesterol levels (OR, 0.969; 95% CI, 0.942 – 0.996) were also negatively associated with abnormal BMI. Cyproheptadine might not improve the body weight of patients in this population. The factors associated with lower body weight in this study may be helpful in further research.

Transaminitis among Patients with Dengue Fever Visiting a Tertiary Care Centre.

Transaminitis is a condition where serum aspartate transaminase and alanine transaminase increase indicating liver dysfunction. One such disease where liver involvement might be observed is dengue, which is a mosquito-borne viral infection. The aim of the study was to find out the prevalence of transaminitis among patients with dengue fever in a tertiary care centre. A descriptive cross-sectional study was conducted in a tertiary care centre from 1 November 2022 to 31 March 2023 after obtaining ethical approval from the Institutional Review Committee. Informed written consent was taken before collecting the data. A rapid immunochromatography test was used to confirm dengue infection. Serum aspartate transaminase and alanine transaminase were measured through routine Reitman and Frankel's enzymatic method. Dengue-confirmed patients from the medical outpatient department, fever clinic, and medical ward of the centre were included in the study. Patients with known prior liver diseases or any other chronic diseases, pregnancy, and patients in the hospice unit were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 442 dengue infected patients, the prevalence of transaminitis was 188 (42.53%) (37.92-47.13, 95% Confidence Interval). The highest frequency of dengue positive was observed among the 18-35 years age group, which was 97 (51.59%) with male predominance 134 (71.27%). The prevalence of transaminitis among patients with dengue fever in a tertiary care centre was found to be lower than other studies done in similar settings. alanine transaminase; aspartate transaminase; dengue.

COVID-19 and Cancer: A Comparison of the Two Important Pandemic Waves in an Indian Cancer Patients' Cohort.

Ullas BatraIt is well known that patients with cancer are at an increased risk of severe COVID-19. There are no reports that depict the differences in outcomes in cancer patients between the two waves of the pandemic. This is a real-world experience aimed at characterizing the differences in demographics, clinical features, treatment details, and outcomes in COVID-19-positive cancer patients between the two pandemic waves. This was a prospective study of all COVID-19-positive cancer patients attending our specialty out-patient department at Rajiv Gandhi Cancer Institute and Research Centre between March 2020 and November 2020 (1st wave) and April 2021 and June 2021 (second wave). All patients diagnosed to have COVID-19 by real-time polymerase chain reaction (RT-PCR) with a biopsy-proven solid organ malignancy attending the medical oncology out-patient department were included during both the waves. A total of 300 patients with proven SARS-CoV-2 infection by either RT-PCR or cartridge based nucleic acid amplification test were encountered, of which 123 were encountered during the first wave of the pandemic and 177 during the second wave. The case fatality rate of the first wave was 9.8%, with a 15-day case fatality rate of 5.6%, whereas for the second wave, it was 13% and 7.2%, respectively. Twelve patients succumbed to COVID-19 disease in the first wave and 23 succumbed in the second. There were no statistically significant correlations; however, the death in the second wave tended to occur more in younger male patients, with comorbidities and history of smoking. There was no relation with ongoing cancer-directed treatment or chemotherapy. Our study is unique in comparing characteristics of the two most important COVID-19 waves and treatment patterns in cancer patients from a single center. The second wave showed a higher CFR, hospital admission rate, and higher frequency of respiratory complications; however, there was no relation to cancer-directed therapy and COVID-19, thus reiterating the fact that cancer treatment should not be halted in the event of a COVID-19 infection.

Topical diclofenac in prevention of capecitabine associated HFS in patients with breast cancer: An exploratory subgroup analysis of the D-ToRCH study.

18 Background: Hand foot syndrome (HFS) is a dose-limiting side effect of capecitabine in patients with breast cancer. Celecoxib, an oral cyclo-oxygenase-2 (COX-2) inhibitor is effective in reducing the incidence of capecitabine associated HFS. However, it has not been adopted in the clinics due to concerns regarding cardiac and gastrointestinal toxicity. We report the efficacy of topical diclofenac in prevention of capecitabine associated HFS in patients with breast cancer. Methods: In the D-ToRCH (Diclofenac-topical for reduction of capecitabine related HFS) trial, we randomized 264 patients with breast or gastrointestinal cancers planned to receive capecitabine to apply either 1% topical diclofenac or placebo gel. Stratified (male or female; capecitabine monotherapy or combination therapy), permuted variable size block randomization was done using a computer-generated random numbers sequence. The primary objective was to compare the incidence of grade 2 or higher HFS in diclofenac and placebo arms. Secondary objectives were incidence of any grade HFS, capecitabine dose reductions due to HFS and self-reported adherence with application. Here, we report the exploratory subgroup analysis of patients with breast cancer. Results: The breast cancer subgroup included 148 patients (77 in drug arm and 71 in placebo arm). Baseline characteristics were similar in both arms. Median age of overall population was 47 years (IQR 39-56). 89 patients (60.1%) had an ECOG (Eastern Co-operative Oncology Group) performance status of 0-1, while the rest had a score of 2. Hypothyroidism was the most common comorbidity (n=24, 16.2%). Majority received capecitabine monotherapy (n=95, 64.2%). The most common additional chemotherapy drug used was lapatinib (n=42, 79.3%). 60 patients had stage 3 disease (40.8%) and 88 patients had metastatic breast cancer (59.5%). Overall, 20 patients developed any grade HFS, of which 6 were in the diclofenac arm and 14 in placebo arm (7.8% vs 19.7%, p=0.034). Grade 2/3 HFS events were noted in 3 patients (3.9%) in diclofenac arm and 11 patients (15.5%) in placebo arm (p=0.016). Capecitabine dose reductions were less frequent in the diclofenac arm compared to placebo (3.9% vs 15.5%). Adherence to topical treatment was similar in both the study arm. Other adverse events of capecitabine like diarrhea, mucositis and myelosuppression were similar in both the arms. Conclusions: Topical diclofenac gel significantly reduced the incidence of all grades of HFS in breast cancer patients receiving capecitabine. Applying topical diclofenac led to less frequent capecitabine dose reductions. Moving forward, we feel this should be the new standard of care and use of topical diclofenac should be regularized in medical oncology outpatient departments. Clinical trial information: CTRI/2021/01/030592 .

Psychiatric morbidities among patients with type-2 diabetes mellitus attending outpatient department in a rural area of North India.

Both diabetes mellitus and psychiatric morbidities are widely prevalent diseases which show a discerning upward trend globally. Coexistence of diabetes and psychiatric morbidities usually manifests as impaired quality of life and poor treatment adherence. The study aimed to estimate the prevalence of psychiatric morbidities among rural diabetic patients and to determine their association with different variables. The present cross-sectional study was conducted in CHC of Rural Health Block attached with PG Department of Community Medicine GMC (Government Medical College) Jammu. The eligible diabetic patients attending medical outpatient department services were enrolled using a consecutive sampling method. DAS scale was used to assess psychiatric morbidity among the study subjects. The findings revealed that the prevalence of psychiatric morbidity in the study participants was 38.9%, 68.5% and 25.64% for depression, anxiety and stress, respectively. Psychiatric morbidities were slightly higher in female patients and were significantly associated with age, marital status, sedentary lifestyle, history of substance abuse, duration of diabetes, presence of complications and underlying morbidities (P < 0.05). The prevalence of anxiety and depression among rural diabetic patients was found to be quite high. Diabetic patients need thorough screening for psychiatric evaluation, and there is an urgent need for psychiatric counselling at regular intervals.

Prevalence of Gastroesophageal Reflux Disease among Diabetic Patients at Sharif Medical City Hospital, Lahore, Pakistan

Background: Diabetes mellitus has been linked to various gastrointestinal motility disorders, including gastroesophageal reflux disease (GERD).This study aimed to determine the proportion of GERD in patients with diabetes mellitus.Method: This descriptive cross-sectional study was conducted at the medical outpatient department of Sharif Medical City Hospital, Lahore, from October to December, 2020. Patients previously diagnosed with type II diabetes were included using non-probability consecutive sampling, and the GERDQ questionnaire was used to determine the frequency. IBM SPSS statistics version 23 was used for the analysis of data.Results: Of the 273 participants, 183 (67.0%) were male and the mean age was 51.13±12.8 years. The mean duration of diabetes was 6.97±4.76 years and oral hypoglycemic agents were used by 133 (48.7%) participants. Overall, 133 (48.7%) of the participants had GERD with a mean GERDQ score of 10.8(±1.4).Conclusion: Almost half (48.7%) of the participants have GERD; the most common symptom is regurgitation of stomach contents. Awareness should be raised, and early screening should be done to prevent long-term complications.

Psychological status and coping measures of individuals living with chronic obstructive pulmonary diseases

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and imparts substantial economic burden on individuals and health systems. Anxiety and depression were almost three times more common in COPD patients compared to the participants from the general population. Objectives: To assess the psychological status and coping measures of individuals living with chronic obstructive pulmonary diseases. Methods: Analytical cross-sectional research was conducted in medical outpatient department of Kathmandu Medical College Teaching Hospital from 2019 Nov 20 to 2020 May 20 after institutional ethical clearance. Total 185 individuals diagnosed with chronic obstructive pulmonary disease seeking medical care were included in the study by using purposive sampling. Data collection was done through face-to-face interview technique using Hopkins Symptoms Checklist-10 and Brief Cope inventory. The collected data were analysed using SPSS software version 20. Results: Based on a cut-off value of ?1.85 of Hopkins symptoms checklist-10, almost all (180, 97.3%) patients had mental distress. Frequently used approach coping subscales by the patients were emotional support (82, 44.2%), religion (81, 42%), planning (80, 41.8%), and active coping (80, 41.7%). Similarly, mostly used avoidance coping were: denial (80, 41.8%), venting (79, 41.1%), and self-blame (78, 40.6%). Conclusion: Almost all patients living with chronic obstructive pulmonary diseases had predicted mental distress and they were using both approach and avoidance coping measures.

Association Between Diabetic Control And Anti-Diabetic Medication Adherence Using 8-Point Morisky Medication Adherence Scale In Local Population Of Khyber Pakhtunkhwa

Abstract:&#x0D; Background: Drug adherence to medications in diabetes is very necessary for strict glycemic control. Many factors in diabetics are associated with low adherence to drugs resulting in complications.&#x0D; Methods: This research was conducted as an observational study with cross-sectional study design. It was scheduled between July 2022 to December 2022 in medical outpatient department of Combined Military Hospital, Peshawar&#x0D; Results: 115 individuals were inducted over a period of 6 months from medical OPD ex Combined Military Hospital Peshawar. Five patients failed to follow-up with research team resulting in a total of 110 participants included in results. Average age across the study sample was 50.25 ± 11.97 years with 58 (52.73%) males and 52 (47.27%) females. Most participant in our study sample were educated up to matriculation with BMI &lt;25kg/m2.&#x0D; Average duration of diabetes across the sample was 6.1 ± 3.69 years. In treatment options, 53 (48.18%) individuals were only managed with oral therapy, 16 (14.55%) on insulin only while 41 (37.27%) were prescribed with both oral hypoglycemic drugs and insulin. Most common comorbid across study population was hypertension, seen in 59 (53.94%) diabetic patients, followed by cataract in 41 (37.47%) and IHD in 33 (30%) patients.&#x0D; In all 110 individuals, only 29 (26.36%) individuals had good glycemic control i.e., HbA1c &lt;7% with average glycosylated hemoglobin percentage measuring 8.29% ± 1.59%. As per MMAS-8 score, 25 (22.73%) patients reported good adherence, 31 (28.18%) patients reported fair adherence while rest 54 (49.09%) were found to have bad adherence. Average MMAS-8 score was 5.17.&#x0D; Conclusion: There is a correlation between medication adherence as measured by MMAS-8 score with control of diabetes as measured by HbA1c score in the range of 1.824% across the range of MMAS-8 score from 0-8. Sleep quality, BMI and multiple comorbid conditions were also linked with raised HbA1c.&#x0D; Key words: Drug adherence, Morisky Medication Adherence Scale, Diabetes, Non-diabetes, diabetic medications

864-P: Effects on Glycemic Control by Combination Therapy of Gliclazide-Metformin and Insulin in Type 2 Diabetes Mellitus Patients

Background: Diabetes mellitus is most common non-communicable diseases. Purpose of this study was to observe the effects on glycemic control by combination therapy of gliclazide-metformin and insulin in type 2 diabetes mellitus patients according to baseline HbA1c, fasting blood glucose (FBG) and blood glucose 2 hours after breakfast. Methods: An observational study was conducted at Endocrinology Outpatient Department of Dhaka Medical College Hospital, Dhaka and Outpatient Department of Ibrahim General Hospital, Mirpur, Dhaka over a period of one year (July 2018 to June 2019). Total 110 type 2 diabetic patients were selected purposively. The patients were divided into two groups. In group I, 55 patients treated with gliclazide (80mg) and metformin (500mg) combination therapy twice daily for consecutive 12 weeks and in group II, 55 patients treated with Insulin (premixed 30/70) twice daily for consecutive 12 weeks. Results: After 12 weeks of treatment HbA1c level reduced from (mean ± SD) 8.94 ± 0.91 to 7.82 ± 1.86 in group I and 10.07 ± 1.28 to 7.90 ± 1.01in group II. FBG level reduced from 10.05 ± 1.57 to 7.96 ± 1.62 in group I and 11.61 ± 2.62 to 7.60 ± 1.23 in group II. Blood glucose 2 hours ABF level reduced from 14.00 ± 2.04 to10.99 ± 1.41 in group I and 16.70 ± 3.61to 10.71 ± 1.52 in group II. In group I, 36.4% patients achieved HbA1c target level, 40% patients achieved FBG target level and 25.5% patients achieved blood glucose 2 hrs ABF target level. In group II, 29.1% patients achieved HbA1c target level, 56.4% patients achieved FBG target level and 29.1% patients achieved blood glucose 2 hrs ABF target level Conclusion: This study showed improvement in the overall glycemic control (HbA1c, FBG and blood sugar 2hours ABF) during the study period. Both groups of drugs are effective in controlling blood glucose but individual group has unique beneficial effect. Key words: Type 2 diabetes mellitus, Glycemic control, Glicazide-Metformin Disclosure M.Saifuddin: None.