Patients In Outpatient Department Research Articles

Dietary and Behavioral Risk Factors of Ischemic Heart Disease Among Patients of Medical Outpatient Departments in Southern Ethiopia: Unmatched Case-Control Study.

BackgroundWorldwide mortality due to cardiovascular disease is the dominant cause of death, and ischemic heart disease is the leading one. Though risk factors for Ischemic heart diseases are modifiable and preventable, it is not well investigated in the local context. Thus, this study aimed to assess the dietary and behavioral risk factors for ischemic heart disease among patients in medical outpatient departments in Southern, Ethiopia.MethodsA facility-based unmatched case-control study was conducted from November 16 to March 20, 2020, among patients with ischemic heart disease and those patients who visited the three hospitals of the Wolaita Zone. A convenient sampling method was used and the data were entered using Epi data version 3.1 and exported to SPSS version 21 for analysis, a p-value <0.05, were considered statistically significant.ResultsA total of 557 study participants (140 cases and 417 controls) were included in a ratio of 1:3. The adjusted odds ratio for having no formal education (AOR = 3.18; 95% CI: 1.59, 6.34), previous history of hypertension (AOR= 2.84; 95% CI: 1.73, 4.66), physical inactivity (AOR= 2.23; 95% CI: 1.32, 3.76), inadequate intake of fruit and vegetable consumption (AOR= 2.43; 95% CI; 1.40, 4,22), palm oil use for food preparation (AOR= 2.12; 95% CI: 1.23, 3.63) and obesity (AOR= 5.68; 95% CI: 2.63, 12.23) increased the occurrence of the disease.ConclusionAlthough ischemic heart disease is preventable, using relatively simple and inexpensive lifestyle changes, it is projected to cause preventable loss of life. So, expanding health education and healthy life styles including exercise is recommended.

ASSESSMENT OF LIVER FIBROSIS IN ALCOHOLIC PATIENTS BY USING FIBROSCAN IN A TERTIARY CARE HOSPITAL

INTRODUCTION: Alcoholic liver disease is one of the major causes of premature deaths worldwide. Alcohol induced liver injury is the most prevalent cause of liver disease and effects 10% to 20% of population worldwide. Alcoholic liver disease comprises a wide spectrum of pathological changes ranging from steatosis, alcoholicsteato-hepatitis, Cirrhosis and nally hepatocellular carcinoma. Our aims in this study are to detect this change by non invasive method by liver broscan and its clinical implications. MATERIALS AND METHODS: Total 200 patients were taken for observational study, conducted at Coochbehar Government Medical college and hospital both outpatient department and indoor patients from May 2019 to January 2020. Liver stiffness was assessed by ultrasound based method of transient elastography using Fibroscan machine. Gradation of liver stiffness was expressed in kilopascals (KPa). RESULTS: Maximum number of patients of alcoholic liver disease were between 40 - 49 years of age (42.5%). Male patients is 87.5% and female patients 12.5%. distribution of Rural population is 36 % and Urban population is 64%. Majority of population85 patients (42.5%) had fatty liver and 40 patients (20%) have hepatomegaly, 41 patients (20.5%) had Coarse echotexture of liver parenchyma and 54 patients (27%) had Splenomegaly, 62 patients (31%) had Nodular liver and 62 patients. It is observed that 11 patients (5.5%) had Fibroscan score ≤7.5 and 47 patients (23.5%) had broscan score 7.6 -9.9 and 40 patients (20%) had broscan score 10-12.4, 36 patients (18 %) had broscan score 12.5 – 14.6 and 66 patients (33%) have broscan score ≥ 14.7. CONCLUSIONS: Transient Elastography (TE) is a newer non invasive assessment technique to detect the progression of brosis or brosis in alcoholic liver disease patient. Major advantage is it is noninvasive (costeffective) so that we can early detect progression of this cirrhosis and can give efforts to halt the disease progression.

Evaluation of and Intervention for Sarcopenia in Hepatology Departments: A Survey of Nurses in Japan.

Sarcopenia is associated with poor prognosis and decreased quality of life in patients with chronic liver disease (CLD). The present study aimed to clarify the dissemination of interventions such as evaluations, prevention efforts, and treatments for sarcopenia among patients in hepatology outpatient departments and wards in Japan, as well as examine the factors related to such dissemination. A cross-sectional study was performed involving nurses from hospitals accredited by the Japan Society of Hepatology. Participants completed a questionnaire regarding evaluations and interventions for sarcopenia in their department. Nurses from 72 outpatient departments and 162 wards provided responses to the questionnaire. Overall, 37.9% of outpatient departments and 37.6% of wards performed evaluations or interventions for sarcopenia. Outpatient departments and wards that evaluated sarcopenia or intervened held more workshops or training regarding sarcopenia than departments and wards that did not (outpatient departments: 52.0% vs. 12.2%, wards: 32.1% vs. 12.9%). Holding workshops or training regarding sarcopenia (outpatient departments; OR = 7.51, 95% confidence interval (CI): 2.12–26.6, wards; OR = 2.61, 95% CI: 1.11–6.15) was significantly associated with dissemination practices. These findings suggest that expanding knowledge of sarcopenia and developing practical skills among general nurses may aid in preventing sarcopenia among patients with CLD.

Antimicrobial Resistance in Enterobacteriaceae Bacteria Causing Infection in Trauma Patients: A 5-Year Experience from a Tertiary Trauma Center.

Introduction Multiple drug resistance emergences among bacteria at an alarming rate worldwide are posing a serious threat to the treatment benefits that have been achieved with antibiotics. This crisis is due to the inappropriate and overuse of existing antibiotics. We evaluated the antimicrobial resistance pattern of Enterobacteriaceae pathogens isolated from intensive care units (ICUs), wards, and outpatient department (OPD) patients. Objectives The aim of the study is to determine the antimicrobial resistance pattern in bacteria of Enterobacteriaceae family. Material and Methods This is a retrospective study conducted at a tertiary care level-1 trauma center in the capital city of India. We collected all the retrospective data of 5 years from the laboratory information system software of the microbiology laboratory. The retrospective data included patients’ details, samples detail, organism’s identification, and their antimicrobial susceptibility testing, done by Vitek2 compact system and disk diffusion test according to each year’s Clinical and Laboratory Standards Institute (CLSI) guidelines. This study included the interpretation of zone diameters and minimum inhibitory concentrations of all isolates according to CLSI guidelines, 2018. Results Among all the Enterobacteriaceae , Klebsiella spp. was the most commonly isolated pathogen, followed by Escherichia coli and Enterobacter spp. in ICUs and wards, while in OPD patients E. coli was the most commonly isolated pathogen, followed by Klebsiella spp. and Enterobacter spp. Enterobacteriaceae isolates remained resistant to all classes of cephalosporins in all settings. In addition, β lactam and β-lactamase inhibitor remained less effective. Carbapenems showed less resistance than quinolones and aminoglycosides. Among the different antimicrobial agents, tigecycline proved most effective in all settings; however, it showed more resistance than other studies. Conclusion Tigecycline proved effective among different multidrug resistance bacteria. Multidrug resistance in bacteria leads to prolonged hospital stays as well as makes the treatment less cost effective. Proper and judicious use of antimicrobials is the need of the hour.

Prevalence of Dental Crowding in the Kabul Dental Hospital, Kabul-Afghanistan

Background: Dental crowding, also called overcrowding, is a condition in which there is not enough space in the mouth for the steady growth of permanent teeth. Common problems that crowding can cause for a person include difficulty chewing food, speech problems, tooth decay, enamel loss, premature tooth loss, pressure on the jaws and pain, gingival resorption, and tenderness. Crowding always creates an unpleasant appearance for a person and even causes a person to be isolated from society and reduce self-confidence due to an ugly appearance. Crowding raises serious functional and aesthetic concerns for many patients.&#x0D; Aims: Conduct a descriptive study in this field with 1000 patients of the (OPD) Outpatient Department of Kabul Dental Hospital on the prevalence of crowding and to finding the relationship between the incidence of crowding according to the upper and lower jaws and the anterior and posterior segments of each jaw.&#x0D; Methods and materials: The sampling method were systematic random sampling that 1000 people were randomly selected from all OPD service clients during nine months and were included in the study. The required information was obtained by clinical examination of patients above the dental unit, under adequate light and the kit of dental examination equipment with direct clinical examination of the patient, and a pre-prepared questionnaire was inserted.&#x0D; The information obtained from the questionnaire reached the coding page, and it was entered into IBM_SPSS-25 software, and its analysis was performed.&#x0D; Results: From the results of this study, it was found that the prevalence of crowding was 59.1%, with the highest incidence of 28.6% in the lower jaw. Also, the highest rate of crowding events was 44.9% in the anterior segment of the mandible. Crowding events were received in the upper jaw 12.7%, with the highest incidence of 29.3% in the anterior segment.

COMPARISON OF PREGABALIN AND NORTRIPTYLINE ON EFFICACY AND SAFETY IN POSTHERPETIC NEURALGIA

Objectives: Antidepressants and anticonvulsants are most commonly prescribed in postherpetic neuralgia (PHN). The aim of the present study was to compare the efficacy and safety of pregabalin and nortriptyline in patients of PHN.&#x0D; Methods: The present study was conducted in 48 patients of PHN attending outpatient department of Dermatology, GMC Jammu. After obtaining written consent, the enrolled patients were randomized into two groups, one group was given pregabalin 150 mg orally per day, and other group was treated with nortriptyline 25 mg orally per day and were followed up to 8 weeks. Patients were assessed on numerical rating scale (NRS), Leeds assessment of neuropathic symptoms and signs (LANSS). Safety of the drugs was monitored by adverse drug reactions (ADRs).&#x0D; Results: All patients were over 57 years and thoracic dermatome was most affected. Both drugs significantly reduced NRS and LANSS (p&lt;0.0001). However, on comparison pregabalin was found to be better than nortriptyline at 8 weeks on mean NRS (p= 0.0073), LANSS (p=0.0032). Total of six mild ADRs occurred, two in group pregabalin and four in nortriptyline treated group.&#x0D; Conclusion: Both pregabalin and nortriptyline were effective in patients of PHN, but pregabalin was found to be better than nortriptyline at 8 weeks. Both drugs were well tolerated, though pregabalin had lesser number of ADRs.

A STUDY ON QUALITY OF SERVICES IN THE OUTPATIENT DEPARTMENT OF A MULTISPECIALTY TEACHING HOSPITAL

Quality of patient care in Outpatient Department (OPD) is as important as other clinical health measures and is a means of measuring the effectiveness of health care delivery system. A study was conducted to evaluate the facilities, infrastructure, services and stafng in the Outpatient Department in multispecialty teaching hospital. The study type is descriptive. Sample sizes of 120 patients were selected using convenience sampling technique. Questionnaire method was used to collect data from patients. The ndings showed that majority of the patients agreed that there were adequate facilities, infrastructure and services in the Outpatient Department. They also said that there were adequate number of nurses, doctors and supportive staff available to manage patients in OPD. The majority of patients were satised with the quality of services provided by the staff in OPD. The study ndings revealed some of the areas which can be improved such as cleanliness, communication skills of staff and pharmacy services to improve the overall quality of service provided.

Improving the leptospirosis disease burden assessment by including ambulatory patients from outpatient departments: a cross-sectional study

Background: In Sri Lanka, the disease burden of leptospirosis is estimated based on a routine notification system, which is predominated by patients ill enough to be hospitalized. The notification system does not function well with ambulatory patients in outpatient departments (OPDs). The objective of this study was to determine the proportion of leptospirosis in an OPD setting in a regional public hospital in Sri Lanka to provide further estimation of disease burden. Methods: This study was conducted in the OPD of the Rathnapura Provincial General Hospital from August to September 2017. Suspected leptospirosis patients were recruited based on standardized criteria and tested using the microscopic agglutination test and quantitative polymerase chain reaction. The number of OPD patients was compared with the reported patient numbers with leptospirosis from the hospital during the same period as the denominator, and the 95% confidence interval was calculated for the proportions using Poisson distribution. Results: During the study period, of 2,960 fever patients presenting to the OPD, 33 (1.1%) were suspected to have leptospirosis; 8/33 suspected (22.3%) cases were confirmed as being due to leptospirosis. There were 82 notifications of leptospirosis cases from hospital inpatients during the same period, none from the OPD. The total missing proportion from the surveillance system was 28.6% (95% CI, 19.4-40.4%). Among OPD patients, 12 (36.4%) had been given antibiotics from a primary care center prior to the OPD visit. No OPD patient was admitted to the hospital for inward care. Conclusions: More than 25% of cases of leptospirosis were not identified because they were not sick enough to be admitted nor subjected to routine leptospirosis diagnostic testing.These data have public health implications if the sources of leptospirosis transmission are to be controlled.

Assessment of outdoor patient’s satisfaction regarding clinical investigation of physicians in government hospitals of Quetta, Pakistan

Objective: The main objective of the study is to measurement of the satisfaction of Outpatient Department patients regarding clinical investigation of physicians in government hospitals of Quetta, Pakistan. Methods: It was a cross sectional questionnaire based study. Data was collected from OPD (Outpatient Departments) of government hospitals (Sandeman provisional hospital, Bolan medical complex hospital) of Quetta, through a pre-structured questionnaire. Total sample size of the study was 447. The data collected, was analysed by using IBM SPSS 22. The descriptive analysis was carried out for the demographic details as well as for other categories. All the data was categorical so was expressed as frequency and percentage. Results: A total of 447 OPD patients were included in the study to know their perceptions towards the doctors and their attitude while consultation. Total of 550 questionnaires were distributed with the response rate of 89.4%. It was found that most of respondents 270 (60.3%) were male and having majority 338 (75.4%) among the age group of 15 to 35 years. Majority 120 (26.8%) respondents were satisfied that physician making them feel ease during physical examination. Among all 175 (39.1%) answered positively (Good) to physician guided you regarding any of dietary change. Conclusion: This study reveals that there is a good satisfaction of patients regarding physician’s attitude, diagnosis, treatment and advice in government hospitals of Quetta city.

A prospective randomized single blind study to compare the safety and efficacy of propronolol and topiramate in migraine prophylaxis

Background: The aim of the study was to compare the Safety and efficacy of propranolol and topiramate in migraine prophylaxis.Methods: This was a prospective, randomized, single blind study which was conducted for six months in 100 patients of outpatient department of Neurology Government General Hospital, Guntur.Results: Among the hundred patients fifty were allotted to group A – propranolol 40 mg bd and fifty were allotted to group B- topiramate 25 mg bd. statistically there is no significant differences were found between the treatment groups of Propranolol and topiramate for the reduction in mean duration and severity of migraine headaches. Both Propranolol and topiramate have p value&lt;0.001. This shows that both propranolol and topiramate have significantly decreased in the mean duration and severity of migraine attacks. However, in the present study topiramate is slightly more efficacious in reducing the symptoms of migraine frequency per month (days), duration and severity (visual analogue scale- VAS score) from baseline at the end of six months. The decrease in frequency of migraine attacks from 10.44±4.38 to 3.18±4.48 i.e., 70.2% from baseline is seen with topiramate.Conclusions: This study demonstrated that both propranolol and topiramate could significantly reduce migraine headache frequency, duration and intensity. However, compared with propranolol topiramate showed better results. topiramate 25 mg reduced the symptoms like frequency, duration and severity of migraine attacks from base line at the end of six months but more number of adverse effects were seen in topiramate group.

Treatment Effect of Type 2 Diabetes Patients in Outpatient Department Based on Blockchain Electronic Mobile Medical App.

As the pace of people's lives accelerates, there are more and more diabetic patients. This research mainly explores the treatment effect of type 2 diabetic patients based on blockchain electronic mobile medical app. Considering that it is more realistic to adopt an off-chain storage solution, the blockchain-based medical data sharing platform in this study adopts an off-chain storage solution. Only key information is stored in the blockchain network, and all medical data will be in the cloud space. For storage, cloud storage uses Aliyun's OSS storage service, which can be expanded infinitely. The cloud operation module is responsible for all operations that interact with cloud storage. The chain code can call the cloud operation module to upload the user's encrypted medical data and user ID to Alibaba Cloud's OSS. The chain code will return the storage address of the medical data and the authorized access address is sent to the blockchain network for consensus on the chain. The message processing module provides information processing functions such as chat information processing, APP use reminders, and health tips. The indicator recording module includes indicator recording functions including 6 indicators of blood sugar, medication, diet, weight, exercise, and sleep. The main function of the indicator analysis module is to display the curve trends of the 6 indicators recorded by the patient in three days, one week, and one month. Comparing the change range of the mean value of glycosylated hemoglobin at the beginning and end of the two groups of patients, it can be found that the change range of glycosylated hemoglobin in the intervention group is −6.04%, while the change range of the control group is only −3.26%. The impact of the mobile medical app designed in this study will indeed be reflected in the patient's blood sugar control and help patients to better control blood sugar.

The effect of the integrated delivery system in rural areas of China.

With the continuous development of modern society, the management of chronic diseases has become the focus of the medical community in China. In particular, diabetes is a chronic disease that cannot be ignored. China has built an integrated delivery system to deal with imminent health problems. The purpose of this study is to investigate the effects of integrated rural supply system in China. We selected 1,061 patients with diabetes from the Zhili Town Health Center's hospital information system. We tracked and studied their outpatient and inpatient expenses, treatment behaviors, incidence of complications, and satisfaction over 5 years. We compared the data collected from 2014 to 2019 to determine the trends of these four factors and the effects of the integrated delivery system for patients with diabetes. We found that the average costs for diabetes patients in outpatient and inpatient departments were increasing slightly every year. The number of patients in tertiary hospitals has decreased significantly, while the number of patients in community hospitals (primary hospitals) has increased, and the number of patients in secondary hospitals has remained relatively unchanged. Meanwhile, the expenses per visit were also lower over this period in hospitals at all levels. Diabetes complications have been increasing marginally, and there is a relatively high degree of satisfaction among patients and doctors in primary hospitals, which is rising. Considering the various needs of people in different stages of life, the integrated delivery system provides and manages continuous services such as health promotion, disease prevention, diagnosis, treatment, rehabilitation, and management through cooperation between institutions at different levels of the health system.

Factors Affecting Intention of Signing an Advanced Directives in Cancer Patients

Purpose: The purpose of this study was to identify factors affecting intention to sign an Advanced Directives (AD) in cancer patients.Methods: A descriptive correlational study design was used. Participants were 173 adult cancer patients in outpatient and inpatient departments at the cancer center of G University Hospital located in J city. Data were collected from February 25 to August 30, 2019. Data were analyzed using x&lt;sup&gt;2&lt;/sup&gt; test, independent t-test, and multivariate logistic regression with SPSS/WIN 24.0.Results: Factors influencing an intention to sign an AD in cancer patients were job status (OR 2.81, 95% CI=1.20~6.56), whether or not any acquaintances had signed an AD (OR 51.48, 95% CI=3.76~704.71), proper time to sign an AD (when diagnosed with end-stage: OR 0.28, 95% CI=0.10~0.80; when near death: OR 0.09, 95% CI=0.02~0.46; reference: when healthy), discussion with family members about signing an AD (OR 15.87, 95% CI=2.28~110.54) and attitude towards AD (OR 6.50, 95% CI=1.23~34.38).Conclusion: In order to increase the intention to sign an AD in cancer patients, the development and implementation of nursing interventions to promote a positive attitude towards AD is highly recommended. Further, encouraging discussion with family members about signing an AD is recommended, and helping cancer patients to recognize that signing an AD is appropriate at a time when it is possible to make a treatment decision rather than when the patients has been diagnosed with end stage cancer.

Impact of Sensitization of Family Caregivers upon Treatment Compliance among Geriatric Patients Suffering from Elder Abuse and Neglect.

Geriatric patients in various outpatient department (OPDs) have been found to agonize from elder abuse and neglect (EAN). Such suffering imposes depressive states within individuals, which in turn affects treatment compliance. The objective of this study was to evaluate the impact of sensitization (psychotherapeutic) of family caregivers (FCGs) upon two denture treatment parameters (maintenance and treatment satisfaction) among EAN patients and compare the differences in outcome with non-abused patients. A survey of completely edentulous subjects (n = 860, aged 41–80 years) provided a sampling frame of 332 EAN patients from which 150 patients (including FCGs) fulfilling the study criteria were distributed (simple random, convenient) into two groups (Group A—control, Group B—test). FCG sensitization for subjects in Group B was performed by a clinical psychologist in 2–4 short (30 min) sessions. Demographic characteristics (frequency) were measured using a self-reported questionnaire, denture maintenance was measured using a denture hygiene index (scores), and treatment satisfaction was analyzed on a 10-point visual analog scale. Relevant data were calculated for means and absolute/relative frequencies. Any difference between two groups was estimated using an unpaired t-test while the level of relationship was determined by Karl Pearson’s test at a p-value of < 0.05. The results showed highest frequency (38.6%) for neglect, with elder neglect (EN) being most common (38.14% alone and 14% in combination). EN was found more if the FCG was a son (52%), in the age group (21–30 years), and with low education and low income (75%). Patients whose FCGs were counselled (Group B) demonstrated low denture plaque scores (mean = 1.38 ± 0.618), while demonstrating comparatively higher scores in six different parameters of treatment satisfaction. Differences between the two groups for both parameters were also found to be statistically significant. Psychotherapeutic counselling in the form of FCG sensitization brings better results of denture maintenance and treatment satisfaction.

STUDY ON MEDICATION APPROPRIATENESS AMONG GERIATRICS IN TERTIARY CARE TEACHING HOSPITAL

Introduction: Older patients are considered as special population, the pharmaceutical care with focus of increasing medication appropriateness and reducing medication related problems is needed. Elderly patients have a higher prevalence of chronic and multiple illness and physiological changes associated with aging may masquerade as illness. Aim &amp; Objectives: To assess and evaluate the drug prescribing pattern and inappropriate prescribing by using beers criteria 2015 among Geriatric patients. Materials &amp; Methodology: A prospective observational study was conducted in general medicine out-patient department, SVRRGGH, Tirupati for period of 6months.The patients of general medicine out-patient department with age above 65yrs old were included in the study. The Patients who are not willing to participate in the study, inpatients and terminally ill patients were excluded from the study. Results &amp; Discussion: Among 200 patients, distribution of age majority of the patients is male (71%) followed by females (29%), Most of patients have multiple diseases (64%) followed by Single disease (29%). All potentially inappropriate medicines (PIMS) are classified as category A, B, C. Drugs have to be avoided in geriatric patients (Category A) being the most common category of inappropriate as per Beers criteria updated by American Geriatric Society 2015.Our study reported 174 drugs as PIMs. Conclusion: It is also necessary to improve the geriatric care, as this age group possess risk for many diseases and medication use. In future a multidisciplinary approach, steps to be taken involving physicians, nurses and pharmacists has a team for bringing out rational drug use in geriatric population.

Comparison of Attendance of Patients Pre-lockdown and during Lockdown in Gynaecology and Antenatal Outpatient Department in a Tertiary Care Hospital of Nadia, West Bengal, India

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has brought about a paramount change in the life. This has lead to a reduction in the number of routine patients visiting the Outpatient Department (OPD) of various hospitals and this department was no exception. Aim: To compare the attendance of patient in Antenatal Care (ANC) and Gynaecology Out Patient Department (GOPD) between pre-lockdown and lockdown period due to COVID-19 pandemic. Materials and Methods: The study was conducted among patients attending the OPD in ANC and Gynaecology for 70 days lockdown from 23rd March to 31st May and 70 days immediate pre-lockdown period from 12th January to 22nd March 2020. Daily attendance was noted and types of patient attending in different sub clinics in Gynaecology OPD compared. Enrolment of new ANC patient and old booked cases was compared during both periods. Descriptive statistics were used and displayed as percentages. Results: There was a significant reduction in number of patients attending OPD in lockdown period. There was a total of 6088 (87.3%) reduction in number of patients in Gynaecology OPD and 2235 (69.6%) reduction of patients in ANC OPD which was found to be significant with p-value &lt;0.001. Reduction of patient in lockdown days among new ANC was 574 while it was 1661 in case of old patients. The different sub clinics of GOPD like infertility (704), endocrine (1450), uro-gynaecology (656), STD/PID (732), postpartum (597), cancer detection (316), abortion and medical termination of pregnancy (MTP) (330), others (1303) also witnessed a diminution of attendance. Conclusion: COVID-19 caused a significant decrease in footfall of patients in outpatient department due to lockdown, though the percentage of types of patient attending Gynaecology OPD was almost same.

Orthopedic clinics under the coronavirus disease-2019 (COVID-19) pandemic: Time to revisit the safety measures

Coronavirus disease-2019 (COVID-19) pandemic has changed the seen in each and every field of the globe and is true for orthopedic clinics as well. As the second surge of COVID-19 pandemic is fading away, number of patients in orthopedic clinics of hospitals, nursing homes, and even private chambers is increasing day by day. Very soon we will see a sudden surge of patients in orthopedic OPD (outpatient department) as the cold cases have been differed for the last one and half years. Visiting/handling the increasing number of patients in the same space of consulting and waiting area will be a challenge and it is quite possible that we may commit a mistake by compromising the protective guidelines, as we did during the beginning of this year. However, the first surge was fading away, which resulted into the entry of second surge of COVID pandemic. Therefore, it is time to revisit the situation in terms of safety measures while attending the patients in orthopedic clinic.

The Impact of a Health Forecasting Service on the Visits and Costs in Outpatient and Emergency Departments for COPD Patients - Shanghai Municipality, China, October 2019-April 2020.

What is already known on this topic?The morbidity and mortality of chronic obstructive pulmonary disease (COPD) is associated with adverse weather and air pollution. However, COPD patients are not able to be alerted in advance of high risk environments.What is added by this report?This prospective controlled trial conducted in Pudong New Area of Shanghai from October 2019 to April 2020 provided evidence of COPD risk forecasting service on the reductions in visits and costs of COPD patients in outpatient and emergency departments in China for the first time.What are the implications for public health practice?This study suggests that COPD risk forecasting service could be integrated into existing COPD management in public health to improve the health and economic outcomes.

What Impact Have SARS-CoV-2/COVID-19 Pandemic Induced Lockdown on the Number of OPD Patients of Diabetes, Hypertension, Stroke (CVA), Acute Heart Disease, Mental Illness, Epilepsy, Ophthalmic, Dental and Oncology in India During the Lockdown Months (April-May-2020)–Observational Research Analysis?

The First human case of the covid-19 global pandemic was reported from Wuhan city of China in December 2019. On 27th January 2020, India found a suspected case of covid-19 in Kerala with a recent travel history of Wuhan; china. The suspected case was reported as positive by the National Institute of Virology located at Pune in Maharashtra, India on January 30, 2020 as positive for COVID-19 infection. This was the first documented COVID-19 case in India. The government of India responded to this novel disease by enforcing nationwide lockdown starting on 25/03/2020 and ending on 31/05/2020. In this retrospective observational quantitative and qualitative study I have done assessment of the impact of covid-19 lockdown measures on OPD health services for some important non communicable diseases. The data is collected, observed, analyzed for the years 2020 and 2019 and the lockdown period of April-May 2020 is compared with the same duration of 2019 (excluding period of 7 days of lockdown in march). The OPD (outpatient Department) services for the patients of Diabetes, Hypertension, Stroke (CVA), Acute Heart Disease, Mental Illness, Epilepsy, Ophthalmic, Dental and oncology were selected for this observational retrospective study-analysis. In version 2 time series analysis (longer period) will be applied to test the significance of difference between pre and post intervention (lockdown). The study found as compared to 2019 when lockdown and pandemic was not in existence, 2020 lockdown period have notable reduction in various OPD health services. The study have derived conclusion that lockdown reduced number of OPD patients and hence reduced access to the health services for non-communicable disease which is the major burden of disease in India as well as at global levels. In the final conclusion the author feel the need of more emphasis and priority for NCDs care in any situations of emergency like pandemic and natural calamities, lockdowns etc which usually disrupt routine healthcare. Routine healthcare is very essential in context of chronic diseases which can be converted to acute emergency conditions like CVA. Funding Information: Self sponsored. No aid taken from individual or agency etc. Declaration of Interests: There are no conflicts / competing of interest. Ethics Approval Statement: This study has not involved any human or animals in real or for experiments. The data on the prevalence and mortality due to COVID-19 pandemic were taken from the Health Department, Bihar and other organizations which are also available online, hence ethical approval was not required.

What Impact Have SARS-CoV-2/Covid-19 Pandemic induced lockdown on the number of OPD patients of Diabetes, Hypertension, Stroke (CVA), Acute Heart Disease, Mental Illness, Epilepsy, Ophthalmic, Dental and oncology in India during the lockdown months (April-May-2020)–Observational Research Analysis?

The First human case of the covid-19 global pandemic was reported from Wuhan city of China in December 2019. On 27th January 2020, India found a suspected case of covid-19 in Kerala with a recent travel history of Wuhan; china. The suspected case was reported as positive by the National Institute of Virology located at Pune in Maharashtra, India on January 30, 2020 as positive for COVID-19 infection. This was the first documented COVID-19 case in India. The government of India responded to this novel disease by enforcing nationwide lockdown starting on 25/03/2020 and ending on 31/05/2020. In this retrospective observational quantitative and qualitative study I have done assessment of the impact of covid-19 lockdown measures on OPD health services for some important non communicable diseases. The data is collected, observed, analyzed for the years 2020 and 2019 and the lockdown period of April-May 2020 is compared with the same duration of 2019 (excluding period of 7 days of lockdown in march) . The OPD (outpatient Department) services for the patients of Diabetes, Hypertension, Stroke (CVA), Acute Heart Disease, Mental Illness, Epilepsy, Ophthalmic, Dental and oncology were selected for this observational retrospective study-analysis. In version 2 time series analysis (longer period) will be applied to test the significance of difference between pre and post intervention (lockdown). The study found as compared to 2019 when lockdown and pandemic was not in existence, 2020 lockdown period have notable reduction in various OPD health services. The study have derived conclusion that lockdown reduced number of OPD patients and hence reduced access to the health services for non-communicable disease which is the major burden of disease in India as well as at global levels. In the final conclusion the author feel the need of more emphasis and priority for NCDs care in any situations of emergency like pandemic and natural calamities, lockdowns etc which usually disrupt routine healthcare. Routine healthcare is very essential in context of chronic diseases which can be converted to acute emergency conditions like CVA.