Outdoor Department Research Articles

Phenotypic Differences between Patients with Smoking Chronic Obstructive Pulmonary Disease and Non-smoking Chronic Obstructive Pulmonary Disease

ABSTRACT Background: In low- and middle-income countries, causes other than tobacco smoking contribute more to the development of chronic obstructive pulmonary disease (COPD). In India, non-smoking-related COPD (NS-COPD) is common due to the high prevalence of pulmonary tuberculosis and biomass fuel exposure. Our study aims to know the phenotypic differences between smoking-related COPD (S-COPD) and NS-COPD patients. Materials and Methods: The study included 217 patients, who visited the outdoor department of a tertiary care center. A detailed clinical history was obtained; radiological and hematological investigations, spirometry, and a 6-min walk test were performed. Results: Of 217 patients, 100 had S-COPD, and 117 had NS-COPD. Male patients were predominantly affected (P < 0.001) in both groups. There were significant differences in the age group (P < 0.001), body mass index (P < 0.045), blood hemoglobin levels (P < 0.02), forced vital capacity (FVC) (P = 0.02), postbronchodilator reversibility in forced expiratory volume in 1 s (FEV1) (P < 0.006), and FEV1/FVC ratio (P < 0.001) between patients with smoking and S-COPD and NS-COPD. Emphysema was more common in S-COPD, whereas COPD-bronchiectasis overlap was more common among NS-COPD patients. Cough was more common, and airflow obstruction was less severe in nonsmokers. There was no significant difference in the exercise capacity. Conclusion: The NS-COPD patients present at younger age, with more COPD-bronchiectasis overlap phenotype. They have less severe airflow obstruction and more postbronchodilator reversibility. Understanding phenotypic characteristics is necessary for accurate diagnosis and management of COPD in nonsmokers.

Serum Levels of Thyroid Hormones and Thyroid Peroxidase Antibodies in Different Types of Glaucoma

Abstract Aim of this study is to analyze connection between thyroid hormones disbalance and thyroid peroxidase antibodies in serum and different types of glaucoma. This was a hospital-based, retrospective case-control study. Eighty-seven patients were recruited for outdoor department of Clinic of ophthalmology for the routine ophthalmological examination from an endocrinologist, with laboratory analysis of serum levels of thyroid hormones and thyroid peroxidase antibodies test. We specifically included patients with primary open-angle glaucoma and pseudoexfoliation glaucoma, since these two types of glaucoma are highly reported clinically. Based on laboratory analysis, we divided patients into three groups: primary open-angle glaucoma patients with hypothyroidism, pseudoexfoliation glaucoma patients with hypothyroidism and control group that included healthy subjects. In our research, we found that there were discrete differences between glaucoma patients and control subjects in serum levels of free triiodothyronine and free thyroxine. In other words, these differences were insignificant. Patients with primary open-angle glaucoma and pseudoexfoliation glaucoma had increased serum levels of thyroid stimulating hormone, when compared to patients in control group. This study highlights the interaction between thyroid hormones and glaucoma development. Laboratory analysis of glaucoma patients confirmed thyroid peroxidase antibodies levels greater than normal. Control group had physiological range of thyroid peroxidase antibodies. These findings support autoimmune theory of glaucoma development.

Risk Factors and Patterns of Drug-Drug Interactions in Two Categories of Level-3 Hospitals in Dhaka: A Cross-Sectional Study.

Drug-drug interactions (DDIs) are a significant health issue that may adversely affect the health and well-being of patients. This study assesses and compares potential DDI (pDDI) patterns, severity, and associated risk factors in government and private hospitals in Dhaka, Bangladesh. A total of 188 and 206 prescriptions were collected from various government and private hospitals' outdoor departments, respectively, by capturing pictures of the prescriptions. Bivariate analyses were performed through STATA 15. MedScape drug interaction checker was applied to identify pDDIs, while their consequences were obtained from DrugBank and MedScape. Private hospitals had more pDDIs containing prescriptions than government hospitals (62.62% and 57.97%, respectively). The mean pDDIs cases were 3.29 in the private hospitals, while at government hospitals they were 3.02. Among the detected pDDIs, pharmacodynamic pDDIs were predominat, accounting for 63.32% and 66.23% of total events in government and private hospitals, respectively. Severity-wise, both types of hospitals had almost equal amounts of serious (10.34% vs. 9.18%), moderate (68.96% vs. 59.61%), and minor (20.06% vs. 21.79%) pDDIs. Polypharmacy was crucial in pDDI cases, responsible for 70.21% and 81.83% of pDDIs in government and private hospitals, respectively. Multiple comorbidities with pDDIs were more common in private hospitals (24.46% vs. 18.93%), while government hospitals displayed a higher frequency of pDDIs with one comorbidity (24.75% vs. 17.55%). Non-mention of comorbidities was correlated with both types of hospitals (p ≤ 0.01) in pDDIs cases. Furthermore, considerable amounts of pDDIs in prescription error categories were detected. Both types of hospitals had a prevalence of antihypertensive, antidiabetic, psychotic, and antiplatelet-related pDDIs. The two kinds of hospitals exhibited similar pDDI patterns, while their associations were random with the risk variables. When prescribing pharmacokinetics and pharmacodynamics pDDIs, physicians should evaluate the risk-benefit ratio.

Pattern of Skin Diseases in Children Attending Dermatology Outpatient Department of a Tertiary Care Hospital

Objective: To determine the pattern and frequency of skin disorders in children attending Dermatology Department of a Tertiary Care Hospital. Study Design: Cross-sectional study. Place and Duration of Study: Dermatology Department, Combined Military Hospital Bahawalpur, from Mar to Aug 2023. Methodology: Three thousand eight hundred and eleven (3811) children reporting to dermatology outdoor department with skin diseases during the study period were included in this study. All cases were diagnosed by a consultant dermatologist. Data regarding patient age and sex was collected for each patient. Diseases were categorized into various groups depending on aetiology and cutaneous structure affected by the disease. Results: The mean age of patients was 8.03+4.40 years. Most common diseases were infections (n=1607, 42.2%), followed by parasitic diseases (n=843, 22.1%), dermatitis and eczematous disorders (n=497, 13.0%) and inflammatory dermatoses (n=136(3.6%) in descending order of frequency. Together, these groups comprised 80.1% of total patients (n=3083). Infections and infestations were found in 64.3 % (n=2445). Conclusion: Infections and infestations are the most commonly encountered disease groups. Scabies followed by pyodermas, dermatophytoses and atopic dermatitis were the four commonly encountered paediatric dermatoses in descending order of frequency, accounting for 54.3% of total number of paediatric patients.

Diastolic Dysfunction in Type 2 Diabetes Mellitus Patients Presenting to Tertiary Care Hospital

Objective: To study the frequency of left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus presenting to a tertiary care hospital. Study Design: Cross sectional study. Place and Duration of Study: Medicine Dept, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Mar to Aug 2022. Methodology: Fifty-one patients between the ages of 30 to 65 years were enrolled, belonging to either gender, presenting to outdoor department, with diagnosed type 2 diabetes mellitus for at least 1 year, on oral hypoglycemic drugs or insulin, and no underlying hypertensive cardiac pathology or diastolic dysfunction. These patients were further analyzed using statistical software based on their 2D echocardiogram findings. Results: Out of 51 type 2 diabetes mellitus patients, there were more males 32(62.7%) as compared to females 19(37.3%), with mean age of 52.25±8.09 years. We observed that 21(41.2%) patients did not have left ventricular diastolic dysfunction at the time of our study, but among these patients, 13(61.9%) had type 2 diabetes mellitus for 1-3 years while remaining 30(58.8%) patients had both type 2 diabetes mellitus and left ventricular diastolic dysfunction, with 13(25.5%) having grade-I, 10(19.6%) having grade-II and 7(13.7%) having grade-III categorization. Conclusion: There was an increased risk of left ventricular diastolic dysfunction in type 2 diabetes mellitus with longer duration of disease and higher HbA1c. Patients with type 2 diabetes mellitus to be followed up for diabetic control and monitored for the presence of asymptomatic left ventricular diastolic dysfunction with measures to be taken to prevent it.

Effects of the Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor Empagliflozin Added to Metformin in Patients with Type 2 Diabetes

Introduction: Type 2 diabetes mellitus (T2DM) is a chronic progressive disease characterized by a progressive decline in pancreatic beta-cell function and insulin resistance. Multiple blood glucose-lowering agents targeting the main pathogenic mechanisms of insulin deficiency and insulin resistance are available for the management of type 2 diabetes. However, many patients do not achieve or maintain recommended blood glucose targets even with combination therapies, which are often delayed. Therefore, this study aimed to observe the effects of Empagliflozin as an add-on to Metformin in patients with type 2 diabetes. Methods: This was a retrospective observational study and was conducted in the Department of Medicine, Popular Medical College Hospital, Dhaka, Bangladesh during the period from January 2023 to December 2023. In our study, we included 255 type 2 diabetes mellitus patients who came to receive treatment at the outdoor department of medicine of our hospital. The patients were divided into three groups- Group A (Patients who received the combination of Empagliflozin 10 mg and Metformin 1000 mg), Group B (Patients who received Empagliflozin 10 mg), and Group C (Patients who received Metformin 1000 mg). Result: We found the mean age was 55.8 ± 11.3 years. Most of our patients were male (60%). Among our patients, the majority (57.25%) of them had HbA1c of 8% to 9%. Most patients (60%) got < 8% HbA1c level in Empagliflozin 10 mg combined with metformin 1000 mg group at the end of our study. The majority (9.41%) of patients in the Empagliflozin 10 mg group had >9% HbA1c level compared to other groups. Dizziness, dyspepsia, diarrhea, nasopharyngitis, hyperglycemia, and hypoglycemia were the most common adverse events. Conclusion: The findings of the study showed that in people with Type 2 diabetes and insufficient glycaemic control, 52 weeks’ treatment with empagliflozin 10 mg as an add-on to metformin 1000 mg resulted in sustained and clinically substantial decreases in HbA1c, body weight,FPG, systolic and diastolic blood pressure.

“Deciphering The Enigma Of Nasal & Paranasal Anatomy Through Computed Tomography (CT) Imaging”

Introduction: the paranasal sinuses are mucosa-lined structures physically contiguous with the nasal cavity that aid in insulation, reducing cranial weight, heating & humidifying the air, imparting resonance to the voice, providing airway defense and simply to replace functionless bone. Sinusitis is rarely life threatening, but the complex anatomy of the facial planes, the associated venous and lymphatic spread and the close location to the central nervous system can lead on to serious complications. It is, therefore, important to understand the normal anatomy of the paranasal sinuses in order to understand the pathogenesis of sinus disease. Hence, the aim of the present study was deciphering the role of ct as the investigation of choice for the preoperative evaluation of the nose & paranasal sinuses and for delineation of obstructive inflammatory sinus disease to aid in the diagnosis and management of recurrent & chronic disease and to define the bony anatomy before surgery. Materials and methods: prospective cross-sectional study was conducted on 100 asymptomatic patients who were getting investigated by computed tomography for non-sinus indications in whom the paranasal sinus region could be included in the field of study referred to department of radio-diagnosis and imaging from indoor and outdoor departments of jan sewa hospital of dr. S. S. Tantia medical college, sri ganganagar. Results: the majority of patients were in the age group of 21-40 years (42.3%) with 70% being male. Patients in the age group equaling or more than 61 years & with diabetes had the most number of incidental findings (68.2 %) agger nasi was the commonest anatomical paranasal sinus variant (82.9 %) followed by concha bullosa (39.3 %), deviation of the nasal septum (35.4 %), onodi cells ( 12.2 %) & haller cells ( 11.8 %). Incidental paranasal sinus abnormality in the form of mucosal thickening, sinus secretions or polyps were detected in 51.9 % patients, mucosal thickening being most common (40.1 %) followed by secretions (31.9 %) and mucosal polyps ( 3.0 %). Incidental paranasal abnormalities were most commonly noted in the ethmoid sinuses (36.7 %) followed by the maxillary sinuses, sphenoid sinuses and then frontal sinuses in descending order of involvement. Conclusion: computed tomography (ct) provides a “road map” for diagnosis and management of recurrent & chronic paranasal sinus disease and to delineate the bony anatomy before sinus surgery and to get an insight into anatomical variants apropos of their clinical relevance & impact on sinus disease.

“Deciphering The Enigma Of Nasal & Paranasal Anatomy Through Computed Tomography (CT) Imaging”

Introduction: the paranasal sinuses are mucosa-lined structures physically contiguous with the nasal cavity that aid in insulation, reducing cranial weight, heating & humidifying the air, imparting resonance to the voice, providing airway defense and simply to replace functionless bone. Sinusitis is rarely life threatening, but the complex anatomy of the facial planes, the associated venous and lymphatic spread and the close location to the central nervous system can lead on to serious complications. It is, therefore, important to understand the normal anatomy of the paranasal sinuses in order to understand the pathogenesis of sinus disease. Hence, the aim of the present study was deciphering the role of ct as the investigation of choice for the preoperative evaluation of the nose & paranasal sinuses and for delineation of obstructive inflammatory sinus disease to aid in the diagnosis and management of recurrent & chronic disease and to define the bony anatomy before surgery. Materials and methods: prospective cross-sectional study was conducted on 100 asymptomatic patients who were getting investigated by computed tomography for non-sinus indications in whom the paranasal sinus region could be included in the field of study referred to department of radio-diagnosis and imaging from indoor and outdoor departments of jan sewa hospital of dr. S. S. Tantia medical college, sri ganganagar. Results: the majority of patients were in the age group of 21-40 years (42.3%) with 70% being male. Patients in the age group equaling or more than 61 years & with diabetes had the most number of incidental findings (68.2 %) agger nasi was the commonest anatomical paranasal sinus variant (82.9 %) followed by concha bullosa (39.3 %), deviation of the nasal septum (35.4 %), onodi cells ( 12.2 %) & haller cells ( 11.8 %). Incidental paranasal sinus abnormality in the form of mucosal thickening, sinus secretions or polyps were detected in 51.9 % patients, mucosal thickening being most common (40.1 %) followed by secretions (31.9 %) and mucosal polyps ( 3.0 %). Incidental paranasal abnormalities were most commonly noted in the ethmoid sinuses (36.7 %) followed by the maxillary sinuses, sphenoid sinuses and then frontal sinuses in descending order of involvement. Conclusion: computed tomography (ct) provides a “road map” for diagnosis and management of recurrent & chronic paranasal sinus disease and to delineate the bony anatomy before sinus surgery and to get an insight into anatomical variants apropos of their clinical relevance & impact on sinus disease.

10-Year Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score Calculation in Out-Patient Department

Objective: To calculate 10-year Atherosclerotic Cardiovascular Disease risk score in outdoor department of a tertiary care hospital and identify individuals at high risk of cardiovascular disease. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Malir, Pakistan, from Oct 2020 to Mar 2021. Methodology: 116 patients presenting to Out-Patient Department of General Medicine of CMH, Malir, Pakistan, without previous evidence of cardiovascular disease were included. Previous history of diabetes, smoking, use of anti-hypertensives, Aspirin and statins was recorded. Systolic and diastolic blood pressures, waist circumference, HbA1c, fasting blood sugar, fasting LDL, HDL and total cholesterol were tested for each patient. 10-year ASCVD risk score was calculated using online ASCVD Risk Estimator calculator. Results: Mean age of the patients was 58.6±9.92 years with 62.1% being males and 37.9% being females. Mean 10-year ASCVD risk score was 13.37±7.1, of which 21 patients (18.1%) had Very High, 66(56.9%) had Intermediate and 29(25%) had Low 10-year ASCVD risk score. Among Very High cases, 80.9% were males, all were in age group 50-79 years, 61.9% were diabetic, 33.3% were smokers and 66.7% were obese. Conclusion: A very high percentage of study group had Intermediate or Very High 10-year ASCVD risk score. Identifying those individuals at high risk early and controlling the modifiable risk factors can help lessen the morbidity and mortality associated with cardiovascular diseases.

Assessment of Risk Factors of The Patients With Lateral Epicondylitis

Background: Lateral epicondylitis, is prevalent in the world of sports; however, this injury still causes confusion among healthcare professionals. Numerous studies have evaluated treatment options, but few have taken into consideration the extent to which tennis players, themselves, understand this ailment. Objectives: To identify the risk factors associated with lateral epicondylitis. Materials and methods: An observational case control study design was carried out among 120 patients attended at outdoor Department of Physical Medicine and Rehabilitation, BSMMU, Dhaka from April 2018 to march 2019. Sixty (60) patients with lateral epicondylitis as case group and another 60 patients without lateral epicondylitis as control group. Data was collected using a structured interviewer- administered questionnaire, enquiring about demographic data and details of risk factors. Result: The mean age was found 39.4:6.3 years in case group and 36.97.4 years in control group. Twenty- seven (45.0%) patients had more than 2 hours of use hand in case group and 12(20.0%) in control group. More than half (53.3%) patients had moderate VAS scale in case group and 9(15.0%) in control group, Nine (15.0%) patients were found past history of recurrent injury in case group and not found in control group. The difference was statistically significant (p<0.05) between two groups. Patients having use hand more than 2 hours 3.273 (95% CI 1.453% to 7.36%) times more likely to developed lateral epicondylitis. Conclusion: Use of hand with repetitive wrist extension more than 2 hours was significantly associated with lateral epicondylitis. J Dhaka Med Coll. 2023; 32(1) : 77-84

Drug utilization study of antidepressant drugs in psychiatric outdoor patients at a tertiary care hospital in Southern Rajasthan

Background: The World Health Organization (WHO) defines “Drug Utilization” as the marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social, and economic consequences. Antidepressants are used to treat depressive illnesses and anxiety disorders. However, these are also employed in the pharmacotherapy of several psychiatric disorders. Very few studies were found regarding the pattern of prescription of antidepressants in outdoor patients in southern Rajasthan. So, this study has been planned to learn about the prescription pattern of antidepressant drugs as per WHO Core Drugs Prescribing indicators at a tertiary care hospital in southern Rajasthan. Methods: A cross-sectional observational study was conducted among 375 patients by convenient sampling over one year duration, in the outdoor Department of Psychiatry at RNT Medical College, Udaipur, Rajasthan. Patient’s prescriptions were analyzed for drug utilisation pattern in OPD after relevant consent. All data was compiled in MS Excel and analyzed using statistical methods. Results: Out of 375 prescriptions analyzed, 48.8% were males and 51.2% were females. Most commonly, patients had a diagnosis of depressive disorder (42.93%), followed by bipolar affective disorder (14.4%). The most common drug class prescribed was SSRI (88.86%). Escitalopram (41.65%) was the most prescribed drug, followed by Sertraline (30.51%). Conclusions: Among the prescribed antidepressants SSRIs were the most common class of drug followed by TCA. Escitalopram was the most common drug to be prescribed followed by sertraline. More than half of the patients receiving antidepressants suffered from non-depressive disorders. Monotherapy was preferred over combination therapy. All patients were prescribed generic drugs.

“Role Of Caroto-Vertebral Duplex Ultrasonography In Patients With Cerebro-Vascular Accident - Hemodynamic Characterisation & Etiological Stratification”

Introduction: cerebrovascular accident is defined as a sudden, non convulsive focal neurological deficit resulting due to brain ischemia predominantly caused by the thrombo-embolism or with atheromatous carotid plaque as the embolic source1 . Cerebrovascular accident is the leading cause of morbidity in elderly patients with varying degrees of neurological deficit. Since it is a preventable condition and with timely intervention, the severity of the disease can be minimized. Hence, the aim of the present study was real time visualization of vascular lesions to characterize the morphology of vessels for intimal-media complex & for any plaque or stenosis, to quantify the degree and percentage of stenosis in the caroto-vertebral arteries and to correlate the degree of stenosis with severity of clinical disease. Materials and methods: prospective cross-sectional study was conducted on 100 patients presenting with cva with or without persistent neurological deficit referred to department of radio-diagnosis and imaging from indoor and outdoor departments of jan sewa hospital of dr. S. S. Tantia medical college, sri ganganagar. Results: the majority of patients were in the age group of 60-69 years with 56% being male, 47% presenting with transient ischemic attack, commonest clinical feature being coronary artery disease (29%) followed by haeadache (17%), nausea vomiting (4%), hemiplegia (2%) patients and coma (1%). Hypertension was the most commonest risk factor (59%) followed by diabetes mellitus (18%), hyperlipidemia (14%), atrial fibrillations (5%) and smoking (4%). Majority of plaques were seen in the carotid bulb with variable laterality & echopattern. It was seen that as the degree of stenosis increases the various velocities and their respective ratios (ica psv/ cca psv, ica edv/cca edv, ica psv/cca edv) tend to increase in proportion to the stenosis suggestive of a positive co-relation between them. Conclusion: caroto-vertebral duplex ultrasonography provides a “road map” for carotid endartectomy and/or carotid angioplasty and stenting due to direct visualization of plaque morphology & surface configuration, measurement of the length of stenosed segment, precise determination of grade of stenosis and to get an insight into hemodynamic disorders.

Prevalence of Psychiatric Disorders - An Evaluation from a Psychiatric Outdoor Department with ICD-10 Diagnostic Criteria for Research (DCR)

Prevalence of Psychiatric Disorders - An Evaluation from a Psychiatric Outdoor Department with ICD-10 Diagnostic Criteria for Research (DCR)

Pattern of Disease Admissions and Their Outcome of Neonates Admitted In Neonatal Intensive Care Unit of A Tertiary Care Hospital in Quetta

Objective: to determine the admission pattern and outcomes of neonatal admissions to a neonatal intensive care unit (NICU) in a tertiary care hospital of Quetta Pakistan. Study Design: Prospective longitudinal study. Place and Duration of Study: Neonatal Intensive Care Unit, Combined Military Hospital (CMH), Quetta Pakistan, from Jan to Dec 2020. Methodology: All neonates admitted to the NICU Indoor or Outdoor Department during study duration were included. The disease pattern of the admission was noted, along with information regarding gender, gestational age, birth weight, diagnosis, duration of NICU stay, and outcome. Results: Of 424 neonates, respiratory-related disorders were predominantly higher (185,43.6%) followed by infection/sepsis-related disorders (105,24.8%), care of prematurity (81,19.1%), whereas 53(12.5%) had miscellaneous disorders. The overall mortality rate was observed in 34(8.0%) babies. A significant mean difference in gestational age (p: <0.001), birth weight (p: <0.001), and duration of stay (p: 0.003) was observed for reasons for admissions. Furthermore, a significant association of reasons for admission was observed with gender (p: 0.013), route of admission (p: <0.001), and respiratory support (p: <0.001). Conclusion: The pattern of the disease admission showed that respiratory-related disorders were predominantly higher, followed by infection/sepsis-related disorders and care of prematurity. Though the mortality rate was low, however, low birth weight, prematurity, and caesarean delivery are common risk factors.

Comparative Analysis of Topical Insulin Dressing Vs Normal Saline Dressing in Diabetic Foot Ulcers Wound Healing

Background: Foot ulcers, a dangerous and common consequence of diabetes, currently have no particular therapeutic options. There are many topical medicines and ointments available for wound management.It has been observed that topical insulin dressings effectiveness is better than other dressings. Aim: To determine the effectiveness of Topical Insulin dressing VS Normal saline dressing in diabetic ulcer in terms of rate of reduction in ulcer area in days and need for re debridement Methods: A randomized control trial conducted in Emergency and Outdoor Department of South Surgical ward, Mayo Hospital, Lahore.Study was carried out insix months from Sept 2022 to March 2023. A total 86 patients fulfilling the selection criteria presented to outdoor/Emergency of South surgical department of general surgery of Mayo Hospital, Lahore falling in Wagner’s classification I and IIwere enrolled in the study after taking informed consent. Patients were divided by method of random allocation (lottery method) to Group A (Topical insulin dressing) and Group B (Normal saline soaked dressing) after explaining the procedure. Rate of reduction in ulcer area was measured in days. Need of re-debridement was labeled as ‘yes’ if patient needed re-debridement or ‘no’ if patient did not need re-debridement. Results: Baseline mean wound area in Group A and in Group B was 34.87±29.23 cm2 and 27.45±24.00cm2. After 2 weeks the wound area reduced to 9.35±10.75 cm2 and 7.33±9.29 cm2 respectively. Mean days for rate of reduction in ulcer areas was significantly less in Group A patients than in Group B patients (p-value<0.001). Rate of re-debridement for Group B patients was significantly higher than patients in Group A (Group A: 18.6% vs Group B: 46.5%, p-value= 0.006). Improved wound healing will reduce need of redebridement and minor to major foot amputations. Conclusion: This study concludes that topical insulin dressing is more effective as that of normal saline soaked dressing for management of diabetic ulcer in terms of rate of reduction in ulcer area in term of days and need for re debridement. Keywords: Effectiveness, Normal saline Dressing, Topical Insulin dressing, Diabetic foot ulcer, Ulcer area, Re-debridement.

Role of C-Reactive Proteins at Early Gestational Age in Predicting Pre-Eclampsia in Pregnant Females

Background: Pre-eclampsia remains a significant concern in obstetrics due to its potential complications for both mother and fetus. Early detection of pre-eclampsia (PE0 is crucial for timely intervention and management. C-Reactive Protein (CRP), an inflammatory marker, has shown promise as a potential predictor of pre-eclampsia when assessed during early gestational age. Objective: To evaluate the diagnostic accuracy of raised serum CRP levels in early gestation to predict the risk of pre-eclampsia in pregnant females. Study Design: Prospective validation Study. Settings: Outdoor Department of obstetrics and gynecology, Lady Atchison Hospital Lahore. Duration: 02-September 2021 to 01-March-2022. Methods: A total of 130 pregnant females having gestational age 16 to 20 weeks and presenting in the hospital for regular antenatal visits were included. A five ml venous blood sample was drawn and was sent to the central hospital laboratory for determination of CRP levels from each case. Patients having CRP ≥5.0 mg/L were labelled as high risk of pre-eclampsia. All patients followed till delivery to determine the development of pre-eclampsia. Results: The mean age of the patients was found to be 28.16±4.74 years, with a mean BMI of 26.27±5.05 kg/m². Among the 130 patients, 12 (9.23%) were identified as having elevated CRP levels, while the remaining 118 (90.77%) showed normal CRP levels. Additionally, pre-eclampsia was diagnosed in 11 (8.46%) of the patients. Evaluation of the diagnostic accuracy of CRP levels revealed a sensitivity of 81.8% and specificity of 97.5%. The positive predictive value (PPV) was calculated at 75%, while the negative predictive value (NPV) stood at 98.3%. Conclusion: The study observed that elevated CRP levels in early pregnancy serve as a significant predictor of pre-eclampsia, with sensitivity of 81.8%, indicating its ability to correctly identify those with pre-eclampsia, while the specificity was 97.5%, suggesting its accuracy in ruling out those without the condition.

Application of VSM as a Lean Tool in a Healthcare Facility

The healthcare industry can be termed as one of the most important sectors of the economy. Healthcare industries are trying to adopt lean management principles in order to maintain quality service to patients, optimize workflow, and eliminate waste. Among the lean management tools, value stream mapping (VSM) is a key tool that uses a flowchart to depict, analyze, and improve the actions involved in the system. The aim of the study is to model the system through value stream mapping to identify wastes and non-value-adding activities in the processes so that the system can get rid of bottlenecks, constraints, and wastes. Sylhet Women’s Medical College Hospital is chosen to conduct the study. The necessary data are collected by interviewing employees and patients at outdoor and indoor departments, as well as by direct observation and going through previous records. eVSM software is used for creating current and future value stream maps. The total waiting time, processing time, and lead time of the processes of outdoor departments and diagnostic centers of the hospital are measured and improved over the existing system in the proposed model of the value stream map. Although the proposed model cannot be implemented, it is clear from this study that VSM can ensure smooth healthcare service and enhance performance.

Evaluation of polypus growth among fecal immunochemical test positive patients

Background: Colorectal cancer is a difficult clinical condition to treat all over the world. Adenomatous polyps are thought to be cancer precursors. A colonoscopy is required to detect and confirm ulcerative colitis mucosal healing. Different screening procedures, including as colonoscopy, fecal immunochemistry test (FIT), guaiac fecal occult blood test (gFOBT), computed tomography (CT) colonography, and others, are used to detect polyps or ulcers early. Although the gold standard colonoscopy serves both diagnostic and therapeutic purposes, the FIT can identify advanced adenoma or established cancer, as well as the mucosal condition of ulcerative colitis. The FIT is a less costly approach for detecting colonic disease that is appropriate for our demographic. The aim of the study was to observe the type of polypus growth among FIT positive patients. Methods: This observational cross-sectional study was conducted at the department of colorectal surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study duration was 1 year, from July 2019 to August 2020. At the initial stage, a total of 510 participants were selected among the patients attending the outdoor department of BSMMU colorectal surgery following the inclusion and exclusion criteria. Results: The male: female ratio was 1.7:1 in our study. 48.28% were from the age group of 50-59 years. The most common clinical presentation or symptom among the participants was constipation, observed in 81.03% of cases. 39.66% of the participants had abdominal pain, 32.76% had rectal mucus discharge, 12.07% had observed changes in their bowel movement, while 6.90% had a lack of appetite. Among the participants, 42 had pedunculated polyp, while 16 had sessile polyps. A total of 55.17% had non-advanced pedunculated polyp, 22.41% had non-advanced sessile polyp, 17.24% had advanced grade pedunculated polyp, while the remaining 5.17% had advanced grade sessile polyp. Histopathological findings revealed that 44.83% of the participants had tubular adenoma with low grade dysplasia (LGD) among the non-advanced pedunculated polyps’ cases, 17.24% had tubular adenoma with LGD among the non-advances sessile cases. Among the advanced pedunculated polyps’ cases, 6.90% had tubular adenoma with high grade dysplasia (HGD), 3 (5.17%) had villous adenoma with dysplasia, and 2 (3.45%) had tubulovillous with dysplasia. Among the 3 advances sessile polyps cases, 3.45% had tubular adenoma with HGD, while 1 patient had malignancy. Conclusions: It was observed that FIT positive patients had a higher frequency of pedunculated polyps, specifically advanced pedunculated polyps. Both sessile and pedunculated polyps had a high prevalence among patients aged between 50-59 years.

Multimorbidity and Pattern of Diseases in Elderly Patients Attending the Geriatric Outdoor Department: A Cross-sectional Study from Western India

Abstract Background: The geriatric population has been increasing in developing countries like India. There are fewer studies on multimorbidity in geriatric populations from low- and middle-income countries including India. Objectives: This study was conducted to assess the multimorbidity and pattern of diseases in patients attending a geriatric clinic. Materials and Methods: This cross-sectional study was conducted in a tertiary care hospital in western India among 300 geriatric patients (age ≥65 years) attending geriatric clinics in 2018. The presence of multimorbidity was defined as the coexistence of two or more chronic conditions. The 10-year survival was estimated using Charlson’s Comorbidity Index. Data were entered in a Microsoft Excel worksheet and analyzed using EpiData Software version 2.8.3. Results: Out of the total 300 patients, 102 (34%) had single morbidity, whereas 198 (66%) suffered from multimorbidity. The most frequent chronic diseases in all patients were hypertension (63.33%), mental diseases (35.66%), diabetes mellitus (25.66%), chronic obstructive pulmonary disease (COPD) (18.66%), and coronary artery disease (CAD) (18.33%). The common prevalent chronic disease pairs were mental and neurological diseases in 107 (35.6%) patients, hypertension and diabetes mellitus in 57 (19%), hypertension and CAD in 38 (12.6%), and hypertension and COPD in 15 (5%) patients. Most of the patients had a Charlson’s Comorbidity Index of 3 with a predicted 10-year survival rate of 77%. Conclusion: Sixty-six percent of our cohort was multimorbid. Hypertension was the most common chronic disease while CAD had the highest relative risk for multimorbidity. The most common comorbid pair was mental and neurological disorders.

A Study of Serum Ferritin and Thyroid-Stimulating Hormone Levels in Male Patients with Androgenetic Alopecia.

Androgenetic alopecia (AGA) is a multifactorial disorder expressed by several genes and various environmental factors apart from nutritional and endocrinological factors. Although association of iron deficiency (ID) as well as thyroid disorder has been evaluated in females, this is still an untouched topic as far as male pattern hair loss (MPHL) is concerned. This study tries to establish if any association of MPHL with ID and thyroid dysfunction. This case-control study comprised 30 consecutive cases of MPHL and equal numbers of age-matched healthy controls attending dermatology outdoor department at a tertiary care hospital. Cases as well as controls were evaluated and screened for the levels of serum ferritin (SF) and thyroid-stimulating hormone (TSH). Value of SF (8-388 ng/mL) and TSH (0.358-3.7 uIU/mL) was used as standardized reference. In cases of AGA, SF level varied from 6.00 to 212.09 ng/mL (mean - 88.30 ng/mL). Whereas controls showed SF levels ranging between 23.67 and 185.05 ng/mL (mean 78.69 ng/mL). The range of TSH level in the case group was 0.379-5.078 uIU/L (mean 2.25 uIU/L), respectively, whereas control group showed serum TSH levels ranging between 0.30 and 4.30 uIU/L (mean - 1.78 uIU/L). Statistically considering two samples of equal variance P (2-tailed) for SF level was found to be 0.424, whereas 0.085 in case of TSH level depicting insignificant association. Spearman's correlations (P = 0.244) between alopecia grade and SF level were found to be statistically insignificant (P = 0.193). Similarly, the P value calculated for the alopecia grade and serum TSH was 0.784, making the correlation between alopecia and serum TSH as insignificant. The study found no statistically significant difference in the SF level and TSH level of the cases as compared to controls.