General Medicine Outpatient Department Research Articles

Peripheral Arterial Disease in Diabetes and its Relation to Cardiovascular Risk Factors in Women

Objectives: Peripheral arterial disease (PAD) is characterized by occlusive disease in the abdominal aorta, iliac, and femoral arteries, leading to reduced blood flow and complications. Diabetes mellitus (DM) is known to contribute to the development and progression of PAD due to factors such as hyperglycemia, dyslipidemia, endothelial dysfunction, and inflammation. However, PAD may be underdiagnosed in women with DM, leading to adverse cardiovascular outcomes. The present study aimed to investigate the prevalence of PAD in women with type 2 DM (T2DM) and its relationship with cardiovascular risk factors. Materials and Methods: This hospital-based, cross-sectional, and observational study was conducted for a period of 3 months from June 10, 2023, to September 10, 2023, in the outpatient department of general medicine. After obtaining the approval from the Institutional Ethical Committee, the study was performed according to the Declarations of Helsinki and Good Clinical Practice requirements for human subject protection. Non-probability purposive sampling technique was used to enroll participants. Participants underwent face-to-face interviews and clinical examinations. Sociodemographic data, medical history, and pharmacotherapy details were collected. Laboratory investigations were conducted, including blood glucose, lipid profile, and glycosylated hemoglobin (HbA1C) tests. The ankle-brachial index (ABI) was measured. Results: The results showed that the majority of the participants were between 50 and 70 years of age, married, and had a high school education. Participants had an average body mass index (BMI) indicating overweight, and the average duration of diabetes was 6.571 years. Hypertension was the most prevalent comorbidity. Overweight, obesity I, and obesity II were present in 15.25% (n = 19), 33.6% (n = 42), and 8.8% (n = 11), respectively. Average values for HbA1C, fasting blood glucose (FBG), and postprandial blood glucose (PPBG) were within the diabetic range. ABI was normal in the right side, left side, and bilateral in 43.2%, 56%, and 14.4% of participants, respectively. ABI was borderline on the right side, left side, and bilateral in 40.8%, 36.8%, and 22.4% of participants, respectively. PAD was observed on the right side, left side, and bilateral in 16%, 7.2%, and 4% of participants, respectively. BMI, duration of DM, glycosylated hemoglobin, FBG, and PPBG showed significant negative correlations with ABI. Age, triglycerides, high-density lipoprotein, and low-density lipoprotein did not show any statistically significant correlation with ABI. Conclusion: The study highlighted the importance of screening for PAD in women with T2DM to improve cardiovascular outcomes. The findings shed light on the prevalence of risk factors for PAD and their association with the disease. These insights can contribute to the development of targeted interventions to reduce adverse clinical outcomes in this population.

Apple Cider Vinegar Effervescent Tablets on Gut Health, Obesity and User Experience: An Observation

Background: The escalating prevalence of obesity is a significant health concern, closely associated with non-communicable diseases like diabetes, hypertension, dyslipidemia, and coronary heart disease. Research indicates that apple cider vinegar (ACV) may aid in lowering blood glucose levels, total cholesterol, triglycerides, body weight, waist circumference, and BMI, as demonstrated in animal studies and clinical trials. The primary objective of the study is to assess the impact of apple cider vinegar effervescent tablets on overweight and obese individuals within a period of 30-days. Methods: This observational study took place at the outpatient department of general medicine at Sudha Institute of Medical Science in Erode, involving 45 participants with abnormal weight. Participants consumed an apple cider vinegar effervescent tablet daily in the afternoon for 30 days, alongside mild exercise and a low-sugar diet recommendation. Anthropometric measurements and participant satisfaction data were collected on the 0th (baseline), 15th, and 30th days. Data analysis was conducted using Microsoft Excel, with descriptive statistics such as mean and percentage utilized. Results: This study comprised 75.56% of participants aged between 18 and 40 years. 44.44% of participants fall into the overweight category. Additionally, 95.5% of participants expressed an interest in weight reduction. The results revealed that reductions of 1.13 cm in waist circumference, 1.07 cm in hip circumference, 1.46 kg in weight, and 0.58 kg/m² in BMI over the 30-day period. Following the 30-day consumption of ACV, improvements were observed in abnormal food intake and resolved issues such as digestion, appetite, constipation, cravings, and gas problems. Conclusion: This study concluded that daily consumption of apple cider vinegar effervescent tablet has a positive impact on weight loss and alleviates issues related to digestion, appetite, constipation, cravings, and gas problems.

Risk factors of non communicable diseases among recently diagnosed diabetic patients in a tertiary care Hospital

There are many risk factors which determine the development of complications among diabetic patients, some of which are modifiable and some non modifiable. Further, taking care of risk factors and controlling other non-communicable diseases among diabetics will defer the complications due to diabetes.To look for distribution of non-communicable disease risk factors among the diabetic patients. : The present cross-sectional study was conducted in Government Medical College & Hospital Jammu from 2019 to 2020. All the recently diagnosed patients (<1 year duration) of type 2 DM who were of ≥ 18 years of age, both males and females and were willing to participate in the study were included. Overall 70 recently diagnosed diabetic patients both males and females attended outpatient department of General Medicine of the Associated Hospital of the college during the study period.: The mean age in study group was 48.9±11.78 years [30-75] years with a mean BMI of 24.3±3.28 kg/m. 22 patients [31.4%] were smokers; hypertension was seen in 13 patients [18.6%]; hypothyroidism in 4 patients [5.7%]; rheumatoid arthritis in 2 patients [2.9%] and epilepsy in 2 patients [2.9%]. Family history of diabetes was present in 29 patients [41.4%] and dyslipidemia in 12 patients [17.1%]. 31 patients [44.3%] had normal glycemic control with Hba1c of less than 7 while as 39 patients [55.7%] had poor glycemic control with Hba1c of greater than 7.: Significant proportion of the participants in our study had one or more risk factor present the development of a chronic disease or where suffering already from a non-communicable disease.

Prevalence of generalized anxiety disorder among patients attending medicine outpatient department in a tertiary care center: A cross-sectional study

ABSTRACT Background: Generalized anxiety disorder is commonly underdiagnosed and undertreated in medical settings. Aim: The objectives of this study were to determine the prevalence and correlates of generalized anxiety disorder among patients presenting to medicine outpatient department in a tertiary care centre. Materials and Methods: A cross-sectional observational study was conducted among the patients visiting the outpatient department of General Medicine in a tertiary care teaching hospital. Sociodemographic and clinical parameters were collected using a structured pro forma. All patients were administered Generalized Anxiety Disorder-7 (GAD-7) to screen for the presence of generalized anxiety disorder. Patients who score 10 or more underwent a semi-structured evaluation using a generalized anxiety disorder module of Structured Clinical Interview for DSM-IV Axis I disorders. Results: Two hundred and fifty patients were recruited for the study. The mean age of the participants was 40.66 ± 12.8 years. More than one-fourth of them had diabetes mellitus and about one-fifth of the participants had systemic hypertension and hypothyroidism. Thirty five (14%) participants screened positive on GAD-7 scale. On detailed evaluation using SCID-I, 19 (7.6%) participants were confirmed to have a generalized anxiety disorder. Female gender was associated with the presence of GAD. Conclusion: One in thirteen patients presenting to the medicine outpatient department were found to have generalized anxiety disorder. Female patients had a greater prevalence of generalized anxiety disorder compared to male patients.

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

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

Association of metabolic syndrome with hypothyroidism and hyperuricemia: A cross-sectional study in a tertiary care hospital, Kolkata, West Bengal

Background: Metabolic Syndrome (MetS) (Syndrome X, insulin resistance syndrome, MetS) consists of a constellation of metabolic abnormalities which include central obesity, hyperglycemia, insulin resistance, high triglycerides, low high-density lipoprotein (HDL) cholesterol, and hypertension. Obesity is a critical component of MetS. It causes alteration in the thyroid hormones and hyperuricemia. Furthermore, insulin resistance seen in MetS causes decreased uric acid excretion. Aims and Objectives: To study the association of MetS with hypothyroidism and hyperuricemia. Materials and Methods: A cross-sectional study was conducted among patients from the outpatient department of General Medicine, IPGME and R, Kolkata from January 2012 to June 2013. A total of 112 patients, consisting of 53 patients with MetS and 59 patients without MetS were selected. Patients’ history, clinical and laboratory findings were recorded and data were analyzed. Results: Majority (66%) of the patients with MetS were female and the rest were male. The mean Body mass index of patients with MetS was 33.31±4.36 (Mean±SD) kg/m2 and without MetS was 25.21±2.62 (Mean±SD) kg/m2. A significant association was observed between weight, height, waist circumference, fasting blood sugar, HDL value, and MetS (P&lt;0.05). About 39.6% of the patients with MetS had hyperuricemia. The association between MetS and hyperuricemia was found to be significant. Similarly, 45.3% of the patients with MetS had hypothyroidism. This association was also found to be significant. Serum thyroid-stimulating hormone had a minimal correlation with serum uric acid in patients with MetS (correlation coefficient r=0.344), while no correlation was observed between fT3, fT4 with serum uric acid. Conclusion: Increased prevalence of hyperuricemia and hypothyroidism was seen among patients with MetS. More extensive population-based research is needed to support this finding.

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

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

Evaluation of the Prevalence and Risk Factors of Drug-Related Problems in Hypertension and Type 2 Diabetes Mellitus Patients at a Tertiary Care Hospital: A Cross-Sectional Study.

Background Drug-related problems (DRPs) potentially interfere with the desired treatment goals which may lead to increased healthcare costs, morbidity, and mortality. Despite the negative consequences of DRPs, there is a lack of comprehensive research on their prevalence and risk factors, particularly in chronic diseases such as hypertension and type 2 diabetes mellitus (DM). This study aims to evaluate the prevalence and contributing factors of DRPs among hypertension, type 2 DM, and hypertension with type 2 DM in the outpatient general medicine department. Methodology A hospital-based, prospective, observational study was conducted over three months. DRPs were classified using the Helper-Strand classification. The potential risk factors contributing to DRPs were assessed using binary and multinomial logistic regression methods. A p-value <0.05 was considered statistically significant. Results Among the 236 study participants, DRPs were more prevalent in males, and the mean age of the participants was 51.73 ± 9.47 years. DRPs were found in 76% of the study participants, and the mean number of DRPs per patient was 1.16 ± 0.45. Among the identified DRPs, suboptimal therapeutic goals (33%) were the most frequently observed, followed by ineffective drugs (32%), medication non-adherence (23%), and drug-drug interaction (5%). Therapeutic duplication and overdose were less commonly encountered as DRPs. The presence of comorbidity (adjusted odds ratio (AOR) = 5.77), and smoking (AOR = 21.07) were found to be significant risk factors (p < 0.05) contributing to DRPs. Conclusions DRPs are more prevalent in hypertension, type 2 DM, and hypertension with type 2 DM. Age range (40-60 years), comorbidity, and smoking were found to be associated with a higher incidence of DRPs. The implementation of a multidisciplinary team approach involving clinical pharmacists and physicians can effectively identify the prevalence and determine the associated risk factors of DRPs and subsequently may help employ targeted interventions to mitigate the development of DRPs.

Factors influencing adherence towards oral hypoglycaemic agents- A cross-sectional study among patients with Type II Diabetes Mellitus

AimsThe present study was conducted to assess the level of medication adherence and factors affecting adherence among Type-2 Diabetes Mellitus (T2DM) patients. MethodsA prospective cross-sectional study was carried out among T2DM patients who were presented to the outpatient department of general medicine. A well-designed data collection form was used to gather information pertaining to various socio-demographic and medical variables. A previously validated and translated 8-item self-reported questionnaire was used to assess the level of medication adherence. Data was analysed using SPSS Version 29.0. ResultsAmong the total 369 subjects enrolled, a majority were found to be males, and the mean age of the population was observed as 56.84 ± 11.32. A total of 125 (33.8%) subjects were found to be within the category of high adherence, 161 (43.6%) subjects were found to have moderate level of adherence and 83 (22.4%) had low level of adherence. On analysis, various medical variables were found to have a statistically significant association with medication adherence. ConclusionThe findings of the present study would form the basis for all the future implications including education intervention programmes to improve the level of adherence towards anti-diabetic medications, which ultimately results in better health outcomes.

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

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

Diabetes among Patients with Overt Primary Hypothyroidism Visiting the Outpatient Department of General Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Thyroid diseases are one of the commonest endocrine disorders and hypothyroidism is the commonest among them. There are many publications about hypothyroidism prevalence in diabetes, however, reports of diabetes in hypothyroidism are scarce. This study aimed to find out the prevalence of diabetes among patients with overt primary hypothyroidism visiting the Outpatient Department of General Medicine of a tertiary care centre. A descriptive cross-sectional study was conducted among adults with overt primary hypothyroidism who attended the Department of General Medicine of a tertiary care centre. Data from 1 November 2020 to 30 September 2021 were collected between 1 December 2021 and 30 December 2021 from the hospital records. Ethical approval was obtained from Institutional Review Committee (Reference number: MDC/DOME/258). Convenience sampling method was used. Out of all patients with different thyroid disorders, consecutive patients with overt primary hypothyroidism were included. The patients with incomplete information were excluded. Point estimate and 95% Confidence Interval were calculated. Among total 520 patients with overt primary hypothyroidism, the prevalence of diabetes was 203 (39.04%) (34.83-43.25, 95% Confidence Interval), with 144 (70.94%) in female and 59 (29.06%) in male. Among 203 hypothyroid patients with diabetes, the proportion of female was more than that of male. The prevalence of diabetes among patients with overt primary hypothyroidism was higher than the other studies done in similar settings. diabetes mellitus; hypertension; hypothyroidism; thyroid disorder.

Prevalence of Vitamin B12 Deficiency in Type 2 Diabetes Mellitus Patients on Metformin Therapy.

Background Long-term metformin treatment in individuals with type 2 diabetes mellitus causes vitamin B12 insufficiency, which is typically neglected, undetected, and under-treated. A severe deficit may cause life-threatening neurological problems. This study assessed the prevalence of vitamin B12 deficiencies among T2DM patients and its factors at a tertiary hospital in the Tamil Nadu district of Salem. Materials and Methods This is an analytical cross-sectional study conducted in a tertiary care hospital in the Salem district, Tamil Nadu, India. Patients with type 2 diabetes mellitus who were prescribed metformin at the outpatient department of general medicine took part in the trial. Our research instrument was a structured questionnaire. We used a questionnaire containing information on sociodemographic characteristics, metformin use among diabetic mellitus patients, diabetes mellitus history, lifestyle behaviors, anthropometric measurement, examination findings, and biochemical markers. Prior to administering the interview schedule, each participant's parents provided written informed consent. A thorough medical history, physical exam, and anthropometric examination were performed. Data were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed using SPSS version 23 (IBM Corp., Armonk, NY). Results Among the study participants, we diagnosed nearly 43% of diabetes cases in participants between the ages of 40-50 years, while we diagnosed 39%aged under 40 years. Nearly 51% had diabetes for 5-10 years, while only 14% had diabetes for over 10 years. In addition, 25% of the study sample had a positive family history of type 2 diabetes. Nearly 48% and 13% of the study group had been on metformin for 5-10 years and >10 years, respectively. The majority, 45%, were found to take 1000 mg of metformin per day, whereas just 15% take 2 g per day. In our study, the prevalence of vitamin B12 insufficiency was 27%, and nearly 18% had borderline levels. The duration of diabetes mellitus, the duration of metformin intake, and the dose of metformin were statistically significant (p-value = 0.05) among the variables associated with diabetes mellitus and vitamin B12 deficiency. Conclusion The results of the study show that a deficiency in vitamin B12 increases the likelihood that diabetic neuropathy would worsen. Therefore, individuals with diabetes who take larger dosages of metformin (more than 1000mg)for an extended period must have their vitamin B12 levels monitored often. Preventative or therapeutic vitamin B12 supplementation can mitigate this issue.

To Assess Causality, Severity and Preventability of Adverse drug reactions of Amlodipine in the treatment of hypertension

Background: Every drug has the potentiality to cause an adverse drug reaction (ADR). ADRs are a major problem in drug therapy. The aim of this study was to assess the incidence and causality, severity and Preventability of ADRs Amlodipine (antihypertensive agents) used for the essential hypertensive patients during the time period of April 2022 to Jun 2022. Methods: This prospective-observational study was carried out in general medicine outpatient department in 15 Patients. Results: Out of 15 patients, 10 (66.66%) patients were developed ADRs to antihypertensive drugs. 8 (85.72%) were male and 2 (14.28%) were female. Calcium channel blockers were the commonest therapeutic class of antihypertensive drugs associated with ADRS (n = 50, 64.10%). According to WHO causality assessment scale most of the ADRs of Amlodipine were "probable" 8(57.14%) followed by "possible" 2 (14.28%), certain 4 (28.57%)). According to Hartwig and Siegel scale of severity assessment, the most of the adrs were mild 10(71.42%) and moderate 4 (28.57%). According to Schumock and Thornton scale of preventability assessment all ADR are definitely preventable. Conclusions: The results of this study concluded that antihypertensive drugs able to induce the development of adverse drug reactions, which were significant cause of increase burden on health care system and decrease the quality of life, the health care professionals should take care about the rational use of antihypertensive agents. Thus, to minimize the incidence of adverse drug reaction and to increase the quality of life.

Thyroid Autoimmunity in Vitiligo: A Case-Control Study.

Introduction There is scanty evidence regarding the role of autoimmunity in vitiligo, especially in the Asian population. Moreover, the existing studies reported conflicting results. This prompted the investigators to identify the association of thyroid autoimmunity with vitiligo by employing a case-control design in this setting. Methodology The present study was a hospital-based case-control study conducted in one of the tertiary care hospitals of North India. We recruited 30 subjects aged 16-60 years with vitiligo attending the skin and venereal diseases outpatient department. The subjects attending the general medicine outpatient department without having a diagnosis of vitiligo were considered for the control group. Thyroid hormones (FT3 and FT4), thyroid-stimulating hormones, anti-thyroid peroxidase(anti-TPO) antibodies, and anti-thyroglobulin (anti-TG) antibodies were the primary investigations performed among the study subjects. Results The mean age of the study subjects was 31.3 (SD: 13.3) years. Both the case and control groups were comparable based on selected socio-demographic variables (p > 0.05). There was a statistically significant difference in terms of mean anti-TPO and anti-TG values between the case and control groups in which subjects with vitiligo reported significantly higher values (p < 0.05). Conclusion Our study reported a significant elevation in the mean values of the thyroid antibodies (anti-TG and anti-TPO antibodies) in vitiligo subjects compared to control subjects in this setting. Hence, screening for autoimmune thyroid diseases among patients with vitiligo is suggested for the early detection and the initiation of appropriate intervention.

Beyond blood sugar: Unraveling the complexities of liver and kidney health in type 2 diabetes mellitus

ABSTRACT Background: Diabetes mellitus (DM) poses a formidable global health challenge, particularly with the alarming rise of type 2 diabetes. Projections indicate that by 2030, around 440 million individuals will grapple with type 2 diabetes, attributing this surge to urbanization, sedentary lifestyles, and obesity. The intricate relationship between diabetes, liver, and renal functions plays a crucial role in the disease’s progression and complications. Aims and Objectives: This study aims to explore the complex interplay between type 2 diabetes mellitus (T2DM), liver function, and renal health. Specific objectives include assessing abnormal liver function, evaluating kidney profile parameters, and examining the prevalence of anemia in T2DM patients. The study seeks to contribute insights that inform proactive management strategies for diabetes-related complications. Material and Methods: Conducted as a facility-based cross-sectional study from March to June 2022, 120 individuals with T2DM participated. The study focused on patients attending routine follow-ups at the Outpatient Department of general medicine in Santosh Hospital, SMCH, SDTU Ghaziabad. Rigorous assessments and statistical analyses were employed to examine gender distribution, liver and kidney profile parameters, and other relevant factors. Results: Among the notable findings, Table 1 reveals a significant gender distribution, with 51.8% males in the diabetes group. Liver profile parameters, including alkaline phosphates and albumin, exhibited statistically significant differences between diabetes and control groups. Kidney profile parameters also showed significant variations, emphasizing the intricate relationship between diabetes and renal complications. The study further explored differences between male and female patients in the control group, revealing significant variations in hemoglobin levels. Conclusion: This study sheds light on the prevalence of abnormal liver function in T2DM individuals, emphasizing the significance of early detection and tailored interventions. Kidney disorders and the often-overlooked complication of anemia further contribute to the complexity of health challenges faced by those with diabetes. The findings underscore the need for vigilant monitoring and comprehensive management strategies to enhance patient care in the face of this multifaceted health challenge.

A Rare Case of Hodgkin’s Lymphoma Presenting as Hypereosinophilia

Although eosinophilia is a recognised associated feature of Hodgkin’s Lymphoma, hypereosinophilia is seldom the presenting feature in the patient. Here, the authors report an unusual case of a 21-year-old male patient who presented to the General Medicine outpatient department of the hospital with a history of multiple episodes of left-sided pleural effusion in addition to mediastinal and cervical lymphadenopathy. Baseline investigations revealed hypereosinophilia which was persistent despite Diethylcarbamazine (DEC) and steroid therapy. Computer Tomography (CT) guided biopsy of an anterior mediastinal mass, likely to be thymus, led to the diagnosis of Hodgkin's Lymphoma. The patient was transferred to the Haematology department where he was started on Adriamycin, Bleomycin, Vinblastine and Dacarbazine (ABVD) chemotherapy regimen. Despite the fact that blood eosinophilia is an associated finding, it is rare for a patient to present with it. The authors also discuss the discrepancies related to the credibility of eosinophilia as a prognostic marker for Hodgkin’s disease.

Knowledge, attitudes, and practice to COVID 19 infection among outpatients attending a general medicine department

Background and Objectives: We aimed to assess the knowledge, attitudes, and practices regarding COVID-19 among general medicine outpatients. Materials and Methods: We recruited people attending a general medicine outpatient department of a tertiary hospital. We assessed knowledge, attitudes, and practices toward COVID-19 using a specially designed questionnaire. Results: Two hundred and sixty-eight participants were recruited. The study documented high knowledge, positive attitude, and good practice among patients and their relatives. Knowledge was significantly associated with higher education (odds ratio [OR] = 2.87; 95% confidence interval [CI] = 1.127.36; P = 0.029) and the use of the Internet as a source of information about COVID-19 (OR = 5.17; 95% CI = 2.2611.85; P = 0.000). However, Internet use (OR = 0.23; 95% CI = 0.100.54; P = 0.001) was associated with a more negative attitude. Good practice was associated with high levels of knowledge (OR = 2.20; 95% CI = 1.223.96; P = 0.009), a positive attitude (OR = 2.31; 95% CI = 1.134.71; P = 0.022), and a professional or semi-professional occupation (OR = 2.80; 95% CI = 1.077.32; P = 0.036). Residence outside of the district (OR = 2.79; 95% CI = 1.077.32; P = 0.036) was associated with better practice related to COVID-19 suggesting people who travel greater distances for health care may be more motivated at maintaining better practice. Conclusion: The study found that good practice in relation to COVID-19 was associated with higher levels of knowledge, a positive attitude, professional occupation, and distance traveled to reach hospital.

Medication Adherence Among Patients of Type II Diabetes Mellitus and Its Associated Risk Factors: A Cross-Sectional Study in a Tertiary Care Hospital of Eastern India.

Type 2 diabetes mellitus is a major public health problem. Adherence to anti-diabetic medications improves glycaemic control, which in turn prevents complications as well as reduces out-of-pocket expenditure. The World Health Organization highlights that the impact of interventions directed to improve adherence has far greater implications than specific medical interventions. There are several factors that contribute to poor adherence. Not many studies have been conducted to explore adherence to diabetes medications in eastern India. To measure medication adherence among patients suffering from diabetes. To determine the various risk factors influencing adherence to medication. To find out the association of health-related quality of life with adherence to medication. Ahospital-based cross-sectional study was conducted in the outpatient Department of General Medicine and Endocrinology of a tertiary care hospital in eastern India from January to March 2020. Adult subjects, who were diagnosed with type 2 diabetes mellitus for at least six months, were interviewed using a pretested, structured questionnaire containing 8-item Morisky Medication Adherence Scale (MMAS-8) to determine adherence to diabetic medications. Data were analysed in SPSS version 27 (IBM Corp., Armonk, NY, USA). The mean age of the 331 participants interviewed was 53.40 (SD 11.0) years and the majority were males (57.1%). Medication adherence of 34.14% (n=113) was found among the subjects. Having any comorbidity, positive family history of diabetes and the habit of current alcohol intake increased the odds of poor adherence by 3.26 times, 1.88 times, and 2.35 times respectively in binary logistic regression analysis. Those following a diabetic diet had a protective effect, decreasing poor medication adherence by 79.6%. Poor medication adherence increased by 1.077 times with every one-day increase in unhealthy days. The medication adherence was 34.14% and as compared to other similar studies medication adherence in the study population was poor and was associated with unhealthy days.

An audit of prescriptions in general medicine outpatient department in a tertiary care government hospital in Eastern India: a quality improvement project

Background: Prescriptions are an important link between physicians and patients. Any medication therapy can become ineffective if not communicated properly to the pharmacist and patient. Therefore, it’s important to maintain the quality of prescription-writing. Thus, we conducted a prescription audit in a tertiary-care hospital.Methods: 413 prescriptions having 1683 drugs were selected by convenience sampling. Adherence to 4 quality parameters, namely mention of date, allergy status, date of next visit, and whether or not the prescription was signed legibly, were observed for each prescription. 5 parameters viz. whether or not the drug was written in capital letters, whether the generic name of the drug was mentioned, and prescription of drug schedule, dose, and duration were evaluated for each drug separately. Frequency tables and appropriate bar plots were created.Results: Dates were mentioned in all prescriptions. There were 4.07±0.44 (mean±SD) drugs per prescription. Using capital letters and generic names was observed for 12% and 21% of the drugs. Dose, duration, and schedule were written for 51.4%, 98.6% &amp; 98.7% drugs respectively. The next visit was mentioned in 61.7% cases. 21.8% prescriptions were signed legibly and only 0.5% prescriptions had allergy status.Conclusions: A significant scope of improvement was observed in signing the prescription legibly, mentioning next visit, using generic names, writing the drug names in capital letters, drug doses, and mentioning allergy status. Conducting regular audit-feedback-audit loops will improve the quality of health care delivery in a practical manner. 

Knowledge, Attitude and Practice of Type II Diabetes Mellitus Patients Attending a Tertiary Care Teaching Hospital of Western Maharashtra; a Cross Sectional Study

Diabetes mellitus is one of the most common non-communicable diseases and is the fifth leading cause of death in most developing countries. There is always a need to investigate knowledge, attitude and behavior among diabetic patients to aid in future development of national health programs and techniques for effective prevention. Objective: To assess knowledge, attitude and practice of type II diabetes patients attending tertiary care teaching hospital of western Maharashtra. Material and Methods: This was observational cross sectional study. Patients above 18 years of age, either gender attending outpatient department of general medicine including newly diagnosed and follow up type II diabetes were included by using simple random sampling. Patients not willing to participate, patients who were not physically or psychologically able excluded. Total 275 patients included as per inclusion and exclusion criteria. Results: Out of total patients 57.82% (159) and 41.18% (116) were males and females respectively. In this study majority of patients were of 51 to 60 years (35.64%) age group followed by 61 to 70 years (28.73%) and 41 to 50 years (24.36%) age group. On analysis we found that though the majority (92.75%) of the patients aware about what diabetes is. Responses on attitude domains were somewhat mixed and 65.81% and 44.72% do not exercise and test blood for sugar regularly. Conclusions: The present study concluded that although type II diabetes patients have good knowledge, attitudes, but they lack in practice which is essential to control diabetes.