Outpatient Ward Research Articles

Evaluation of Perceptual Indicators Regarding Environmental Quality of Medical Centers (Case Study: Selected Wards of One of Yazd's Private Hospitals)

Background: Locations, by creating a sense of comfort and peace or sorrow and distress have a great effect on self-confidence, personality, and personal health. Paying attention to the perceptual indicators of environmental quality can lead to sustainable changes in architectural designs. The aim of this study is to identify perceptual indicators of the environmental quality in medical centers and use these indicators to evaluate the physical-spatial qualities of those centers. The study environment was one the private hospitals in Yazd.
 Methods: This was a cross-sectional study conducted in 2022 in a private hospital in Yazd. The statistical population includes patients, visitors, carers and staff. 73 users from the pediatric care and hospitalization ward and 47 users from the outpatient ward were selected as the statistical sample through convenience sampling. The data collection tool was a researcher-made questionnaire consisting of 27 questions with 5 Likert scale options and 5 demographic questions, the validity of which was approved by 10 experts in the field of architecture and psychology. The reliability of the questionnaire was also confirmed by Cronbach's alpha test with a value of 0.75. Questions included 3 dimensions of perceptual indicators regarding the quality of hospital environment. 2 dimensions evaluated the physical aspects of the hospital exterior and interior space of the wards and 1 dimension evaluated social aspects. For statistical analysis, descriptive methods (frequency, mean, etc.) and SPSS 26 software were employed.
 Results: The outcome of the percentages obtained regarding the dimension of physical-spatial aspects of the hospital's external spaces, pediatric care and hospitalization ward, the outpatient ward and the socio-functional aspects of hospital spaces, were obtained as + 25, + 38.38, + 44.73, and +36 % respectively.
 Conclusion: Based on the results, the outcome of the percentages obtained for the dimensions of the physical-spatial aspects of the hospital's external spaces, pediatric care and hospitalization ward, the outpatient ward and the socio-functional aspects of hospital spaces indicated the favorable status of the dimension from the users' point of view.

Mental Health Outcomes and Sleep Status among Patients with Coronavirus Disease 2019.

Objective: The immediate impacts of coronavirus disease 2019 (COVID-19) on mental health of affected patients and psychiatric morbidities of these patients has been neglected by researchers. We assessed mental health outcomes and sleep status among inpatients and outpatients with COVID-19 who were initially referred to our COVID-19 clinic in Mashhad, Iran during April-October 2020. Method : In this ethically approved cross-sectional study, 130 patients with confirmed COVID-19 who were referred to outpatient clinics and wards of a referral hospital in Mashhad, Iran were surveyed during April-October 2020. Demographic data were collected after obtaining informed written consent. Validated Persian versions of insomnia severity index (ISI), 9-item patient health questionnaire (PHQ-9), and 7-item generalized anxiety disorder (GAD-7) and revised impact of event scale (IES-R) were used as main outcome measures (i.e. status of anxiety, depression, insomnia, and event-related distress). Analysis was performed with SPSS using binary logistic regression. P-values < 0.05 were considered significant. Results: Overall, 65 inpatients and 65 outpatients were surveyed. The two groups did not significantly defer in terms of insomnia and depression severity, but the outpatients showed higher levels of anxiety (52.3% vs. 24.6%, P = 0.005) and distress compared to inpatients (80.0% vs. 64.6%, P < 0.001). Male sex (OR = 0.017, 95%CI = 0.000-0.708, P = 0.032) exhibited independent and inverse association with depression in COVID-19 patients. Being married (OR = 0.102, 95% CI = 0.018-0.567, P = 0.009) was independently and inversely associated with anxiety. Insomnia was independently associated with event-related distress (OR = 7.286, 95%CI = 2.017-26.321, P = 0.002). Only depression was independently associated with insomnia (OR = 49.655, 95%CI = 2.870-859.127, P = 0.007). Conclusion: We found symptoms of psychological distress and anxiety to be more prevalent among outpatients with COVD-19 than inpatients. Insomnia can be a potential risk factor for adverse mental health outcomes in these patients.

Effect of total exclusive breast feeding on the prevalence of malaria among children at the pediatric outpatient ward of a Tertiary health care center in Owerri, Southeastern Nigeria

This study was undertaken to assess the effect of total excusive breast feeding on the prevalence of malaria among children, 0-2 years of age. A simple random sampling method was used to select 176 nursing mothers, having children aged 0-2 years during consultation hours at the pediatric outpatient ward of the Federal Medical Center, Owerri, Nigeria. A well-structured interviewer administered questionnaire was used to source information from the nursing mothers that provided answers to the questions on socio demographic characteristics and breast feeding practices. Blood samples also were collected from the concerned children, stained with Giemsa and Leishman for both thick and thin film preparations respectively, and examined under the oil immersion microscopy for malaria parasites. The results showed that 100% of the mothers had good knowledge of breast feeding, but their practice of total exclusive breast feeding was low (22.7%). Out of 40 exclusively breast-fed children examined in the study, only 4(10.0%) were infected with malaria, while out of the 136 non-exclusively breast-fed children, 50(36.8%) had malaria. The prevalence of malaria was also lowest (6.7%) among the exclusively breast-fed children in the age group 0-6 months. Total exclusive breast feeding practice should be sustained and recommended to all nursing mothers in order to gain from its numerous and indispensable benefits including reduction in the prevalence of malaria among children.

Effect of total exclusive breast feeding on the prevalence of malaria among children at the pediatric outpatient ward of a Tertiary health care center in Owerri, Southeastern Nigeria

Effect of total exclusive breast feeding on the prevalence of malaria among children at the pediatric outpatient ward of a Tertiary health care center in Owerri, Southeastern Nigeria

Correlation between innate and adaptive immunity response in TB children post BCG vaccination. Is it effective or not?: Cross-sectional study

BackgroundHow far the role of innate immunity and adaptive immunity do in children who have been BCG vaccinated in controlling the course and the severity of the TB disease has not been completely known. Mycobacterium tuberculosis entry to the body will be recognized by Toll-like receptors found on macrophages, neutrophils, and dendritic cells as part of the innate immune response, after which the dendritic cells will then present the antigen to lymphocyte T0 cells and initiate the adaptive immune response (of which CD4 T cells have an important role in). Was one or were both of these immune responses function well or not in a BCG Vaccinated Children with TB? ObjectiveThis study aim to find a better understanding of the role of innate immune response assessed by TLR2/TLR4 mRNA gene expression and serum TLR2/TLR4 levels, while the role of adaptive immune response is assessed by analyzing serum CD4 level in children with TB who have had BCG vaccination. MethodsThis cross-sectional study was conducted among children with TB at the outpatient and inpatient wards at Bhakti Medicare and Jakarta Islamic Hospital. Expression of mRNA gene was measured using the Boom method and protein serum levels were measured using the ELISA method. The results were analyzed by using the SPSS v.23 program. ResultsSixty-nine children were recruited as subjects. In this study, 68.1% of whom had BCG scars. TLR4 mRNA gene expression was found to be higher than TLR2 mRNA gene expression. Serum CD4 level was found to be highest out of TLR2 and TLR4 level, but serum TLR2 level was higher than TLR4 level. TLR2/TLR4 mRNA gene expression, serum TLR2/TLR4 levels, and CD4 levels in subjects with BCG scar were also found to be significantly higher than in subjects without BCG scar (p < 0.001). There was a significant positive correlation between TLR2/TLR4 mRNA gene expression and serum TLR2/TLR4 levels (r = 0.860; r = 0.864; p < 0.001) and between serum levels TLR2/TLR4 with serum CD4 levels (r = 0.822; r = 0.832 p < 0.001). ConclusionAs early as possible, BCG vaccine administration is needed in endemic countries, but it must be ensured that scars can be formed. It is also important to control Latent TB Infection (LTBI) to prevent transmission and relapse of disease.

IDF21-0568 Peripheral Neuropathy and potential risk factors in patients with Diabetes Mellitus in Kano, Northwestern Nigeria

Background: Peripheral Neuropathy is a common complication of DM and a cardinal event in the pathway to foot ulceration in many patients. It may be preventable if detected early and promptly managed. Aim: To determine the prevalence of peripheral neuropathy and its potential risk factors in patients with DM attending two hospitals in Kano, Nigeria. Method: In a cross – sectional descriptive study consenting patients with DM who fulfilled the inclusion criteria were recruited from the diabetes outpatient clinic and wards of two hospitals in Kano. Questionnaires were used to obtain Socio- demographic data and clinical characteristics of the study subjects. Vibration perception threshold using biothesiometer was used to assess for presence of peripheral neuropathy. Results: We recruited 394 patients with DM (163 males and 231 females) with mean age and duration of DM of 50.8±12.5years and 7.72±6.65years respectively. Ninety five percent of the study subjects had type 2DM. 149(37.2%) of the study subjects had VPT > 25 volts which is significant for PN. Older age, level of education, longer duration of DM, HTN, PVD, proteinuria, diabetic retinopathy, presence of DFU and foot deformities were significant predictors of PN. The independent risk factors for PN after multivariate regression were older age, longer duration of DM, proteinuria, presence of foot deformities and DFU. Discussion: Peripheral neuropathy still remains one of the most complications of DM which leads to development of DFU and subsequently amputation. Screening with early identification, education and treatment of associated risk factors may go a long way in reducing one of the cardinal event to foot ulceration.

Revision of the non-suicidal self-injury behavior scale for adolescents with mental disorder.

Adolescents are at high risk of non-suicidal self-injury (NSSI). Currently, there is no clinical assessment tool for adolescent NSSI behaviors measurement with global consistency. The Ottawa Self-injury Inventory (OSI) is considered as a relatively comprehensive assessment tool for NSSI, but the questionnaire is discussed with excessive content and timecostly, which may affect the reliability of the measurement results for adolescent.Thus, this study, based on OSI, aims to revise the assessment tool for adolescent with NSSI that is suitable for both clinically and scientifically, referring to the diagnostic criteria for NSSI in the 5th Diagnostic and Statistical Manual of Mental Disorder (DSM-5). This study was led by the Second Xiangya Hospital of Central South University and collaborated with 6 mental health service institutions in China from August to December 2020. Adolescent aged from 12 to 24 years old who had self-injury behavior and met the DSM-5 diagnostic criteria for NSSI were continuously recruited in the psychiatric outpatient department or ward. After clinical diagnosis by an experienced attending psychiatrist or above, the general information and OSI were collected by questionnaires. SPSS 24.0 and AMOS structural equation model statistical softwares were used to conduct item analysis and exploratory factor analysis on the obtained data to complete the revision of the scale. Cronbach's alpha coefficient, split-half reliability, test-retest reliability, and content validity and structure validity were performed to analyze the reliability and validity and confirmatory factor analysis was carried out to test the structure validity for the revised scale. A total of 234 adolescent with NSSI were enrolled, including 33 (14.1%) males and 201 (85.9%) females with the mean age of (16.2±2.6) years old. The most common clinical diagnoses were depression disorder (57.4%), bipolar disorder (20.9%), adolescent mood disorder (17.1%), etc. Nine items (item 2, 7, 11, 13, 23, 24, 10, 17, 18) in the functional scale of OSI were deleted according to extreme grouping method, correlation analysis, and principal component analysis in exploratory factor analysis. The revised functional scale for NSSI consisted of 15 items. The reliability analysis showed that the Cronbach's alpha coefficients of NSSI thought and behavior frequency, addiction characteristics, and function scales were 0.799, 0.798, and 0.835, respectively, and the split-half coefficients were 0.714, 0.727, and 0.852, respectively. The test-retest coefficients of the latter 2 scales were 0.466 and 0.560, respectively. The correlation coefficient between sub-items and total scores in each part of the scale showed good content validity. The exploratory factor analysis showed that a component was extracted from the frequency of thoughts and behaviors of NSSI, one component was extracted from the addictive characteristics, and three components were extracted from the functional part. The three functional subscales were social influence, external emotion regulation, and internal emotion regulation. The factor load of each item was >0.400. The revised Chinese version OSI targeted the adolescent patients with mental disorders has relatively ideal reliability and validity. The scale shows high stability, dependability, and a reasonable degree of fit. It is a suitable assessment tool for clinical and scientific research on adolescent with NSSI.

Assessment of the efficacy of electrical vestibular nerve stimulation as an adjunct therapy in the management of motor functions and quality of life in patients with Parkinson’s disease

Background: The existing treatments for Parkinson’s disease (PD) were associated with side effects and do not offer a complete cure. Hence, there is a need for an alternative therapy that can prevent or delay the onset of PD with less or no side effects. Our extensive review of literature has shown no studies to be existing so far in India regarding vestibular stimulation as a treatment method for PD. Aims and Objectives: The present study was undertaken to administer electrical vestibular nerve stimulation (VeNs) as an adjunct therapy in the management of motor functions and to improve the quality of life in PD patients. Materials and Methods: The present study was a randomized controlled trial. (ClinicalTrials.gov Identifier: NCT04450550). 30 cases of PD, of both genders, were part of the study by convenient sampling after obtaining written informed consent. Patients were recruited from the out-patient ward of the General Medicine department, R.D. Gardi Medical College. Motor activities were assessed using the Berg balance scale, strength procedures by hand dynamometer and hand-eye coordination by 100 pin dexterity test. Quality of life was assessed by the World Health Organization Quality of Life Brief. Results: The study results support the earlier studies as there was a significant improvement in the motor functions and quality of life of the study participants. Conclusion: The study recommends further detailed studies with higher sample size and involving many centers to recommend the use of electrical VeNs as adjunctive therapy in the management of PD.

Hospital performance comparison of inpatient fall rates; the impact of risk adjusting for patient-related factors: a multicentre cross-sectional survey

BackgroundComparing inpatient fall rates can serve as a benchmark for quality improvement. To improve the comparability of performance between hospitals, adjustments for patient-related fall risk factors that are not modifiable by care are recommended. Thereafter, the remaining variability in risk-adjusted fall rates can be attributed to differences in quality of care provided by a hospital. Research on risk-adjusted fall rates and their impact on hospital comparisons is currently sparse. Therefore, the aims of this study were to develop an inpatient fall risk adjustment model based on patient-related fall risk factors, and to analyse the impact of applying this model on comparisons of inpatient fall rates in acute care hospitals in Switzerland.MethodsData on inpatient falls in Swiss acute care hospitals were collected on one day in 2017, 2018 and 2019, as part of an annual multicentre cross-sectional survey. After excluding maternity and outpatient wards, all inpatients older than 18 years were included. Two-level logistic regression models were used to construct unadjusted and risk-adjusted caterpillar plots to compare inter-hospital variability in inpatient fall rates.ResultsOne hundred thirty eight hospitals and 35,998 patients were included in the analysis. Risk adjustment showed that the following factors were associated with a higher risk of falling: increasing care dependency (to a great extent care dependent, odds ratio 3.43, 95% confidence interval 2.78–4.23), a fall in the last 12 months (OR 2.14, CI 1.89–2.42), the intake of sedative and or psychotropic medications (OR 1.74, CI 1.54–1.98), mental and behavioural disorders (OR 1.55, CI 1.36–1.77) and higher age (OR 1.01, CI 1.01–1.02). With odds ratios between 1.26 and 0.67, eight further ICD-10 diagnosis groups were included. Female sex (OR 0.78, CI 0.70–0.88) and postoperative patients (OR 0.83, CI 0.73–0.95) were associated with a lower risk of falling. Unadjusted caterpillar plots identified 20 low- and 3 high-performing hospitals. After risk adjustment, 2 low-performing hospitals remained.ConclusionsRisk adjustment of inpatient fall rates could reduce misclassification of hospital performance and enables a fairer basis for decision-making and quality improvement measures. Patient-related fall risk factors such as care dependency, history of falls and cognitive impairment should be routinely assessed.

Epstein\u2013Barr virus-associated infectious mononucleosis with acute epididymitis: a case report

BackgroundInfectious mononucleosis due to the Epstein–Barr virus is an infectious disease that causes the appearance of atypical lymphocytes in the peripheral blood; it mainly presents with fever, tonsillar pharyngitis, and lymphadenopathy. In addition to hepatitis, splenomegaly, and rashes, it can involve different organs. Here, a case of epididymitis as a rare complication in a patient with Epstein–Barr virus-associated infectious mononucleosis was reported.Case presentationA healthy 23-year-old man visited an outpatient clinic with fever and pharyngitis. Tonsillar pharyngitis, lymphadenopathy, atypical lymphocytes in the peripheral blood, liver dysfunction, and splenomegaly were observed. The patient was diagnosed with infectious mononucleosis based on clinical signs. The next day, the patient developed left testicular pain and was immediately transferred to the emergency outpatient ward. Pain, redness, and swelling were observed in the left scrotum. Ultrasonography revealed swelling of the epididymis and increased blood flow, and the patient was hospitalized with a diagnosis of left epididymitis. The patient’s symptoms improved with symptomatic treatment and was discharged on day 16 after admission. Changes in antibody titers established a definitive diagnosis of infectious mononucleosis caused by the Epstein–Barr virus. Based on the disease course, the patient was also diagnosed with infectious mononucleosis associated with unilateral epididymitis.ConclusionsThis is the first case report of Epstein–Barr virus-associated infectious mononucleosis complicated with acute epididymitis. Infectious mononucleosis can cause numerous organ-related complications; thus, physicians and healthcare workers should remain cognizant of Epstein–Barr virus-associated complications throughout the body and not just in the primary organs affected by infectious mononucleosis.

Daytime urotherapy in nocturnal enuresis: a randomised, controlled trial

ObjectiveAccording to international guidelines, children with enuresis are recommended urotherapy, or basic bladder advice, before treatment with evidence-based alternatives such as the enuresis alarm is given. The efficacy of this...

Rapid urine-based screening tests increase the yield of same-day tuberculosis diagnoses among patients living with advanced HIV disease.

Investigation of the diagnostic yield of urine-based tuberculosis (TB) screening in patients with advanced HIV disease. A cross-sectional screening study. HIV outpatient clinics and wards at two hospitals in Johannesburg, South Africa, between June 2015 and October 2017. Two hundred and one patients living with advanced HIV disease (CD4+ T-lymphocytes <100 cells/μl) attending healthcare facilities following cryptococcal antigen (CrAg) screening. Screening for TB using sputum for microscopy, culture, and Xpert MTB/Rif and urine for lipoarabinomannan (LAM) and Xpert Ultra. Proportion of positive results using each testing modality, sensitivity, and specificity of urine-based testing compared with culture, and survival outcomes during 6 months follow up. Urine was obtained from 177 of 181 (98%) participants and sputum from 91 (50%). Urine-based screening increased same-day diagnostic yield from 7 (4%) to 31 (17%). A positive urine test with either LAM or Xpert Ultra had 100% sensitivity (95% confidence interval, 59-100%) for detecting culture-positive TB at any site. Patients with newly diagnosed TB on urine-based screening were initiated on treatment and did not have excess mortality compared with the remainder of the cohort. Urine is an easily obtainable sample with utility for detecting TB in patients with advanced HIV disease. Combining urine and sputum-based screening in this population facilitates additional same-day TB diagnoses and early treatment initiation, potentially reducing the risk of TB-related mortality. Urine-based as well as sputum-based screening for TB should be integrated with CrAg screening in patients living with advanced HIV disease.

Factors associated with distress among female cancer survivors at the workplace: A cross-sectional study.

ObjectivesThis study aimed to investigate the levels of fatigue, social support, spiritual well‐being, and distress of female cancer survivors at the workplace, and identify factors associated with distress.MethodsOne hundred and eighty‐two working female cancer survivors participated from the outpatient ward in two medical institutions in South Korea and they completed questionnaires assessing their general characteristics, fatigue, social support (colleagues and superiors), and spiritual well‐being distress (existential and religious well‐being). The data were analyzed using descriptive statistics, T‐test, one‐way ANOVA, correlation, and multiple linear regression with SPSS /WIN18 version.ResultsMost of the participants were breast and thyroid cancer (78.5%), married (46.2%), working periods below 10 years (62.7%) and the average age was 49.7 years. Distress positively correlated with fatigue and significant predictors of distress were “type of work” and “main source of household income” among general characteristics, fatigue, religious well‐being, and existential well‐being.ConclusionsOur findings suggest that integrated program including educational and practical factors to reduce fatigue and increase spiritual well‐being (i.e., peace, faith, meaning, et al.) can decrease distress. Whereas, the “ambivalence” of God accompanied by high religious well‐being (i.e., punishment, abandon, blame, and so on) can rather increase distress. The development of an integrated management system of distress at work can be applied as a practical factor to improve job satisfaction, organizational performance, and quality of life.

Healthcare providers\u2019 perception of advance care planning for patients with critical illnesses in acute-care hospitals: a cross-sectional study

BackgroundIn acute-care hospitals, patients treated in an ICU for surgical reasons or sudden deterioration are treated in an outpatient ward, ICU, and other multiple departments. It is unclear how healthcare providers are initiating advance care planning (ACP) for such patients and assisting them with it. The purpose of this study is to clarify healthcare providers’ perceptions of the ACP support provided to patients receiving critical care in acute-care hospitals.MethodsA cross-sectional study was conducted using questionnaires. In this study, 400 acute-care hospitals with ICUs in Japan were randomly selected, and 1490 subjects, including intensivists, surgeons, ICU nurses, surgical floor nurses, and surgical outpatient nurses, participated. Survey items examined whether ICU patients received ACP support, the participants’ degree of confidence in providing ACP support, the patients’ treatment preferences, and the decision-making process, and whether any discussion was conducted on change of values.ResultsResponses were obtained from 598 participants from 157 hospitals, 41.4% of which reportedly supported ACP provision to ICU patients. The subjects with the highest level of ACP understanding were surgeons (45.8%), and differences in understanding were observed across specialties (P < 0.001). Among the respondents, physicians and nurses expressed high levels of confidence in providing ACP support to patients requiring critical care. However, 15.2% of all the subjects mentioned that they would not attempt to resuscitate the patients. In addition, 25.7% of the participants handed over patients’ values to other departments or hospitals, whereas 25.3% handed over the decision-making process.ConclusionsAmong the participating hospitals, 40% provided ACP support to patients receiving critical care. The low number is possibly because support providers lack understanding of the content of patients’ ACP or about how to support and use ACP. Second, it is sometimes too late to start providing ACP support after ICU admission. Third, healthcare providers differ in their perception of ACP, widely considered an ambiguous concept. Finally, in acute-care hospitals with different healthcare settings, it is necessary to confirm and integrate the changes in feelings and thoughts of patients.

Costs of providing hospital-based psychotic disorder treatment in Indonesia

Background Mental illness prevalence is increasing globally and has caused a significant economic burden. However, information from developing countries regarding this issue is still limited. Aims To estimate the cost of treating psychotic disorders in outpatient and inpatient wards in a provincial referral mental health hospital in West Java province, Indonesia. Methods We collected data on the direct cost of treating psychotic disorders within 2014–2015. Billing data from 1565 patients were used to calculate inpatient cost, while micro-costing was used to estimate outpatient cost. One hundred and five patients visiting the hospital were interviewed to estimate indirect costs, for example, patients’ and caretakers’ travel, meal, and opportunity costs. Results For inpatient care, the average direct and indirect cost/patient/episode are USD328.84 and USD213.22, respectively. For outpatient care, the direct and indirect costs are USD148,484.83/year (USD25.38/visit) and USD88,503.70/year (USD15.13/visit), respectively. The total societal cost of treating patients in the hospital is USD1,085,310.21/year (39% is an indirect cost, dominated by productivity loss). Conclusion The societal cost of treating psychotic disorders is large and potentially catastrophic to the patients. Early treatment for mental illness may avoid the high costs and lead to better productivity. Potential access barriers such as financial factors and stigma should be addressed.

Post-traumatic stress disorder symptoms among nursing staff who provided direct care to COVID-19 patients: a cross-sectional study

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has led to a major physical and psychological burden on nursing staff who provide patient care in difficult circumstances with persistent exposure to infected patients. This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) symptoms among nursing staff working during the COVID-19 pandemic and its relationship with different work-related variables. It was designed as a cross-sectional comparative study in which 102 nurses on duty during the past 6 months were enrolled and divided into two groups. The first group included fifty-one COVID-dealing nurses who provided direct patient care to COVID-19 patients (emergency department, isolation zone, and intensive care unit (ICU)), while the second group included fifty-one non-COVID-dealing nurses on duty during the same period but in other hospital units and not providing direct care to COVID-19 patients (inpatient and outpatient wards).Sociodemographic data, work-related variables, PTSD symptom severity, and diagnosis were all assessed.ResultsThe COVID-dealing nurses had significantly less frequent short breaks (P = 0.007), inadequate organizational support and compensation (P = 0.024), and inadequate time off work (P = 0.004) compared to non-COVID-dealing nursing staff. They were also significantly suffering from PTSD compared to second-line staff (P = 0.025).ConclusionsCOVID-dealing nurses providing direct care to COVID-19 patients suffered significantly from PTSD with a variety of contributing work-related variables.

Study of prescribing pattern of antimicrobials in a tertiary care hospital

Background: Antimicrobials are routinely prescribed in several disease conditions in which infections are established or suspected to be the reason for the illness. Excessive and irrational use of antimicrobials leads to development of drug resistance in microorganisms, besides increasing health-care expenditure. Antimicrobial resistance (AMR) leads to increase in morbidity and mortality. The rational use of antimicrobials is a major health need in all countries. Hence, assessment of prescribing pattern of antimicrobials is essential for clinical, educational, and economic purposes. Aims and Objectives: The objectives of the study were to evaluate and compare the prescribing pattern of antimicrobials by assessing – (i) commonly used antimicrobials; and (ii) disease conditions for which they were prescribed. Materials and Methods: It was a prospective observational study done for a period of 1 month. All the prescriptions in which antimicrobials were prescribed in the outpatient departments (OPD) and in-patient wards (IP) were included in the study. Prescriptions were analyzed for demographic and antibiotic data. Results: 1092 prescriptions were collected and analyzed. Among them, 690 prescriptions were from OPD and 382 prescriptions from in patient wards. Out patient data: Cefixime (21.30%) was commonly prescribed followed by fixed dose combination of Amoxicillin + Clavulanic acid (14.64%) and Ciprofloxacin (8.84%). Cefixime was commonly prescribed for URTI (13.43%). Oral route (82.17%) was the preferred route of administration. IP data: Cefotaxime (26.45%) was commonly prescribed followed by fixed dose combination of Piperacillin + Tazobactum (15.29%) and Ceftriaxone (14.46%). Cefotaxime was commonly prescribed preoperatively for most of the surgeries (76.56%). Intravenous route (46.86%) was the preferred route of administration. Single antimicrobial therapy (81.41%) was preferred followed by double (17.80%) and triple (0.79%) antimicrobial therapy. Conclusion: Cefixime and cefotaxime were commonly used in OPD and in patient wards, respectively. Oral route and intravenous route were the preferred route in OPD and IP wards, respectively. Single antimicrobial therapy was commonly preferred in both IP and out-patient wards. Although double and triple antimicrobial therapy was prescribed in small number of patients, it should be cautiously used to prevent AMR.

Effect of Antiepileptic Drugs on Serum Lipid Profile among Children with Epilepsy at a Tertiary Care Hospital, Chennai, India

Introduction: An arsenal of Antiepileptic Drugs (AED) is used in the management of childhood seizure disorders. Most of them are taken long-term. These drugs have the potential to cause hyperlipidemia by inducing the P450 enzyme system. The alteration in lipid profile caused by long-term use of antiepileptic drugs in children needs to be studied to reduce the risk of future atherosclerosis. Aim: To analyse the effect of antiepileptic drugs on serum lipid profile in children with epilepsy in a tertiary care. Materials and Methods: This prospective descriptive study was conducted in the Outpatient and Inpatient Wards of the Department of Paediatrics and Neurology, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India, from February 2017 to September 2017. The study involved a total of 155 children, who were on monotherapy antiepileptic drugs for atleast 6 months (33 on phenytoin, 42 on phenobarbitone, 20 on levetiracetam, 20 on carbamazepine, 40 on sodium valproate). A corresponding numbers of children, who attended the General Outpatient Department for acute upper respiratory tract and were otherwise healthy, were included as controls. A blood sample (3 mL) was drawn after an overnight fast for serum glucose, liver enzymes, total cholesterol, High Density Lipoprotein-Cholesterol (HDL-C), Low Density LipoproteinCholesterol (LDL-C), Very Low Density Lipoprotein (VLDL) cholesterol and Triglycerides (TG) measurement. Chi-square test was performed to find out the significance of association and independent t-test was used to compare the mean between various groups. Results: Cytochrome P450 (CYP) enzyme inducers like carbamazepine, phenytoin and phenobarbitone significantly modified serum lipids in epileptic children when compared to healthy controls. In children on long-term phenytoin monotherapy, mean cholesterol levels were significantly higher in the cases compared to controls (156.73±31.93 mg/dL vs 105.03±8.60 mg/dL, p-value &lt;0.0001), significantly elevated triglycerides (123.48±25.99 mg/dL vs 87.88±12.16 mg/dL, p-value &lt;0.0001), and HDL-C level was significantly lower (44.52±10.14 mg/ dL vs 56.73±12.56 mg/dL, p-value &lt;0.0001) than in controls. Phenobarbitone use was associated with significantly higher levels of cholesterol (164.97±34.41 mg/dL vs 107.76±9.28 mg/dL, p-value &lt;0.0001), LDL (155.27±28.55 mg/dL vs 93.36±6.81 mg/ dL, p-value &lt;0.0001), and triglycerides (125.55±42.19 mg/dL vs 86.30±8.12 mg/dL, p-value &lt;0.001) and lower HDL (46.30±9.47 mg/dL vs 57.73±14.41 mg/dL, p-value &lt;0.0001). Levetiracetam was not associated in significant alteration in both liver enzymes and lipid profile (p-value &gt;0.05). Carbamazepine monotherapy was associated with higher levels of cholesterol (180.50±28.06 mg/dL vs 112.15±13.55 mg/dL, p-value &lt;0.0001), LDL (138.85±22.55 mg/dL vs 82.45±12.12 mg/dL, p-value&lt;0.0001) and triglycerides (142.80±9.48 mg/dL vs 85.40±6.29 mg/dL, p-value &lt;0.0001) when compared to healthy controls. There was no alteration in lipid profile in valproate monotherapy. Valproate monotherapy was associated with significant increase in levels of SGOT and SGPT when compared to mean levels (40.35±11.208 (IU/L), and 40.70±8.809 (IU/L), respectively) observed in other AEDs and significant increase in SGPT levels when compared to healthy controls (36.50±10.61(IU/L) in cases vs 40.70±8.81 (IU/L) in controls). Conclusion: Levetiracetam did not produce significant changes in the serum lipid profile and liver enzymes and appears to be safe to use in children for long-term epilepsy management especially in children with baseline deranged lipid profile.

Health-related quality of life of persons with diabetic foot ulcers in a cosmopolitan city in northwestern Nigeria.

Diabetic foot ulcer is one of the most serious and disabling complications of diabetes mellitus (DM). It is a major source of morbidity, mortality, and a leading cause of hospitalization. It constitutes a major burden to the patient, family, and health-care system as well as impairs quality of life (QoL). The aim of this study was to determine the QoL of persons with diabetic foot ulcers attending two major hospitals in a cosmopolitan city in northwestern Nigeria. We conducted a descriptive cross-sectional study at the diabetes outpatient clinics and wards of two major hospitals in Kano, Northwestern Nigeria. Sociodemographic characteristics, type of DM, duration of DM, and the presence of risk factors for foot ulcers were assessed. The QoL of patients with and without foot ulcer was determined a well-validated questionnaire for chronic diseases, short form 36 (SF 36) health-related QoL questionnaire. We recruited 394 patients with DM (163 males and 231 females) with mean age and duration of DM of 50.8 ± 12.5 years and 7.72 ± 6.65 years, respectively. Ninety-five percent of the study participants had type 2 DM. Foot ulcers were present in 57 (14.5%) study participants. The QoL was generally poor (P < 0.001) in patients with DFU, compared with those without DFU in all domains of the SF 36, that indicated poor QoL in the physical, mental, and emotional well-being of the patients. Diabetic foot ulcers are quite common and impart significantly on the QoL of persons with DM affecting their physical, mental, and emotional well-being. Early detection and management of foot ulcers will reduce the burden of the disease and improve the QoL of affected individuals.

Correlation of Pupil to Limbus Diameter Ratio with Blood Pressure and Heart Rate among Parkinson’s Disease Patients

Introduction: Variation in blood pressure and heart rate is observed in patients with parkinson’s disease. Pupil to Limbus Diameter (PDL) ratio is one of the emerging autonomic functions. The studies measuring the autonomic functions of parkinson’s patients are sparse. Aim: To observe the correlation of the PLD ratio with blood pressure and pulse rate among parkinson’s disease patients. Materials and Methods: This observational study was conducted among 31 parkinson's disease patients attending Outpatient Ward of General Medicine Department at Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India, from 1st March 2021 to 1st November 2021. Pupil to limbus diameter ratio was recorded using the two-box method. Data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Pearson’s correlation was used to observe the correlation. A p-value less than 0.05 was considered significant. Results: The mean age of the participants was 61.9±13.07 years. The mean PLD ratio of the left eye was 0.343±0.042. There was a significant positive correlation between the PLD ratio of the left and right eye with blood pressure in males. There was a positive correlation between pulse rate also with PLD ratio of the left and right eyes. However, it was not significant. Conclusion: There was a significant positive correlation of the PLD ratio with blood pressure and pulse rate in males, but negative correlation was observed between the PLD ratio of the left eye with systolic and diastolic blood pressure in females. The study results support the need for further detailed studies in this area to investigate further details of this correlation observed.