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Objective: To study prevalence of various gram negative bacteria in infected burn wounds among stable burn patients reporting to out-patient department on follow-ups. Study Design: Cross Sectional study. Setting: Department of Pathology, Sahara Medical College Narowal. Period: January to June 2020. Material & Methods: Patients with burn wounds with clinical signs and symptoms of infection but vitally stable, wound less than one month old involving < 20% body surface, reporting to out-patient door of study institution on follow-ups were enrolled into the study. Swabs of infected wounds were taken and sent for bacterial culture and sensitivity to the pathology department of the institution, where micro flora were isolated and their antibiotic susceptibility pattern was determined using standard techniques. Consent was taken from patients before including them in study. Results: Total 210 cases were studied. Gram negative bacteria were isolated from 190 cases, out of them 30% were oxidase positive ad 70% were oxidase negative. Most common organism isolated was Pseudomonas Aeruginosa (30%), followed by Proteus Sps. (25.3%) and Entero bacter Sps. (15.8%) etc. Conclusion: Among gram negative bacteria pseudomonas is a major isolated organism from infected burn wounds having high susceptibility to imipenem and cefepime.

Background and Aims: Patient satisfaction is acknowledged as the corner stone of quality management and it is the paramount of any quality management program in health care system. This study is aimed to conduct an up-to-date systematic review on different validated tools that provide quantification of patient satisfaction in out-patient physical therapy services. Type: Systematic review Literature survey: An extensive literature search was performed using 3 electronic database systems (Google scholar, PubMed, and PEDro) for articles published between 2000 and 2020. Boolean operator AND was used in compilation with the exhaustive list of search terminologies. A total of 19 studies that investigated any patient satisfaction tool in outpatient physiotherapy settings were included. Methodology: The process of data extraction was performed in accordance with PRISMA guidelines (2009). Results: Consensus based standards for the selection of health status measurement instruments (COSMIN) scoring quantified psychometric property of each study as excellent, good, and fair. 8 studies reflected fair scoring of Cronbach alpha, 3 studies showed excellent whereas, 2 appeared to be poor. Conclusion: The COSMIN scoring quantified multiple patient satisfaction tools. However, no gold standard was found. Nevertheless, physiotherapists working in out-patient care can increase the efficiency of patient-centered treatment by identifying and maximizing these patient satisfaction tool determinants.

Introduction: Metabolic syndrome (MetS) occurs as co-morbidity in chronic obstructive pulmonary disease (COPD) and requires evaluation. Methods: MetS was studied in 336 patients of COPD (NCP-ATP III guidelines). TNF-α, IL-6 and C reactive protein were analysed. Patients were divided into metabolic (n=89) and non-MetS (n=247) groups and further divided into mild to very severe COPD category as per Global Initiative for Chronic Obstructive Lung Disease. Results: The 89 patients (26.49%) had MetS. Waist hip ratio (WHR) was more in 80.89% (72/89). Triglycerides and HDL derangements were found in 63 and 75 patients. Fasting blood glucose, systolic and diastolic blood pressure criterion were met by 58 (65.17 %), 20 (22.47%) and 32 (35.95%) patients respectively. In non-MetS group, the derangement in above parameters were found in 41, 53, 109, 47, 43 and 46 patients respectively. Compared to MetS group, significant difference was found in WHR, lipid profile and blood pressure. Significant difference was found in waist circumference, triglycerides, HDL, fasting blood glucose and diastolic blood pressure between COPD groups with and without MetS. Moderate COPD patients had highest MetS. Difference in results as per severity of disease was found to be non-significant. Inflammatory markers between COPD groups with and without MetS were non-significant with levels more in latter group. Within COPD group (as per severity of disease) with MetS their levels were significantly raised. Conclusion: MetS occurs as co-morbidity in COPD and requires evaluation which will help in better management and prevent cardio metabolic complications.

Objective: The study assessed the knowledge, attitude and management practices of diabetes patients attending medical outpatient department in Federal Capital Territory Abuja. Materials and Methods: A total of 120 randomly selected respondents between 18 - 65 years were assessed using standard methods in a cross-sectional survey involving the use of validated semi-structured questionnaires. Results: The findings revealed that 60% of patients were without health insurance despite the fact that they are educated; 53% have been diagnosed and began their treatment between 2 and 5 years. For the knowledge indicators, 50% of the patients know two types of diabetes, 35% were able to list two types of diabetes while 56.70% could not list any type of diabetes. Attitude assessment among the diabetic patients revealed that 79.17%, 62.50%, 68.33% and 51.67% visit a physician; do monitor their blood glucose, have altered their eating habit and agreed that sedentary lifestyle is not good respectively; 41.67% of the respondents read health materials. In the area of lifestyle, changes made by the diabetic patients include check-up (3.33%), diet (18.33%) and exercise (20.00); 40.00% and 14.17% made a combination of two and three lifestyle changes respectively. Majority of the respondents do have their blood glucose level checked monthly. Conclusion: Based on the research findings, the diabetic patients’ knowledge, attitude and dietary practices are contributing factors to their high fasting blood glucose and poor nutrition status.

Background: Hematologic malignancies are of diverse incidence, prognosis, and etiology. Dhaka medical college hospital (DMCH) is a tertiary level hospital and dealing with patients attending from all over the country. We have analyzed data of patients present with hematological malignancy in our Out Patient Department (OPD). As Hematology Dept DMCH deal with patients referred from all over the country, its OPD data represents the picture of whole country. Methods: This is a retro-spective study of OPD patients with hematological malignancy in the department of Hematology of DMCH from January 2018 to December 2018. The diseases were diagnosed on the basis of bone marrow morphology or histopathology (Lymphoma) and or immunophenotyping & molecular genetics. Results: Total 5747 patients were treated in 2018 with the complaints related to hematological malignancy of which 4599 (80%) were old patients and 1148 (20%) were new patients. Among all the treated patients 1420 (24.7%) were female and 4327 (75.3%) were male. Among 1148 new cases 37 were AL(3%), 386 were ALL (34%), 265 were AML(23%), 32 were CLL (3%), 126 were CML (11%), 40 were HL (3%), 18 were MDS (1%), 76 were MM (7%), 168 were NHL (15%). Data shows variation in total number of new patients per month- 83 in January (7.23%), 96 in February (8.36%), 140 in March (12.20%), 98 in April (8.54%), 94 in May (8.19), 89 in June (7.75%), 98 in July (8.54%), 66 in August (5.75%), 99 in September (8.62%), 103 in October (8.97%), 98 in November (8.54%), 84 in December (7.31%) But it does not show any statistical significant frequencies of diseases according to months. Conclusion: We deal a lot of patients with hematological malignancy each year in DMCH. A good portion of them are of ALL because of monthly maintenance of ALL protocols. Analysis of new cases shows ALL, AML, NHL is most common three diseases encounter in OPD. OPD patients’ inflow does not show any significant monthly variation for any of the diseases.

Background: Drug promotional literatures can often be misleading and have biased information and can contribute to irrational use of medicines. Thus, it is necessary that prescribers critically analyze the drug promotional literatures presented to them. This study attempts to understand if the prescribers at Tribhuvan University Teaching Hospital are aware about the necessary information that should be present in a drug promotional literature.Methods: A descriptive cross-sectional study was conducted over six months in which prescribers at Tribhuvan University Teaching Hospital were provided with the self-administered questionnaire and were requested to submit the filled in questionnaire. Prescribers presently working at Tribhuvan University Teaching Hospital, attending out patient department services and had received drug promotional literatures within last six months were included in this study. Results: During the study, 163 of the received questionnaires met the inclusion criteria and were utilized for analysis. Advertisement, reminder items and others type of drug promotional literatures were commonly received by prescribers included in our study. Higher proportion of faculties (35.29%) preferred reprint type of drug promotional literatures. Most of the participants (47.85%) searched for 5-8 WHO-Ethical Criteria for Medicinal Drug Promotion criteria when referring a drug promotional literature. It was seen that 42.94% of prescribers realised that at least two out of four types of information related to negative attribute of the promoted medicines were missing.Conclusions: The prescribers with least duration of clinical exposure are more likely to always prescribe the medicines promoted to them. Prescribers were more confident on claims made in drug promotional literatures if they were supported using scientific evidences.Keywords: Drug promotional literatures; prescriber perception;WHO-ECMDP

Introduction: Fungal infections have been a serious disease over a few decades. Superficial fungal infections not only cause life-threatening illnesses but slowly reduce the Quality of life of patients. Objective: To study the prescribing pattern of antifungal drugs, distribution of fungal disease, and cost variability between different antifungal drugs prescribed. Materials and methods: Prospective observational study was carried out at Justice K.S. Hegde Charitable Hospital from August 2018 to April 2019. Outpatient departments patient satisfying the inclusion criteria were included in the study. Factors like age, gender, diagnosis, and type of prescribed antifungal drugs along with Price variability among different brands of the drug were considered. Antifungal drug prescriptions of patients were analyzed. Results: More than 50% of the patients were from age 21-40 yrs. Males (51.8%) were more than females (48%). The majority of the drugs prescribed were topically (64%). Tine a corpor is was the most prevalent fungal disease. The Azoles group of Antifungal was most prescribed. And the percentage variability between different brands was high. Conclusion: The study concluded the extensive use of antifungal agents. The highly prescribed drug was found to be luliconazole. The study also concluded that the use of generic prescriptions might reduce the cost of illness and enhance the rational use of the drug.

Introduction: Growing incidence of hypertension and its significant association with diabetes mellitus are being observed in both developing and developed countries around globe. Scanty literature is available about the comparative study of inter-arm variation of blood pressure in normal individuals and diabetic among Nepalese population. This research was performed to determine extent of inter-arm variation in normal individuals and diabetics. Methods: A descriptive observational study was carried out from 2013 January to 2014 January in a tertiary level teaching hospital of Nepal. After taking the consent and giving necessary instructions, blood pressures were measured in both the arms one after another in sitting posture using mercurial sphygmomanometer and Littman cardiosonic stethoscope. Arterial blood pressure was measured by palpatory method followed by auscultatory method The cuff pressure at which the tap sound were first perceived was noted as systolic blood pressure (SBP). Similarly, diastolic blood pressure (DBP) was noted at the point where the sound disappeared. Results: A total of 120 volunteers between ages of 40-80 years were studied. Highly significant inter-arm variation of both SBP and DBP was found in diabetics as compared to normal (p

BACKGROUND We wanted to estimate the incidence and prevalence of ocular injuries among occupational workers in welding and grinding industry treated in a tertiary care hospital, determine the major types of ocular morbidities in welding and grinding workers and identify the vulnerable age groups suffering from ocular injuries due to welding and grinding. METHODS This hospital based cross-sectional study was carried out among 712 patients having ocular injuries only for occupational workers doing welding, grinding or polishing work. The study period was from 01 / 01 / 2018 to 30 / 06 / 2018. The study was conducted in the Department of Ophthalmology, Hi-Tech Medical College and Hospital. All patients were assessed for demographic distribution, detailed ocular evaluation and a questionnaire related to awareness about the injuries and safety measures taken during the work. RESULTS During the period of study, 712 patients who had ocular injuries due to welding and grinding work were included in the study. The mean age was 33.87 years with a standard deviation (SD) of 9.86. There were no female workers who reported such injuries. Most injuries were corneal foreign body (63.90 %), conjunctival foreign body (2.81 %), conjunctivitis due to fumes (11.94 %), laceration (8.71 %) and keratoconjunctivitis (12.64 %). CONCLUSIONS To complement standard epidemiological research, the narrative accident text offers useful evidence. Staff conducting a welding job or working with local welders should be qualified to recognise possible dangers and appropriate protective equipment should be used to prevent eye injury. KEYWORDS Ocular Injuries, Welding & Grinding Work, Risk Factor for Eye Injuries

Introduction: Prevalence and severity of depressive illness among the youth are on the rise. Objective: To examine the prevalence and severity of depressive illness among youth coming to the psychiatry outpatient department of District Headquarters Hospital, Sargodha. Material and Methods: This is a descriptive cross-sectional study. The study population includes young people (15-24 years) coming to the Out-patient Department of Psychiatry in District Headquarters Hospital, Sargodha. The duration of the study was from 1st February 2018 to 20th May 2018. 50 patients were selected through the convenience sampling technique. Beck’s depression inventory-II semi-structured questionnaire was used for data collection from people aged 15-24 years coming to psychiatry OPD. The diagnosis was made as per the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V). Informed consent was obtained from all participants. Chi-square applied. P-value of 0.05 taken as cut off value. Results: Depression was present in 64% of the study participants. Among female participants, 77.42% of females while among male participants, 42.11% of males were suffering from depression (P-value=0.012) which shows that there is a significant association between gender and depression. Overall, 50% of the participants were mildly depressed, 34.37% were moderately depressed and only 15.63% were severely depressed (P-value = 0.618). Among depressed, 75% were 20-24 years old and 25% were 15-19 years old. Conclusion: Prevalence of depression is found to be more among women and in the young age group 20-24 years. Therefore, regular psychiatric screening, treatment, and follow-up are recommended in an educational institute for early diagnosis and treatment.

Patient satisfaction reflects the quality of an institution’s delivery of health care services. Patient satisfaction is a critical factor in improvement or complete recuperation to wellness because satisfied patients will mean better compliance to treatment or follow up. As reported in the 2017 Annual OPD census of the Department of Obstetrics and Gynecology, there were 2617 total patient consultations. Majority of these (2138 or 81.7 %) were obstetrical cases. The average number of consultations per day (for Obstetrics and Gynecology patients combined) is 91. Therefore, the Out-Patient Clinic plays an important role in prenatal care specifically the prevention of adverse maternal and neonatal morbidity and mortality. This study aimed to assess the level of patient satisfaction among obstetrical patients in the Out Patient Department of the Obstetrics and Gynecology Section at Metropolitan Medical Center from July 1, 2018 to July 31, 2018 and to see the relationship between socio-demographic characteristic and the level of patient satisfaction. This is a descriptive, cross sectional study. The level of patient satisfaction assessed as to physical facilities, interaction between doctor and patient, interaction between nurses and patient, and registration service. There were sixty three subjects in this study. Sixty three were satisfied with inclusion criteria. The validated questionnaire was the pretested questionnaire which was 96 % valid and reliable by Cronbach’s analysis. Statistical analysis was done which showed respondents were generally satisfied. There were significant relationship association between socio-demographic characteristics and level of patient satisfaction with P value < 0.05.Key Word : Patient Satisfaction, Socio Demographic Characteristic

Introduction: The Lumbosacral angle (LSA), is the angle formed between a line across the plane of the superior margin of the sacrum and a horizontal line. Various literature and studies around the world shows wide normal variation in LS angle, ranging from 320 to 440. Abnormal variation in LS angle is commonly associated with low back pain. Hence research involving study of normal variation of LSA in different ethnic population plays a significant role. In Indian scenario very few studies are available, especially from rural population, to know up to what extent, variation in LS angle is normal. Hence, the present study attempts to study the normal variation in LSA in rural population of Telangana. Materials and Methods: A descriptive study of normal LSA variability, involving 100 asymptomatic subjects between the age group of 20-60 years was carried out in orthopedic department of Medical College hospital, Telangana. Ferguson’s technique was employed for calculation of LSA. Results: In this study variation of LSA ranges from 280 to 600. Overall average LSA was 340.Females have greater average LSA as compared to males. Conclusion: Results of the present study show variability when compared to other similar studies, which further strengthen the fact that normal variation in LSA differs among different region and races; hence results of the present study will be a useful tool to health care providers for treating different spinal disorders of rural Telangana population. Keywords: Lumbosacral angle (LSA), Ferguson technique, Lumbar lordosis, LSA Variation, Spinal maturity.

Introduction: It has been observed that use of computer by medical students is increasing. Study material is becoming more digital, computers are used in many of the diagnostic tests that take place within the hospital. This study was conducted with the aim to study the prevalence, risk factors and clinical evaluation and spread awareness of computer vision syndrome among medical students. Materials and Methods: This Cross sectional study was conducted at a Medical college in Pune. The questionnaire was allotted to students in campus of medical College, those who were found to be symptomatic were further evaluated in Out Patient Department of Ophthalmology data analyzed by using SPSS software version 17.0. Statistical tools used were proportions & percentages & other appropriate. Statistical tests of significance applied. Result: the prevalence of computer vision syndrome was 54.44%. using computers for 6-8hours have higher percentage (39.12%) & duration more than 6-8 years of using computers 29.02% students suffering from computer vision syndrome (cvs). ocular & non ocular symptomps were statistically significant. Conclusion: The prevalence of computer vision syndrome amongst medical student was 54.44%. Factors to relieve symptoms were also studied and it is found that awareness of CVS definitely reduce symptoms. Keywords: Computer vision syndrome, Digital eye strain, Visual display unit.

Objective : To evaluate the relationship between the frequency of ED visits and outpatient department (OPD) follow-up in sickle cell disease (SCD) pediatric patients. Methods : A retrospective cohort study included 247 SCD pediatric patients between January 2016 and December 2018 at the Maternity and Children Hospital, Department of Pediatrics, Al Medinah Al Munawarah, Saudi Arabia. Data were extracted from electronic medical record system; patient demographics, medications, frequency of emergency department (ED) and OPD visits. Pearson correlation coefficient, linear regression and independent sample t-test were applied. Results : There was no significant correlation (95% CI [-0.013- 0.233]; p =0.07) between the frequency of ED and OPD visits. However, a significant correlation was found between ED visits and missed OPD appointments. Thus, linear regression was applied and indicated that one missed OPD appointment is associated with 1.92 ED visits, (95% CI: 0.19-0.42; p less than 0.001). Also, a higher rate of ED visits was observed when compared with other studies, with a high ED reliance of 43%. Conclusion : This study found that regular OPD visits could improve SCD management, as a directly proportional relationship between the frequency of ED visits and missed OPD appointments along with high ED reliance. Saudi Med J. 2020 Dec;41(12):1324-1329 doi: 10.15537/smj.2020.12.05585 How to cite this article: Ismail AF, Tarawah RA, Azzouni ZY, Alharbi LT, Altayyar RM. The relation between regular outpatient follow-up and frequency of emergency department visits in sickle cell pediatric patients. Saudi Med J. 2020 Dec;41(12):1324-1329. doi: 10.15537/smj.2020.12.05585. PMID: 33294890.

Background Nasal sprays are used to deliver the medications locally to the nasal cavity. The majority of patients have been observed to perform nasal spray use techniques inadequately. This study was conducted to evaluate the impact of the intervention on nasal spray use technique. Methods This was a prospective pre- and post-interventional study to evaluate the nasal spray use technique among the subjects with the help of nasal spray checklist. A standardized WHO nasal spray checklist was used on the study conducted in Manipal Teaching Hospital, Pokhara, Nepal from July to October 2019. Subjects were asked to demonstrate the technique and a scoring system was applied before and after the intervention by the researcher. The total score of the intervention technique ranges from 0 to 11. After evaluation of the technique at the first visit, subjects were provided with an informative leaflet having all the steps to be followed to use the spray and the technique was re-evaluated after 10 days. Results A total of 81 subjects (51.9% male and 48.1% female) participated in the study. The average duration of nasal drug use was 15 days. The overall mean±SD score was 4.31±1.625 before intervention and 9.84±1.699 after intervention. After the intervention, the percentage of subjects using the nasal spray correctly increased by 50.27%. Wilcoxon signedrank test showed intervention on nasal spray use technique was effective (p=0.0001). Conclusion The nasal spray use technique was poor among the subjects before the intervention. The intervention was substantially effective in improving the technique to use the nasal spray. Regular assessment and reinforcement of correct technique by health professionals will improve the proper use technique of nasal spray, hence increasing the effectiveness of the therapy.

BackgroundThe usage of guideline-directed medical therapy (GDMT) in the treatment of heart failure (HF) has shown to reduce morbidity and mortality. However, majority of the HF patients do not receive GDMT or do not achieve the target dose. Literature has shown that the patients who are managed in HF clinics receive GDMT and target doses of disease-modifying drugs (DMD) when compared to those treated in other general cardiology outpatient departments (OPD’s). It was a retrospective hospital-based study in which patients treated in HF clinic and other cardiology OPD in the year of 2017 were included (200 patients in each arm). The aim of this study was to assess the impact of heart failure clinics in medication therapy management including usage of guideline-directed medical therapy, if target dose specified by the guideline is achieved and time to reach target dose in comparison to other general cardiology OPD’s. IRB and IEC approval were obtained before the commencement of the study. Data relevant to the study were obtained from the electronic medical record (EMR) and were compared between the study groups to see for the adherence to guideline and achievement of target doses. Data storage and analysis were performed using SPSS Version 24. A significance level of 5% was used.ResultsThe usage of GDMT was higher in HF clinic when compared to other cardiology OPD (81% vs 55%,P= 0.001). A significantly higher number of patients in HF clinic achieved target dose when compared to other cardiology OPD (58% vs 29% -betablockers, 45% vs 9% -ACEI/ARB/ARNI,P= 0.000). Moreover, the number of eligible patients receiving DMD was found to be higher in HF clinic (98% vs 85% -betablockers, 69% vs 44% -ACEI/ARB/ARNI, 76% vs 44% -MRA). Also, the patients in HF clinic attained the target doses faster when compared to other cardiology OPD. In addition, there was better improvement in ejection fraction, as well as decreased rate of rehospitalisation and mortality in patients managed in HF clinic.ConclusionHF clinics were compared with other cardiology OPD for various parameters and it was observed that HF clinics were better than other cardiology OPD in maintaining the medication therapy management.

Diabetes Mellitus is a chronic lifelong disease one has to live with. The quality of life assessment is considered an important measure of outcome in long-term illness and management. Objective: The objective of the study to assess the health-related quality of life among diabetic patients with determination of relationship between the domains and to determine the association between socio-demographic variables and health related quality of life. Material and method: A quantitative research approach and descriptive research design was adopted to conduct study. The non- probability convenience sampling technique was used to select 150 diabetic patients visiting medical out-patient department of selected health care facilities. Modified quality of life instrument was used to assess the health-related quality of life among diabetic patients. Result: All the study participants had good health related quality of life with mean percentage (68.345%), overall mean and SD score of health-related quality of life among subjects i.e. mean score ± S.D 136.69 ± 26.343. As the result of chi2 test, gender, age (in years), education, monthly income, dietary habit, physical activity, treatment had significant association (p ≤ 0.05) with health-related quality of life. Conclusion: The study concluded that majority of the subjects (diabetic patients) had good health related quality of life. Role limitation had positive relationship with all the domains of health-related quality of life. Gender, age (in years), education, monthly income, dietary habit, physical activity and treatment were significantly associated with health-related quality of life.

Premature ejaculation (PE) is the most frequent sexual complaint of men. It may develop not only due to psychiatric disorders but also due to many chronic organic illnesses. Coronary artery stenting is an invasive procedure to manage coronary artery disease which is one of the leading chronic illnesses all over the world. Patients who survive from coronary artery diseases by getting invasive cardiac procedures, often develop reduced sexual function. The aim of the study was to identify the frequency of premature ejaculation among post coronary artery stenting patients. This was a descriptive, cross sectional study conducted in cardiology outpatient department (OPD) of Bangabandhu Sheikh Mujib Medical University (BSMMU) and cardiology OPD of National Institute of Cardiovascular Diseases (NICVD) from October 2017 to September 2018. 153 patients were selected purposively. After taking written consent a predetermined questionnaire containing 11 socio-demographic variables was filled for each patient through face to face interview. After that PEDT bangle version was applied.37.25% post coronary artery stenting male scored 11 or more and were identified as highly suggestive to have PE. Among the socio-demographic variables, Regular exercise, amount of sleep per day, smoking and history of chronic physical illness were found to be significantly associated with PE among post coronary artery stenting patients. The study showed that the patients who practiced a disciplined and healthy lifestyle were not in risk. The research findings may help us for the early diagnosis and better treatment plan to reduce patient sufferings. Bang J Psychiatry June 2018; 32(1): 9-13

Deafmutism affects communication and wholesome development of an individual. India has a significant burden of deafness in the country. Even fourteen years after the launch of a National Program for Prevention and Control of Deafness in year 2006, we lack detailed data about the disability from most regions of the country. This study aims at finding out the prevalence, clinical history-examination and audiological profile of deaf-mute patients visiting the Out Patient Department (OPD) of a tertiary care institute in Uttarakhand, and compare the results with similar studies published during last 20 years from India to generate a literature review. Out of 46,049 patients that visited OPD of the institute during the given period of 24 months, 73 cases were short-listed clinically to be enrolled in the study. However, only 55 (75%) of them completed the questionnaire and audiological testing. All information was extracted from the patients/relatives with the help of a questionnaire in the Hindi language. The prevalence of deafmutism in patient presenting in our OPD in the study period was 0.3%. The history of pre-, peri- and post-natal risk factors was present in high percentage (58.2%, 78.2% and 34.5% respectively) of patients. This warrants review of our maternal and child healthcare strategies. The literature review revealed lack of uniform and standardized tool in conducting and reporting of studies on deafmutism. The questionnaire used in this study can be further improved and modified in the future as per the requirements of data collection.

Context: Non-steroidal anti-inflammatory drugs (NSAIDs) are most commonly used drugs for years for management of pain and inflammation with good efficacy. NSAIDs are increasingly used for variety of indications like rheumatoid arthritis (RA), osteoarthritis (OA), low back pain (LBP) etc. Prescribing patterns need to be evaluated periodically to increase the therapeutic efficacy, decrease adverse effects and provide feedback to prescribers. A prospective observational study was conducted among patients attending the Out Patient Department (OPD) of Orthopedic and received prescription for NSAIDs in the Mymensingh Medical College Hospital (MMCH) and Community Based Medical College Hospital (CBMCH) in Mymensingh. Material and Methods: The study was carried out on 300 (three hundreds) prescriptions for NSAIDs from orthopedic Out Patient Department (OPD) of Mymensingh Medical College Hospital (MMCH) and Community Based Medical College Hospital (CBMCH). A prospective observational study was conducted from January 2015 to December 2015. Data were collected only from the patients prescribed for NSAIDs and prescribing pattern of NSAIDs were analyzed using SPSS method version 20.1 Results: In case of orthopedic OPD patients most common NSAIDs prescribed to the patients was aceclofenac (29.33%). Others NSAIDs prescribed to the patient in pain management were ketorolac (10%), etoricoxib(8%), ibuprofen (9%), naproxen(9%), sulindac (7%) in orthopedic out patients of both Medical College Hospitals. Most of the NSAIDs were prescribed in brand name (85.34%) where only (14.76%) were prescribed in generic name in both hospitals. Conclusion: From the study it was observed that aceclofenac was the most common NSAIDS used in orthopedic OPD of CBMCH and indomethacin was the most common used NSAIDs in MMCH. Other used NSAIDs were ketorolac, naproxen, etoricoxib, ibuprofen and sulindac. J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 195-198

Sri Lanka is a country in South Asia that has a high-level health care system. The National Hospital, Sri Lanka (NHSL) situated in Colombo, is the largest teaching hospital in Sri Lanka and the final referral centre in the country consisting of 3000 beds and the bed occupancy rate is 75 with 3.7 average lengths of stay. Outpatient care, sometimes called ambulatory care, is defined as medical care or treatment that does not require an overnight stay in a hospital or medical facility. The outpatient department (OPD) is considered as the window to hospital services and a patient's impression of the hospital begins at the OPD. The OPD of the National Hospital of Sri Lanka (NHSL) also faces the problem of congestion. This study aims to identify the causes of congestion at OPD of NHSL and provide solutions. Key informant interviews with relevant stakeholders, focus group discussions, desk review of secondary data, and direct observations of OPD processes were used as methodologies. Key informant interviews were conducted with the deputy director, OPD, medical officer-in-charge, and nursing sister in charge of the unit by the principal investigator. Two focus group discussions were conducted, with 12 randomly selected medical officers and 10 nursing officers with a minimum of one year of work experience at the OPD. Data retrieved from the desk review of the secondary data from the admission book, and OPD monthly statistics. Direct observation was used to triangulate the data. Around 690,000 patients are treated annually in OPD of NHSL. The average number of OPD patients per day is about 1900. Usually, a doctor at OPD of NHSL examines 36 patients per hour. Therefore, consultation time is limited to 1.6 minutes which is highly inadequate. Root causes for congestion were analyzed by using the Ishikawa diagram. Poor layout arrangements, delay of doctors and quota system of doctors, the non-availability of the patient information management system, absence of proper referral system in the country, the larger number of staff members were identified as root causes. Improvement of the layout of OPD in a unidirectional way, advised doctors to start duties on time abolish the quota system of doctors, establishment of the computer-based patients' registration system, establishing laboratory within OPD, establishing two more counters at OPD pharmacy were the major recommendation of this study to minimize the congestion at OPD, NHSL.

Background: Evaluation of prescription patterns would determine the drug utilization with main emphasis on rational use of medicine. The problem of irrational use of drugs is rampant particularly in developing nations. The present study was undertaken for evaluating the prevailed prescription patterns in tertiary hospitals with diarrhoea and/or Acute Respiratory Infection (ARI) to address specific areas of deficiencies and deviation from the available guidelines. Method: We conducted this observational cross-sectional study from August 2019 to December 2020 in Medicine & Paediatrics outpatient departments and Urban Health Training Centre in two Government teaching hospitals in West Bengal, India. We included 630 prescriptions (511 – ARI, 119- diarrhoea) and evaluated in terms of disease and medicine prescribed including antibiotic related indicators. We compared prescription patterns across different age groups, different strata of prescribers and compared against WHO standards. A Rational Use of Medicine Consensus (RUMC) committee was formed and the prescriptions were assessed for appropriateness independently by a pharmacologist and clinician. Deviations, if any, were ascertained from the available guidelines and the acceptability of the deviations were determined by consensusResult: Age and sex were mentioned in all prescriptions however signs & symptoms, provisional diagnosis and follow up visit were mentioned in 90.3%, 4.9% and 67.9% prescriptions respectively. Body weight was mentioned in 88.5% of prescription of children (< 18 years). Higher rates of Fixed Dose Combination (51%), lower proportion of generic drug (23.3%) and adherence to hospital formulatory (36.5%) were some the major concerns identified. Antibiotics prescription rate (APR) and multiple antibiotic prescription rate (MPR) were respectively 57% and 10%; both found significantly higher for diarrhoea than ARI. Deviations from Standard Treatment Guidelines were found in 98.9% prescriptions and 90.4% of which were unacceptable. Agreement between clinician and pharmacologist was observed in 90% prescriptions (Kappa -0.114). Deviations were most commonly observed with prescriptions by interns and house-staff (99.6%), whereas acceptable deviations were more frequent among the residents (15%).Conclusion: We conclude that in light of identified irrational prescription patterns, development of level specific treatment protocol coupled with periodic training of physician including junior doctors is required to ensure rational medicine practice.

Aims: To find out the prevalence and profile of chronic suppurative otitis media (CSOM) in district level of Bangladesh. Methods: This was a prospective cross sectional study which was carried out patients of chronic suppurative otitis media attended in OPD of 250 Bedded General Hospital, Gopalganj. A total number of 200 patients of CSOM were randomly selected from OPD irrespective of sex and religion during period of July 2015 to June 2016. Age ranging 0- 60 years and person residents of Gopalganj and adjacent districts. Results: In this study 60.5% were male and 39.5%female. Male Female ratio 3:2. Majority of respondents were age group is 11 to 20 years. (36.5%). Mean age of patient 29.98 years. Maximum families 52% had monthly income of TK 10,000 to 15,000 and maximum patients were dependant (37.5%). 5- 6 family members were highest group (60%), 60% respondent lived in Kacha house, 75% lived in rural area and 35% respondents used to bath in pond. The majority of clinical features were otorrhea (100%), deafness (32%), otalgia (42%), itchy ear (10%), tinnitus (50%), odor from ear (10%) and vertigo (5%). Most of ears (90%) were tubotymponic type of CSOM and medium size perforation were maximum (32.5%). Conclusion: Prevalence of CSOM is still high in rural area of our country and community found in younger age group. Improvement of socio-demographic factors, health awareness campaign, improved health education and easy accessibility to health care facilities can reduce the incidence of disease. Bangladesh J Otorhinolaryngol; October 2016; 22(2): 102-109

Background: Proton pump inhibitors (PPIs) are one of the most frequently prescribed classes of drugs in the world in the treatment of peptic ulcer, dyspepsia and gastro-oesophageal reflux. Objectives: To determine demographic, clinical response and practice characteristics of PPIs among the patients attending the out-patient department of a tertiary care hospital. Materials and Methods: In this prospective observational study 100 patients attending the out-patient department and taking oral proton pump inhibitors (PPI) for different symptoms and duration were included. Patient’s socio-demographic characteristics, PPI-related information (duration, frequency of use, doses and classes of PPIs) and symptomatic responses after taking PPI were noted. Drugs or diseases that influenced the intake of PPI were also recorded. Investigations done before or during PPI use and their findings were also noted. Results: Omeprazole (43%) and esomeprazole (35%) were the most frequently prescribed PPIs. Most of the patients (52%) were on PPI therapy for 1−3 months. Majority of the patients (72%) had taken PPIs on daily basis and 19% patients had taken irregularly or occasionally. Dosing frequency of PPIs prescribed were twice daily in most of the patients (77%). Sixty seven percent (67%) patients had taken PPI prescribed by doctors and 33% patients had taken PPI prescribed by non-doctors. Common indications for prescribing PPIs were heart burn (54%), upper abdominal pain/discomfort (38%) and bloating (33%). Symptoms reappeared after stopping the PPI in most of the patients (40%) and 35% patients had satisfactory relief of symptoms with PPI. Conclusions: Omeprazole and esomeprazole are the most frequently prescribed PPIs. Majority of the patients had taken PPIs on daily basis. In around one-third of the patients PPIs were prescribed by non-doctors. Common indications for prescribing PPIs were heart burn, upper abdominal pain/discomfort and bloating. Symptomatic responses varied after taking PPI and symptoms reappeared after stopping the PPI in most of the patients. J Enam Med Col 2020; 10(1): 10-16

Background: Epilepsy is the most common chronic neurological disease in the general population and affects approximately 1% of the population in the United States. Anxiety disorders are common co morbidity among patients with epilepsy. Incidence of anxiety was found to be 16.7% in patients with epilepsy. This study has tried to evaluate the anxiety disorder in patients with epilepsy attending outpatient department of Nepal Medical College. Objective: To estimate the prevalence of anxiety in outpatients with epilepsy and the sociodemographicprofiles of patients with epilepsy. Methods: It is a descriptive cross-sectional study. The sample comprised of 55 outpatients with epilepsy attending Psychiatry department of Nepal Medical College Teaching Hospital. Informed consent was taken and semi- structured proforma was filled with adequate information. Diagnosis was based on ICD-10 DCR and severity was assessed using Hospital Anxiety and Depression Scale (HADS). Data was evaluated with SPSS 16 and appropriate statistical tools were applied. Results: The study found that a great number of epileptic patients were suffering from comorbidanxiety disorder (36.36%). Also married patients had higher anxiety disorder (57.69%), thus, showed a significant relation based on marital status and anxiety in epileptic patients. Conclusion: Anxiety disorders are common in people with epilepsy. Increased awareness of the clinical presentations of anxiety disorders should be initiated for securing the mental health and quality of life in people with epilepsy.

One of the health service facilities is a hospital. Hospitals are required to provide the bestservices for patient satisfaction. Satisfaction will be fulfilled if the service provided in a hospitalis felt to be in accordance with patient expectations, otherwise the patient will not feel satisfied.Disatisfaction with services will encourage patients to use the services of other competitors andwill result in decreased profits for the hospital. The level of satisfaction is closely related toquality services so that the services provided are in accordance with patient expectation. Thepurpose of this study was to determine the level of patient satisfaction, patient assessment ofthe quality of health services and the relationship between the level of satisfaction with thequality of health services in an Out Patient Department (OPD) of Bandar Lampung AdventistHospital.The method used in this study is a descriptive correlation involving 160 patients in OPD ofBandar Lampung Adventist Hospital. The data gathering was done by purposive sampling, andused a questionnaire instrument. The questionnaire used in the form of a checklist consist oftwo parts were those related to the patient satisfaction levels (23 questions) and related to thequality of OPD services (45 questions), so the total of all questions was 68. Then the data wereanalyzed using the McClave percentage formula, Benson, and the correlation formulaaccording to Sugiyono (2007: 122).The results of this study found the percentage level of patient satisfaction in the Out PatientDepartment of Bandar Lampung Adventist Hospital is 76.35%. This states that the level ofpatient satisfaction is included in the high category. The percentage of patients' assessment ofservice quality is 75.96%, this value is also included in the high category. Through these twopercentages, the correlation value is 0.852. It states that there is a very strong relationshipbetween the level of patient satisfaction with the quality of health services in OPD of BandarLampung Adventist Hospital.Based on the results of the study it can be concluded that patients in OPD of Bandar LampungAdventist Hospital have a high level of satisfaction that related to the quality of hospital healthservices. Suggestions given to the head of the OPD are expected to be able to maintain andimprove quality services so that the patient satisfaction is maintained properly.

IntroductionSri Lanka has a hierarchy of health services, from health care units with fewer facilities to hospitals with specialized care. Due to the absence of well demarcated draining areas and lack of clear referral policies, patients tend to bypass the primary health care units and attend much superior health care institutions without referrals. This practice has caused congestion in hospitals and deterioration of efficacy and quality of care provided to needy patients. This study was designed to identify the reasons for bypassing primary health care institutions by patients. MethodA cross sectional study was done among conveniently selected sample of patients attending outpatient department of Teaching Hospital Karapitiya (THK). Data were collected by an interviewer administered questionnaire that assessed their socio demographic status and reasons for bypassing their nearest hospital. Patients whose nearest hospital are THK and referred patients were excluded from the study. ResultsAmong 344 patients, 60.2% were females, mean age was 41 years. Most were educated up to GCE O/L, unemployed, and had an average income

IntroductionDiabetes is a major contributing factor for overall health status, morbidity, mortality and quality of life. Adequateknowledge and sufficient practice can prevent many possible diabetic complications. Hence, the objective ofthis study was to find out the knowledge and practice regarding prevention of complications of diabetes amongdiabetic patients.MethodsA descriptive, cross sectional design was carried out in Tribhuvan University Teaching Hospital Kathmandu (TUTH).A total 124 diabetic patients who came for follow-up in endocrine Out Patient Department were selected throughpurposive sampling technique by using pre-tested structured interview schedule during four weeks. Data wasanalyzed by using the descriptive and inferential statistics with the help of Statistical Package of Social Science(SPSS) version 16.ResultsThe study findings showed that 24.2% respondents had adequate knowledge about complications . Morethan half of the respondents had sufficient practice (52.4%) regarding prevention of diabetic complications.Association between knowledge and selected variables showed that sex and education level tends to besignificantly associated and regarding practice, area of residence and duration of illness were significantlyassociated (p

Introduction: Gallstone disease (GSD) is a major public health problem that is associated with a number of risk factors. This study aims to analyze the risk factors of GSD in patients visiting General Practice Outpatient Department of Tribhuvan Universtiy Teaching Hospital. Methods: A case-control study of 174 participants comprising 85 cases with GSD and 89 controls without GSD, as confirmed by ultrasonography of abdomen was conducted as hospital based in outpatient department of General practice, Tribhuvan University Teaching Hospital, Kathmandu from 1st February 2018 to 31st January, 2019. The participants were asked questions regarding putative risk factors for development of GSD and underwent physical and ultra sonographic examination. Risk factors included were age, sex, BMI, occupation, co-morbidities e.g. diabetes mellitus, hemolytic diseases, family history of GSD, smoking status, alcohol consumption, parity if applicable and dietary history. Data analysis was done by univariate method. Results: The mean age of the case group was 47.82 years whereas mean age for the control was 46.51 years (p=0.355). 22% of cases were male and 78% were female where as in control group 29% were male (p=0.3030). Majority of the participants in both group were housewife by occupation and Hindu by religion. Mean BMI of the cases and control were 24.05 kg/m2 and 21.13kg/m2 respectively. BMI was found significant for the gall stone diseases (p=

Objective: To determine the incidence of Lower Urinary Tract Symptoms (LUTS) among patients visiting the gynaecology Outpatients Department (OPD) of Shalamar Hospital. Material & Methods: A cross sectional study was performed and 300 patients were recruited. Patients aged 40 to 60 years, visiting the Gynaecology OPD at Shalamar Hospital, Lahore were enrolled from 1st February 2018 to 30th September 2018. The participants were categorized in to two sets: Premenopausal (n=187) and Post-Menopausal (n=113). They were asked to fill the international Consultation and Incontinence Questionnaire-Short Form (ICIQ-UI Short Form). Results: Increased urinary frequency was found to be the most commonly reported symptoms (48%).Stress incontinence and urge incontinence were reported by 58% subjects amongst postmenopausal category and 42% in the premenopausal category. Presence of LUTS was observed to be directly proportional with age. Conclusion: A high incidence of LUTS was observed among patients visiting gynaecology OPD of Shalamar Hospital, Lahore. Risk factors of LUTS and incontinence, like obesity and multiparity were frequency reported. Further studies are required to understand the magnitude of this problem in general population of Pakistan.

STATE INSTITUTION OF SCIENCE SCIENTIFIC AND RESEACH CENTER OF PREVENTIVE AND CLINICAL MEDICINE" STATE ADMINISTRARIVE DEPARTMENT: FROM OUT-PATIENT DEPARTMENT TO THE UNIVERSITY CLINIC

bjective: To assess the preferred teaching strategies for undergraduate medical students of clinical sciences. Study Design and Setting: -This cross-sectional study was conducted among the 4th and 5thyear students of clinical sciences at Al-Tibri Medical College and Hospital Isra University. Karachi campus. Methodology: All medical students of 4th and 5th year were enrolled and included for this study from May 2018 to June 2018 and absentees were excluded. A questionnaire was given to students in which they opted for the best teaching aid and strategy. Data was collected and analysed by principle Investigator. Demographic variables included were gender and year of M.B.B.S. Descriptive statistics was carried out via frequency and percentages. Results: A total of 166 Students, 82 from 4th year and 84 from 5th year were reviewed. Among 4th year students; preference in academic teaching aids were white boards and multimedia and were equally preferred and for clinical teaching the most preferred aid was Out Patient Department (OPD)/clinical rotation. Among 5th year medical students’ multimedia was most preferred for academic teaching and for clinical teaching the most preferred teaching aid was clinical based learning, i.e. 32 (38.1%). Conclusion: White board, multimedia, were the most preferred teaching methods for academic teaching and bed side teaching and clinical based learning were highly preferred teaching method for clinical teaching among both cohorts of 4th and 5th year medical students. Therefore, approaches for improvement of the preferred teaching methods and establishing better facilities for students can be improve both knowledge and skills among clinical students