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Objectives: This study aimed to explore the incidence of and potential risk factors for adverse drug reactions (ADRs) after non-ionic iodinated contrast media (NICM) administration for CT exams in out-patient settings in China. Materials and methods: A total of 473,482 out-patients who underwent intravenous NICM between January 1st, 2017, and Dec 31st, 2021, were retrospectively enrolled from three institutions. The occurrence of ADRs and clinical information were recorded. Chi-square test, Poisson regression, and logistic regression analyses were used to evaluate potential ADR risk factors and correlation with demographics, season, and NICM type. Results: Among the 473,482 patients (mean age 55.22 ± 14.85; 253,499 male) who received intravenous NICM, the overall ADR incidence was 0.110% (522 of 473,482), with 0.099% acute-related drug reactions (469 of 473,482) and 0.0004% serious ADRs (two of 473,482). Iopromide was associated with a higher risk of acute ADRs. Late ADRs were more frequently observed with iodixanol 320. Multi-level logistic regression of patients with acute ADRs and a control group (matched 1:1 for age, gender, NICM, prescriber department, and institution) showed that summer (adjusted OR = 1.579; p = 0.035) and autumn (adjusted OR = 1.925; p < 0.001) were risk factors of acute ADRs. However, underlying disease and scanned body area were not related to a higher ADR incidence. Conclusion: The use of NICM for out-patients is in general safe with a low ADR incidence. The type of contrast medium (iopromide) and the seasons (summer and autumn) were associated with a higher risk of acute ADRs. Late ADRs were more often observed with iodixanol. Clinical relevance statement: In comparison to in-patients, out-patients may be exposed to higher risk due to a lack of extensive risk screening, less nursing care, and higher throughput pressure. Safety data about NICM from a large population may complement guidelines and avoid ambiguity. Key Points: • The incidence and risk factors for adverse events after using non-ionic iodinated contrast media are complex in out-patients. • Non-ionic iodinated contrast media are safe for out-patients and the overall incidence of adverse drug reactions was 0.110%. • There is a higher risk of acute adverse drug reactions in summer and autumn. [ABSTRACT FROM AUTHOR]

(1) Background: The surgical procedure to create an arteriovenous fistula (AVF) can be performed in either an ambulatory or in-patient hospital setting, depending on the case's complexity, the anesthesia type used, and the patient's comorbidities. The main scope of this study is to assess the cost-effectiveness and clinical implications of surgically creating an AVF in both ambulatory and in-hospital settings. (2) Methods: We conducted a retrospective observational study, in which we initially enrolled all patients with end-stage kidney disease (ESKD) admitted to the Vascular Surgery Department, Emergency County Hospital of Targu Mures, Romania, to surgically create an AVF for dialysis, between January 2020 and December 2022. The primary endpoint of this study is to assess the cost-effectiveness of surgically creating an AVF in an ambulatory vs. in-hospital setting by comparing the costs required for the two types of admissions. Further, the 116 patients enrolled in this study were divided into two groups based on their preference for hospitalization: out-patients and in-patients. (3) Results: Regarding in-patient comorbidities, there was a higher prevalence of peripheral artery disease (PAD) (p = 0.006), malignancy (p = 0.020), and previous myocardial infarction (p = 0.012). In addition, active smoking (p = 0.006) and obesity (p = 0.018) were more frequent among these patients. Regarding the laboratory data, the in-patients had lower levels of white blood cells (WBC) (p = 0.004), neutrophils count (p = 0.025), lymphocytes (p = 0.034), and monocytes (p = 0.032), but there were no differences between the two groups regarding the systemic inflammatory biomarkers or the AVF type. Additionally, we did not register any difference regarding the outcomes: local complications (p = 0.588), maturation failure (p = 0.267), and primary patency (p = 0.834). In our subsequent analysis, we discovered no significant difference between the hospitalization type chosen by patients regarding AVF primary patency failure (p = 0.195). We found no significant association between the hospitalization type and the recorded outcomes (all ps > 0.05) in both multivariate linear regression and Cox proportional hazard analysis. (4) Conclusions: In conclusion, there are no significant differences in the clinical implications, short-term and long-term complications of AVF for out-patient and in-patient admissions. Additionally, we found no variation in the costs associated with laboratory tests and surgical supplies for an AVF creation. Therefore, it is safe to perform ambulatory AVFs, which can reduce the risk of hospital-acquired infections and provide greater comfort to the patient. [ABSTRACT FROM AUTHOR]

Hypertension is a poorly controlled risk factor for cardiovascular disease in South Africa, particularly among patients receiving care in the public sector who are mostly from low socioeconomic backgrounds. This cross-sectional study investigated uncontrolled hypertension, treatment, and predictors among hypertensive out-patients attending primary health care facilities in Johannesburg, South Africa. The WHO STEPwise approach to the surveillance of non-communicable diseases was used to collect data, including sociodemographic and lifestyle factors, health status, and measurements for anthropometry and blood pressure along with self-reported adherence to treatment, estimated through the general medication adherence scale. Uncontrolled hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg in diagnosed patients receiving anti-hypertensive treatment. Overweight and obesity were defined as a body mass index ≥25 and ≥30 kg/m2, respectively. Logistic regression models were used to assess the predictors of uncontrolled hypertension. Four hundred (n = 400) hypertensive out-patients (mean age: 50 ± 8 years) participated in this study, with most living in poor sociodemographic environments. The prevalence rate of uncontrolled hypertension was 57%. Obesity (62% vs. 42%, p ≤ 0.0001), salt consumption (90% vs. 55%, p ≤ 0.0001), alcohol intake (42% vs. 19%, p ≤ 0.0001), a smoking habit (23% vs. 4%, p ≤ 0.0001), alternative medicine use (51% vs. 40%, p = 0.043), and comorbidities (64% vs. 36%, p ≤ 0.0001) were higher in the uncontrolled group than the controlled group, whereas the prevalence of physical activity (38% vs. 15%, p ≤ 0.0001) was high in the controlled group vs. the uncontrolled. Overall, 85% of the patients moderately adhered to treatment, only 2% exhibited high adherence, and 13% demonstrated low adherence; over half of the patients received tri-therapy treatment. The predictors of uncontrolled hypertension are a number of prescribed antihypertensive therapies [adjusted odds ration = 2.39; 95% confidence interval: 1.48–3.87], treatment adherence [0.46; 0.21–0.97], salt consumption [28.35; 7.87–102.04], physical activity [0.22; 0.13–0.37], current alcohol use [2.10; 1.22–3.61], and current cigarette smoking [4.79; 1.88–12.18]. The high prevalence of uncontrolled hypertension in this study suggests a need to optimize prescriptions, adherence to BP-lowering medications, and lifestyle modifications. The management of comorbidities such as diabetes could offer considerable benefits in controlling blood pressure. [ABSTRACT FROM AUTHOR]

Background Although effective treatments for bulimic-spectrum eating disorders exist, access is often delayed because of limited therapist availability and lengthy waiting lists. Web-based self-help interventions have the potential to bridge waiting times for face-to-face treatment and overcome existing treatment gaps. Aims This study aims to assess the effectiveness of a web-based guided self-help intervention (everyBody Plus) for patients with bulimia nervosa, binge eating disorder and other specified feeding and eating disorders who are waiting for out-patient treatment. Method A randomised controlled trial was conducted in Germany and the UK. A total of 343 patients were randomly assigned to the intervention ‘everyBody Plus’ or a waitlist control condition. The primary outcome was the number of weeks after randomisation until a patient achieved a clinically relevant improvement in core symptoms for the first time. Secondary outcomes included eating disorder attitudes and behaviours, and general psychopathology. Results At 6- and 12-month follow-up, the probability of being abstinent from core symptoms was significantly larger for the intervention group compared with the control group (hazard ratio: 1.997, 95% CI 1.09–3.65; P = 0.0249). The intervention group also showed larger improvements in eating disorder attitudes and behaviours, general psychopathology, anxiety, depression and quality of life, compared with the control group at most assessment points. Working alliance ratings with the online therapist were high. Conclusions The self-help intervention everyBody Plus, delivered with relatively standardised online guidance, can help bridge treatment gaps for patients with bulimic-spectrum eating disorders, and achieve faster and greater reductions in core symptoms.

(1) Background: The surgical procedure to create an arteriovenous fistula (AVF) can be performed in either an ambulatory or in-patient hospital setting, depending on the case’s complexity, the anesthesia type used, and the patient’s comorbidities. The main scope of this study is to assess the cost-effectiveness and clinical implications of surgically creating an AVF in both ambulatory and in-hospital settings. (2) Methods: We conducted a retrospective observational study, in which we initially enrolled all patients with end-stage kidney disease (ESKD) admitted to the Vascular Surgery Department, Emergency County Hospital of Targu Mures, Romania, to surgically create an AVF for dialysis, between January 2020 and December 2022. The primary endpoint of this study is to assess the cost-effectiveness of surgically creating an AVF in an ambulatory vs. in-hospital setting by comparing the costs required for the two types of admissions. Further, the 116 patients enrolled in this study were divided into two groups based on their preference for hospitalization: out-patients and in-patients. (3) Results: Regarding in-patient comorbidities, there was a higher prevalence of peripheral artery disease (PAD) (p = 0.006), malignancy (p = 0.020), and previous myocardial infarction (p = 0.012). In addition, active smoking (p = 0.006) and obesity (p = 0.018) were more frequent among these patients. Regarding the laboratory data, the in-patients had lower levels of white blood cells (WBC) (p = 0.004), neutrophils count (p = 0.025), lymphocytes (p = 0.034), and monocytes (p = 0.032), but there were no differences between the two groups regarding the systemic inflammatory biomarkers or the AVF type. Additionally, we did not register any difference regarding the outcomes: local complications (p = 0.588), maturation failure (p = 0.267), and primary patency (p = 0.834). In our subsequent analysis, we discovered no significant difference between the hospitalization type chosen by patients regarding AVF primary patency failure (p = 0.195). We found no significant association between the hospitalization type and the recorded outcomes (all ps > 0.05) in both multivariate linear regression and Cox proportional hazard analysis. (4) Conclusions: In conclusion, there are no significant differences in the clinical implications, short-term and long-term complications of AVF for out-patient and in-patient admissions. Additionally, we found no variation in the costs associated with laboratory tests and surgical supplies for an AVF creation. Therefore, it is safe to perform ambulatory AVFs, which can reduce the risk of hospital-acquired infections and provide greater comfort to the patient.

Many patients referred for psychodynamic psychotherapy are also seen by other services. Due to the complex interplay between psychological distress, physical symptoms and care-seeking behaviour, engagement with a psychotherapy department has the potential either to increase or decrease use of other services. This service evaluation compared 268 patients' service use in the year preceding and following contact with an NHS psychodynamic psychotherapy department using t-tests. There were no significant changes from before therapy to afterwards for the sample as a whole. However, for sub-groups who made regular use of services at baseline, a full course of psychotherapy (16+ sessions) was associated with a statistically significant reduction in outpatient contacts, both for mental health (N = 32, mean 11.69 appointment per year pre-therapy vs 5.16 post-therapy, p = 0.01) and medical services (N = 23, from mean 9.65 to 3.00, p < 0.01). No compensatory changes were found in either A&E or inpatient contacts, suggesting this represents an overall reduction in service use. Due to the study design, it was not possible to establish causality; there may be other reasons for this observed reduction such as natural illness course. These findings tentatively support the existing literature that psychodynamic psychotherapy is associated with a reduction in use of wider services. [ABSTRACT FROM AUTHOR]

Abstract Background Pediatric physiotherapists help children to achieve their optimal physical development. The present study was aimed to evaluate the out-patient pediatric conditions managed by physiotherapists in Federal Medical Centre, Abeokuta, Nigeria (FMCA). Methods The present study included all children attended to at Pediatric Unit (outpatient) of FMCA in the period between the beginnings of May 20121 to the end of May 2022. The clinic runs every Tuesdays and Thursdays. All children below and equals to 15 years of age were included. Complete clinical, socio-demographic characteristics of patients and parents were manually scrapped from the electronic medical records (EMR) of the hospital. Descriptive statistics was used to present the results. Results During this period a total of 160 patients presented with different disorders were seen. There were 100 males (62.5%) and 60 females (37.5%). Cerebral palsy which can be classified as a neurological disorder was the most common condition managed (63.7%). Obstetric brachial palsy injury (OBPI), injection palsy, post-immobilization stiffness, congenital talipes equinivarus, and among others were managed during this period. Cerebral palsy was common among males, obstetric brachial palsy injury, and injection palsy. Cerebral palsy patients had late presentation for physiotherapy (1–5 years). Only 2 patients out of 11 with OBPI came for early physiotherapy. There is higher risk for cerebral palsy and OBPI among primiparous mothers. Conclusions It was concluded that neurological disorders are the most common pediatric cases managed by physiotherapists in Federal Medical Centre, Abeokuta, with cerebral palsy having higher prevalence.

Abstract Background Over 70% of individuals with type 2 diabetes mellitus (T2DM) may have metabolic syndrome in sub-Saharan Africa. Evidence about the prevalence, clustering, and determinants of metabolic syndrome components is needed to guide the implementation of interventions to prevent cardiovascular diseases in low-income countries. Methods A clinic-based cross-sectional study was conducted among 430 out-patients attending two-selected diabetes mellitus clinics in the Bono Region of Ghana. Data was collected in June 2016 among participants aged 30–79 years. The prevalence of metabolic syndrome was assessed using the harmonized definition. Patients were interviewed using semi-structured questionnaires and T2DM status was confirmed by reviewing medical records. The components of MS that were assessed included body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, high-density lipoprotein (HDL)-cholesterol, and blood glucose. Multiple logistic regression models were constructed to evaluate the risk factors of MS. Results The mean age of participants was 58.8 ± 11.49 years. The prevalence of MS was 68.6% (95% CI: 64.0–72.8), higher among women (76.3%, 95% CI: 70.6–81.2) than men (58.0%, 95% CI: 35.0–49.4) and in the 50–59-year age group (32.1%). The majority of participants [248 (57.7%)] had either two [124 (28.8%)] or four [124 (28.8%)] components of MS. Excluding fasting blood glucose (78.4%), the predominant components of MS identified in the study were reduced HDL cholesterol (70.2%), high waist circumference (60.9%), and elevated systolic blood pressure (49.8%). The study found that the odds of MS in women are 2.2-fold higher than in men (95% CI: 1.29–3.58, p = 0.003). Duration of T2DM (OR 5.2, 95% CI: 2.90–9.31, p

Hypertension is a poorly controlled risk factor for cardiovascular disease in South Africa, particularly among patients receiving care in the public sector who are mostly from low socioeconomic backgrounds. This cross-sectional study investigated uncontrolled hypertension, treatment, and predictors among hypertensive out-patients attending primary health care facilities in Johannesburg, South Africa. The WHO STEPwise approach to the surveillance of non-communicable diseases was used to collect data, including sociodemographic and lifestyle factors, health status, and measurements for anthropometry and blood pressure along with self-reported adherence to treatment, estimated through the general medication adherence scale. Uncontrolled hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg in diagnosed patients receiving anti-hypertensive treatment. Overweight and obesity were defined as a body mass index ≥25 and ≥30 kg/m2, respectively. Logistic regression models were used to assess the predictors of uncontrolled hypertension. Four hundred (n = 400) hypertensive out-patients (mean age: 50 ± 8 years) participated in this study, with most living in poor sociodemographic environments. The prevalence rate of uncontrolled hypertension was 57%. Obesity (62% vs. 42%, p ≤ 0.0001), salt consumption (90% vs. 55%, p ≤ 0.0001), alcohol intake (42% vs. 19%, p ≤ 0.0001), a smoking habit (23% vs. 4%, p ≤ 0.0001), alternative medicine use (51% vs. 40%, p = 0.043), and comorbidities (64% vs. 36%, p ≤ 0.0001) were higher in the uncontrolled group than the controlled group, whereas the prevalence of physical activity (38% vs. 15%, p ≤ 0.0001) was high in the controlled group vs. the uncontrolled. Overall, 85% of the patients moderately adhered to treatment, only 2% exhibited high adherence, and 13% demonstrated low adherence; over half of the patients received tri-therapy treatment. The predictors of uncontrolled hypertension are a number of prescribed antihypertensive therapies [adjusted odds ration = 2.39; 95% confidence interval: 1.48–3.87], treatment adherence [0.46; 0.21–0.97], salt consumption [28.35; 7.87–102.04], physical activity [0.22; 0.13–0.37], current alcohol use [2.10; 1.22–3.61], and current cigarette smoking [4.79; 1.88–12.18]. The high prevalence of uncontrolled hypertension in this study suggests a need to optimize prescriptions, adherence to BP-lowering medications, and lifestyle modifications. The management of comorbidities such as diabetes could offer considerable benefits in controlling blood pressure.

The growing burden of non-communicable diseases amidst the largest burden of HIV in South Africa leads to disease combinations of multimorbidity with the complexity of care. We conducted a cross-sectional study to assess multimorbidity, medication adherence, and associated factors among out-patients with chronic diseases in primary health care (PHC) facilities in Tshwane, South Africa. A structured questionnaire was used to collect data on comorbidities and medication adherence, along with socio-demographic and lifestyle factors. Logistic regression models were used to analyse the determinants of multimorbidity and medication adherence. In all 400 patients with chronic diseases (mean age: 47 ± 12 years) living in poor environments, common chronic conditions were hypertension (62%), diabetes (45%), HIV (44%), TB (33%), hypercholesterolemia (18%), and gout (13%). The proportion of concordant comorbidity (i.e., diseases with similar risk profiles and management) was 72%, more than 28% of discordant comorbidity (i.e., diseases not related in pathogenesis or management). Most patients had two coexisting chronic conditions (75%), while few had more than two chronic conditions (23%) and single-occurring conditions (2%). Prevalence rates for common multimorbidity patterns were 25% (HIV and TB), 17% (hypertension and diabetes), 9% (hypertension, diabetes, and hypercholesterolemia), and 2% (hypertension diabetes and HIV), while medication adherence was estimated at 74%. In multivariate analysis, multimorbidity was associated with an older age and lower socio-economic status, while medication non-adherence was associated with a younger age and socio-economic factors. The study highlights the presence of multimorbidity among primary care patients attributed to hypertension, diabetes, HIV, and TB in South Africa with non-adherence to medication in one-third of patients. Policies are needed for education on multimorbidity with a need to optimize lifestyle modifications, perhaps proactive outreach or nursing contact with high-risk patients with public-health-sensitive conditions, such as HIV and/or TB, as well as patients with a history of non-adherence to medications. Considerations should be given to the development of a medication adherence scale for multiple chronic conditions beyond assessing adherence to a single index medication.

Background and purposes : The brief Spanish Zung Self-Rating Anxiety Scale is a ten-item tool available; however, there is little information about its psychometric performance. The study aimed to test the dimensionality, internal consistency, nomological validity, and gender differential item functioning of the scale in patients with chronic obstructive pulmonary disease (COPD) in Colombia. Methods : A psychometric study was designed. It participated in 408 COPD patients aged between 40 and 102 years. Results : The confirmatory factor analysis showed both one- and two-dimension structures with acceptable goodness-of-fit indicators. The brief Spanish Zung Self-Rating Anxiety Scale presented high internal consistency, acceptable nomological validity, and non-gender differential functioning. Conclusions : The brief Spanish Zung Self-Rating Anxiety Scale presents some good indicators of validity and reliability, and it can be used in the measurement of anxiety in COPD patients. [ABSTRACT FROM AUTHOR]

Background: Over 70% of individuals with type 2 diabetes mellitus (T2DM) may have metabolic syndrome in sub-Saharan Africa. Evidence about the prevalence, clustering, and determinants of metabolic syndrome components is needed to guide the implementation of interventions to prevent cardiovascular diseases in low-income countries.Methods: A clinic-based cross-sectional study was conducted among 430 out-patients attending two-selected diabetes mellitus clinics in the Bono Region of Ghana. Data was collected in June 2016 among participants aged 30-79 years. The prevalence of metabolic syndrome was assessed using the harmonized definition. Patients were interviewed using semi-structured questionnaires and T2DM status was confirmed by reviewing medical records. The components of MS that were assessed included body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, high-density lipoprotein (HDL)-cholesterol, and blood glucose. Multiple logistic regression models were constructed to evaluate the risk factors of MS.Results: The mean age of participants was 58.8 ± 11.49 years. The prevalence of MS was 68.6% (95% CI: 64.0-72.8), higher among women (76.3%, 95% CI: 70.6-81.2) than men (58.0%, 95% CI: 35.0-49.4) and in the 50-59-year age group (32.1%). The majority of participants [248 (57.7%)] had either two [124 (28.8%)] or four [124 (28.8%)] components of MS. Excluding fasting blood glucose (78.4%), the predominant components of MS identified in the study were reduced HDL cholesterol (70.2%), high waist circumference (60.9%), and elevated systolic blood pressure (49.8%). The study found that the odds of MS in women are 2.2-fold higher than in men (95% CI: 1.29-3.58, p = 0.003). Duration of T2DM (OR 5.2, 95% CI: 2.90-9.31, p < 0.001) and overweight status (OR 6.1, 95% CI: 3.70-10.07 p < 0.001) were also found to be significant determinants of MS.Conclusions: Metabolic syndrome was common among patients attending routine diabetes mellitus clinics in sub-urban hospitals in the middle belt of Ghana. Significant factors associated with metabolic syndrome included being female, living with diabetes for more than five years, and being overweight. Nationwide advocacy for routine screening and prevention of the syndrome should be initiated to prevent cardiovascular disease and mortality in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Incorporating plant-based diets as a supplement to medical treatment may have a beneficial impact on patients with Crohn's disease, however, research with intervention studies is required., Objective: To investigate the feasibility of a plant-based diet intervention. Secondly, the purpose was to investigate whether such diet may reduce disease activity and enhance quality of life., Materials and Methods: This study was designed as a single arm feasibility study. Outpatients with Crohn's disease in biological therapy were guided over twelve weeks towards a dietary lifestyle change., Outcome Measures: Feasibility concerning recruitment, retention rate and compliance. Secondary outcomes were measures of patient reported outcome questionnaires (PROMS). Paired t-tests were used to examine changes in CO 2 emissions, anthropology, biomarkers, and patient-reported data. Δ-values were used to investigate difference between dietary intake and requirements. Linear regression analyses examined the association between biomarkers and PROMS., Results: In total, 15 participants completed the intervention with easy recruitment and a retention rate at 87.6%. A clinically positive tendency was seen towards improved symptom scores for disease (HBI; p=0.028 and IBDQ; p=0.006) but not for fatigue (IBD-F; p=0.097), although none of these were statistically significant. Adverse effects were decreased protein intake (p=0.69) and slightly reduced muscle mass. It remains unclear to what extent the intervention contributed to the improved self-reported effects although perception of disease activity was improved., Conclusion: This study demonstrates that it is possible to retain patients following a plant-based diet. However, the dietary change required ongoing dietetic support with a focus on anti-inflammatory agents and the still unattainable protein requirements., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: The study assessed the knowledge, attitude and management practices of diabetes patients attending medical out- patient 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.

Abstract Background Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gasses. An acute exacerbation of COPD refers to a flare up or episode where a person breathing becomes worse than normal. An acute exacerbation of COPD refers to a flare up or episode where a person breathing becomes worse than normal. Acute exacerbation in COPD (AECOPD) is frequent in the course of the illness and is the most common reason for medical visits, hospital admissions, and mortality among these patients. Exacerbations of COPD are associated with increased morbidity and mortality. To assess the exposure and severity of acute exacerbations of COPD with COPD Assessment Test (CAT Scale) and mMRC (modified Medical Research Council) Dyspnea scale. Study design was a hospital-based prospective observational study. Study site was conducted at Pulmonology Department of Government General Hospital, Vijayawada. Results The total patients were 197. Out of which, 119 were from In-patient Department (IPD) and 78 were from Out-patient Department (OPD). In this study, males were 167 (85%), among which, IPD were 97 (49%), OPD were 70 (36%), and females were 30 (15%), among which, IPD were 22 (11%), OPD were 8 (4%). Conclusion The morbidity and mortality of COPD have been increased in recent years. This study concludes that there is a relation between risk of acute exacerbations in COPD with habitual history and occupational history. Increase in exposure to occupational hazards, smoking habit leads to an increase in risk of acute exacerbations in COPD patients. The level of severity was more in smokers and the patients who had biomass, organic dust, and mineral exposure. When severity was observed, group D severity is more observed in population according to CAT scale and mMRC dyspnea scale.

Abstract Background Four major non-communicable diseases (NCD), including T2DM, contributed to nearly three-quarters of all deaths worldwide in 2017. Dietary and lifestyle actors associated with NCDs are potentially modifiable. Therefore, this study was conducted to determine the dietary and lifestyle factors associated with T2DM, pre-diabetes, and hypertension among adult outpatients in Manzini, Swaziland. Methods A random sample of 385 subjects aged 18 years and above was selected. The data regarding demographics, socio-economic status, lifestyle behaviour, diet, and physical activities were collected. Additionally, participants’ anthropometric measurements and vital signs were taken. A biochemical examination was done for fasting plasma glucose, and a 2-h oral glucose tolerance test, where necessary. The Statistical Package for Social Sciences (SPSS) version 26 was used for this data analysis, and the level of statistical significance was set at p

Objective: To establish the association between quality of life and depression among COPD patients of the Colombian Caribbean. Method: A cross‐sectional study was carried out with the participation of adult COPD patients. COPD‐related quality of life was quantified with the COPD Assessment Test (CAT) and depression using the Zung 10‐item Self‐rating Depression Scale (SDS‐10). The relationship between COPD‐related quality of life and depression with odds ratios (OR), crude and adjusted, was determined. Results: 408 patients participated in the study. They were aged between 40 and 102 years (mean = 72.9, SD = 10.2) and 58.8% men. Two hundred eighty‐four patients (69.6%) reported worse health status (CAT ≥10), and 114 patients (27.9%) scored for depression (SDS‐10). Patients with worse health status presented more depression (OR = 5.85, 95% CI 3.01–11.36) and after adjusting for gender (OR = 5.70, 95% CI 2.92–11.13). Conclusions: In patients with COPD and CAT ≥10, there is a five times greater risk of depression than patients with CAT <10. However, the relationship may be bidirectional. It is essential to specify the direction of causality in future investigations. [ABSTRACT FROM AUTHOR]

Background: Studies from developed countries have shown that poor premorbid adjustment in patients with schizophrenia is associated with poor outcome. However, similar studies in developing countries like Nigeria are few despite the stability of schizophrenia prevalence across cultures. Aim: The aim of this study was to assess the prevalence and correlates of poor premorbid adjustment amongst outpatients with schizophrenia. Setting: The Neuropsychiatric Hospital, Abeokuta in Ogun State, Nigeria. Methods: The premorbid adjustment of 300 outpatients with schizophrenia was assessed using the premorbid adjustment scale. Pattern and severity of psychosis, overall illness severity, global assessment of functioning and socio-demographic factors were investigated as correlates of premorbid functioning. Results: About half (53.3%) of the respondents had poor premorbid adjustment and most of them were males (56.9%). Poor premorbid adjustment was associated with male gender (χ2 = 7.81, p = 0.005) whilst good premorbid adjustment was associated with no or borderline illness severity (χ2 = 8.26, p = 0.016) as well as no or mild impairment in functioning (χ2 = 7.01, p = 0.029) amongst the respondents. Positive, negative and general symptomatology were predicted by premorbid adjustment at different developmental stages. Conclusion: Consistent with existing literature, poor premorbid adjustment was prevalent amongst patients with schizophrenia in this study and was associated with male gender, poorer clinical outcomes and greater illness severity. Mental health promotion and other preventative approaches are recommended as possible early intervention strategies in dealing with schizophrenia.

This study assessed the association between religiosity and treatment adherence, psychopathology of patients diagnosed with schizophrenia in a Nigerian psychiatric hospital. Duke University Religion Index (DUREL), Morisky Medication Adherence Scale (MMAS-8), Positive and Negative Symptoms Scale (PANSS) were used to measure religiosity, medication adherence and psychopathology, respectively. Organisational Religious Activity (ORA) was defined by DUREL's item 1, Non-Organisational Religious Activity (NORA) by item 2, and Intrinsic Religiosity (IR) by summing items 3, 4 and 5 of the DUREL. PANSS positive subscale was defined by summing PANSS first seven items (P1-P7), PANSS negative by summing next seven items (N1-N7) and general psychopathology dimension by summing last 16 items (G1-G16). Results showed no significant association between all measures of religiosity and medication adherence, and no significant association between ORA and various dimensions of psychopathology. NORA and IR tended to be negatively correlated with PANSS negative psychopathology. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Since the outbreak in China due to coronavirus disease 2019 (COVID-19) various studies have been published describing olfactory and gustatory dysfunction (OGD). Objective: The aim was to investigate the frequency and severity of OGD in SARS-CoV-2 (+) out-patients compared to controls with common cold/flu like symptoms and two negative RT-PCR. Methods: A multicenter cross-sectional study on SARS-CoV-2-positive out-patients (n = 197) and controls (n = 107) from five Spanish Hospitals. Severity of OGD was categorized by visual analogue scale (VAS). Frequency and severity of the chemosensory impairment were analyzed. Results: The frequencies of smell (70.1%) and taste loss (65%) were significantly higher among COVID-19 subjects than in the controls (20.6% and 19.6%, respectively). Simultaneous OGD was more frequent in the COVID-19 group (61.9% vs 10.3%) and they scored higher in VAS for severity of OGD than controls. In the COVID-19 group, OGD was predominant in young subjects 46.5 ± 14.5 and females (63.5%). Subjects with severe loss of smell were younger (42.7 years old vs 45.5 years old), and recovered later (median = 7, IQR = 5.5 vs median = 4, IQR = 3) than those with mild loss of smell. Subjects with severe loss of taste, recovered later in days (median = 7, IQR = 6 vs median = 2, IQR = 2), compared to those with mild loss. Conclusion: OGD is a prevalent symptom in COVID-19 subjects with significant differences compared to controls. It was predominant in young and females subjects. Stratified analysis by the severity of OGD showed that more than 60% of COVID-19 subjects presented a severe OGD who took a longer time to recover compared to those with mild symptoms. [ABSTRACT FROM AUTHOR]

Objective. This study evaluated whether the satisfaction of patients attending a physiotherapy-led postarthroplasty review out-patient clinic was non-inferior to that of patients attending traditional surgeon clinics. Methods. Using a modified nine-item Visit-Specific Satisfaction Instrument (VSQ-9), 50 patients attending the physiotherapy clinic and 50 patients attending surgeon clinics were surveyed. Sample means (± s.d.) were calculated for each domain of the VSQ-9. Non-inferiority testing was performed using 95% confidence intervals (CIs) of the adjusted mean difference to examine whether normalised patient satisfaction scores in the physiotherapy group were no worse than those in the surgeon group. Results. Both groups were satisfied (overall domain; 100% of both groups rated good-excellent). Based on mean item score, there was strong evidence that the satisfaction of the physiotherapy group was non-inferior to that of the surgeon group (adjusted mean difference (physiotherapy - surgeon) in mean score 5.1 (95% CI -0.3, 10.4). Furthermore, the mean differences in all but one of the nine domains were in favour of the physiotherapy group in this study. Conclusion. The satisfaction of patients attending a physiotherapy arthroplasty review clinic is not inferior to that of patients attending traditional surgeon clinics. [ABSTRACT FROM AUTHOR]

Background: Studies from developed countries have shown that poor premorbid adjustment in patients with schizophrenia is associated with poor outcome. However, similar studies in developing countries like Nigeria are few despite the stability of schizophrenia prevalence across cultures. Aim: The aim of this study was to assess the prevalence and correlates of poor premorbid adjustment amongst outpatients with schizophrenia. Setting: The Neuropsychiatric Hospital, Abeokuta in Ogun State, Nigeria. Methods: The premorbid adjustment of 300 outpatients with schizophrenia was assessed using the premorbid adjustment scale. Pattern and severity of psychosis, overall illness severity, global assessment of functioning and socio-demographic factors were investigated as correlates of premorbid functioning. Results: About half (53.3%) of the respondents had poor premorbid adjustment and most of them were males (56.9%). Poor premorbid adjustment was associated with male gender (χ² = 7.81, p = 0.005) whilst good premorbid adjustment was associated with no or borderline illness severity (χ² = 8.26, p = 0.016) as well as no or mild impairment in functioning (χ² = 7.01, p = 0.029) amongst the respondents. Positive, negative and general symptomatology were predicted by premorbid adjustment at different developmental stages. Conclusion: Consistent with existing literature, poor premorbid adjustment was prevalent amongst patients with schizophrenia in this study and was associated with male gender, poorer clinical outcomes and greater illness severity. Mental health promotion and other preventative approaches are recommended as possible early intervention strategies in dealing with schizophrenia. [ABSTRACT FROM AUTHOR]

Background: Although effective treatments for bulimic-spectrum eating disorders exist, access is often delayed because of limited therapist availability and lengthy waiting lists. Web-based self-help interventions have the potential to bridge waiting times for face-to-face treatment and overcome existing treatment gaps., Aims: This study aims to assess the effectiveness of a web-based guided self-help intervention (everyBody Plus) for patients with bulimia nervosa, binge eating disorder and other specified feeding and eating disorders who are waiting for out-patient treatment., Method: A randomised controlled trial was conducted in Germany and the UK. A total of 343 patients were randomly assigned to the intervention 'everyBody Plus' or a waitlist control condition. The primary outcome was the number of weeks after randomisation until a patient achieved a clinically relevant improvement in core symptoms for the first time. Secondary outcomes included eating disorder attitudes and behaviours, and general psychopathology., Results: At 6- and 12-month follow-up, the probability of being abstinent from core symptoms was significantly larger for the intervention group compared with the control group (hazard ratio: 1.997, 95% CI 1.09-3.65; P = 0.0249). The intervention group also showed larger improvements in eating disorder attitudes and behaviours, general psychopathology, anxiety, depression and quality of life, compared with the control group at most assessment points. Working alliance ratings with the online therapist were high., Conclusions: The self-help intervention everyBody Plus, delivered with relatively standardised online guidance, can help bridge treatment gaps for patients with bulimic-spectrum eating disorders, and achieve faster and greater reductions in core symptoms.

ObjectiveThe study aimed to evaluate the association between disease knowledge and medication adherence in patients with type 2 diabetes mellitus.MethodsA cross-sectional study was conducted for three months, in patients with type 2 diabetes who visited three community pharmacies located in Khobar, Saudi Arabia. Patients’ disease knowledge and their adherence to medications were documented using Arabic versions of the Michigan Diabetes Knowledge Test and the General Medication Adherence Scale respectively. Data were analyzed through SPSS version 23. Chi-square test was used to report association of demographics with adherence. Spearman’s rank correlation was employed to report the relationship among HbA1c values, disease knowledge and adherence. Logistic regression model was utilized to report the determinants of medication adherence and their corresponding adjusted odds ratio. Study was approved by concerned ethical committee (IRB-UGS-2019-05-001).ResultsA total of 318 patients consented to participate in the study. Mean HbA1c value was 8.1%. A third of patients (N = 105, 33%) had high adherence and half of patients (N = 162, 50.9%) had disease knowledge between 51% - 75%. A significantly weak-to-moderate and positive correlation (ρ = 0.221, p < 0.01) between medication adherence and disease knowledge was reported. Patients with >50% correct answers in the diabetes knowledge test questionnaire were more likely to be adherent to their medications (AOR 4.46, p < 0.01).ConclusionDisease knowledge in most patients was average and half of patients had high-to-good adherence. Patients with better knowledge were 4 to 5 times more likely to have high adherence. This highlights the importance of patient education and awareness regarding medication adherence in managing diabetes.

Background: The prescription error is a failure in the prescription writing process leading to wrong instructions about the identity of the recipient, the identity of the drug, the formulation, dose, route, timing, frequency, and duration of administration. This study is an effort directed to find errors in prescription writing and interventions to improve on such error-prone practices of prescription writing. Methods: This was a cross-sectional, observational study conducted to analyze the prescription writing errors in the outpatient department in the rural area of Anand district of Central Gujarat. Prescriptions were collected from two nearby rural areas of Anand city-Petlad and Anklav. The prescription copies so-obtained were analyzed as per the WHO guidelines for “Prescription Writing Errors.” Results: Overall, 191 prescriptions were collected from both rural areas in the study. The highest number of prescriptions was collected from general practitioners, followed by surgeons and gynecologists. Name, qualification, and address of prescribers were mentioned in all the prescriptions while registration number was mentioned only in 14.10% of prescriptions. The esoteric symbol was mentioned in 63% of prescriptions. Prescribers signed their prescription only in 48% of prescriptions. A total of 420 drugs were prescribed to the patients in the study. All but one drug were prescribed by brand name. Dosage form and route of administration of drugs were mentioned in >60% of drugs. Conclusion: Most medical schools provide some training in prescribing to medical undergraduates; however, this training is perceived to be suboptimal by medical students and junior doctors. Such training programs are the need of the hour.

Background: Four major non-communicable diseases (NCD), including T2DM, contributed to nearly three-quarters of all deaths worldwide in 2017. Dietary and lifestyle actors associated with NCDs are potentially modifiable. Therefore, this study was conducted to determine the dietary and lifestyle factors associated with T2DM, pre-diabetes, and hypertension among adult outpatients in Manzini, Swaziland.Methods: A random sample of 385 subjects aged 18 years and above was selected. The data regarding demographics, socio-economic status, lifestyle behaviour, diet, and physical activities were collected. Additionally, participants' anthropometric measurements and vital signs were taken. A biochemical examination was done for fasting plasma glucose, and a 2-h oral glucose tolerance test, where necessary. The Statistical Package for Social Sciences (SPSS) version 26 was used for this data analysis, and the level of statistical significance was set at p < 0.05.Results: A total of 385 (197 men and 188 women) subjects aged 18 years and older participated in the study. The overall prevalence of hypertension was 48.3%, while the prevalence of hypertension stage 1 and 2 were 29.4 and 19%, respectively. Smoking, SES and consumption of sweet drinks, salty processed foods, fruits, and vegetables were significantly associated with T2DM. However, in the multivariate analysis, only consumption of vegetables (p < 0.0001), fruits (p =0.014), sweet drinks (p = 0.042), and salty processed foods (p = 0.005) remained significantly associated with T2DM. Smoking (p = 0.002) and consumption of fruits (p < 0.0001), vegetables (p < 0.0001), and sweet drinks (p = 0.043) were independently associated with pre-diabetes, while the consumption of vegetables (p = 0.002) and salty processed foods (p = 0.003) were the factors independently associated with hypertension.Conclusions: The factors associated with T2DM, pre-diabetes, and hypertension are potentially modifiable. Therefore, interventions which target lifestyle changes at primary health care and population levels are warranted to address the growing burden of these chronic conditions in Swaziland. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to evaluate the association between disease knowledge and medication adherence in patients with type 2 diabetes mellitus. Methods: A cross-sectional study was conducted for three months, in patients with type 2 diabetes who visited three community pharmacies located in Khobar, Saudi Arabia. Patients' disease knowledge and their adherence to medications were documented using Arabic versions of the Michigan Diabetes Knowledge Test and the General Medication Adherence Scale respectively. Data were analyzed through SPSS version 23. Chi-square test was used to report association of demographics with adherence. Spearman's rank correlation was employed to report the relationship among HbA1c values, disease knowledge and adherence. Logistic regression model was utilized to report the determinants of medication adherence and their corresponding adjusted odds ratio. Study was approved by concerned ethical committee (IRB-UGS-2019-05-001). Results: A total of 318 patients consented to participate in the study. Mean HbA1c value was 8.1%. A third of patients (N = 105, 33%) had high adherence and half of patients (N = 162, 50.9%) had disease knowledge between 51% - 75%. A significantly weak-to-moderate and positive correlation (ρ = 0.221, p < 0.01) between medication adherence and disease knowledge was reported. Patients with >50% correct answers in the diabetes knowledge test questionnaire were more likely to be adherent to their medications (AOR 4.46, p < 0.01). Conclusion: Disease knowledge in most patients was average and half of patients had high-to-good adherence. Patients with better knowledge were 4 to 5 times more likely to have high adherence. This highlights the importance of patient education and awareness regarding medication adherence in managing diabetes. [ABSTRACT FROM AUTHOR]

A large proportion of consultant time is spent in outpatient practice. This setting provides an excellent learning environment for different levels of a trainee if well organised. This article describes an evidence-based teaching approach and its evaluation by trainees, patients and carers in a typical district general hospital setting which it is hoped others might find helpful. [ABSTRACT FROM AUTHOR]

The study is aimed towards the assessment and improvement of complex informational, healthcare, and medical processes existing in the distributed environment during monitoring and providing healthcare services to patients with chronic diseases. The study is performed within a framework of a project for development a complex unified medical information system capable to work on large scale (on population-level). The presented experimental studies show that predictive modelling enables unified detection of remote patients' state using self-measuring and distributed electronic health records. In addition, an experimental mobile application is presented as a tool for data collection and user-system interaction during chronic disease monitoring and treatment. [ABSTRACT FROM AUTHOR]

Salivary alpha-amylase has been implemented as renewed non-invasive biomarker of interest to measure the levels of stress in humans. In the current clinical study, two-factor repeated-measures cross-sectional design was implemented to determine the salivary alpha-amylase levels and its rhythm characteristics in newly diagnosed female breast cancer in- and out-patients. Alpha-amylase levels were determined using the Salimetrics® salivary alpha-amylase assay kit. Rhythm characteristics of alpha-amylase were computed using the Cosinor Rhythmometry technique. Results showed that the levels of alpha-amylase significantly increased from/to the increasing number of chemotherapy cycle in patients of both group; however the levels were higher in in-patients. Further, results revealed significant differences in rhythm characteristics of alpha-amylase characterized by higher MESOR, lower amplitude, and advanced acrophase in in-patients as compared to out-patients. Current findings indicate that patients of both the groups were associated with progression under stress levels across the number of chemotherapy cycle; however, the levels of stress were higher in in-patients as compared to out-patients. Higher level of stress in cancer in-patients could be attributed to the possible effect of hospitalization and/or relative social isolation. [ABSTRACT FROM AUTHOR]

The growing burden of non-communicable diseases amidst the largest burden of HIV in South Africa leads to disease combinations of multimorbidity with the complexity of care. We conducted a cross-sectional study to assess multimorbidity, medication adherence, and associated factors among out-patients with chronic diseases in primary health care (PHC) facilities in Tshwane, South Africa. A structured questionnaire was used to collect data on comorbidities and medication adherence, along with socio-demographic and lifestyle factors. Logistic regression models were used to analyse the determinants of multimorbidity and medication adherence. In all 400 patients with chronic diseases (mean age: 47 ± 12 years) living in poor environments, common chronic conditions were hypertension (62%), diabetes (45%), HIV (44%), TB (33%), hypercholesterolemia (18%), and gout (13%). The proportion of concordant comorbidity (i.e., diseases with similar risk profiles and management) was 72%, more than 28% of discordant comorbidity (i.e., diseases not related in pathogenesis or management). Most patients had two coexisting chronic conditions (75%), while few had more than two chronic conditions (23%) and single-occurring conditions (2%). Prevalence rates for common multimorbidity patterns were 25% (HIV and TB), 17% (hypertension and diabetes), 9% (hypertension, diabetes, and hypercholesterolemia), and 2% (hypertension diabetes and HIV), while medication adherence was estimated at 74%. In multivariate analysis, multimorbidity was associated with an older age and lower socio-economic status, while medication non-adherence was associated with a younger age and socio-economic factors. The study highlights the presence of multimorbidity among primary care patients attributed to hypertension, diabetes, HIV, and TB in South Africa with non-adherence to medication in one-third of patients. Policies are needed for education on multimorbidity with a need to optimize lifestyle modifications, perhaps proactive outreach or nursing contact with high-risk patients with public-health-sensitive conditions, such as HIV and/or TB, as well as patients with a history of non-adherence to medications. Considerations should be given to the development of a medication adherence scale for multiple chronic conditions beyond assessing adherence to a single index medication., Competing Interests: The authors declare no conflict of interest.

Background: The prescription error is a failure in the prescription writing process leading to wrong instructions about the identity of the recipient, the identity of the drug, the formulation, dose, route, timing, frequency, and duration of administration. This study is an effort directed to find errors in prescription writing and interventions to improve on such error-prone practices of prescription writing. Methods: This was a cross-sectional, observational study conducted to analyze the prescription writing errors in the outpatient department in the rural area of Anand district of Central Gujarat. Prescriptions were collected from two nearby rural areas of Anand city-Petlad and Anklav. The prescription copies so-obtained were analyzed as per the WHO guidelines for “Prescription Writing Errors.” Results: Overall, 191 prescriptions were collected from both rural areas in the study. The highest number of prescriptions was collected from general practitioners, followed by surgeons and gynecologists. Name, qualification, and address of prescribers were mentioned in all the prescriptions while registration number was mentioned only in 14.10% of prescriptions. The esoteric symbol was mentioned in 63% of prescriptions. Prescribers signed their prescription only in 48% of prescriptions. A total of 420 drugs were prescribed to the patients in the study. All but one drug were prescribed by brand name. Dosage form and route of administration of drugs were mentioned in >60% of drugs. Conclusion: Most medical schools provide some training in prescribing to medical undergraduates; however, this training is perceived to be suboptimal by medical students and junior doctors. Such training programs are the need of the hour. [ABSTRACT FROM AUTHOR]

Prescriptions comprising multi-drug therapy mostly illustrate the prescribing error. The phenomenon of error is bonded with human inaccuracy. The erroneous practice is observed in under developed countries like Pakistan, Bangladesh and also in developed ones. Consequently drug-drug interaction is one of the most common error associated with potentially serious adverse response even death. Accordingly the present study was conducted to assess the prevalence of prescribing errors and drug-drug interactions in out-patients receiving angiotensin receptor blockers. The study was done with population size one hundred fifty prescriptions obtained from different out-patient settings in Karachi. The prescriptions were screened for prescribing errors and risk factors for drug-drug interactions. Drug-drug interactions were recognized by Micromedex.2.0.Drug-Reax®database. The most common type of error was omission error. These errors were patient's age, weight and diagnosis found in 51.3%, 97.3% and 74% of prescriptions, respectively. The prevalence of drug-drug interaction was 38%. A total of 746 drugs were prescribed with an average of 5 drugs per prescription and 450 medication errors were detected. Majority of the interaction were moderate (19.33%), others were minor (14%) and major (6%) in severity. Patients who prescribed many drugs (more than 5 drugs in a while) had a higher risk of developing drug-drug interactions (OR=4.76; 95% CI=2.30-9.64; p=0.0001*).The study data reports the occurrence of prescribing errors in Karachi and also necessitate the need of clinical pharmacist's services in health care system. The step will help to minimize the risk factors by having the drug prescriptions reviewed by the pharmacists. [ABSTRACT FROM AUTHOR]

Unlike normal humans, an alteration in circadian pattern in energy expenditure (EE) has been observed in cancer patients. In the current cross sectional study we examined rhythm characteristics of EE in cancer in- (n = 30) and out-patients (n = 26), and healthy controls (n = 30). EE was assessed non-invasively using an electronic device - the Actical, programmed with data sampling epoch of 60 seconds. All patients and control subjects wore instrument on their non-dominant hand for 3-4 consecutive days. Cosinor rhythmometry was used to determine the rhythm characteristics, such as 24-h average/Mesor, amplitude, and peak/acrophase of EE. Circadian and rhythm quotients were derived from the rhythm characteristics. Two-way ANOVA was employed to determine the effects of factors, 'group' and 'gender' on rhythm characteristics. A significant circadian rhythm in EE was validated in all groups. However, rhythm detection ratio, at 12 h period, was found to be low in both cancer in- and out-patients as compared to controls. Factor 'group' produced significant effect on 24-h average, amplitude, acrophase, rhythm quotient and circadian quotient of EE rhythm. However, effects of factor 'gender' and interaction of both factors was significant on circadian quotient only. At the group level, rhythm characteristics, namely 24-h average, amplitude, and circadian quotient of three groups varied from each other significantly in the following order: in-patient < out-patient < control. In conclusion, EE rhythm deteriorated in both in- and out-patients as compared to control subjects, although the deterioration was more pronounced in cancer in-patients. We suggest that further extensive investigation involving larger sample should be carried out to validate the above findings. [ABSTRACT FROM AUTHOR]

Background: Herbal medications are used worldwide for a variety of diseases and conditions. Patients often elect not to disclose their herbal use history, or health care practitioners fail to enquire about specific alternative therapy. The aim of this study was to assess the conditions most frequently self-treated with herbal remedies by patients visiting a tertiary hospital in Garankuwa, South Africa. Methods: Patients attending an out-patient's clinic at the Dr George Mukhari Academic Hospital were given a questionnaire regarding their use of herbal remedies for various reasons. Assessment was done on past, current, and possible future use of herbal interventions. These interventions were categorised into acute medical conditions, chronic ailments, and cultural uses. Results: Respiratory tract infections were most frequently treated (34%). Other highly ranked uses included protection from evil spirits (32%) and for HIV/AIDS (29%). Digestive ailments (27%), hypertension (18%), and general malaise (17%) accounted forthe remainder. Previous herbal use amounted to 74%, but only 30% indicated that they would use herbal medication in future. Conclusions: Traditional medication plays an important role in many communities in South Africa. For this reason health care workers need to be aware of the conditions most frequently self-treated with herbal remedies. Having knowledge about the incidence of herbal treatment for a specific condition could alert the health care practitioner to possible reasons for unidentifiable drug interactions, adverse events, treatment failure, or even death. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate available and desired sources and types of social-support among hypertensive and type-2-diabetes (T2D) patients. Associations of medication adherence and clinical outcome with access to most available social-support and medicine affordability were subsequently investigated. Design: Cross-sectional questionnaire-guided interview among 250-hypertensive and 200-T2D patients, and review of medical records to retrieve disease-specific clinical parameters. Settings: University College Hospital and Ring-Road State Hospital, Ibadan, southwestern Nigeria. Participants: Adults out-patients with hypertension, T2D, and T2D comorbid with hypertension were enrolled, while in-patients were excluded. Results: Family source of support was the most available [hypertensive (225; 90.0%); T2D (174; 87.0%)], but government and non-governmental organisation support were largely desired, with financial support preferred, 233(93.2%) hypertensive and 190(95.0%) T2D, respectively. Adherent hypertensive patients with or without access to family support were (127; 56.4%) versus (18; 72.0%), p=0.135; while for T2D were (103; 59.2%) versus (21; 80.8%), p=0.035. Mean systolic blood pressure of hypertensive and fasting plasma glucose of T2D with access to family and financial support were better than their counterparts without access (p>0.05). Hypertensive (110; 76.4%) and T2D (87; 87.0%) participants who consistently afford medicine expenses had significantly better adherence and outcome (p<0.05). Conclusions: Family source of support is the most accessible, but government and non-governmental organisation support were largely desired. Access to family support did not positively influence medication adherence, while access to financial support marginally impacted on outcome among hypertensive and T2D patients. However, unwavering tendency for therapy affordability significantly influenced adherence and outcome, thus, the need for expanded social-support system in order to consistently ensure improved outcome. [ABSTRACT FROM AUTHOR]

Background:Psychopathy research has thus far focused mostly on child, male, and delinquent samples, but the results are most likely non-generalizable to adolescent girls with mental health disorders. Aim:The present study aimed to compare self-rated psychopathic traits between female psychiatric outpatients and girls in the community, and to investigate how psychopathic traits relate to psychiatric disorders. Method:The outpatient sample comprised 163 girls aged 15–17-years recruited from municipal mental health services. Psychiatric diagnoses were assessed based on the ICD-10 classification. The community sample comprised 355 girls from secondary, vocational, and high schools. The Youth Psychopathic trait Inventory (YPI) served as a self-assessment tool. Results:Treatment-seeking girls exhibit a more impulsive and irresponsible lifestyle than do girls in the community. Girls with externalizing psychopathology, unlike those with an internalizing disorder, exhibit more deficient affective experience than do girls in the community. Psychopathic traits associate with having a psychiatric disorder, a depressive disorder, ADHD, and a conduct disorder. Conclusions:The psychiatric examination of treatment-seeking adolescent girls would likely benefit from screening for psychopathy and its underlying components. [ABSTRACT FROM PUBLISHER]

Aim: To assess the current dyslipidemia management in the Arabian Gulf region by describing the demographics, study design, and preliminary results of out-patients who achieved low-density lipoprotein cholesterol (LDL-C) goals at the time of the survey., Background: The Arabian Gulf population is at high risk for atherosclerotic cardiovascular disease at younger ages. There is no up-to-date study regarding dyslipidemia management in this region, especially given the recent guideline-recommended LDL-C targets., Objective: Up-to-date comprehensive assessment of the current dyslipidemia management in the Arabian Gulf region, particularly in view of the recent evidence of the additive beneficial effects of ezetimibe and proprotein convertase subtilisin/kexin-9 (PCSK-9) inhibitors on LDL-C levels and cardiovascular outcomes., Methods: The Gulf Achievement of Cholesterol Targets in Out-Patients (GULF ACTION) is an ongoing national observational longitudinal registry of 3000 patients. In this study, adults ≥18 years on lipidlowering drugs for over three months from out-patients of five Gulf countries were enrolled between January 2020 and May 2022 with planned six-month and one-year follow-ups., Results: Of the 1015 patients enrolled, 71% were male, aged 57.9±12 years. In addition, 68% had atherosclerotic cardiovascular disease (ASCVD), 25% of these patients achieved the LDL-C target, and 26% of the cohort were treated using combined lipid-lowering drugs, including statins., Conclusion: The preliminary results of this cohort revealed that only one-fourth of ASCVD patients achieved LDL-C targets. Therefore, GULF ACTION shall improve our understanding of current dyslipidemia management and "guideline gaps" in the Arabian Gulf region., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Tinnitus is an increasingly serious problem for health care systems. According to epidemiological data, 7-14 % of outpatients have asked their physician about tinnitus and management strategies. Integrative outpatient treatments are currently regarded as promising therapeutic approaches for managing tinnitus. In this article we report on the treatment success of an outpatient tinnitus treatment center in Germany.Methods: This cohort study included pre-post data of 5536 outpatients which were treated between 2003 and 2010 in the tinnitus-therapy center, Krefeld-Düsseldorf (TTZ). The intervention consisted of psychological immunization training as well as an auditory stimulation therapy component. The main outcome parameter was the score of the Tinnitus Questionnaire (TQ) which was assessed before and after a 9 days treatment and (in a small subsample) at a 6 months follow-up. Missing data were multiply imputed. Pre-post effect sizes were calculated and adjusted for regression to the mean (RTM).Results: RTM-adjusted treatment effects at the end of treatment were estimated as -18.6 (CI: -18.9 to 18.2, p < 0.001) score points which corresponds to a standardized effect of d = -1.03 (CI: -1.05 to -1.01). These effects can be corroborated in various subgroups and all subscales of the TQ (d ranging from -0.31 to -0.97).Conclusion: The study suggests the effectiveness of this outpatient tinnitus therapy concept. Multiple imputations techniques and RTM analysis were helpful in carving out true treatment effects. [ABSTRACT FROM AUTHOR]