The Complication for Ventricular Shunt Based on Different Etiologies: A Prospective Study in Tehran, Iran

Objectives:The purpose of this study was to evaluate and compare complications caused by VP shunt (based on imaging changes, clinical and laboratory findings) in children with congenital (intrauterine) infections, referred to as TORCH, in contrast to other causes of Shunt insertion in children.Materials and Methods:In this cross-sectional, observational and descriptive study, 68 hospitalized patients in Rasool-Akram Hospital were selected using convenience method during 2 years from 2013 to August, 2016. Clinical examination and organ involvement were determined. Blood sampling, serological and complementary tests were performed to determine the type of infection, cause and duration of shunt insertion, mechanical and infectious complications (meningitis and peritonitis), the course of the disease and finally, mortality and morbidity. All data were collected in questionnaires. Statistical analysis was performed using SPSS-24 version software. The comparison was carried out between two groups of infectious and noninfectious causes. P-value less than 5.5 was considered significant.Results:From total 68 children with VP shunt, 13 patients died (including 8 males and 5 females with a mean age of 69.41 ± 81.57 months-old). The main cause of shunt insertion was infection in 4 patients and tumor, cerebral hemorrhage and myelomeningocele in 9 other children. Shunt-induced meningitis and peritonitis were detected in 92% and 7.7% respectively. The leading causes of shunt insertion In remaining 47 live children (including 27 males and 19 females with a mean age of 63 +83 months) were infectious in 28% and noninfectious in the rest of cases. The shunt mechanical complications were reported in 8.7% (4 patients). Fever was detected in 33% of patients. Positive blood culture and cerebrospinal fluid were reported in 6.8% and 8.5% of patients in that order, but meningitis was detected in 26% (12 cases) and peritonitis in 10.9% (5 cases). Although, there were no significant differences between two groups in terms of mechanical complications such as shunt obstruction, cerebral hemorrhage ;but, a considerable difference was reported in death rate due to shunt insertion between two groups with infectious and noninfectious origin. The risk of shunt-induced meningitis was clearly higher in group with infectious origin. (P-value = 0.05). But peritonitis risk was not different.Conclusion:VP shunt complications were observed in one-quarter of children, but mechanical complications of VP shunt were uncommon (8% in live patients). VP shunt mortality was relatively high (13 patients from total 68), and occurred more often in patients with non-infectious causes of VP shunt, mainly due to meningitis. Shunt meningitis was very common In patients with infectious origin. Shunt infection in patients (meningitis, bacteremia and peritonitis) was common and could increase mortality if not controlled. Prescribing antibiotics is not recommended without initial diagnostic measures (such as spinal fluid puncture, ascites, and proper imaging) because it will result in incomplete and improper treatments.

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Breastfeeding: a potential protective factor against ventriculoperitoneal shunt infection in young infants

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/2/138 ◽

2008 ◽

Vol 1 (2) ◽

pp. 138-141 ◽

Cited By ~ 4

Author(s):

Farideh Nejat ◽

Parvin Tajik ◽

Syed Mohammad Ghodsi ◽

Banafsheh Golestan ◽

Reza Majdzadeh ◽

...

Keyword(s):

Human Milk ◽

Protective Factor ◽

Medical Center ◽

Shunt Infection ◽

Trend Test ◽

Shunt Insertion ◽

Vp Shunt ◽

Young Infants ◽

Significant Difference ◽

Nutritional Benefits

Object Previous studies have shown nutritional benefits of breastfeeding for a child's health, especially for protection against infection. Protective factors in human milk locally and systemically prevent infections in the gastrointestinal as well as upper and lower respiratory tracts. It remains unclear whether breastfeeding protects infants against ventriculoperitoneal (VP) shunt infection. Methods A cohort study was conducted from December 2003 to December 2006 at Children's Hospital Medical Center in Tehran, Iran. A total of 127 infants with hydrocephalus who were treated using a VP shunt in the first 6 months of life were enrolled. Each infant's breastfeeding method was classified as either exclusively breastfed (EBF), combination feedings of breast milk and formula (CFBF), or exclusively formula-fed (EFF). Infants were followed up to determine the occurrence of shunt infection within 6 months after operation. Statistical analysis was performed using survival methods. Results Infants ranged in age from 4 to 170 days at the time of shunt insertion (mean 69.6 days), and 57% were males. Regarding the breastfeeding categories, 57.5% were EBF, 25.2% were CFBF, and 17.3% were EFF. During the follow-up, shunt infection occurred in 16 patients, within 15 to 173 days after shunt surgery (median 49 days). The 6-month risk of shunt infection was 8.5% (95% confidence interval [CI] 4–18%) in the EBF group, 16.5% (95% CI 7–35%) in the CFBF group, and 26.0% (95% CI 12–52%) in the EFF group. There was no statistically significant difference between these 3 groups (p = 0.11). The trend test showed a significant trend between the extent of breastfeeding and the risk of shunt infection (p = 0.035), which persisted even after adjustment for potential confounding variables (hazard ratio = 2.01, 95% CI 1.01–4). Conclusions This study supports the protective effect of breastfeeding against shunt infection during the first 6 months of life and the presence of a dose–response relationship, such that the higher the proportion of an infant's feeding that comes from human milk, the lower the incidence of shunt infection. Encouraging mothers of infants with VP shunts to breastfeed exclusively in the first 6 months of life is recommended.

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Conversion of external ventricular drains to ventriculoperitoneal shunts after aneurysmal subarachnoid hemorrhage: effects of site and protein/red blood cell counts on shunt infection and malfunction

Journal of Neurosurgery ◽

10.3171/jns.2008.109.12.1001 ◽

2008 ◽

Vol 109 (6) ◽

pp. 1001-1004 ◽

Cited By ~ 36

Author(s):

Stylianos Rammos ◽

Jeffrey Klopfenstein ◽

Lori Augsburger ◽

Huan Wang ◽

Anne Wagenbach ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Blood Cell ◽

Red Blood Cell ◽

Shunt Infection ◽

Adult Patients ◽

Shunt Malfunction ◽

Shunt Insertion ◽

Vp Shunt ◽

The Mean

Object The purpose of this study was to determine the incidence of shunt infection in patients with subarachnoid hemorrhage (SAH) after converting an external ventricular drain (EVD) to a ventriculoperitoneal (VP) shunt using the existing EVD site. The second purpose was to assess the risk of shunt malfunction after converting the EVD to a permanent shunt irrespective of the cerebrospinal fluid (CSF) protein and red blood cell (RBC) counts. Methods Data obtained in 80 consecutive adult patients (18 men and 62 women, mean age 60.8 years, range 33–85 years) who underwent direct conversion of an EVD to a VP shunt for post-SAH hydrocephalus between August 2002 and March 2007 were retrospectively reviewed. In each patient, the existing EVD site was used to pass the proximal shunt catheter. In no patient was VP shunt insertion delayed based on preoperative RBC or protein counts. Results The mean period of external ventricular drainage before VP shunt placement was 14.1 days (range 3–45 days). No patient suffered ventriculitis. The mean perioperative CSF protein level was 124 mg/dl (range 17–516 mg/dl). The mean and median perioperative RBC values in CSF were 14,203 RBCs/mm3 and 4600 RBCs/mm3 (range 119–290,000/mm3), respectively. No patient was lost to follow-up. The mean follow-up duration was 24 months (range 2–53 months). Three patients (3.8%) had shunt malfunction related to obstruction of the shunt system after 15 days, 2 months, and 18 months, respectively. There were no shunt-related infections. No patient suffered a clinically significant hemorrhage from ventricular catheter placement after VP shunt insertion. Conclusions In adult patients with aneurysmal SAH, conversion of an EVD to a VP shunt can be safely done using the same EVD site. In this defined patient population, protein and RBC counts in the CSF do not seem to affect shunt survival adversely. Thus, conversion of an EVD to VP shunt should not be delayed because of an elevated protein or RBC count.

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Prevalence and factors related to inappropriate referrals during intrapartum care – a mixed method study

10.21203/rs.3.rs-39844/v1 ◽

2020 ◽

Author(s):

Binyam Fekadu Desta ◽

Bethabile L. Dolamo

Keyword(s):

Qualitative Study ◽

P Value ◽

Second Phase ◽

Hospital Level ◽

Governance System ◽

Chi Square ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Neonatal Deaths ◽

Danger Signs

Abstract Background: Complications during delivery are responsible for half of all maternal deaths, one-third of stillbirths and a quarter of neonatal deaths. The care necessitates emergency care, and it is a known fact that reductions in maternal mortality and morbidity are not possible without an effective referral system. This study is aimed at measuring the prevalence of inappropriate referrals and identifying factors that contribute to it. Methods: The study employed a sequential explanatory mixed research design. In the first phase, a retrospective cross-sectional quantitative study was done, 718 medical records were reviewed. The second phase involved a qualitative study of 26 key informants being interviewed. Results: Three quarters of cases, (74.23%; n=533), who visited the selected hospitals could have been managed at the health center level. Sixty-five percent of them, (n=436), sought care at the hospital level with no referral from the lower level. Further analysis of the data showed no major difference as to the appropriateness of hospital level care in relation to age of mothers, previous medical and obstetrics history as well as danger signs at admission. On the other hand, number of parities, (chi-square = 9.3; P-value = 0.010), frequency of ANC, (chi-square = 6.7; p-value = 0.037) and the institution where ANC was sought, (chi-square = 12.9; p-value = 0.005) were found to be associated with appropriateness of the case for hospital level care. Further inventory of the referred cases revealed that 33.2% of referred cases were appropriate for hospital level care. In addition, the qualitative study identified three major themes in relation to appropriateness of referrals: capability of identifying appropriate cases for referral, proper initiation of the referral process determining the outcome and functional cross-facility support platforms for better collaboration and coordination between facilities. Conclusion: Referral, which is the coordination between facilities, requires readiness of the facilities at both ends as well as a transportation system. The governance system should also be strengthened to ensure the emergency management system in the country is effective.

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Association of cord blood and maternal lipid profile

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20200211 ◽

2020 ◽

Vol 7 (3) ◽

pp. 478

Author(s):

Noor Fathima S. Zohra ◽

Anitha S. Prabhu ◽

Smitha B. Rao ◽

Prakash R. M. Saldanha

Keyword(s):

Cord Blood ◽

Lipid Profile ◽

Venous Blood ◽

Colorimetric Method ◽

P Value ◽

Lipid Levels ◽

Blood Lipid Profile ◽

College Hospital ◽

Cross Sectional ◽

Mortality And Morbidity

Background: Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity with dyslipidemia as an important contributing risk factor. Objective of the study was to determine whether there is an association between maternal lipid profile and the cord blood lipid profile of their newborns.Methods: This was a hospital-based Cross-sectional study on 60 mothers and their respective newborns (30 term and 30 preterm) conducted in Yenepoya medical college hospital from August to November 2019. Umbilical cord blood samples from the newborns were collected after birth and the mother's venous blood was collected in the fasting state (8hrs of fasting) before delivery. The levels of total cholesterol, triglycerides, HDL, LDL and VLDL were determined in mothers and their newborns by an enzymatic colorimetric method. Data obtained was analyzed by the SSPS software 23.0 version and Pearson's correlation was done.Results: There was a significant correlation between the mean concentration of maternal Triglycerides and the Triglycerides and HDL levels of neonates (p-value <0.05).Conclusions: There was a significant association of cord blood and maternal lipid profile, hence changes in maternal lipid levels might influence the lipid levels in the cord blood of newborns.

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Clinical Outcome of Meningitis and Its Risk Factors Among Children Admitted in Debre Markos Referral Hospital Pediatric Ward, Northwest Ethiopia,2019

10.21203/rs.3.rs-36044/v1 ◽

2020 ◽

Author(s):

Hailemariam Abiy ◽

Zelalem Shiferaw ◽

Yilkal Tafere

Keyword(s):

Risk Factors ◽

Health Care Team ◽

Cross Sectional Study ◽

Northwest Ethiopia ◽

Referral Hospital ◽

P Value ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Debre Markos ◽

Hospital Pediatric

Abstract Background:Meningitis remains a major cause of mortality and morbidity in patients in many countries of the world including Ethiopia. This study aimed to assess clinical outcomes and associated risk factors of meningitis among children who were admitted to Debre Markos Referral Hospital from January 2017 to December 2018.A backward stepwise multivariable logistic regression was applied with 95% confidence interval of odds ratio (OR) andstatistical significance less than 0.05 p-value were taken as cut off value.Methods:A retrospective cross-sectional study was conducted. The study includesAll pediatric meningitis 211 cases from the age of one month to fourteen who were admitted due to meningitis in Debre Markos Referral Hospitalfrom January 2017 to December 2018.Data were entered, cleaned, and analyzed using SPSS for Windows, version 20.Results:The study showed that 18.9% of children with meningitis developed bad outcomes. In this study, children who were a worse clinical condition at admission 6 times more likely to develop bad outcomes [AOR= 6.321(2.121, 18.837)] and having a seizure at admission almost 19 times more likely to develop bad outcomes [AOR=18.953(6.677, 53.799)]. Conclusions:About one in five children with meningitis developed bad outcomes. The health care team should due attention to improving care for patients with severe conditions at admission and seizures were the alarming signs for poor outcomes in children.

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HUBUNGAN JUMLAH TROMBOSIT DAN JUMLAH LEUKOSIT PADA PASIEN ANAK DEMAM BERDARAH DENGUE

Jurnal e-Biomedik ◽

10.35790/ebm.1.1.2013.4152 ◽

2013 ◽

Vol 1 (1) ◽

Author(s):

Jilly J. G. Masihor ◽

Max F. J. Mantik ◽

Maya Memah ◽

Arthur E. Mongan

Keyword(s):

Dengue Hemorrhagic Fever ◽

Pearson Correlation ◽

Hemorrhagic Fever ◽

P Value ◽

Inclusion Criteria ◽

Laboratory Findings ◽

Cross Sectional ◽

Pearson’S Correlation ◽

Correlation Test ◽

Pearson's Correlation

Abstract: Dengue hemorrhagic fever (DHF) is an acute fever disease with high mortality and morbidity in many regions of the world. Leucopenia and thrombocytopenia are two of several laboratory findings that could be found in the course of DHF. This was an analytical retrospective study with a cross sectional design. Samples were patients diagnosed with DHF in Prof. Dr. R.D Kandou General Hospital Manado during the period of 2012. The inclusion criteria were patients <15 years, were diagnosed as DHF according to WHO 1997 criteria, and were examined for platelet and white blood cell count. This study used the medical record data which were analyzed statistically by using the Pearson's correlation test. There were 137 children with DHF during the period of 2012. Samples were 56 children that fulfiled the inclusion criteria. The Pearson correlation test showed a P value 0.801 and correlation coefficient r = -0.034 that indicated that there was a negative correlation which was not significant. Conclusion: There was no significant correlation between the number of thrombocytes and leukocytes in children with dengue hemorrhagic fever.Keywords: dengue hemorrhagic fever, leukocyte, thrombocyteAbstrak: Demam berdarah dengue (DBD) merupakan penyakit demam akut dengan morbiditas dan mortalitas yang tinggi di banyak daerah di dunia. Leukopenia dan trombositopenia merupakan dua temuan laboratorik yang sering ditemukan pada DBD. Penelitian ini bersifat analitik retrospektif dengan pendekatan potong lintang. Sampel penelitian ialah pasien anak yang terdiagnosis DBD di RSUP Prof. Dr. R.D. Kandou Manado selama periode tahun 2012. Pasien yang masuk dalam kriteria inklusi ialah pasien < 15 tahun, telah terdiagnosis menurut kriteria WHO 1997, serta melakukan pemeriksaan laboratorium trombosit dan leukosit. Penelitian ini menggunakan catatan rekam medik, dan untuk analisis statistik digunakan Pearson’s correlation test. Terdapat 137 anak dengan demam berdarah dengue pada periode 2012 dan 56 anak menjadi sampel dalam penelitian ini. Hasil penelitian melalui uji korelasi Pearson mendapatkan nilai P = 0,801 dan koefisien korelasi r = -0,034 yang berarti bahwa korelasi tidak bermakna, dengan kekuatan korelasi lemah dan arah korelasi negatif. Simpulan: Tidak terdapat hubungan yang bermakna antara jumlah trombosit dan leukosit pada pasien anak demam berdarah dengue.Kata kunci: demam berdarah dengue, leukosit, trombosit

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Albumin, Leukosit, And Protrombin As Predictors Of Sepsis Mortality Among Adult Patients In Soetomo General Hospital, Surabaya, Indonesia

Indonesian Journal of Anesthesiology and Reanimation ◽

10.20473/ijar.v1i12019.8-12 ◽

2019 ◽

Vol 1 (1) ◽

pp. 8 ◽

Cited By ~ 1

Author(s):

Rahmat Sayyid Zharfan ◽

Ahmad Lukman Hakim ◽

Abdul Khairul Rizki Purba ◽

Soni Sunarso Sulistiawan ◽

Bambang Pujo Semedi

Keyword(s):

Prothrombin Time ◽

General Hospital ◽

Multivariate Regression Analysis ◽

Albumin Level ◽

Adult Patients ◽

P Value ◽

Laboratory Findings ◽

Mortality And Morbidity ◽

Control Approach ◽

Predictors Of Mortality

Introduction: Sepsis is presented as a complex and multifactorial syndrome where the morbidity and mortality rates still high around the world. Strong evidencewith regard to early predictive factors for mortality and morbidity is rare to be provided. Objective: The aim of this study was to analyse the prominent predictors from the values of laboratory findings among patients with sepsis. Method and Material: The study was an analytic observational study with a case-control approach. The data were extracted from patients' medical records between 2014 and 2015. This study involved 50 septic patients admitted to Dr. Soetomo General Hospital, Surabaya, Indonesia. Blood urea nitrogen (BUN), creatinine serum, albumin, leukocytes count, haemoglobin, hematocrite, platelets, sodium, potassium, chloride, prothrombin time (PT), and activated partial thromboplastin time (APTT) were collected from blood samples. Logistic regression was used to estimate sepsis related mortalities frequencies and the relationship between laboratory findings and under 28-days mortality. Result and Discussion: From 50 patients, 22 patients were died (44%).The regression model was intially conducted using all three biomarkers as covariates, then using backward elimination, the covariate with the highest p-value was eliminated. The process was repeated until covariates with statistically significant remained. Multivariate analysis showed that albumin, leukocytes count, and prothrombin time (PT) were the findings associated with high mortality. The independent predictors of mortality identified by further multivariate regression analysis were taken into account as a lower than 3.5 g/dL of albumin, above12.000/µL of leukocytes count, and prolonged more than 14 seconds of prothrombin time; with p value <0,05 respectively (0.029; 0.049; 0.027). Conclusion: Notably, low albumin level, elevated levels of leukocytes, and prolonged prothrombin time were clinically considered as independent predictors of mortality among adult patients with sepsis.

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Hubungan Anemia pada Ibu Hamil dengan Kejadian Persalinan Prematur di RSUP Prof Dr. R. D. Kandou Manado

e-CliniC ◽

10.35790/ecl.5.1.2017.14700 ◽

2017 ◽

Vol 5 (1) ◽

Author(s):

Florensia S. Larumpaa ◽

Erna Suparman ◽

Rudy Lengkong

Keyword(s):

Pregnant Women ◽

World Health Organization ◽

Preterm Labor ◽

World Health ◽

P Value ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Iron And Folic Acid ◽

Cross Sectional Design ◽

Health Organization

Abstract: Preterm labor is a labor that occurs at 20-<37 weeks of gestational age calculated from the first day of the last menstrual. Until now the mortality and morbidity of preterm labor is still high. This matter is related with the maturity of the organs in the newborn such as lungs, brain and gastrointestinal tract. There are several factors that cause preterm labor inter alia maternal factor. Pregnant women with anemia potentially have preterm labors. World Health Organization (WHO) estimates that 35–37% of pregnant women in developing countries are anemic during pregnancy. In pregnant women it is important to meet iron needs during pregnancy by supplementation of iron and folic acid. The aim of this study was to determine the correlation between anemia in pregnant women and preterm labor. This was an analytical observational study with a cross-sectional design. Samples were mothers delivered in Obstetrics and Gynecology department at Prof. Dr. R. D. Kandou General Hospital Manado from September until November 2015. The results showed correlation between anemia in pregnant women with preterm labor from 168 samples that met the inclusion criteria (p value = 0.000). Conclusion: There was a significant correlation between anemia in pregnant women and preterm labor.Keywords: anemia, preterm labor, pregnant women Abstrak: Persalinan prematur adalah persalinan yang terjadi antara usia kehamilan 20-<37 minggu dihitung dari hari pertama haid terakhir. Sampai saat ini mortalitas dan morbiditas persalinan prematur masih sangat tinggi. Hal ini berkaitan dengan maturitas organ pada bayi baru lahir seperti paru, otak, dan gastrointestinal. Beberapa faktor dapat menyebabkan terjadinya persalinan prematur diantaranya faktor ibu, dimana ibu hamil dengan anemia berpotensi mengalami persalinan prematur. World Health Organization memperkiran bahwa 35-37% ibu hamil di negara berkembang mengalami anemia selama kehamilannya. Pada ibu hamil penting untuk memenuhi kebutuhan zat besi selama kehamilan dengan suplementasi zat besi dan asam folat. Penelitian ini bertujuan untuk mengetahui hubungan antara anemia pada ibu hamil dengan kejadian persalinan prematur. Jenis penelitian ialah analitik observasional dengan desain potong lintang. Sampel penelitian yaitu ibu yang bersalin di Bagian Obstetri dan Ginekologi RSUP Prof. Dr. R. D. Kandou Manado pada bulan September hingga November 2015. Hasil penelitian dari 168 sampel ibu bersalin yang memenuhi kriteria inklusi menunjukkan terdapat hubungan bermakna antara anemia pada ibu hamil dengan kejadian persalinan prematur (p=0,000). Simpulan: Terdapat hubungan bermakna antara anemia pada ibu hamil dengan kejadian persalinan prematur.Kata kunci: anemia, persalinan prematur, ibu hamil

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438 Is Cerebrospinal Fluid Sampling Necessary at The Time of First Ventriculo-Peritoneal Shunt Insertion in Paediatric Patients?

British Journal of Surgery ◽

10.1093/bjs/znab134.279 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

C W L Chia ◽

P Leach

Keyword(s):

Cerebrospinal Fluid ◽

Shunt Infection ◽

Antibiotic Prescribing ◽

Shunt Insertion ◽

Vp Shunt ◽

Patient Demographics ◽

Paediatric Patients ◽

Future Risk ◽

Fluid Sampling

Abstract We aim to evaluate whether intraoperative cerebrospinal fluid (CSF) sampling during ventriculo-peritoneal (VP) shunt insertion can predict future shunt infection or guide its management, as there is currently no evidence for this. 83 paediatric patients undergoing VP shunt insertion between February 2013 and July 2019 were retrospectively identified. Patient demographics, presence of pre-operative extra ventricular drain (EVD), pre-operative CSF results, and intra-operative CSF results were identified. All patients were followed up for a minimum of 6 months for identification of shunt infection. 90 VP shunt insertions were performed in 83 patients. Age at time of shunt insertion ranged from 5 days to 15.8 years (mean 44.2 months). Tumours were the most common aetiology for hydrocephalus (n = 24). 67 cases (74.4%) had intra-operative CSF samples, of which 2 revealed the presence of bacteria. Only 1 patient with intraoperative CSF sampling positive for growth developed shunt infection during follow up. Two cases developed a shunt infection despite normal intra-operative CSF results. Three cases did not have intra-operative CSF sampling but developed a shunt infection during follow up. Our results show that intraoperative CSF sampling as a method to predict future risk of shunt infection and to help inform future antibiotic prescribing is unreliable.

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HYPERTENSION;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.01.2513 ◽

2019 ◽

Vol 26 (01) ◽

Author(s):

Hafiz Muhammad Bilal ◽

Neelam Iqbal ◽

Muhammad Kamran Raza

Keyword(s):

Health Status ◽

Tertiary Care ◽

Cross Sectional Study ◽

Morbidity Rate ◽

Bivariate Analysis ◽

P Value ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Outpatient Departments ◽

Tertiary Care Hospitals

Background and Objectives:Asymptomatic nature of hypertension (HTN) has made it a silent killer. The better understanding of the underlying causes or factors can be beneficial in reducing the mortality and morbidity rate. Thus, the present study aims to determine the risk factors associated with HTN among adults and elderly patients visiting outpatient departments (OPDs) and the knowledge of patients about their health status. Study Design: Cross-sectional study. Setting: Outpatient departments (OPDs) of four tertiary care hospitals (Nishtar hospital, Khawaja Farid Social Security hospital, Railway hospital and Bakhtawar Amin Memorial hospital) of Multan, Pakistan. Period:1st May 2017 and 31st October 2017. Patients and Methods:364 patients (≥18 years−≥60 years of age) in OPDs of four tertiary care hospitals of Multan, Pakistan. Data regarding demographic details, medical history and blood pressure measurements were collected on a structured questionnaire. Data were analyzed by using Statistical Packages for Social Sciences (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) and Microsoft Excel (MS Office 2010).Result: Overall 38.7% of the participants were suffering from HTN. Most of them were 40-59 years of age and had body mass index (BMI) >23 kg/m2. Bivariate analysis (p-value <0.005) showed a significant association of age, marital status, gender, weight, and physical activity with HTN. Conclusion: The major determinants of HTN include increase in age, obesity, sedentary lifestyle, genetics, diabetes mellitus (DM) and lack of health concerns. Although patients are knowledgeable of their poor health status but make little or no efforts in controlling and preventing HTN.

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