Study of HbA1c & microalbumin in urine in patients of metabolic syndrome

We aimed to provide correlation of HbA1c & Microalbumin in urine in patients of metabolic syndrome.: 100 patients coming to OPD of Medicine department in Shri Mahant Indresh Hospital. Plasma samples taken for Hba1c and urine for microalbumin and run on VITROS 5600/7600 and reported for Hba1c & microalbumin. : 51 were males and 49 were females out of 100 total patients. For males age mean & SD was 55.84±13.52 & for females was 57.56±10.08.For raised and unraised HbA1c 10.42±+9.628 & 5.066±.0.216 for raised and unraised microalbumin 412.±1133 & 11.97±7.129.When we compared both HbA1c and microalbumin in both males and females then mean and SD came out to for HbA1C for males 8.56±2.663 and females were 11.62±12.86 with t value 2.327 and p value 0.021 that states it was significant. And for micralbumin for male 391.5±1184 & for females 60.37±116.6 t value was 2.7832 and p value was 0.0059 it also states it was significant. Therefore both the parameters were significant in patients of metabolic syndrome.

Study of fasting & PP C- peptide & its correlation with HbA1c in T2 Diabetes mellitus in population of Uttarakhand

We aimed to provide correlation of Fasting & PP C-peptide with HbA1C in patients of T2 Diabetes Mellitus.: 50 patients admitted in IPD of Medicine department in Shri Mahant Indresh Hospital from April-August 2021. Serum samples taken for fasting & PP C-peptide and HbA1C for patients of T2 Diabetes Mellitus and run on VITROS 5600/7600 which is based on dry chemistry. : We took 50 patients who were T2DM then we did fasting C peptide & PP C-peptide and HbA1c. Out of 50, 15 were females &35 were males. Out of 50, 45 patients had raised HbA1C maximum around 8-10.Mean & SD for fasting C-Peptide for males was 1.346±1.070 & for females 2.442±2.57.Mean & SD for Post prandiol C-Peptide for males was 4.208±5.020 & for females 2.993±2.130.It was significant for fasting C- Peptide with P value 0.0371 and non significant for PP C peptide with p value 0.3731.: Insulin secretion estimated by measurement of Fasting C-Peptide was either normal or raised in newly diagnosed T2DM subjects in my study indicating predominant role of insulin resistence in the etiology. Further research can explore the exact contribution of insulin resistence and insulin secretory defects in this area.

Response to winter pressures in acute services: analysis from the Winter Society for Acute Medicine Benchmarking Audit

Background There is increased demand for urgent and acute services during the winter months, placing pressure on acute medicine services caring for emergency medical admissions. Hospital services adopt measures aiming to compensate for the effects of this increased pressure. This study aimed to describe the measures adopted by acute medicine services to address service pressures during winter. Methods A survey of acute hospitals was conducted during the Society for Acute Medicine Benchmarking Audit, a national day-of-care audit, on 30th January 2020. Survey questions were derived from national guidance. Acute medicine services at 93 hospitals in the United Kingdom completed the survey, evaluating service measures implemented to mitigate increased demand, as well as markers of increased pressure on services. Results All acute internal medicine services had undertaken measures to prepare for increased demand, however there was marked variation in the combination of measures adopted. 81.7% of hospitals had expanded the number of medical inpatient beds available. 80.4% had added extra clinical staff. The specialty of the physicians assigned to provide care for extra inpatient beds varied. A quarter of units had reduced beds available for providing Same Day Emergency Care on the day of the survey. Patients had been waiting in corridors within the emergency medicine department in 56.3% of units. Conclusion Winter pressure places considerable demand on acute services, and impacts the delivery of care. Although increased pressure on acute hospital services during winter is widely recognised, there is considerable variation in the approach to planning for these periods of increased demand.

Prevalence and Associated Factors of Depression in Outpatients of Internal Medicine Department of Kigali University Teaching Hospital, Rwanda

Background Depression is more prevalent in medically ill patients than in the general population. More is not known about depression rates in internal medicine outpatients consulting the teaching hospitals in Rwanda. Adults with medical diseases are more likely to develop depression, it is an often-unrecognized co-morbidity in this group, and it has a major impact on their function and disability. In the absence of studies in our region, we did this research in our country with interest in what factors might be associated with depressive symptoms. Methods The descriptive cross-sectional study was used to determine the prevalence of depression and associated factors among internal medicine outpatients of Kigali university teaching hospital (CHUK). The 9 items Patient Health Questionnaire (PHQ-9) instrument was used to screen depression symptoms among outpatients. The validated cut-off score of 10 for diagnosing depression was applied in this study. Patients’ clinical and socio-demographic characteristics were collected and analyzed for their relationship with depression. All patients who scored PHQ-9 above 10 were referred to CHUK mental health department for appropriate management. Results Three hundred patients were recruited, of whom 65.3%) were females and 51% had an age between 45 and 96 years. The overall prevalence of depression among outpatients in the internal medicine department of CHUK was 45.7%. Outpatients had 20.7%, 17%, and 10% for moderate, moderately severe, and severe depression, respectively. Age, educational status, and follow-up visits as current physical complaints were independently associated with depression (P < 0.05). As much as 22.7% of patients were presenting with Suicidal ideas. The study showed that low income was strongly associated with suicide ideation (P < 0.001). Regardless of age and gender, the prevalence of depression was higher among outpatients of internal medicine than the general population. Conclusions A holistic approach in the management of internal medicine outpatients should be implemented to facilitate the early detection and treatment of depression in general tertiary hospitals. Furthermore, intervention programs that address depression and suicide in adults are needed.

Determinants of adherence to antiretroviral therapy among people living with HIV/AIDS in Chhattisgarh, India

Background: Achieving the WHO 2020 treatment goals will not only depend on access to HIV treatment, but also on good adherence. Chhattisgarh SACS under guidance of CST division NACO and community and family medicine department AIIMS, Raipur undertook this study to investigate the major factors that influence the adherence of PLHIV visiting ART centres of Chhattisgarh.Methods: From five ART centres, 415 participants were interviewed through simple random sampling method through a semi structured interview schedule. Results: We found that 346 of the 415 (83.3%) patients had ≤95% adherence to ART on the basis of pill count method. Major proportion (90.0%) of patients were on TLE regimen, among them (74.4%) were non-adherent. An association was found between health condition of patient, poor life style and adherence rate. Three-month drug dispensation was recommended by most of the participants to improve adherence.Conclusions: Multiple months drug dispension along with other innovative approaches should be tailored made to improve the adherence and compliance among PLHIV individuals.

Evaluation of Hepatic Biochemical Parameters during Antiviral Treatment in COVID-19 Patients

(1) Background: The antiviral treatment for COVID-19 disease started to be largely used in 2020 and has been found to be efficient, although it is not specific for SARS-CoV-2 virus. There were some concerns that it may produce liver damage or other side effects. (2) Methods: The aim of this study was to observe if antiviral therapy is affecting liver parameters or producing other side-effects in patients hospitalized for COVID-19 disease. The study included a group of patients hospitalized in the internal medicine department of Oradea Municipal Clinical Hospital, Romania, between August 2020–June 2021, diagnosed with SARS-CoV-2 viral infection by RT-PCR method or rapid antigen test. During hospitalization, patients were treated with a Lopinavir/Ritonavir (Kaletra) combination, or with Favipiravir or Remdesivir. In addition to monitoring the evolution of the disease (clinical and biochemical), also hepatic parameters were analyzed at admission, during hospitalization, and at discharge. (3) Results: In the group of studied patients, the mean value of aspartat aminotrensferase did not increase above normal at discharge, alanin aminotransferase increased, but below twice the normal values, and cholestasis registered a statistically insignificant slight increase. (4) Conclusions: In our study, we found that all three antivirals were generally well tolerated and their use did not alter liver function in a significant manner.

A Study on the Prescription Pattern of Antimicrobial Agents Used in the Treatment of Infectious Disease

Antibiotics are anti-infective agents produced from natural sources, whereas antimicrobial agents are generated through chemical synthesis. It was a prospective and observational study and was conducted in the medicine, OBG, and urology departments in Sagar Hospitals. The study was conducted over a period of 18 to 20 months. Among 542 participants, 325 (60%) were males, while 217 (40%) were females. The frequency of patients surviving different hospital departments was 416 (76.6%), and they survived the medicine department. Moreover, the urology department had 80 (14.8%) patient visits, while in the obstetrics and gynaecology departments, only 46 (8.5%) patients visited. It was found that the percentage and order of various micro-organisms isolated as Neisseria meningitides 20 (3.7%) and a lesser number of organisms were found in K. Pneumonia 01 (0.2%), respectively. The cephalosporin class of drugs is commonly prescribed in empirical and prophylactic therapy because they are more effective in infectious diseases Furthermore, 36 patients out of 542 had drug interactions; quinoline derivatives, such as Ciprofloxacin, typically have a higher number of drug interactions. Among 542 patients, 38 had severe drug reactions in that most of the reactions were dermatological reactions caused by cephalosporin drugs. Most of our physicians prescribed based on patient characteristics and behaviors, and the recovery rate was also good. In our study, we observed common outcomes of DIs, such as increased theophylline toxicity and digoxin toxicity, increased laboratory values, and also reduced some drugs' effectiveness. Correlations of drug and disease characteristics were found more in ciprofloxacin drugs.

Can RUDAS Be an Alternate Test for Detecting Mild Cognitive Impairment in Older Adults, Thailand?

The Montreal Cognitive Assessment (MoCA) is the commonly used cognitive test for detecting mild cognitive impairment (MCI) in Thailand. Nevertheless, cultural biases and educational levels influence its performance. The Rowland Universal Dementia Assessment Scale (RUDAS) seems to lower the limitation of the MoCA. This study aimed to compare the performance of the RUDAS and the MoCA for the diagnosis of MCI and demonstrate the correlation between them. A cross-sectional study of 150 older participants from the outpatient setting of the Internal Medicine Department, Srinagarind Hospital, Thailand was recruited during January 2020 and March 2021. The diagnostic properties in detecting MCI of the RUDAS and the MoCA were compared. MCI was diagnosed in 42 cases (28%). The AUC for both RUDAS (0.82, 95% CI 0.75–0.89) and MoCA (0.80, 95% CI 0.72–0.88) were similar. A score of 25/30 provided the best cut-off point for the RUDAS (sensitivity 76.2%, specificity 75%) and a score of 19/30 for the MoCA had sensitivity and specificity of 76.2% and 71.3%. The Spearman’s correlation coefficient between both tests was 0.6. In conclusion, the RUDAS-Thai could be an option for MCI screening. It was correlated moderately to the MoCA.

The Frequency of Prescribing Nicotine and Varenicline in a Public Hospital

Aim: This study was conducted to demonstrate the prescribing pattern of nicotine and varenicline in a public hospital in Alkharj. Methodology: This is a retrospective study includes evaluating outpatient prescribing of nicotine and varenicline from 1st of January 2018 to 30th of June 2018 in a public hospital in Alkharj. Results: All of the nicotine patch prescriptions were written by internal medicine department and all of the prescriptions were prescribed by residents. The age of more than half of them was between 30 and 39 (53.33%). All of the varenicline tablet prescriptions were written by internal medicine department. The age of about 88.23% of the patients who received varenicline tablet was more than 29 years. Conclusion: Nicotine and varenicline prescribing was infrequent in Al-kharj. More awareness programs are needed for health care workers and for the public. Moreover, the physicians should assess if the treatment is needed or no according to the person condition.