The present study aimed to investigate role of Attitudes towards medication, subjective norms and Perceived Behavioral Control in predicting Intentions of patients to take Anti-TB medication. The sample comprised of 147 patients with pulmonary TB, recruited from Gulab Devi Chest Hospital, Lahore. Correlation Research design was used. Urdu translated version of Theory of planned behavior questionnaire was used for assessment. Results showed that, Distance to hospital and Attitude of doctors and staff negatively predicted Intentions. However, Monthly family Income, Attitudes towards medication and Subjective Norms positively predicted Intentions. Results also revealed that high and low intenders were significantly different in terms of Behavioral, Normative and Control Beliefs. Findings of the present study highlighted the importance of environmental and patient related factors influencing the decisions to take medication. These factors should be considered while developing interventions to promote future medication adherence behavior as intentions drives behavior and patients has to be motivated in order to perform the behavior.

Chronic Obstructive Pulmonary Disease is associated with increased inflammatory cells. Combination of long acting beta agonist and inhaled corticosteroids are standard treatment. Roflumilast targets inflammatory cells and decreases the frequency of exacerbation. This study looks at the effect of Roflumilast on inflammatory cells in sputum and inflammatory markers in the blood when used as add-on therapy in COPD patients. This observational comparative study conducted in Department of Pulmonary Medicine for 1.5 years duration. 70 COPD patients were divided into two Group A (Roflumilast + Standard treatment) and Group B (Standard treatment). Pulmonary Function Test, Sputum Eosinophil & Sputum Neutrophil, CRP were measured at baseline and after 4 months of treatment in both groups. Intergroup analysis between Group A and Group B was done at baseline and after 4 months. Mean age of patients in Group A was 64.3 years and in Group B was 61.2 years. Maximum patients were in age groups 51-60 and 61-70 years. Of total 70 patients, 60% were males and 40% females. Majority of patients in both groups had low BMI. Sputum inflammatory cells were significantly lower in Roflumilast group. Pulmonary function parameters showed significant improvement in Roflumilast treated group. There was no significant decrease in CRP when compared between two groups. Roflumilast, add-on therapy to standard treatment in COPD patients have improved lung function and decreased level of inflammatory cells in airway significantly.

Thyroid Dysfunction (TD) and Diabetes Mellitus (DM) are often found associated in the same patient and TD may affect the metabolic control of DM. TD is more prevalent in diabetics than in general population. The current study investigates the prevalence of TD in patients with DM, and explores its correlation with age, sex, type and duration of DM, and glycemic control (HbA1c levels). This was an observational, cross-sectional study of 212 patients with DM. All patients had undergone routine clinical and laboratory evaluations as per the standard clinical care. Medical data was collected and analyzed using Epi Info V3.5.4. Among the 212 DM patients evaluated, the overall prevalence of TD was 24.52%. The overall prevalence of TD was less in type-2 DM (T2DM; 24.46%) as compared to type-1 DM (T1DM; 37.5%); and slightly more in females (31.94%) as compared to males (28.65%). The prevalence of TD was high in the middle age (41-60 years) group (52.17%) as compared to other age groups. Subclinical hypothyroidism (SCH) was the most common type of TD (11.79%) with maximum prevalence (50%) in T2DM. Patients with DM reported a high prevalence rate of 24.52% for TD. Patients between 41-60 years of age had higher prevalence of TD. Prevalence was slightly more in more in females as compared to males. Our data suggests for screening of DM patients for risk of TD that might be helpful in secondary and primary prevention and possible better metabolic control

Naso-Orbito-Ethmoidal fractures can occur in single entity or in conjunction with other craniofacial fractures. Most often they are associated with frontal Le Fort II or Le Fort III fractures. It involves nasal bones including bony septum, the frontal process of the maxilla and nasal–orbital–ethmoid complex bilaterally. Open and Closed reduction are the two ways of management which are adapted by surgeons according to the situation and severity. This article describes a case report of 21-year male patient with history of road traffic accident who is diagnosed with naso-orbito-ethmoid fracture and was treated with open reduction and internal fixation

Primary immune thrombocytopenia (IT) is one of the common causes of thrombocytopenia in otherwise asymptomatic adults. Though most of the patients with IT are asymptomatic the presentation can be varied from mild petechiae to severe hemorrhage such as intracranial haemorrhage. Subconjunctival haemorrhage is an extremely rare presentation of IT. We report a 15 year old previously healthy boy presented with bilateral subconjunctival haemorrhage which was ultimately diagnosed as immune thrombocytopenia which was resistant to Steroid as well as IV Immunoglobulin therapy and managed with Rituximab successfully.

Systemic lupus erythematosus (SLE) is a prototypic systemic autoimmune disease with variable multisystem involvement and heterogeneous clinical features. Haematological abnormalities were common findings in patients with SLE. Sometimes, haematological abnormalities can be caused by the pathophysiology of SLE itself, but at other times the anaemia may not be directly related to the SLE. This retrospective study included patients who were diagnosed according to the American college of rheumatology criteria and treated for SLE from April 2015 to March 2018 at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Ogun State, Nigeria. The Demographic and haematological parameters at diagnosis were recorded. A total of 26 SLE patients were seen. All the cases were females and the mean age was 33.3± 8.9 years. Twenty-two (84.6%) had haematological abnormalities. Anaemia was present in 20 (76.9%) patients with a mean hemoglobin value of 8.6 mg/dl at the time of first presentation. Leukopenia was seen in 6 (23.1%), lymphopenia in 17 (65.4%), thrombocytopenia in 8 (30.8%) and 2 (7.7%) patients presented with anti-phospholipid antibody syndrome. The most common hematological abnormality among our patients was anemia which has a multifactorial aetiology. Lymphopenia was far more common than leucopenia.

Diabetes Mellitus is the most common endocrinological condition. We can see complications as a result of the changes in microcirculation and tissue collagen structure. In our study; we aimed to discuss the clinical features and wound evaluations of the patients who applied to our clinic with diabetic hand wound, as well as their treatments and results. Patients with diabetic hand wounds who applied to our clinic between 2013-2015 were included. Demographic data, type of diabetes, characteristics of hand wounds, laboratory values, culture results, abscess involvement, treatment methods, and treatment results of the patients were obtained. Nine of the 29 patients were female and 20 were male. The mean age was 63.62 ± 14.12. 22 patients had the wound in their right hand while 7 patients had it in the left hand. While 25 patients had finger involvement, 2 had volar part involvement and 2 had wounds in the dorsal part of the hand. 19 patients were treated with debridement and 10 patients were amputated. Flaps / grafts were applied to 5 of the patients. 8 patients had high sedimentation rates. The mean C-reactive protein value was calculated as 43.94. The mean HbA1c of the patients was 8.70 ± 1.74. The wounds of all 29 patients were treated successfully. Patients should be careful while they are using hand tools, cutting nails, and should wear protective equipment. Strict blood glucose control, aggressive debridement, and antibiotics in the treatment of these wounds can reduce the risk of amputation

Clear cell sarcoma of tendon and aponeuroses is extremely rare tumour, arises in deeper soft tissues, bound to tendons or aponeuroses. Despite histological similarity with cutaneous melanoma, it is distinct from it clinically, genetically. It is mainly seen between the ages 20 to 40 yrs and rarely occurs in children. Here we report a case of clear cell sarcoma of soft tissue arising in the left foot of a 12 year old child

Hyperuricemia is commonly seen in subjects with cardiovascular disease and it one of the risk factor for morbidity and mortality with cardiovascular diseases. Uric acid is a product of synthesis from nucleic acids, amino acids, and Kreb's Cycle. Uric acid is biologically active and can stimulate oxidative stress and endothelial dysfunctions, inflammation, and vasoconstriction. The present study tries to evaluate the levels of uric acid in patients suffering from an acute ischemic stroke in comparison with normal subjects. Methods: This prospective cross-sectional study was conducted in the Departments of General Medicine and Biochemistry Prathima Institute of Medical Sciences, Naganoor, Karimnagar. A total of 80 subjects were included in the study. They were divided into two groups. Group I [cases] (n=40) consisted of patients reporting to the Emergency Department within 24 hours of onset of symptoms of stroke. The Group II [controls] (n=40) were the age and sex-matched patients attending the General Medicine OPD with minor complaints. Results: The mean age of Group I (n=40) was 61.42 ± 2.99 years and Group II was (n=40) 48.9 ± 4.53 years. The numbers of the male in Group I were 29 and female were 11 and in control, Group was 20 male and female each. The blood urea Group I was 38.7 ± 5.59 mg/dl and in Group II 30.12 ± 8.86 the p values were not found to be significant. The serum creatinine was 1.13 ± 6.61 in group I and in Group II was 0.91± 0.17 mg/dl and the p values were found to be significant. The uric acid levels were 7.32 ± 2.25 mg/dl in group II and 4.95 ± 1.5 mg/dl in Group I the values were found to be significant. Conclusion: Within the limitations of the present study it can be concluded that serum uric acid levels are significantly associated with ischemic stroke in this group of the population. The other important factors for the risk of ischemic strokes include Hypertension and Diabetes mellitus. There is growing evidence that uric acid may play a key role in the development and progression of cardiovascular diseases

Ankle fractures are the most common type of fractures treated by orthopedic surgeons in daily practice. Most of these fractures are complex type and difficult to manage. If not treated properly, may produce significant long-term disability and complications like pain, instability and early degenerative arthritis. Good functional results are obtained by surgical management of bimalleolar ankle fractures. Early weight bearing, and mobilization is achieved in these patients. This study was conducted at Prathima Institute of Medical Sciences, Karimnagar from January 2016 to December 2017. 40 adult patients with bimalleolar fractures of ankle who underwent open reduction and internal fixation were included in this study. Follow up was done at regular intervals of 6 weeks for minimum of 6 months. Baird and Jackson’s ankle scoring system of subjective, objective and radiographic criteria was used for the study. 24(60%) cases of medial malleolar fractures were fixed with malleolar screws, followed by cancellous screw in 4(10%) cases, tension band wiring in 10(25%) cases and K-wire in 2(5%) cases. 28(70%) cases of lateral malleolus were fixed with plate (24 with one-third tubular plate, 2 with 3.5mm DCP and 2 with 3.5mm recon plate) followed by malleolar screw in 4(10%) cases, Rush nail in 5(12.5%) cases and K wire/TBW in 3(7.5%) cases. Average time to union in our study was 10.4 weeks. However, most (80%) of the cases (80%) united by 8-12 weeks. Excellent results were achieved in 23(57.5%) cases, good results in 10(25%) cases, fair in 5(12.5%) cases and poor in 2(5%) cases. Open reduction and stable internal fixation of unstable bimalleolar ankle fractures restore the articular congruity of the ankle joint. Operative results in our study were satisfactory in 82.5% cases, with good to excellent functional outcome. Functional results were much better in younger age groups and men. Early weight bearing, and mobilization is achieved in these patients

Diabetes Mellitus type 2 is a group of disorders characterized by high glucose levels. Electrolyte abnormalities are commonly encountered in chronic diabetes mellitus type 2 patients. These patients usually have Potassium, Magnesium and Phosphate depletion. This study was conducted to investigate the electrolytes and lipid abnormalities in chronic type 2 diabetes mellitus in patients attending Rajiv Gandhi Institute of Medical Sciences and Hospital Adilabad. This study was conducted in the Department of General Medicine and Biochemistry, Rajiv Gandhi Institute of Medical Sciences [RIMS], Adilabad. The study included male and female subjects diagnosed with chronic diabetes mellitus type 2. Chronic diabetics were defined as those diagnosed with diabetes mellitus type 2 and on medications, for the duration of 5 years or more they were designated as Group I. Similarly age and sex-matched controls from the normal population were included in Group II as controls. Fasting blood samples will be collected in Vacutainer 10ml and serum fasting blood sugar, Serum Electrolytes and lipid profile will be estimated in fully automatic chemistry analyzer ‘Beckman Coulter Au 400’. The results obtained were recorded and analyzed using statistical software. Results: A total of 100 patients were included in the study divided into two groups Group I (diabetics) and group II (controls). The serum fasting blood glucose was measured in group I the mean values was 174.5 ± 25.6 mg/dl and in group II 96.5 ± 20.5 mg/dl the p values were found to be significant. The triglyceride levels as compared to controls the mean values in group I was 201.55 ± 35.8 mg/dl and group II was 190.5 ± 30.12 mg/dl the p values were found to be significant. The potassium levels were also elevated in the group I (diabetic) as compared to group II and the p values were found to be significant. It can be concluded that type 2 diabetes patients have abnormal lipid and electrolyte balance. The impaired mineral metabolism can result in disturbances in enzymatic activities, hormone secretions, and antioxidant levels. Therefore monitoring of these patients every 3 months will help in preventing the occurrence of long-term complications related to diabetes

Acute intestinal obstruction is a common surgical emergency that a general surgeon comes across and one has to accomplish the skills of diagnosing art of Surgery and knowledge of postoperative management, which carries gratifying results. With this in mind, we in this study the tried to evaluate the symptomatology of Intestinal Obstruction to study the various causes of intestinal obstruction modalities of surgical procedures and its outcome. Methods: The cross-sectional study was conducted at the Department of General Surgery, Prathima Institute of Medical Sciences, Karimnagar. A total of hundred patients belonging to both sex groups were included in the study. All patients were evaluated thoroughly from their history and clinical examination. Patients with signs and symptoms of acute obstruction were managed by appropriate surgical procedure after resuscitation and the diagnosis was established. The postoperative period was monitored carefully and all parameters were recorded hourly or fourth hourly basis depending upon the resuscitation and the diagnosis was established. Results: The most common involved age group was 31 - 40 having 40% of the patients followed by 14 – 50 has 38%. Adhesions are the most common cause of intestinal obstruction accounting for 36% of the cases. Malignancy of the large bowel was found to cause obstructive features with a single case being due to ascending colon growth, one case of small bowel tumor and the 7 is due to recto-sigmoid growth, 2 descending colon, thus a total of 11 cases of malignant obstruction. 39 patients who underwent surgical procedure had no complications. 25 patients had wound infection with wound gaping and had to be treated with secondary suturing. 8 patients who underwent surgery expired with an overall mortality rate of 8 %. Conclusion: Clinical radiological and operative findings put together can bring about the best and accurate diagnosis of intestinal obstruction. Intestinal obstruction with tuberculosis of the intestine is more likely to develop postoperative complications, proper anti-tubercular management is necessary to prevent mortality and morbidity.

Many patients with gastrointestinal (GI) symptoms go through endoscopy often unnecessarily and without indication. Observational studies have generally shown poor adherence to international guidelines of endoscopy. This study aims to identify the common indications of GI endoscopy and the subsequent findings among the population of Al Kharj Province, KSA. We conducted a cross-sectional study on 516 patients who underwent upper or lower GI endoscopy at the Endoscopy Unit of King Khaled Hospital, Al Kharj, KSA in the period from March 2017 to March 2018. GI bleeding, dyspepsia and reflux symptoms were the most commonly reported causes for referral to endoscopy (26.8%, 19.6% and 10.7% respectively). Normal endoscopic findings were reported in 33% and 37% of the patients who underwent gastroscopy with dyspepsia and reflux symptoms, respectively). Only six patients (1.8%) of those who underwent colonoscopy had an indication of colorectal screening. Almost half of the patients 45 % (45/100) with dyspepsia 53% (27/55) unnecessary gastroscopy. High rates of unnecessary upper GI endoscopy are performed for inappropriate indication such as dyspepsia and reflux symptoms. Also, colorectal screening strategy has not been adopted by the physicians. We recommend the implementation of the recent international guidelines when referring patients to endoscopy to avoid the unnecessary invasive procedures.

Adverse events (AE) are an ongoing challenge in healthcare. Apart from having a significant impact on patient morbidity and mortality, AE also result in increased healthcare costs due to longer hospital stays. However, little is known about AE occurrence and their risk factors in Tunisian healthcare system. To determine the incidence of severe adverse events (SAEs) and identify risk factors associated with SAE during hospitalization in a Tunisian University Hospital. A case-control study with incident cases was conducted including all patients hospitalized in the Teaching Hospital Farhat Hached within a one-month period in 13 clinical units. Medical records for caseswere selected by using stratified random sampling. The sample size was proportional to the number of admissions in each of 13 clinical departments. Controls were matched by the service and the duration of hospitalization preceding the appearance of SAE. Risk factors were collected and analyzed by conditional stepwise logistic regression. Overall, 304 controls were matched to cases, totalizing 456 patients. Multivariate conditional stepwise logistic regression analysis showed that night-time admission, hospitalization in the last six months, difficulty of communication, longer surgical operation, biopsy, presence of at least two medical devices, exposure to peripheral venous catheter, exposure to more than four medications and blood transfusion were considered as independent risk factors of SAE occurrence. Our results highlighted care-related risk factors such as catheters, blood transfusion and polymedication, which underlined the need to strengthen the care safety by focusing efforts especially in the field of hospital hygiene and infection control as well as pharmacovigilance

Once prescribed, within a hospital structure, the drug will follow a complex circuit, involving many intermediates, human and technical, and leading to the drug administration and its monitoring. From the point of view of pharmaceutical practice, the circuit is of course made of an important logistic part but also of a clinical part often underestimated but nevertheless essential to the safety of the patients during their stay in the hospital. In order to be able to combine the logistic and clinical aspect of the pharmaceutical activity in a hospital environment, it is essential to adopt an appropriate dispensing mode that allows to better secure the patient's medication management. The purpose of this article is to describe the practice of the nominative dispensing in hospital and to share the experience of introduction of this practice at the pharmacy of the Moroccan Institute of Oncology