Higher Medical Costs Research Articles

Frequency of use and cost of biologic treatment for inflammatory bowel disease and inflammatory bowel disease-associated arthropathy in Colombia in 2019

Introduction and aimsInflammatory bowel disease (IBD) has a high economic burden due to its chronicity. Treatment has evolved, thanks to the understanding of IBD pathogenesis and the advent of biologic therapy, albeit the latter increases direct costs. The aim of the present study was to calculate the total cost and cost per patient/year of biologic therapy for IBD and IBD-associated arthropathy in Colombia. MethodsA descriptive study was conducted. The data were obtained from the Comprehensive Social Protection Information System of the Department of Health for the year 2019, utilizing the medical diagnosis codes of the International Classification of Diseases related to IBD and IBD-associated arthropathy as keywords. ResultsThe prevalence of IBD and IBD-associated arthropathy was 61 cases per 100,000 inhabitants, with a female-to-male ratio of 1.5:1. Joint involvement was 3%, and 6.3% of the persons with IBD and IBD-associated arthropathy received biologic therapy. Adalimumab was the most widely prescribed biologic drug (49.2%). Biologic therapy had a cost of $15,926,302 USD and the mean cost per patient/year was $18,428 USD. Adalimumab had the highest impact on healthcare resource utilization, with a total cost of $7,672,320 USD. According to subtype, ulcerative colitis had the highest cost ($10,932,489 USD). ConclusionBiologic therapy is expensive, but its annual cost in Colombia is lower than that of other countries due to the government’s regulation of high-cost medications.

Recent Advancements in Plant- and Microbe-Mediated Synthesis of Metal and Metal Oxide Nanomaterials and Their Emerging Antimicrobial Applications

Antibiotic resistance against infections caused by microbes has emerged as a global challenge resulting in longer hospitalizations and higher medical cost and mortality. The excessive use of antibiotics has led to the swift progression of antibiotic resistance in bacterial strains. Metallic and metal oxide (M/MO) nanoparticles (NPs) have the potential to provide a pertinent alternative to antibiotics as they interact with the critical cellular organelles and biomolecules such as DNA, enzymes, ribosomes, and lysosomes. This affects the permeability of the cell membrane causing oxidative stress, gene expression, protein activation, and enzyme activation restricting the habitat of microbes. Further, NPs simultaneously target multiple biomolecules at once making them an efficient antibacterial agent against which microbes are unable to develop resistance easily, although the toxicity associated with the M/MO NPs still remains a key challenge for clinical uses. Green synthesis provides an efficient solution to reduce the toxic effects associated with these NPs as it does not use harsh chemicals and environment for the synthesis of NPs. In this work, we have provided a comprehensive review of the green synthesis of M/MO NPs using plants (roots, seeds, barks, flowers) and microbes (bacteria, fungi, algae). The yield of the NPs achieved from the green synthesis is lower than that of conventional methods and significant advancements have been made recently which are delineated in this review for different M/MO NPs. Further, the mechanism of NP interaction with the microbes and their different antimicrobial applications have been discussed in detailed. The present review aims to provide a critical overview of the current state of the large-scale synthesis of the M/MO NPs as well as their different antimicrobial activities.

Frecuencia de uso y costo del tratamiento biológico para enfermedad inflamatoria intestinal y artropatía asociada a enfermedad inflamatoria intestinal en Colombia durante el año 2019

Introduction and aimsInflammatory bowel disease (IBD) has a high economic burden due to its chronicity. Treatment has evolved, thanks to the understanding of IBD pathogenesis and the advent of biologic therapy, albeit the latter increases direct costs. The aim of the present study was to calculate the total cost and cost per patient/year of biologic therapy for IBD and IBD-associated arthropathy in Colombia. MethodsA descriptive study was conducted. The data were obtained from the Comprehensive Social Protection Information System of the Department of Health for the year 2019, utilizing the medical diagnosis codes of the International Classification of Diseases related to IBD and IBD-associated arthropathy as keywords. ResultsThe prevalence of IBD and IBD-associated arthropathy was 61 cases per 100,000 inhabitants, with a female-to-male ratio of 1.5:1. Joint involvement was 3%, and 6.3% of the persons with IBD and IBD-associated arthropathy received biologic therapy. Adalimumab was the most widely prescribed biologic drug (49.2%). Biologic therapy had a cost of $15,926,302 USD and the mean cost per patient/year was $18,428 USD. Adalimumab had the highest impact on healthcare resource utilization, with a total cost of $7,672,320 USD. According to subtype, ulcerative colitis had the highest cost ($10,932,489 USD). ConclusionBiologic therapy is expensive, but its annual cost in Colombia is lower than that of other countries due to the government's regulation of high-cost medications.

Association Between Perinatal Mental Health and Pregnancy and Neonatal Complications: A Retrospective Birth Cohort Study.

Maternal mental health as an important precursor to reproductive and neonatal complications remains understudied in the United States, particularly in the Southeastern region, despite high medical costs, maternal morbidity, and infant burden. This study sought to estimate the incidence of perinatal mental health disorders and the associated increased risk of leading pregnancy and infant complications. A population-based retrospective birth cohort of childbirth hospitalizations and readmissions was constructed for women in South Carolina, 1999 to 2017. Prevalence rates were calculated for perinatal mood and anxiety disorders (PMAD), severe mental illness, and mental disorders of pregnancy (MDP). Poisson regression models using generalized estimating equations were used to estimate adjusted relative risks for the association between mental health conditions and severe maternal morbidity, hypertensive disorders of pregnancy, gestational diabetes, cesarean section, preterm birth, and low birthweight. The most prevalent maternal mental condition was MDP (3.9%), followed by PMAD (2.7%) and severe mental illness (0.13%). PMAD was associated with a higher risk of severe maternal morbidity, hypertensive disorders of pregnancy, and cesarean section, as well as a higher risk of preterm birth and low birthweight infants. Severe mental illness was associated with low birthweight, hypertensive disorders of pregnancy, and cesarean section. Pregnant populations with MDP were more at risk for severe maternal morbidity, preterm birth, hypertensive disorders of pregnancy, low birthweight, and cesarean section. Each maternal mental health outcome was associated with an increased risk for hospital readmissions up to 45days after childbirth. Results demonstrate the escalating burden of PMAD and MDP for pregnant populations over time, with important consequences related to maternal and infant morbidity.

In-Hospital Outcomes of Heart Failure Patients with Valvular Heart Disease: Insights from Real-World Claims Data.

Heart failure (HF) is a serious public health burden that is rapidly increasing in the aging population. Valvular heart disease (VHD) is a known etiology of heart failure (HF); however, the impact of VHD on outcomes of patients with HF has not been well-studied in Japan. This study aimed to determine the rates of VHD in Japanese patients admitted for HF and explore associations of VHD with in-hospital outcomes through a claim-based analysis. We analyzed claims data from 86,763 HF hospitalizations (January 2017 through December 2019) from the Medical Data Vision database. Common etiologies of HF were examined, then hospitalizations were categorized into those with VHD and those without. Covariate-adjusted models were used to explore the association of VHD with in-hospital mortality, length of stay, and medical cost. Of 86,763 hospitalizations for HF, 13,183 had VHD and 73,580 did not. VHD was the second most frequent etiology of HF (15.2%). The most frequent type of VHD was mitral regurgitation (36.4% of all hospitalizations with VHD), followed by aortic stenosis (33.7%) and aortic regurgitation (16.4%). There was no significant difference in in-hospital mortality between hospitalizations with VHD vs those without (9.0% vs 8.9%; odds ratio [95% CI]: 1.01 [0.95-1.08]; p=0.723). Hospitalizations with VHD were associated with significantly longer length of stay (26.1 vs 24.8 days; incident rate ratio [95% CI]: 1.05 [1.03-1.07]; p<0.001) and higher medical costs (1536 vs 1195 thousand yen; rate ratio [95% CI]: 1.29 [1.25-1.32]; p<0.001). VHD was a frequent etiology of HF that was associated with significant medical resource use. Future studies are needed to investigate whether timely VHD treatment could reduce HF progression and its associated healthcare resource utilization.

Novel stem cell treatment to combat pediatric inflammatory response during cardiopulmonary bypass surgery

Abstract Cardioplegia and exposure to the heart-lung machine required in cardiopulmonary bypass induce a systemic inflammatory response. Adverse effects cause longer ICU stays, higher medical costs, and worsened mortality and morbidity, especially in neonatal and pediatric populations. nCPCs have been shown to have regenerative and anti-inflammatory properties when introduced in animal studies as a treatment. Surgeons at UMB performed cardiopulmonary bypass surgery on non survival porcine subjects with a control and treatment group of 6 porcine subjects in each. NDMU tested and analyzed serum samples of the subjects for immunological markers or interleukins. The results revealed that the treatment does seem to have an effect on the pro-inflammatory cytokines of TNF-α, IL-1β, and IL-6. TNF-α, IL-1β, and IL-6 concentrations decreased significantly from 3124 to 1480 pg/mL, 8319 to 2714 pg/mL, and 18,011 to 10,825 pg/mL, respectively. Furthermore, the treatment also has an effect on IL-10, an anti-inflammatory cytokine, noted by an increase from 289 to 328 mg/mL. Overall, the treatment seems to have a greater effect on the macrophage immune response, while it seems to have little to no effect on the neutrophil immune response. Surgeons are currently working on survival porcine subjects. Moreover, H&amp;E staining and RT-qPCR of samples will be performed to determine the localization of damage and relative expression of the cytokines of interest.

Derivation and Validation of a Prognostic Model for Acute Decompensated Cirrhosis Patients.

Acute decompensated cirrhosis (AD) is related to high medical costs and high mortality. We recently proposed a new score model to predict the outcome of AD patients and compared it with the common score model (CTP, MELD and CLIF-C AD score) in the training and validation sets. A total of 703 patients with AD were enrolled from The First Affiliated Hospital of Nanchang University between December 2018 and May 2021. These patients were randomly assigned to the training set (n=528) and validation set (n=175). Risk factors affecting prognosis were identified by Cox regression analysis and then used to establish a new score model. The prognostic value was determined by the area under the receiver operating characteristic curve (AUROC). A total of 192 (36.3%) patients in the training cohort and 51 (29.1%) patients in the validation cohort died over the course of 6 months. A new score model was developed with predictors including age, bilirubin, INR, WBC, albumin, ALT and BUN. The new prognostic score (0.022×Age + 0.003×TBil + 0.397×INR + 0.023×WBC- 0.07×albumin + 0.001×ALT + 0.038×BUN) for long-term mortality was superior to three other scores based on both training and internal validation studies. This new score model appears to be a valid tool for assessing the long-term survival of AD patients, improving the prognostic value compared with the CTP, MELD and CLIF-C AD scores.

The Biosimilar Paradox: How Anti–Vascular Endothelial Growth Factor Biosimilars Could Increase Patient and Overall Health Care Costs

Anti-vascular endothelial growth factor (VEGF) medications for intraocular use are a major and increasing cost, and biosimilars may be a means of reducing the high cost of many biologic medications. However, a bevacizumab biosimilar, which is currently pending Food and Drug Administration (FDA) approval (bevacizumab-vikg), paradoxically may increase the cost burden of intravitreal anti-VEGF agents, because off-label repackaged drugs may no longer be allowed per the Drug Quality and Security Act (DQSA). We aimed to investigate the potential impact of biosimilars on costs in the United States. Cost analysis of anti-VEGF medications. Medicare data from October 2022 and previously published market share data from2019. Average sales prices (ASPs) of ranibizumab, aflibercept, and bevacizumab were calculated from Medicare allowable payments. The ASPs of biosimilars were calculated from wholesale acquisition costs from a representative distributor. The cost of an intraocular bevacizumab formulation is modeled at $500/1.25-mg dose and $900/1.25-mg dose. Costs of anti-VEGF drugs to Medicare Part B and patients. If an intraocular bevacizumab biosimilar were to be priced at $500, costs to Medicare would increase by $457 million from $3.01 billion to $3.47 billion (15.2% increase). Patient responsibility would increase by $117 million from $768 million to $884 million. Similarly, if intraocular bevacizumab were priced at $900, Medicare costs would increase by $897 million to $3.91 billion (29.8% increase), and patient responsibility would increase by $229 million to $997 million. If bevacizumab were $500/dose, switching all patients currently receiving ranibizumab or aflibercept to respective biosimilars would compensate for only 28.8% of the increased cost. Current prices of ranibizumab and aflibercept biosimilars would have to decrease by an aggregate of 15.7% to $616.80/injection, $1027.97/injection, and $1436.88/injection for ranibizumab 0.3 mg, ranibizumab 0.5 mg, and aflibercept, respectively. An FDA-approved bevacizumab biosimilar for ophthalmic use could increase costs to the health care system and patients, raising concerns for access. This increase would not be offset by ranibizumab and aflibercept biosimilar use at current prices. These data support the need for an exemption of section 503B of the DQSA and continued use of repackaged off-label bevacizumab. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Evaluation of the Combination of Recombinant FSH and Antioxidant Therapy on DNA Fragmentation Index (DFI) in Infertile Men

Introduction. Medications such as antioxidants and recombinant FSH are prescribed to improve sperm DFI (DNA fragmentation index) and treat infertility. Due to the high cost and duration of medications, in this study, we decided to investigate the effectiveness of combining these two medications with lower doses and in less time, compared to previous studies prescribing them individually, to reduce sperm DFI in infertile men. Methods. This study, a retrospective observational before and after trial, included a group ( <math xmlns="http://www.w3.org/1998/Math/MathML" id="M1"> <mi>n</mi> <mo>=</mo> <mn>94</mn> </math> ) of men aged 18-50 years with <math xmlns="http://www.w3.org/1998/Math/MathML" id="M2"> <mtext>DFI</mtext> <mo>&gt;</mo> <mn>20</mn> <mi>%</mi> </math> suffering from male factor infertility in an andrology clinic in Tehran, Iran, from 2019 to 2020. Patients received the combination of two medications, recombinant FSH every 5 days (75 IU subcutaneously) and an antioxidant every day (selenium, vitamin E, CoQ10, and folic acid) for 2 months. The patient’s sperm DFI and sperm parameters have been measured before and after the medication and were reported in patient’s files. In all patients, we compare the sperm DFI and sperm parameters before and after the treatment to evaluate the effect of the combination therapy. Results. The sperm DFI was significantly reduced ( <math xmlns="http://www.w3.org/1998/Math/MathML" id="M3"> <mi>p</mi> </math> value ≤0.001) in the patients treated by the combined medication. The sperm DFI improvement was 50.16% in the total population. However, there were no significant changes in other sperm parameters such as sperm concentration, total motility, progressive motility, immotile sperms, and abnormal morphology. Total sperm count and nonprogressive motility had significant changes statistically. Conclusion. Sperm DFI is an important indicator for evaluating the quality of semen. In this study, we demonstrate that the combination of recombinant FSH and antioxidants in a shorter time and with lower doses is effective in reducing DFI significantly. But in terms of other sperm parameters, it does not make a significant difference.

Insights Into Medication Adherence Among Patients With Chronic Diseases in Jeddah, Saudi Arabia: A Cross-Sectional Study.

Background Non-adherence to medication is a common problem in managing chronic diseases, which are a significant public health concern globally. This study aimed to identify factors related to medication adherence among patients with chronic diseases in Saudi Arabia. Methods A cross-sectional survey design was used to collect data through an online survey administered to 400 patients with chronic diseases residing in Jeddah between January and March 2023. The survey included questions about socio-demographic characteristics, chronic disease diagnosis, medication adherence, and factors that may influence medication adherence. Results This study recruited 400 participants and found that the majority were female, with a mean age of 46.2 years, and most had at least one chronic disease, with hypertension and diabetes being the most common.The medication adherence score for the entire sample was 5.4, indicating moderate adherence. Overall,22.9% of study participants had poor adherence to medications.Factors associated with medication adherence included age, gender, and education level, with older age, female gender, and higher education being positively associated with adherence. Medication-related factors such as the number of medications prescribed, medication complexity, and medication cost were also found to be significantly associated with medication adherence. Conclusion Our study of medication adherence among chronic disease patients in Saudi Arabia found that adherence rates were moderate, with several factors significantly associated with better adherence. Specifically, older age, female gender, and higher education level were positively associated with better adherence, while a higher number of prescribed medications, more complex medication regimens, and higher medication costs were all significant predictors of poorer adherence.

CDBN-YGXZ, a Novel Small-Molecule Drug, Shows Efficacy against Clostridioides difficile Infection and Recurrence in Mouse and Hamster Infection Models.

Clostridioides difficile infection (CDI) causes severe diarrhea and colitis, leading to significant morbidity, mortality, and high medical costs worldwide. Oral vancomycin, a first-line treatment for CDI, is associated with a high risk of recurrence, necessitating novel therapies for primary and recurrent CDI. A novel small-molecule compound, CDBN-YGXZ, was synthesized by modifying the benzene ring of nitazoxanide with lauric acid. The mechanism of action of CDBN-YGXZ was validated using a pyruvate:ferredoxin/flavodoxin oxidoreductase (PFOR) inhibition assay. The efficacy of CDBN-YGXZ was evaluated using the MIC test and CDI infection model in mice and hamsters. Furthermore, metagenomics was used to reveal the underlying reasons for the effective reduction or prevention of CDI after CDBN-YGXZ treatment. The inhibitory activity against PFOR induced by CDBN-YGXZ. MIC tests showed that the in vitro activity of CDBN-YGXZ against C. difficile ranging from 0.1 to 1.5 μg/mL. In the mouse and hamster CDI models, CDBN-YGXZ provided protection during both treatment and relapse, while vancomycin treatment resulted in severe relapse and significant clinical scores. Compared with global effects on the indigenous gut microbiota induced by vancomycin, CDBN-YGXZ treatment had a mild influence on gut microbes, thus resulting in the disappearance or reduction of CDI recurrence. CDBN-YGXZ displayed potent activity against C. difficile in vitro and in vivo, reducing or preventing relapse in infected animals, which could merit further development as a potential drug candidate for treating CDI.

Phytochemical Screening and Evaluation of the Anti-Salmonella Activity of Leaf Extracts of Telfairia occidentalis Hook. F. (Cucurbitaceae) on Salmonella typhii Cell Culture

Typhoid fever, a bacterial infection caused by Salmonella typhi whose treatment is by use of antibiotics. And the use of these antibiotics associated with drug resistance, high cost of medication and less accessibility to rural populations remains an issue of concern. The aim of this research was to indentify bioactive metabolites of the leaf of T. occidentalis and determine the anti-salmonella typhi activity. The antibacterial activity of the leaf extracts (aqueous maceration, decoction, infusion and ethanol maceration) of Telfairia occidentalis (Fluted pumpkin or gourd) on Salmonella typhi, was determined using the agar well diffusion technique to investigate its potential use as anti-bacterial agent. The phyto-chemical constituents, Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of the leaf was analyzed. The phytochemical analysis of the extracts showed the presence of saponins, flavonoids, tannins, phenolics and coumarin with the absence of phlobatanins and oxalates. The decoction of the leaves demonstrated the highest activity against S. typhi (15+/-2.7mm) at 1000mg/ml. MIC for aqueous maceration, infusion, and decoction was recorded at 62.5mg/ml and that of the ethanol maceration was at 15.625mg/ml. Due to the extraordinarily high concentration of extract needed to produce anti-salmonella activity, the study's findings imply that the leaf extract has negligible activity against Salmonella.

Prevention of falls in the elderly and senile patients with cardiovascular diseases

A fall is defined as an event, which results in a person coming to rest inadvertently on the ground or floor or other lower level, except in cases, which are the result of a blow, loss of consciousness, sudden paralysis or an epilepsy [1]. Falls and fear of falling cause serious health problems, which, in turn are associated with high injury rate, high medical costs and a negative impact on quality of life. Older and senile patients with cardiovascular disease (CVD) are at high risk of falling. However, in clinical practice, the prevalence of falls and the risks of falls are not well understood and underestimated by physicians and patients themselves. An increased risk of falling is associated with various factors, such as drugs, structural heart disease, orthostatic hypotension and arrhythmias, as well as gait and balance disorders, physical weakness, sensory disturbances. These risks are especially important with the growing number of older people with cardiovascular disease. All physicians involved in the care of patients with CVD should pay attention to the assessment, prevention and treatment of falls in adults with heart disease, and the treatment of cardiovascular disease in patients at risk of falls.

Rib Fixation for Multiple Rib Fractures: Healthcare Professionals Perceived Barriers and Facilitators to Clinical Implementation

BackgroundSurgical stabilization of rib fractures (SSRF) is associated with improved respiratory symptoms and shorter intensive care admission in patients with flail chest. For multiple rib fractures, the benefit of SSRF remains a topic of debate. This study investigated barriers and facilitators of healthcare professionals to SSRF as treatment for multiple traumatic rib fractures.MethodsDutch healthcare professionals were asked to complete an adapted version of the Measurement Instrument for Determinants of Innovations questionnaire to identify barriers and facilitators of SSRF. If ≥ 20% of participants responded negatively, the item was considered a barrier, and if ≥ 80% responded positively, the item was considered a facilitator.ResultsSixty-one healthcare professionals participated; 32 surgeons, 19 non-surgical physicians, and 10 residents. The median experience was 10 years (P25–P75 4–12). Sixteen barriers and two facilitators for SSRF in multiple rib fractures were identified. Barriers included lack of knowledge, experience, evidence on (cost-)effectiveness, and the implication of more operations and higher medical costs. Facilitators were the assumption that SSRF alleviates respiratory problems and the feeling that surgeons are supported by colleagues for SSRF. Non-surgeons and residents reported more and several different barriers than surgeons (surgeons: 14; non-surgical physicians: 20; residents: 21; p < 0.001).ConclusionFor adequate implementation of SSRF in patients with multiple rib fractures, implementation strategies should address the identified barriers. Especially, improved clinical experience and scientific knowledge of healthcare professionals, and high-level evidence on the (cost-) effectiveness of SSRF potentially increase its use and acceptance.

SIMPLIFYing cystic fibrosis treatment in a post-modulator era.

The introduction of CFTR modulators, which are oral drugs that improve the function of the CFTR protein, has changed the treatment paradigm in cystic fibrosis from one that has been limited to treating the downstream consequences of CFTR dysfunction to one that, hopefully, prevents those complications from developing. The benefits of CFTR modulators in improving lung function, pulmonary exacerbations, nutrition, quality of life, and sweat chloride have been established in clinical trials for children aged 6 years or older, with studies in children aged 2–5 years underway. 1 Middleton PG Mall MA Dřevínek P et al. Elexacaftor-tezacaftor-ivacaftor for cystic fibrosis with a single Phe508del allele. N Engl J Med. 2019; 381: 1809-1819 Crossref PubMed Scopus (699) Google Scholar , 2 Zemanick ET Taylor-Cousar JL Davies J et al. A Phase 3 open-label study of elexacaftor/tezacaftor/ivacaftor in children 6 through 11 years of age with cystic fibrosis and at least one F508del allele. Am J Respir Crit Care Med. 2021; 203: 1522-1532 Crossref PubMed Scopus (61) Google Scholar The first modulator (ivacaftor) was only effective for patients with gating mutations; however, with the advent of effective triple therapy (elexacaftor plus tezacaftor plus ivacaftor [ETI]) for patients who are heterozygous for the most common genetic variant (F508del), more than 90% of patients are expected to benefit from CFTR modulators. 3 Bell SC Mall MA Gutierrez H et al. The future of cystic fibrosis care: a global perspective. Lancet Respir Med. 2020; 8: 65-124 Summary Full Text Full Text PDF PubMed Scopus (345) Google Scholar Many challenges, including timely diagnosis (particularly in low-income and middle-income countries), equitable access to these high-cost medications, and the absence of modulators for patients with less common genetic variants, cannot be disputed. However, highly effective CFTR modulators are arguably the biggest event in cystic fibrosis treatment since the introduction of pancreatic enzymes in the 1950s. Discontinuation versus continuation of hypertonic saline or dornase alfa in modulator treated people with cystic fibrosis (SIMPLIFY): results from two parallel, multicentre, open-label, randomised, controlled, non-inferiority trialsIn individuals with cystic fibrosis on ETI with relatively well preserved pulmonary function, discontinuing daily hypertonic saline or dornase alfa for 6 weeks did not result in clinically meaningful differences in pulmonary function when compared with continuing treatment. Full-Text PDF

Comparing the Clinical Efficacy of Topical Application of Virgin Coconut Oil and 1% Clotrimazole Cream as an Adjuvant to Systemic Antifungal in Chronic Dermatophytoses: A Randomized Controlled Trial

Introduction: Dermatophyte infections have become a common entity with a prevalence ranging from 36.6-78.4%. Majority of the patients are from low socioeconomic background who favour topical treatment. High treatment costs of antifungal medication and consequent poor compliance have given rise to the need of an effective and economical topical preparation. Objectives: To compare efficacy of topical 1% clotrimazole versus virgin coconut oil application as an adjuvant to systemic antifungals in dermatophytosis. Materials and Methods: A total of 100 patients presenting to the dermatology outpatient department and diagnosed with tinea infection clinically and by potassium hydroxide mount were taken up for the study. The patients were randomized into two groups with 50 patients in each group. One group received virgin coconut oil while the other group received 1% clotrimazole cream twice daily application as the topical preparation. Mycological cure was assessed by potassium hydroxide mount and clinical improvement was assessed objectively by severity score for itch, changes in clinical signs and symptoms and subjectively by Dermatology Life Quality Index questionnaire. Statistical analysis was analyzed using SPSS software version 17. Results: Virgin coconut oil and 1% Clotrimazole had equivocal response after 12 weeks of treatment with respect to potassium hydroxide mount positivity, itch severity, clinical improvement and changes in Dermatology Life Quality Index scores when used along with systemic antifungal. Conclusion: Virgin coconut oil can be easily used as a topical emollient and antifungal preparation along with systemic antifungals in the treatment of dermatophytosis.

The Singapore Experience With Uncontrolled Gout: Unmet Needs in the Management of Patients.

Gout is the most common type of inflammatory arthritis, and its impact on cardiovascular health and quality of life is often underestimated. The prevalence and incidence of gout are increasing globally. Further, ischemic heart disease (IHD) and chronic kidney disease (CKD) are prevalent in gout patients. Some unmet needs for gout management include physicians' low initiation rate of urate-lowering therapy (ULT) and poor treatment adherence in patients with gout. There is also a lack of randomized controlled trials that establish safe doses of acute and long-term treatment for gout, particularly in patients with IHD and stage 4 CKD and above (including end-stage renal failure).Furthermore, there is also a lack of studies showing optimal serum uric acid (SUA) target and validated clinical outcome measures, including disease activity and remission criteria for gout tailored to treat-to-target approaches and the high cost of newer gout medications. The causal relationship between asymptomatic hyperuricemia or gout with comorbidities such as IHD and CKD has yet to be fully elucidated. There is a pressing need for collaborative international efforts to address the overall suboptimal management of gout.

Effects of Physical Exercise on Left Ventricular Function in Type 2 Diabetes Mellitus: A Systematic Review

Diabetes mellitus is characterized by a group of metabolic disorders marked by high blood glucose levels. Over 90% of people with diabetes have type 2 diabetes (T2DM). The prevalence of T2DM has been increasing over the last decades worldwide, making it a serious global health concern. T2DM leads to an increased risk of the development of several health problems that result in high medical costs, poor quality of life, and higher mortality rates. More specifically, high blood glucose levels can [...]

Role of hospitalists in Japan for heart failure in the elderly: single center retrospective cohort study

ABSTRACT Objective In Japan, the benefits of hospitalist physician-led care after heart failure have not been sufficiently demonstrated. We evaluated quality of care by the general internal medicine hospitalist (GIM-H) system for patients after acute heart failure and compared it with care by cardiologists. Methods This retrospective cohort study enrolled adult patients from within a two-year period who were admitted to our institution for heart failure. Primary outcome measures were medico-economic indicators: length of hospital stay and medical costs. Secondary outcomes included readmission within 30 days of discharge, death within 30 days of admission, rate of prescription of ACEI/ARB and beta-blockers for heart failure with reduced left ventricular ejection fraction, and the percentage of patients receiving bespoke written treatment plans after discharge. This was thought to represent quality of heart failure-specific care. Outcomes between the groups were compared by adjusting for background factors using a propensity score. Results We enrolled 404 patients, and 81 were assigned to each group after matching (mean age: 86 years, female: 64.2%, mean left ventricular ejection fraction: 53.2%). The GIM-H-treated group had a significantly shorter hospital stay (13.7 days vs. 21.8 days, P < 0.001), a significantly lower total medical cost (618,805 JPY vs. 867,857 JPY, P < 0.05) but a higher medical cost per day (48,010 JPY vs 42,813 JPY, P < 0.05) than the cardiologist-treated group. Other indicators were not significantly different. Conclusions : GIM-H physicians in Japan are suggested to be useful and effective in care of patients with heart failure. The hospitalist system may positively impact the health economic outcomes of such patients.

SUDs Cost Employer Health Insurance $35 Billion Per Year

SUDs Cost Employer Health Insurance $35 Billion Per Year