Hospital-based Population Research Articles

Effects of age, sex and pathological type on the risk of multiple polyps: A Chinese teaching hospital study.

The lack of risk profile data on changes in multiple polyps identified by a colonoscopy constrains the creation of evidence-based guidelines. Our study aimed to investigate the relationship between size, location and histology of multiple polyps and patients' characteristics in a large teaching hospital-based Chinese population. We conducted a large, case-control, retrospective analysis on polyps obtained from 8308 patients who presented at the Digestive Endoscopy Center, Changhai Hospital (Shanghai, China) from January 2013 to August 2015. In total 10572 polyps were analyzed, with risk factors extrapolated through chart reviews of patients' electronic medical records. Single polyps were identified in 6843 (82.4%) patients while multiple polyps were found in 1465 (17.6%). A multivariate analysis indicated that men were more likely than women to have multiple polyps (P < 0.001). Compared with the single polyps group, the numbers of patients with multiple polyps increased significantly with age (P < 0.001). Multiple small (6-9 mm) non-advanced adenomas were more likely to be found than were diminutive (<5 mm) non-advanced adenomas (P < 0.001). While most advanced and non-advanced adenomas were diagnosed in patients with single adenomas (55.9% and 65.6%, respectively), advanced adenomas were more likely than non-advanced adenomas to be in multiples (P < 0.001). Our data indicate that particular features of colorectal polyps, such as their large size, advanced histology, together with patients' characteristics, including their sex and age, are risk factors associated with multiple polyps during diagnosis, screening and surveillance.

Prevalence and molecular characteristics of DNA mismatch repair deficient endometrial cancer in a Japanese hospital-based population.

The prevalence and molecular characteristics of defective DNA mismatch repair endometrial cancers in the Japanese population have been underexplored. Data supporting clinical management of patients with Lynch-like syndrome and germline variant of uncertain significance of mismatch repair genes are still lacking. Immunohistochemistry of mismatch repair proteins (MLH1, MSH2, MSH6 and PMS2) was performed on formalin-fixed paraffin-embedded sections prepared from resected primary endometrial cancers in 395 women with a median age of 59years. Genetic and/or epigenetic alterations of the mismatch repair genes were also investigated. Loss of expression of one or more mismatch repair proteins was observed in 68 patients (17.2%). A total of 17 out of 68 patients (25%, 4.3% of all cases) were identified as candidates for genetic testing for Lynch syndrome after excluding 51 patients with MLH1 hypermethylated cancer. Fourteen of these 17 patients subjected to genetic testing were found to have Lynch syndrome (n=5), germline variant of uncertain significance (n=2) or Lynch-like syndrome (n=7). Compared with patients with Lynch syndrome, those with germline variant of uncertain significance and Lynch-like syndrome tended to demonstrate an older age at the time of endometrial cancer diagnosis (P=0.07), less fulfillment of the revised Bethesda guidelines (P=0.09) and lower prevalence of Lynch syndrome-associated tumors in their first-degree relatives (P=0.01). This study provides useful information for management in patients with DNA mismatch repair endometrial cancer. Specifically, cancer surveillance as recommended in patients with Lynch syndrome might not be necessary in patients with germline variant of uncertain significance and Lynch-like syndrome and their relatives.

Diabetes Mellitus and Periapical Abscess: A Cross-sectional Study

IntroductionDental morbidities associated with diabetes mellitus (DM) include an increased prevalence of periodontal diseases (PDs). However, the occurrence of periapical infections in DM has not been sufficiently documented in the literature. The purpose of this study was to investigate the occurrence of periapical abscesses (PAs) in type 1 DM (T1DM) patients, type 2 DM (T2DM) patients, and nondiabetics in a hospital-based population. MethodsWe conducted a cross-sectional study by accessing the University of Florida Health Integrated Data Repository, and diagnoses of T1DM, T2DM, and PA were obtained from queries using the International Statistical Classification of Diseases, 10th Revision. The following parameters were recorded: age, sex, and race. A logistic regression model for aggregated data was used to assess the association between the occurrence of PA and the diabetic groups (T1DM, T2DM, and nondiabetic groups) after adjusting for PDs and cardiovascular disease (CVD). ResultsAmong 867,526 patients, we found 5260 (0.6%) with T1DM and 52,493 (6.1%) with T2DM. The prevalence of PAs in the total hospital population was 4923 (0.6%), 102 patients (1%) with T1DM and 766 (6%) with T2DM with statistically significant differences. In subjects without PDs, diabetic patients are almost 3 times likely to have PAs compared with nondiabetic subjects. Among subjects with PDs, the association is weaker (odds ratio = 1.35) but still significant at a level of 0.05. In subjects without CVD, DM subjects are greater than 3 times more likely to have PA, whereas among subjects with CVD, subjects with DM are 1.5 times more likely to have PA. ConclusionsA higher prevalence of PAs was reported in diabetic patients compared with the other hospital population. Comprehensive dental treatment should be administered to diabetic patients to maximize glycemic control.

Oxidative Stress, Telomere Shortening, and Apoptosis Associated to Sarcopenia and Frailty in Patients with Multimorbidity.

Background: The presence of oxidative stress, telomere shortening, and apoptosis in polypathological patients (PP) with sarcopenia and frailty remains unknown. Methods: Multicentric prospective observational study in order to assess oxidative stress markers (catalase, glutathione reductase (GR), total antioxidant capacity to reactive oxygen species (TAC-ROS), and superoxide dismutase (SOD)), absolute telomere length (aTL), and apoptosis (DNA fragmentation) in peripheral blood samples of a hospital-based population of PP. Associations of these biomarkers to sarcopenia, frailty, functional status, and 12-month mortality were analyzed. Results: Of the 444 recruited patients, 97 (21.8%), 278 (62.6%), and 80 (18%) were sarcopenic, frail, or both, respectively. Oxidative stress markers (lower TAC-ROS and higher SOD) were significantly enhanced and aTL significantly shortened in patients with sarcopenia, frailty or both syndromes. No evidence of apoptosis was detected in blood leukocytes of any of the patients. Both oxidative stress markers (GR, p = 0.04) and telomere shortening (p = 0.001) were associated to death risk and to less survival days. Conclusions: Oxidative stress markers and telomere length were enhanced and shortened, respectively, in blood samples of polypathological patients with sarcopenia and/or frailty. Both were associated to decreased survival. They could be useful in the clinical practice to assess vulnerable populations with multimorbidity and of potential interest as therapeutic targets.

Prevalence and risk factors for bacteremia in patients with Staphylococcus aureus bacteriuria: A retrospective cohort study

ObjectivesStaphylococcus aureus bacteriuria (SABU) is rare but can be an indicator of S. aureus bacteremia (SAB). The objective of this study was to assess the proportion of SAB in patients with SABU and identify risk factors in a hospital-based population. MethodsWe used electronic databases to identify eligible patients to be enrolled in a retrospective cohort study. Inclusion criteria were (i) SABU, (ii) ≥18 years of age, and (iii) ≥1 blood culture sampled ±3 months of SABU. Patients with missing values for demographic (e.g., age, sex) or clinical characteristics (e.g., comorbidities) and laboratory analyses were excluded. ResultsIn total, 245 patients attending the University Hospital Münster, Germany, between 1 January 2012 and 31 December 2019 met the inclusion/exclusion criteria. Of the 245 patients with SABU, 66 had a concomitant SAB (26.9%). Elevated C-reactive protein (CRP) levels were associated with SAB. Other parameters (e.g., leukocytes, comorbidities) were not associated with SAB in a multivariate analysis. ConclusionThe frequency of SAB in patients with SABU was high and warrants active screening for bloodstream infections in hospitalized patients, particularly if CRP levels are elevated.

Association of Gut Microbiota-Dependent Metabolite Trimethylamine N-Oxide with First Ischemic Stroke.

Aim: We aimed to investigate the relationship of trimethylamine N-oxide (TMAO) concentrations with ischemic stroke in a large-scale case-control study conducted among the hospital-based general population.Methods: We recruited 953 case-control sex- and age-matched pairs, and cases were confined to first acute ischemic stroke in this study. Fasting plasma TMAO was measured using high-performance liquid chromatography–tandem mass spectroscopy. Conditional logistic regression analysis was conducted to calculate odds ratios (OR) for the association of plasma TMAO with ischemic stroke.Results: We found that plasma TMAO concentrations in patients with ischemic stroke were significantly higher than that in the control group (median: 2.85 µmol/L vs. 2.33 µmol/L, P < 0.001). In multivariable conditional logistic regression models, higher plasma TMAO concentrations were associated with increased odds of ischemic stroke [fully adjusted OR for highest vs. lowest TMAO quartile: 1.81; 95% confidence interval (CI): 1.27, 2.59; P for trend < 0.001]. The multivariable-adjusted OR for ischemic stroke per 1 µmol/L increment of plasma TMAO was 1.05 (95% CI: 1.02, 1.08). Additionally, the positive association also persisted in subgroups stratified by age, sex, body mass index, smoking status, alcohol habits, history of diabetes, and history of hypertension.Conclusions: This study suggested a positive association between plasma TMAO and ischemic stroke. Further studies are required to explore the role of plasma TMAO concentrations in predicting stroke risk.

Seroprevalence, Biochemical Investigation and Risk Factor Assessment for HBV &amp; HCV Infection in Hospital Based Patients of Islamabad, Pakistan

Viral hepatitis poses a serious threat to mankind. Hepatitis B and C Virus are blood borne pathogens that affect millions of individually globally. This study was conducted on a hospital-based population in Islamabad, Pakistan over a period of 4 months, utilizing ELISA as the diagnostic technique which suggested a higher seroprevalence rate for both HBV and HCV i.e. 2.07% and 8.24% respectively. A correlational analysis of the biochemical parameters of these individuals with HBV and HCV infection was carried out and the results indicated a positive correlation of HBV with Alkaline Phosphatase (ALP), HCV with Total Bilirubin (TBil) and both the viruses with Alanine Aminotransferase (ALT). Furthermore, the risk factors in relation to these viral infections were explored upon which our data suggested that surgery, blood transfusion and contact with contaminated instruments at the barber for haircut/shaving and jewelers for piercings were the major risk factors responsible for aiding the contraction of the viral disease by patients in the hospital. These high percentages of the viral infection among the population require proper management and prevention techniques to minimize the number of casualties and further cases to provide a healthier surrounding for the people to live in.

The clinical and laboratory manifestations profile of antiphospholipid syndrome among Saudi Arabia population: Examining the applicability of Sapporo criteria.

Antiphospholipid syndrome is a organized autoimmune disease presented with vascular thrombosis and pregnancy morbidity. The Sapporo classification criteria of APS were revised in 2006 and are used as the main diagnosis guideline, which validity as standard measurements is still in debate. This study observe the clinical and laboratory indices of APS among Saudi patients. This is a retrospective study hospital-based population. The clinical and Laboratory manifestations of diagnosed APS patients from electronical medical records identifies by ICD-9 code 795.79 in the King Saud University Medical City, Riyadh, Saudi Arabia, between 1990 and 2012. We selected patients with ICD-9 code 795.79 as. Sapporo criteria applied to all patients, then divided into cases fulfilled criteria and cases failed the criteria. To notice the difference in clinical and laboratory indices and comorbidities between the two groups, the T-test was performed and Logistic regression for the fulfilled criteria and clinical indices of vascular thrombosis, DVT/PE, recurrent, and pregnancy morbidity. A total of 72 (90%) females and 8 (10%) males, with the female-to-male ratio 9:1. The mean (±SD) age at diagnosis was 28.1 (±8.7) years (range 11–63 years). There were 22 patients (27.5%) attained the revised criteria (APS confirmed) and no significant difference between the two groups was observed (p > 0.2). However, we found Sapporo confirmed APS cases had significantly higher percentage of serological manifestation presence than clinically diagnosed APS cases. Though there is no statistically significance, Sapporo confirmed APS cases had advanced odds of undergoing vascular thrombosis (OR = 1.61, 95%CI) and DVT/PE (OR = 1.53, 95%CI) and lesser odds of undergoing recurrent DVT/PE (OR = 0.67, 95%CI) and pregnancy morbidity (OR = 0.63, 95%CI) than the clinically diagnosed APS cases. Over 70% of the study population with diagnosed APS did not accomplish the revised Sapporo criteria due to negative laboratory manifestations, which reflects heterogeneous but not degreed disease severity profiles.

Helicobacter pylori prevalence in the Southwest of China: A protocol for systematic review.

Objectives:This epidemiological research will be aimed to evaluate the longitudinal changes of Helicobacter pylori prevalence in Southwest China during recent period through a systematic review and analysis.Methods:The database PubMed and China National Knowledge Infrastructure will be searched. The cross-sectional studies or cohort studies on either massive or hospital-based health checkup population will be potentially eligible. The study population was originated from one of the southwestern major cities, Chengdu (Sichuan), Chongqing, Kunming (Yunnan), Guiyang (Guizhou), or Lhasa (Tibet). Two reviewers will independently select studies, extract data, and assess the quality of studies. The prevalence of H pylori infection will be estimated. In the individual city, the longitudinal comparisons will be conducted to evaluate the trends referring to the earliest cross-sectional baseline. The risk ratio and its 95% confidence interval will be estimated. Subgroup analyses will be performed in sex-specific and age-specific subsets. Trend analysis for proportions (p for trend) will be estimated in the longitudinal evaluation. If applicable, the longitudinal clearance rate (%) will be estimated.Ethics and Dissemination:The ethical approval is not required due to the nature of literature-based research. The results will be disseminated through meetings and a peer-reviewed journal.PROSPERO Registration Number:CRD42019120764

Asian management of hypertension: Current status, home blood pressure, and specific concerns in Philippines (a country report).

Incidence of cardiovascular diseases (CVD) in the Philippines based on the Philippine Heart Association survey among hospital-based population showed hypertension as the highest (38.6%), followed by stroke (30%), coronary artery disease(CAD) (17.5%), and heart failure (10.4%). Based on Philippine FNRI data, the prevalence of coronary, cerebrovascular, and peripheral arterial diseases were 1.1%, 0.9%, and 1.0%, respectively. Cardiovascular risk factor prevalence were the following: diabetes at 3.9%, dyslipidemia at 72%, smoking at 31%, obesity at 4.9% (BMI), and 10.2% and 65.6% by waist-hip ratio in men and women, respectively. In a more recent study on risk factors, urban dwellers were more hypertensive, overweight, obese, and with impaired fasting glucose. More smokers and dyslipidemia by high TC, high non-HDL-C, and low HDL-C were seen in those living in the rural areas. Subjects with higher level of education were more overweight, obese and have dyslipidemia by a high TC, TG, and LDL-C while there were more smokers, low HDL-C, and hypertensive participants who have reached a lower level of education. Latest data on prevalence of hypertension were 28% equal for males and females. Unaware was 9%. Treatment rate was 56%, compliance was 57%, and BP control rate was 20%. Antihypertensive medications used were beta-blockers (36%), calcium channel blockers (CCB) (33%), angiotensin receptor blockers (ARB) (28%), ACE inhibitors (5%), and centrally acting agents (4%). Mortality from CVD was stroke, mostly infarct (22.6%), myocardial infarction (6.5%), and Heart Failure (6.5%).

Subclinical hypothyroidism and anxiety may contribute to metabolic syndrome in Sichuan of China: a hospital-based population study

The prevalence of Metabolic syndrome (MetS) in Sichuan of China has not yet been estimated. Meanwhile the association among anxiety, subclinical hypothyroidism (SCH) and MetS was less well-studied. The data was retrieved retrospectively from Health Promotion Center of West China Hospital database between 2014 and 2017. Internal validation by randomizing into training and testing panel by 9:1 and external validation with National Health and Nutrition Examination Survey (NHNES) were conducted. 19006 subjects were included into analysis, and 3530 (18.6%) of them were diagnosed with MetS. In training panel, age, sex (male), SCH (presence), SAS score, alcohol (Sometimes & Usual) and smoking (Active) were identified as independent risk factors for MetS, which was confirmed in testing panel internally. NHNES data validated externally the association between free thyroxine (fT4) and MetS components. The C-indices of predicting MetS nomogram were 0.705 (95% CI: 0.696–0.714) and 0.728 (95% CI: 0.701–0.754) in training and testing panel respectively. In conclusion, MetS prevalence was 18.6% in Sichuan. SCH and anxiety may be associated with MetS independently. A risk scale-based nomogram with accurate and objective prediction ability was provided for check-up practice, but more cohort validation was needed.

The presence of ectopic atrial rhythm predicts adverse cardiovascular outcomes in a large hospital-based population

Whether ectopic atrial rhythm (EAR) is a high-risk cardiovascular phenotype (eg, the manifestation of a diseased sinoatrial node) or just a benign accelerated ectopic pacemaker remains unclear. We aimed to analyze the cardiovascular outcomes and underlying mechanisms in patients with EAR. From a 12-lead electrocardiogram hospital-based electrocardiogram database, a total of 2896 adults with EAR were propensity score matched at 1:5 with 14,480 patients with sinus rhythm (SR). Patients were retrospectively followed up for cardiovascular mortality (the primary outcome) and permanent pacemaker implantation (the secondary outcome). Heart rate variability was analyzed to compare autonomic function between patients with EAR and those with SR. The prevalence of EAR was 1.13%, which increased with age. Compared with the matched patients, those with EAR had a higher risk of cardiovascular mortality (adjusted hazard ratio 1.93; 95% confidence interval 1.52-2.44; P < .0001) and permanent pacemaker implantation (adjusted hazard ratio 5.94; 95% confidence interval 3.89-9.09; P < .0001) according to the Cox proportional hazards regression model. The risk of cardiovascular mortality was similar across the subgroups on the basis of age, sex, hypertension, type 2 diabetes mellitus, congestive heart failure, myocardial infarction, stroke, and chronic kidney diseases. In patients with EAR, the low frequency/high frequency and standard deviation of the mean normal-to-normal intervals/root mean square of successive RR interval differences ratios for heart rate variability were both lower than those in patients with SR. This implied autonomic imbalance in patients with EAR. Patients with EAR have a higher risk of cardiovascular mortality and permanent pacemaker implantation, which was associated with autonomic imbalance.

Pocket-sized echocardiography for screening structural heart disease: diagnostic accuracy and cost-effectiveness for population-based studies.

The standard transthoracic echocardiography has some limitations in emergent and community-based situations. The emergence of pocket-sized ultrasound has led to influential advancements. In this prospective study, in the hospital-based phase, children with suspected structural heart diseases were enrolled. In the school-based phase, healthy children were randomly selected from six schools. All individuals were examined by experienced operators using both the standard and the pocket-sized echocardiography. A total of 73 individuals with a mean age of 9.9 ± 3.2 years in the hospital-based cohort and 143 individuals with a mean age of 12.8 ± 2.9 years in the school-based cohort were examined. The agreements between the standard and the pocket-sized echocardiography were good or excellent for major CHDs in both cohorts (κ statistics > 0.61). Among valvular pathologies, agreements for tricuspid and pulmonary valves' regurgitation were moderate among school-based cohorts (0.56 [95% confidence interval 0.12-1] and 0.6 [95% confidence interval 0.28-0.91], respectively). The agreements for tricuspid and pulmonary valves' regurgitation were excellent (>0.9) among hospital-based population. Other values for valvular findings were good or excellent. The overall sensitivity and specificity were 87.5% (95% confidence interval 47.3-99.7) and 93.8% (95% confidence interval 85-98.3) among the hospital-based individuals, respectively, and those were 88% (95% confidence interval 77.8-94.7) and 68.4% (95% confidence interval 56.7-78.6) among the school-based individuals, respectively. The cost of examination was reduced by approximately 70% for an individual using the pocket-sized device. When interpreted by experienced operators, the pocket-sized echocardiography can be used as screening tool among school-aged population.

CT Angiography detection of ruptured intracranial aneurysms with subarachnoid hemorrhage in a hospital-based population

CT Angiography detection of ruptured intracranial aneurysms with subarachnoid hemorrhage in a hospital-based population

Patterns of traumatic intracranial hemorrhage on Non-contrast computed tomography - A study on a hospital-based population

Patterns of traumatic intracranial hemorrhage on Non-contrast computed tomography - A study on a hospital-based population

Higher DNA methylation of ABO gene promoter is associated with acute myocardial infarction in a hospital-based population in Karachi.

Objective:To find out if there is any relationship of methylation status of ABO gene promoter with the risk of acute myocardial infarction (AMI) in a hospital-based Pakistani population in Karachi, Pakistan.Methods:A case control study comprising of 39 adult AMI patients (both males and females; age range 30-70 years) and 39 normal healthy controls (both males and females and similar age range) nested in a large study (to see the relationship of ABO genotypes with AMI) was designed to investigate the methylation status of ABO gene promoter and its association with AMI. The study was carried out at the Aga Khan University, Karachi during July 2018 to June 2019. DNA isolated from samples of AMI patients and normal healthy controls were converted into bisulphite DNA using a kit method. Methylation specific polymerase chain reaction was carried out to determine the methylation status of ABO gene promoter in both cases and controls. Logistic regression was used to find out any association between increased methylation status of ABO gene promoter and risk of AMI.Results:A significantly higher percentage of DNA methylation of the ABO gene promoter was observed in AMI patients as compared to normal healthy controls (82.1% vs. 35.9%; p value <0.001). This higher methylation status of ABO gene promoter was associated with AMI and the odds of AMI in this population were more than 6-fold in subjects with methylated gene promoter compared to those with unmethylated gene promoter after adjusting with age and waist circumference [AOR (95% CI) = 6.27 (1.76-22.3); p value = 0.005].Conclusion:The ABO gene promoter’s hypermethylation appears to be increasing the risk of AMI in a hospital-based Pakistani population in Karachi, Pakistan.

Meibomian Gland Dysfunction in a Hospital-Based Population in Central India.

To estimate the prevalence of meibomian gland dysfunction (MGD) in a hospital-based population in India. This cross-sectional study screened 3410 subjects ≥20 years or older attending the outpatient department by systematic random sampling. The patients were subjected to a comprehensive eye examination, Ocular Surface Disease Index questionnaire, fluorescein tear film breakup time, Schirmer I test, lissamine green stain, lid margin changes, and meibomian gland expression. MGD was diagnosed when 1 or both of the following was present in at least 1 eye: reduced or absent meibum secretion and cloudy to inspissated toothpaste-like secretion on digital pressure over the eyelids. The study included 570 subjects with a mean age of 49.3 ± 16.2 (20-84) years. MGD was diagnosed in 317 (55.61%) subjects, of whom 272 (47.7%) had only MGD and 45 (7.9%) had coexisting MGD and aqueous tear deficiency. The age-adjusted prevalence rate of MGD was 48.4% (95% confidence interval: 43.9-52.1). This rate increased significantly with age (P < 0.001) in both men (P < 0.001) and women (P < 0.001). The crude and age-adjusted prevalence of symptomatic MGD (Ocular Surface Disease Index score ≥13) was 26.1% (71/272) and 32.9% (95% confidence interval: 27.4-38.6), respectively. The prevalence of symptomatic MGD significantly declined with increasing age (P = 0.003), and this was reflected in both men (P = 0.013) and women (P = 0.179) but was not statistically significant in the latter. The prevalence of MGD was higher in Indian subjects than that previously reported. Although the total MGD prevalence increased with age, the prevalence of symptomatic MGD decreased. Asymptomatic MGD was more common than symptomatic MGD.

Prevalence of Lynch syndrome among patients with upper urinary tract carcinoma in a Japanese hospital-based population.

The prevalence of Lynch syndrome and the use of universal tumor screening to identify Lynch syndrome among unselected patients with upper urinary tract urothelial carcinoma, which is associated with Lynch syndrome, have not been closely investigated yet. A total of 166 tumors from 164 upper urinary tract urothelial carcinoma patients were tested for microsatellite instability and expression of mismatch repair proteins (MLH1, MHS2, MSH6 and PMS2) by immunohistochemistry. Genetic testing was performed for patients suspected of having Lynch syndrome. Clinicopathological factors, including familial and personal cancer history associated with mismatch repair deficiency, were evaluated. The frequency of high-level microsatellite instability and loss of at least one mismatch repair protein was 2.4% (4/164); the microsatellite instability and immunohistochemistry results showed complete concordance. Of these four patients, three were genetically proven to have Lynch syndrome, while the remaining one was highly suggestive for Lynch syndrome based on their personal cancer history. Univariate analysis showed that age<70years (P=0.04), ureter as the tumor location (P=0.052), previous history/synchronous diagnosis of colorectal cancer (P<0.01) and fulfillment of the criteria per the revised Bethesda guideline (P<0.01) tended to be or were significantly associated with high-level microsatellite instability/mismatch repair loss. The prevalence of Lynch syndrome among unselected upper urinary tract urothelial carcinoma patients was at least 1.8% in our study population. The screening efficacies of the microsatellite instability test and immunohistochemistry appear equivalent. Universal tumor screening may be a valid approach; however, selective screening methods that consider factors associated with mismatch repair loss/high-level microsatellite instability tumors require further investigation.

Types of Human Papillomavirus Observed in Hospital-Based Population

AbstractBackground and Objectives: Human papillomavirus (HPV) is the causative agent of cervical cancer, a major cause of cancer mortality in Indian women. The current study was undertaken to add information to the existing data on HPV type distribution in Indians, in an attempt to document HPV types for future vaccination programme, if any. Materials and Methods: HPV infection was screened in 223 cervical cancer cases and 2408 healthy women without cancer and cervical intraepithelial neoplasia (control). HPV was typed using polymerase chain reaction, Southern hybridisation using specific probes and HPV GenoArray (Hybribio) test. Results: HPV DNA was found in 92.8% of cases and 7.3% of controls. Of the 383 HPV-infected women, 30.0% had single infection; 50.9% had multiple infections (two or more types) and 19.1% were infected with HPV types other than HPV-16, -18, -6 and -11. Besides HPV-16, HPV-51 and HPV-33 were also seen as single infection in cases. In cases, HPV-18 or its homologous HPV-45 was always present as co-infection with HPV-16 or with other high-risk type. Binary logistic regression (backward) analysis highlighted significant association of age, parity and socioeconomic status with HPV infection. The present study highlighted the presence of multiple HPV infection (186 of 207, 89.9%) along with HPV-16 in women with cervical cancer. In control, 27.3% were co-infected with other sexually transmitted infections, while Chlamydia trachomatis infection was seen in 13% of cases. Conclusions: The study highlighted the type of HPV infection seen among the hospital-based population. For better screening, HPV tests available in the market should include all the types seen in the population.

Home Visiting Program for NICU Graduates: Feasibility and Potential for Impact

Neonatal intensive care unit (NICU) admissions have been increasing. Home visiting services are an integral part of caring for high-risk children with limited resources. The effectiveness of physician-led home visiting programs on post-NICU health outcomes is not well studied. The Pediatric Visiting Doctors (PVD) program provides home-based primary care for high-risk children including NICU graduates, for 6 months after discharge. The team consisted of a pediatrician, and care coordinator or social worker. The study compares the characteristics and care utilization of PVD program participants with a hospital-based pediatric clinic population. A retrospective cohort study of PVD infants born from 2013–2016, who were enrolled after referral during their NICU admission, was conducted. Data were also obtained on infants who were hospital clinic patients born during the same time frame, with parents residing in the PVD catchment area, and had a minimum 72-hour NICU stay. Between group differences were assessed; and logistic regression and generalized linear models were used to adjust for uneven group characteristics. Forty-six PVD participants completed the program, and 91 comparison infants had at least 6 months of post-NICU clinic visits. PVD program completers received a median of 5 home visits. There were no differences in emergency care use or hospitalization. PVD program participants were more likely to attend development clinic compared to the non-PVD group (59% vs 12%, p = 0.002). Physician-led home visiting services is a feasible way of providing clinical care to this population. Additional research is needed to assess patient-centered outcomes of these programs.