Hospital In Tamil Nadu Research Articles

A study to compare the prevalence of posterior capsular opacity between patients implanted with hydrophobic acrylic intra ocular lens (IOL) versus hydrophilic acrylic intra ocular lens (IOL) in the diabetic and non-diabetic group following cataract surgery: A hospital based prospective study

: To study and compare the prevalence of posterior capsular opacity between patients implanted with hydrophobic acrylic IOL versus hydrophilic acrylic IOL in the diabetic and non diabetic group following cataract surgery. All patients with senile cataracts, whether they had diabetes or not, who visited a tertiary care hospital in Tamil Nadu between 2020 and 2022 were enrolled in this study after signing a written consent form. In this study, 200 patients underwent screening and were split into 4 equal groups.The PCO observation of patients in all 4 groups in the current study showed that Groups 3 and 4 with hydrophilic IOL found higher incidences of PCO than Groups 1 and 2 with hydrophobic IOL. In our study, more PCO was reported with hydrophilic IOL with known (Group 3) and unknown (Group 4) cases of diabetes. Regardless of the patient's level of diabetes during the course of a year-long follow-up, hydrophobic acrylic IOLs showed a greater decrease in PCO rates than hydrophilic acrylic IOLs.

Uterine Cancer: A Nine-year Review from a Tertiary Hospital in Tamil Nadu

Background: With increasing uterine cancer in developing nations, there is a need for timely determination of the diagnosis, prognosis, and management options to reduce morbidity and mortality. Objective: To analyze the socio-demographic, etio-pathological features and management of uterine cancer and evaluate its correlation with grading/staging in our population. Methods: This retrospective descriptive study analyzed data from 97 histologically proven uterine cancer cases. Age, parity, symptoms, co-morbidities, body mass index (BMI), ultrasound features, histopathology type, stage and grade of the tumor, type of hysterectomy done, complications and mortality were analysed. Statistical analysis was done using ANOVA and chi-square test, and a p-value<0.05 indicated statistical significance. Results: The mean age of diagnosis was 57.91 years, and the mean BMI was 29.32 Kg/m2. Majority of the patients were multiparous (42.27%), and only 10% were nulliparous. The disease was detected at an earlier age in nulliparous and obese women. Diabetes and hypertension were found in 75.25%. Most of the patients were detected with stage I cancer (80.6%). Patients diagnosed with uterine cancer on biopsy were treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy andbilateral pelvic lymph node dissection (55.8%). Over 36% of patients received postop radiotherapy and/or chemotherapy. 21% patients were lost to follow-up and 12.37% died. Also, 24 cases had postoperative complications (wound infection). Conclusion: Uterine cancer is common among obese women with diabetes and hypertension. In nulliparous and the obese, the cancer was detected at an earlier age. Most of our patients had stage 1 disease, and 90% was endometroid cancer. The study highlights the importance of endometrial sampling before hysterectomy in perimenopausal women to avoid suboptimal surgery in patients diagnosed with uterine cancer after a simple hysterectomy.

Root Cause Analysis of Increased Referral Rates in a Sub-district Hospital, Tamil Nadu: A Quality Improvement Initiative.

Background Sub-district hospitals in Tamil Nadu are critical in providing essential healthcare services, but they face significant challenges that can lead to increased patient referrals to higher-level facilities. High referral rates can overburden tertiary care centers, delay specialized treatment, and affect patient outcomes. This study aims to identify the root causes of increased referral rates in a sub-district hospital and implement targeted interventions to reduce unnecessary referrals. Methods A descriptive study was conducted at Sriperumbudur sub-district hospital in Tamil Nadu from May to August 2023. The study utilized a root cause analysis (RCA) approach, incorporating qualitative data from brainstorming sessions with healthcare providers and administrative staff, and quantitative data from hospital records on referral rates. A fishbone (Ishikawa) diagram was employed to map causal factors, and Pareto and bar charts were used to analyze and present referral trends. Interventions were implemented using the Plan-Do-Study-Act (PDSA) cycle. Results The analysis identified several key factors contributing to high referral rates, including inadequate diagnostic services, insufficient staffing, and lack of essential resources such as CT scans and blood components. Following targeted interventions, referral rates decreased significantly from 101 cases in May-June 2023 to 52 cases in July-August 2023 highlighting a reduction of over 48%. The most notable reductions were seen in referrals for road traffic accidents with head injury (38.7%) reduction, chronic kidney disease (CKD)/hypertension (HT)/diabetes mellitus (DM) (46.2%) reduction, and crush injuries (45.5%) reduction. Conclusions The RCA revealed systemic issues that were contributing to increased referral rates at the sub-district hospital. Implementing targeted interventions based on the RCA findings led to a significant reduction in referrals, improving patient care at the local level and alleviating the burden on tertiary care centers. This study underscores the importance of continuous quality improvement initiatives in strengthening healthcare delivery at the sub-district level.

Task-sharing spinal anaesthesia care in three rural Indian hospitals: a non-inferiority randomised controlled clinical trial

BackgroundTask-sharing of spinal anaesthesia care by non-specialist graduate physicians, termed medical officers (MOs), is commonly practised in rural Indian healthcare facilities to mitigate workforce constraints. We sought to assess whether...

Histopathology of gallbladder in gallstone disease at a tertiary care hospital in Tamil Nadu

Histopathology of gallbladder in gallstone disease at a tertiary care hospital in Tamil Nadu

The time motion study of an out-patient department in a tertiary care hospital in Tamil Nadu

The time motion study of an out-patient department in a tertiary care hospital in Tamil Nadu

Predictive Value of Neutrophil-to-Lymphocyte Ratio in Differentiating Perforated from Non-perforated Appendicitis: A Cross-Sectional Study in a Tertiary Care Hospital, Tamil Nadu.

Introduction Acute appendicitis is a common reason for acute abdominal pain.It has a high perforation rate of 20%. Diagnosis of acute appendicitis is usually through well-known clinical signs and symptoms.Radiologic imaging is by and large carried out in peculiar cases with indistinct signs and symptoms.Although various scoring methods are available for screening and diagnosis, those have inadequate validity to accurately predict the severity of acute appendicitis.From the differential counts, the neutrophil-to-lymphocyte ratio (NLR) is an economical and straightforward measure of subclinical inflammation. NLR may be a useful marker for predicting the onset and severity of appendicitis because of the insight it gives into immunological and inflammatory pathways. In this study, we aimed to determine the association between NLR and acute appendicitis among adult patients to differentiate between perforated and non-perforated appendicitis in a tertiary care hospital in Tamil Nadu, India. Methods This was a cross-sectional study conducted in the Department of General Surgery of a deemed university in Chennai, Tamil Nadu.The study was conducted from March 2022 to December 2022. Patients aged 18 years and above undergoing appendicectomy surgery were included in the study.Patients with hematology disorders, chronic kidney disease, chronic liver disease, chronic obstructive pulmonary disease, asthma, cancer, or auto-immune diseases, and any viral, bacterial, or parasitic infections were excluded.Pregnant women were also excluded from the study.After obtaining informed consent from the patients, blood samples were collected as and when they were diagnosed as acute appendicitis.Laboratory analysis for complete hemogramincluding white blood cell (WBC) count, neutrophil, and lymphocyte count was carried out using an automated hematology analyzer.Prevalence of perforated appendicitis was reported as a percentage.The receiver-operating characteristic (ROC) curve was developed for NLR in differentiating perforated and non-perforated appendicitis.Data were entered in Microsoft Excel 2023.These analyses were carried out in STATA 12.0 (StataCorp, College Station, Texas, USA). Results A total of 212 patients aged 18 years and above were included in the study.Among them 93 (43.9%) were male and 119 (56.1%) were female.Prevalence of perforated appendicitis observed intra-operatively was 29.7% and non-perforated appendicitis was 70.3%. The mean (SD) of NLR among patients with perforated appendicitis was 8.8 (5.1) and non-perforated appendicitis was 3.2 (2.4) with a statistically significant difference (p-value < 0.0001).ROC curve with a cut-off value of 3.78 NLR, had sensitivity of 65.9% and specificity of 93.1% in differentiating perforated and non-perforated appendicitis.The positive predictive value (PPV) and negative predictive values (NPV) were reported as 85.7% and 81.2%, respectively. Conclusion NLR has a reasonable validity in differentiating perforated and non-perforated appendicitis.NLR may be useful in low-resource settings where routine confirmatory radiological procedures like computed tomography scans are not available.

Quantifying the Occurrence of High-Risk Pregnancy: A Comprehensive Survey.

Background High-risk pregnancies are characterized by various factors that pose potential risks to maternal and newborn health outcomes. Early detection of these high-risk pregnancies serves as a crucial initial step in preventing maternal mortality and morbidity, thereby promoting the overall health of both mother and baby. This study sought to assess the occurrence of high-risk pregnancy and investigate the factors associated with it among pregnant women. Methods A descriptive survey was undertaken at the Obstetrics and Gynaecology outpatient department of a District Government Hospital in Tamil Nadu, involving 1889 pregnant women in their second and third trimesters. A structured questionnaire, constructed following the Indian standard criteria outlined by the National Health Portal of India, served as the data collection tool. The survey was conducted in February and March 2022, during which pregnant women were interviewed. Subsequently, the collected data underwent descriptive and inferential statistical analysis. Results Among the 1889 pregnant women surveyed, 29% (n=530) were classified as high-risk pregnancies. Within this group, 34.3% (n=182) were diagnosed with hypothyroidism, while 23.2% (n=123) experienced pregnancy-induced hypertension. Significant associations with high-risk pregnancy were observed for factors such as age, education status, occupation, family income, socioeconomic status, and gravida among the pregnant women. Conclusion Policymakers must urgently implement evidence-based interventions aimed at early detection and treatment of high-risk pregnancies. This proactive approach is essential in preventing maternal mortality and morbidity.

Root Cause Analysis of Gaps in Non-communicable Disease Monitoring in a Sub-district Hospital, Tamil Nadu: A Quality Improvement Initiative.

Introduction Non-communicable diseases (NCDs) present a significant public health challenge globally, and India is deeply affected. With the largest population in the world, India struggles with a high burden of NCDs, encompassing cardiovascular diseases, diabetes, cancer, and chronic respiratory conditions. These ailments contribute substantially to morbidity and mortality, placing a strain on healthcare systems. Despite efforts through public health initiatives, NCD monitoring and management remain deficient, especially at grassroots levels. Methods At a sub-district hospital in Tamil Nadu, India, a quality improvement initiative targeted diabetes and hypertension, prevalent NCDs. Utilizing Fishbone analysis and process flow diagrams, we identified gaps in NCD monitoring. Employing the Plan-Do-Study-Act model and reorienting the patient flow, we enhanced NCD monitoring by optimizing patient health record maintenance within the hospital. Results Root cause analysis identified a lack of patient record protocols and patient loss of records as key hindrances in NCD monitoring. We revamped patient flow and implemented a robust record-keeping system, boosting access to patient health records. This initiative was embraced by healthcare providers, enhancing NCD management. Leveraging these records, we assessed control rates of diabetes and hypertension patients effectively. Conclusion The research underscores the importance of maintaining comprehensive patient health records in healthcare centers for enhancing NCD monitoring. These records serve as valuable tools for healthcare providers, aiding in the monitoring and treatment of patients with diabetes and hypertension. By leveraging these records, healthcare providers can achieve better disease control outcomes, thereby improving the overall management of NCDs.

Emergence of Dematiaceous Fungal Hypopyon in a Tertiary Care Hospital in Tamil Nadu: A Case Study

Emergence of Dematiaceous Fungal Hypopyon in a Tertiary Care Hospital in Tamil Nadu: A Case Study

Assisted Reproductive Technologies Helping Infertile Couples or Using Minor Girls in Poverty; Boon or Bane?

Abstract: According to WHO data, one in every four couples in developing countries is affected by infertility, and the prevalence remains high year by year. Infertility is considered to be a globally concerned health issue, which affects millions of people of reproductive age worldwide. Nowadays in our modern and developing field of medicine, we have different solutions and treatments for almost each and every disease. Treatment for infertility varies based on the cause, from simple psychological therapy to some complicated procedures. All these procedures are regulated by World Health Organization and their own country’s legislation. Each country has uniqueness in their legislation, but almost all countries mainly focus on ethics, medical outcomes and health of both donor and recipients. However, in some parts of the world, laws are sometimes over-ruled and not abided properly. One of such recent incident took part in southern part of India (4 private hospitals in Tamilnadu, and 2 more hospitals in Andhra Pradesh and Kerala), which made a shocking news for people all over the country. The minor girl aged 16 years was exploited as egg (oocyte) donor. In the modern world, we are focusing and researching more and more on female related health problems, but such incidents worry us. We have a responsibility to prevent from such dreadful incidents in future, since respective governments and courts proceed the case for veracity and justice. As doctors or medical professionals, we have to follow our own medical and professional ethics. And as a citizen, all people including doctors and patients must obey our countries own rules and regulations accordingly. Further we request government authorities to make procedures and laws to be more strict and highly punishable when violated.

A pilot study on determination of dietary intake of geriatric epileptic patients

Epilepsy, a complex neurological condition, stems from multifaceted factors, including genetic predispositions and various triggers. The elderly, a rapidly growing demographic globally, encounter an increased risk of seizures. In India, a significant population lives with epilepsy, notably more prevalent in rural areas. Moreover, malnutrition and epilepsy exhibit a complex relationship, potentially influencing each other's onset and progression. Geriatric individuals with epilepsy often face sedentary lifestyles and potential weight-related concerns due to medication. This pilot study aimed to assess the nutrient profile of geriatric patients with epilepsy. A quantitative research approach was adopted; studying 30 individuals aged 60 to 80 years at a private neurology hospital in Tamil Nadu. Data was collected through interviews and dietary assessments, including the 24-hour recall and food frequency methods. Statistical analysis using SPSS provided insights into nutrient intake among the participants. Results indicated that while certain nutrients met recommended levels, fat and carbohydrate intake exceeded the prescribed amounts. Additionally, dietary patterns varied among different types of seizures. Despite differences, no statistical significance was found. Food frequency analysis revealed varied consumption patterns, notably lower intake of fruits and vegetables among the epilepsy geriatric patients. The study emphasizes the importance of understanding the nutritional needs of individuals with epilepsy, particularly in the geriatric population, to formulate personalized dietary interventions for improved seizure management and overall health.

Prospective Study on Estimation of Stature of Adult from Length of Clavicle in a Tertiary Care Hospital in Tamilnadu

Forensic anthropology can play an important role in the identification process. Besides determination of race, sex and age of the unknown individual, estimation of stature enhances the reliability of identification. It is easier to get those data when the whole body or the entire skeleton isavailable to the forensic anthropologist. However incases of deliberate mutilation and disposal in parts, interference by wild animal and bomb blast by terrorist attack, recovery of the whole body or complete skeleton may not be possible. In those cases, in the forensic anthropologists have to give this opinion based upon the available supplied skeleton remains. Although approximate stature of the individual can be estimated from most of the long bones using either multiplication factors or regressionformulae, studies on estimation of stature from clavicle are limited. In the past, Terry, Oliver and Thieeme have tried to estimate the stature of the individual from clavicle. So the present study is planned to determine the stature from clavicle.

Prevalence of Physical Nicotine Dependence and its Determinants among Tobacco users in the Rural Field Practice Area of a Tertiary Care Hospital in Tamil Nadu, India.

Tobacco is the major cause of preventable death globally, which kills one person prematurely every six seconds. In India, around 46.9% of men and women aged 15 years and above use any kind of tobacco, according to NFHS-5. Tobacco use for longer duration with increased frequency is often addictive. Nicotine in tobacco is often associated with dependence, which is recognized as a public health menace and the single most significant factor for premature death. Hence, assessment of nicotine dependence among tobacco users is essential to implement tobacco control measures effectively. To estimate the prevalence of nicotine dependence among tobacco users and to study the factors associated with nicotine dependence among those tobacco users in a rural area of Kancheepuram district, Tamil Nadu. A community-based descriptive cross-sectional study was conducted among 375 tobacco users aged 18 years and above residing permanently in the rural field practice area of the Rural Health and Training Centre (RHTC) attached to a Tertiary Care Hospital in Tamil Nadu. The study has been conducted for 6 months. A systematic random sampling technique was used to recruit the study participants. Data was collected by conducting personal interviews using a pre-tested semi-structured questionnaire. The data obtained was subjected to statistical analysis using SPSS version 23. About 48.7% of the study participants had high dependence, 25% had moderate dependence, and 26.3% had low physical dependence on nicotine. The duration of tobacco use (P < 0.0000) and age of initiation of tobacco use (mean age was 28 ± 7.1 years) (P < 0.0001) was found as a significant risk indicator for nicotine dependence. The high nicotine dependence (48.7%) among the study participants is quite alarming and warrants more visible and aggressive anti-tobacco campaigns and targeted preventive strategies.

Etiology and predictors of heart failure in pregnancy. Newer Insights from the M-PAC registry

Abstract Background Women with heart disease undergoing pregnancy is on the increase, along with an increasing cardiac contribution to maternal mortality. Aim To identify the proposition of pregnant women with heart disease, who develop heart failure as a complication and to identify the predictors of heart failure in pregnancy Methods The Madras medical college Pregnancy And Cardiac (M-PAC) registry (1) is a single-centre prospective observational registry conducted at a tertiary care public hospital in Tamil Nadu, India from July 2016 to December 2019. Patient with new or worsening heart failure during pregnancy and up to 1 week post-delivery were included in the present analysis. When heart failure was the presenting symptom, it was considered as the primary event and when patient presented with failure symptoms secondary to another inciting event, heart failure was considered as secondary event. This cohort of patient were evaluated for the aetiology, predictors and outcome of heart failure and were placed on extended follow up. The accuracy of mWHO and CARPREG I score to predict heart failure were assessed. Results 1005 women with 1029 pregnancies were enrolled. Heart failure was observed in 127 (%) pregnancies, in 103 as primary event and in 24 as a secondary event. The common aetiologies of heart failure include rheumatic valvar heart diseases (n=45), peripartum cardiomyopathy (n=45) and congenital heart diseases (n=18). The univariable predictors of heart failure include, NYHA class at first visit, mWHO class of disease, first diagnosis of heart disease, during current pregnancy, pulmonary hypertension, left ventricular ejection fraction ≤ 45%, significant mitral stenosis, mechanical prosthetic heart valve and history of prior cardiac events. However, when peripartum cardiomyopathy was excluded from the analysis, current pregnancy diagnosis was no longer a predictor. Multivariable predictors of heart failure are shown in Figure-1. CARPREG-1 score was marginally more effective than modified World Health Organisation (mWHO) score (C-statistic of 0.820 vs 0.802) in predicting heart failure (Figure-2). Maternal death was 15.7% (20/127). Caesarean delivery was more common in patients with heart failure (53/119; 44.5%; vs 318/838; 38%) Patients with heart failure had significantly higher proportion of composite adverse fetal outcome (46.5% vs 31.9%, P&amp;lt;0.001), preterm birth (9.2% vs 4.5%, P=0.029) and low birth weight (41.2% vs 26%, P &amp;lt;0.001) Conclusion Heart failure is the commonest complication of pregnant women with heart disease. Mortality is very high in patients presenting with heart failure. Modified WHO classification and CARPREG 1 score have moderate accuracy to predict heart failure in pregnancy.Fig-1: Predictors of Heart FailueFig-2: Prediction by CARPREG-1 and mWHO

Clinico Pathological Profile of Adnexal Torsion Cases- A Retrospective Analysis from A Tertiary Care Teaching Hospital in Southern India

Introduction: Adnexal torsion is a significant source of morbidity, and nonspecific signs can make diagnosis difficult. Early identification is crucial to avoid ovarian infarction and the likelihood of related infertility. Our study aims to assess the clinicopathological profile of adnexal torsion cases through retrospective analysis from a tertiary care teaching hospital in southern India. Methods: This retrospective study was carried out in the Department of Obstetrics and Gynaecology at a tertiary care teaching hospital in Tamil Nadu, India. Data was collected on women with surgically proven adnexal torsion from January 2019 to December 2022. Proper ethics permission was obtained, and informed consent was taken from all the patients prior to the commencement of the study. The subjects' confidentiality was maintained. The data was represented using detailed descriptive analyses, medians, and percentages. Statistical analysis was carried out using Microsoft Excel 2007 and IBM SPSS version 21. Conclusion: Adnexal torsion is an uncommon condition. Acute stomach discomfort, nausea, and vomiting are the most common symptoms. Adnexal torsion’s clinical and radiographic diagnosis is challenging for both doctors and radiologists. As a result, extensive clinical experience and radiological abilities are necessary. Early identification and surgical treatment save the ovary while maintaining its function.

A cross-sectional study of the clinical profile of children admitted with yellow phosphorous poisoning in a tertiary care hospital

Background: Yellow phosphorous (YP) is a protoplasmic poison that is mainly used as a rodenticide. Aims and Objectives: The aim of the study is to describe the clinical profile of YP poisoning in children in a tertiary care hospital. Materials and Methods: This is a cross-sectional study done in a tertiary care hospital in Tamil Nadu. A convenience sample of all the cases admitted during the year 2022 was done. Demographic and clinical data were collected and analyzed. Results: The male: female ratio was 1.16:1 (n=13). The mean age of the children was 4.0769±1.373 years. About 84.61% of the children reported to the hospital within 6 h. On admission, fever (30.76%), vomiting (30.76%), abdominal pain (30.76%), bleeding (15.38%), and altered sensorium (15.38%) were the common symptoms. All the children ingested YP accidentally. Leukocytosis was observed in about 30.76%. The mean peak serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were 516.9231±685.976 IU/L and 161.9231±215.107 IU/L, respectively. There were no alterations in the Electrocardiographic tracings, levels of serum electrolytes, blood glucose, and serum creatinine in children with YP poisoning. Significant differences were observed between children who survived and children who died in the levels of mean peak AST, mean peak ALT, INR, and in the presence of encephalopathy and bleeding manifestations. Conclusion: YP is an uncommon but lethal poison in children. Creating awareness among parents about the dangers of YP and nationwide prohibition of the sale of YP will be an important step in eliminating deaths in children who are accidental victims.

Identifying key factors contributing to treatment costs for snakebite envenoming in private tertiary healthcare settings in Tamil Nadu, India.

India suffers ~58,000 annual deaths due to snakebites. The 'Big Four' snakes (Russell's viper, Indian cobra, common krait, and saw-scaled viper) that are responsible for most bites cause diverse clinical effects. Delayed treatment increases the risk of serious complications and treatment costs. Although government hospitals offer free treatment for snakebites in India, most patients opt for private healthcare, which is an out-of-pocket expense as they often lack health insurance coverage. This study aims to analyse snakebite treatment costs in private tertiary care hospitals in Tamil Nadu, India and identifies the key factors contributing to treatment costs. The treatment cost details for 913 snakebite victims were collected from 10 private tertiary care hospitals across Tamil Nadu. The data were classified into hospital, pharmacy, investigation, and laboratory costs, and analysed to determine various factors that contribute to the costs. The results demonstrate that the average treatment costs vary widely for different snakes. The hospital and pharmacy costs are higher than investigation and laboratory costs for all snakebites. Notably, Russell's viper bites cost significantly more than the bites from other snakes. Overall, the type of snake, nature of complications, specialist treatments required, and arrival time to hospitals were identified as some of the key factors for higher treatment costs. These data demonstrate that ~80% of snakebite patients can be treated with INR 100,000 (~GBP 1000 or USD 1200) or less. This study emphasises the urgent need to improve rural medical care by providing appropriate training for healthcare professionals and essential resources to facilitate early assessment of patients, administer the initial dose of antivenom and refer the patients to tertiary care only when needed. Moreover, the outcome of this study forms a basis for developing appropriate policies to regulate snakebite treatment costs and provide affordable medical insurance for vulnerable communities.

Testosterone as a biomarker of colorectal cancer in the South Indian population

Colorectal cancer (CRC) is a highly life-threatening disease associated with a significant mortality rate. It has been proposed that testosterone levels may play a role in predisposing individuals to such devastating conditions. Testosterone primarily governs the maturation of the male reproductive system while also exerting physiological effects in both genders. In the present study, we investigated testosterone levels in CRC patients among the South Indian population. Blood samples were collected in the hospitals in Tamil Nadu, South India, and a cohort of healthy controls was selected for comparative analysis. A total of 130 subjects participated in the study, consisting of 65 CRC patients and an equal number of healthy controls. Approximately 7 mL of blood was collected from each subject for radioimmunoassay. The results of radioimmunoassay on the blood samples were analyzed using SPSS to assess differences between discrete and continuous data variables. Chi-square and t-tests were conducted for statistical evaluation. CRC patients exhibited significantly (P &lt; 0.0001) reduced mean testosterone levels (06.68 &amp;plusmn; 2.15 nmol/L) compared to controls (22.54 &amp;plusmn; 8.85 nmol/L). Further stratification by smoking status revealed that non-smoker CRC patients had lower testosterone levels (06.81 &amp;plusmn; 2.21 nmol/L) than non-smoking controls (10.15 &amp;plusmn; 2.48 nmol/L), with a statistically significant difference (P &lt; 0.0001). Adjusting for alcohol consumption, CRC patients displayed decreased mean testosterone levels (06.31 &amp;plusmn; 2.30 nmol/L) compared to controls (07.96 &amp;plusmn; 2.45 nmol/L), and this difference was found to be significant (P &lt; 0.022). These findings support the notion that reduced testosterone levels serve as a critical risk biomarker in the pathogenesis of CRC.

Household catastrophic health expenditures for rheumatoid arthritis: a single centre study from South India

Rheumatoid arthritis (RA) not only has a physical and emotional toll but also has a substantial economic impact. This study aims to estimate the burden of catastrophic health expenditure (CHE) on households due to RA in Tamil Nadu, India. We conducted cross-sectional descriptive hospital-based single-centre study at a tertiary care private multispecialty hospital in Tamil Nadu, India. The study comprised 320 RA patients who visited the outpatient clinic from April to October 2022. Demographic and baseline descriptive characteristics were reported. Multivariable logistic regression analyses were performed to identify major determinants associated with CHE. We also examined the inequality in household annual income and CHE. Most study participants were females (88.1%) with a mean age (SD) of 55.57 ± 12.29 years. About 93% of RA patients were from urban areas, and 89.4% were literate. Only 8.1% of respondents reported having health insurance. Households experiencing CHE owing to RA were 51.4% (n = 162). The mean (95% CI) annual health expenditure for treating RA is ₹44,700 (₹41,710 to 47,690) with a median (IQR) of ₹39,210 (₹25,500) [$476 ($310)]. The corresponding mean (95% CI) and median (IQR) Out of pocket expenditure among RA patients per household were ₹40,698 (₹38,249 to 43,148) [$494 ($464 to $524)] and ₹36,450 (23,070) [$442 ($280)] respectively. Nearly half of the households with RA patients had a financial catastrophe due to healthcare costs being paid out-of-pocket and limited health insurance coverage. The results underscore the need for comprehensive approaches to strengthening public health policies along with financial risk protection and quality care in India.