Morbidity Profile Research Articles

Health System Factors and Morbidity Profiles as Determinants of Nutritional Status of Under 5 Orphans and Vulnerable Children in Isiolo County, Kenya

Malnutrition is the single most important threat facing those under 5 years with alarming associated morbidity and mortality. Whereas the assessment of malnutrition under 5 in the general population is commonly done, little is known about the nutritional quagmire facing Orphans and vulnerable children in the country. The study was a cross-sectional analytical study design administered at the community level. Data were collected from 394 OVCs and their caregivers. Simple random sampling was used to sample individual sample respondents from each of the 3 wards of Garbatulla Sub-County of Isiolo County. Both structured and semi-structured questionnaires were used to collect data. Data was then cleaned and analysed using SPSS version 26.0. Level one analysis involved the use of descriptive statistics whereas level 2 analysis entailed both bivariate and multivariate regression analysis. Acute malnutrition affected a third 127(32.9%) of under 5 OVC residing in Garbatulla sub county whereas 48(12.5%) were stunted. Underweight was noted to be 20(5.2%). Negative attitudes towards health workers increased the odds of malnutrition by 3.51 times with COR 3.51 (95% CI 1.74, 7.46). In addition, the lack of medicines and vaccines in the health facility increased the odds of malnutrition by 3.66 times: COR 3.66(95 CI 1.60, 9.14). Lastly, sickness in the previous month increased the chance of malnutrition in OVC by 58% COR 1.58 (95 CI 1.01, 2.50). The age group affected most is aged 2 to 5 years. In conclusion, negative attitudes towards healthcare workers, lack of basic medicines and immunization services and sickness in the previous 1 month increase the chance of malnutrition. Provision of basic preventive and curative services at health facilities, teaching the community about the role of healthcare work in community health and prompt treatment of common ailments are recommended to mitigate the effect of malnutrition on those under 5 OVC

Surgical approach to hypertrophic cardiomyopathy: septoplasty versus transaortic myomectomy

Introduction: Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by asymmetric hypertrophy of the myocardium, often resulting in left ventricular outflow tract (LVOT) obstruction. This condition affects approximately 1 in 500 individuals in the general population and is one of the leading causes of sudden death in young people. Surgical treatment is indicated when clinical management fails to relieve symptoms and reduce the risk of adverse events. The two main surgical approaches for obstructive HCM are septoplasty and transaortic myomectomy, aiming to improve blood flow and reduce the intraventricular gradient. However, there is disagreement in the literature regarding which technique offers better long-term outcomes. Objective: The study aims to compare the surgical outcomes of septoplasty and transaortic myomectomy in patients with obstructive hypertrophic cardiomyopathy, evaluating the efficacy of both techniques in reducing symptoms, relieving LVOT obstruction, incidence of postoperative complications, and long-term survival. Methodology: A systematic review was conducted following PRISMA guidelines, with a search in PubMed, Embase, Scopus, Web of Science, and Cochrane Library databases, covering January 2000 to September 2024. Randomized studies, cohorts, and case series that directly compared septoplasty and transaortic myomectomy in patients with obstructive HCM were included. Exclusion criteria included studies that did not directly compare the two techniques, isolated case reports, and narrative reviews. Two independent reviewers conducted study selection, with a third reviewer resolving any discrepancies. Results: Septoplasty showed greater efficacy in reducing symptoms and left ventricular outflow gradient, and was associated with a lower risk of immediate complications such as infection and the need for reoperation. Transaortic myomectomy, while also effective, was associated with a slightly higher risk of surgical complications, particularly in cases of complex septal anatomy. Both procedures showed comparable operative mortality rates, but septoplasty demonstrated better long-term outcomes in terms of survival and preservation of cardiac function. Conclusion: Both septoplasty and transaortic myomectomy are effective techniques for the treatment of obstructive HCM, with septoplasty being preferred due to its lower morbidity profile and better long-term outcomes. However, transaortic myomectomy may be indicated in cases of extensive septal hypertrophy or complex anatomy. Surgical decisions should be individualized, taking into account patient characteristics and the surgical team's experience. Future studies are needed to evaluate the nuances of long-term outcomes in different patient populations.

Mental Multimorbidity Among General-Population Adults: Sex-Specific Sociodemographic Profiles of Anxiety, Insomnia, and Eating Disorders.

To determine the prevalence and sociodemographic profiles of mental morbidity and multimorbidity. A descriptive analysis was performed with data from 25,269 women and 8,389 men from the French NutriNet-Santé general-population cohort. Participants were split into 8 groups: 1. No mental morbidity; 2. Pure anxiety; 3. Pure insomnia; 4. Pure eating disorders (ED); 5. Comorbid anxiety and insomnia; 6. Comorbid anxiety and ED; 7. Comorbid insomnia and ED; 8. Multimorbid anxiety, insomnia, and ED. Data were weighted using the 2016 French Census and analyzed with Chi2 tests. 40.6% of the participants had ≥1 mental disorder; 2.3% had all 3 disorders. Most pure and comorbid disorders were more common in women than in men. The multimorbidity group had the largest proportions of men who were overweight (52.1%) and current smokers (23.2%). Men with insomnia and ED were the most likely to have obesity (45.8%) and low physical activity (44.3%). Women with ≥2 disorders were the most likely to be current smokers. The findings could inform research, prevention, and public health guidelines for multimorbidity.

Permanent and persistent atrial fibrillation are independent risk factors of mortality after severe COVID-19

Abstract Background New coronavirus disease (COVID-19), pandemic infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), had a deep global influence on morbidity and mortality profile. Comorbidities, especially cardiovascular diseases were identified to strongly modify the clinical course of COVID-19. However, the prognostic role of incident or prevalent atrial fibrillation has not been fully explained. Purpose The aim of this study was to evaluate the association between atrial fibrillation and outcomes following hospitalization in patients with severe COVID-19. Methods We analyzed 199 patients (72 female, median age 70 years) with severe COVID-19 hospitalized between November 2020 and February 2021, due to SARS-CoV-2 infection. Study cohort included 68 patients with a history of AF (34 patients with paroxysmal AF, 19 with permanent AF, 15 patients with persistent AF) and 51 patients presented with AF during hospitalization. Results Overall mortality during 90 days from the admission to hospital was 41% (n=82). Non-survivors were older, had significantly elevated inflammation markers (CRP, WBC, procalcitonin, IL-6), NT-proBNP and D-dimer on the first day of hospitalization, lower left ventricular ejection fraction and worse kidney function as compared to those who stayed alive during the follow-up. Among the hospitalized patients with COVID-19, a history of AF and the presence of AF during hospitalization contributed to higher mortality, p=0.001. The patients with permanent and persistent AF were at the greatest risk of death, p<0.001. In multivariate analysis, taking into account whether the patients had a history of AF, the subtypes of AF (paroxysmal, permanent, persistent) and whether the AF was present during hospitalization to identify the independent risk factors of death in the study period, we found that AF was related to worse prognosis and persistent or permanent form represented an independent predictor of mortality, p=0.035. Conclusions Different clinical presentations of AF have varying impact on survival in severe COVID-19. Mortality in hospitalized patients with severe COVID-19 was higher among patients with history of AF, especially with persistent and permanent type of AF, and with AF present during hospitalization.Figure.Survival depending on the type o.

Morbidity Profile And Nutritional Assessment Of School Children In The Rural Field Practice Area Under Government Medical College, Srikakulam, Andhra Pradesh: A Descriptive Cross‐Sectional Study

Morbidity Profile And Nutritional Assessment Of School Children In The Rural Field Practice Area Under Government Medical College, Srikakulam, Andhra Pradesh: A Descriptive Cross‐Sectional Study

Clinical Profile and Outcomes of Late Preterm Neonates in Relation to Gestational Age and Maternal Psychosocial Factors in a Tertiary Care Centre

The relationship between maternal psychosocial factors and outcomes among LPN remains unexplored. Objectives: To determine the morbidity profile of LPN with respect to gestational age and study its association with maternal psychosocial, lifestyle and demographic factors. Methodology: Cross-sectional study on LPNs in a tertiary care centre over one year. Results: Total sample: 263. LPN incidence: 94/1000 live births; Maternal age 20-30 years (p=0.03), high screen time (p=0.02), Caesarean section (p=0.02), moderate Maternal Stress (MS) (p=0.014) was associated with (a/w) births at 35 0/6 to 6/7 weeks of gestation (WOG).Low Birth Weight (LBW) LPN: 66.5% incidence, highest at 35 0/6 to 6/7 WOG; a/w maternal age 20-30 (p=0.002), nulliparity (p=0.02), moderate to severe MS (p=0.012), and Pregnancy Induced Hypertension (PIH) (p=0.04).Small for Gestational Age (SGA): 35%, peaking at 35 0/6 to 6/7 WOG; a/w nulliparity and severe MS. Sepsis 12.2%, highest at 34-35 0/6 to 6/7 WOG (p=0.001); a/w lower-middle socioeconomic status (p=0.05) and multiparity (p=0.02). Respiratory Distress Syndrome (RDS) 5.3%, peaked at 34 0/6 to 6/7 WOG (p=0.044); a/w poor socioeconomic status (p= 0.00). Transient tachypnoea of Newborn (TTN) 49.4%, a/w nulliparity (p=0.02). Neonatal hyperbilirubinemia (NNH) 57.8%, peaking at 34-35 0/6 to 6/7 WOG (p=0.01); a/w nulliparity (p=0.03). Perinatal asphyxia (PA) 6.5%, highest at 35 WOG. Conclusion: NNH and TTN were common in LPN. 35 WOG related to various risk factors and morbidities. LPN born to mothers with moderate MS, PIH, nulliparity, and age 20-30 were LBW. Mother’s screen time > 4 hours/day a/w LPNs born at 35 WOG.

A Retrospective Study of the Profiles of Outpatients Attending the State Adolescent Friendly Health Resource Center, Andhra Pradesh, South India.

Adolescents compose a significantly large age group, and attention to their health needs is lacking due to insufficient data and policy implementation globally and in India. India, having 268 million adolescents, faces the world's largest adolescent population, which highlights the importance of addressing their health requirements. The aim of this study was to describe the morbidity profiles of adolescent patients attending the State Adolescent Friendly Health Resource Centre at a tertiary-level healthcare institution in South India. A retrospective secondary data analysis was conducted at the State Adolescent Friendly Health Resource Center from 2022 to 2023. Data on adolescent health were collected from this center's OPD using a structured questionnaire, which included information on demographics, immunization status, chief complaints, and dietary intake. Diagnosis coding was done using the International Classification of Diseases, Tenth Revision (ICD-10), with estimated energy and protein intake. The study analyzed 4,000 adolescent patients, with a nearly equal gender distribution across physical OPD and telemedicine services. Adolescent females between 15 and 16 years had more visits for consultation. Most patients were within the normal BMI range, and telemedicine was popular among females with normal BMI. Obesity was more common in males, while overweight was prevalent in females. Energy and protein intake varied across BMI categories, with obese individuals having the highest intake. The morbidity profiles revealed significant gender differences in healthcare utilization and disease patterns. Gender differences in adolescent morbidity and the underutilization of telemedicine highlight the need for tailored healthcare interventions and further research based on socioeconomic factors.

A Study On The Morbidity Profile Of Construction Workers In Visakhapatnam City

A Study On The Morbidity Profile Of Construction Workers In Visakhapatnam City

Morbidity profile of the patients attending Mobile Medical Unit camps in Telangana – a record-based study

Introduction: Mobile Medical Units (MMUs) were one of the major initiatives under the National Rural Health Mission. These MMUs help in reaching the unreached. It helps people in remote, underserved areas to access healthcare at affordable prices at their doorstep. Objectives: In this study, we aim to assess the morbidity profile of the patients attending Mobile Medical Unit camps in Yadadri-Bhuvanagiri district between April 2022 to December 2022. Methodology: This is a record-based study. MMU is run by department of Community and Family Medicine, AIIMS, Bibinagar in six selected villages of Yadadri-Bhuvanagiri district. (Fig.1). A register is maintained for recording the details of patients visitingthe MMU camp. Patient’s name, age, gender, place, mobile number, height, weight, blood pressure (BP), glucometer based Random Blood Sugar (GRBS), diagnosis, and details of medication dispensed were entered in the register. Diabetes was diagnosed using the WHO criteria , hypertension using the Eighth Joint National Committee guidelines , obesity using the WHO Asia Pacific guidelines. Mobile Medical Unit camp data is entered into excel database at the end of every month. As it is a record-based analysis, we used data between April 7th 2022 to December 31st, 2022 for analysis. Results: A total of 1494 patients were treated in the MMU camps during this period. Among them 89.4% were adults & 10.6 % were children (less than 18 years). Among 1336 adult patients, majority of the study participants suffered from osteoarthritis followed by non-communicable diseases. The mean systolic BP of the adult population was 131 (±21) mmHg and diastolic BP of the population was 77 (±13) mm Hg. The mean random blood glucose levelof the adult Population was 150 (±74) mg/dl. A total of 158 children were less than 18 years, out of which 78 participants were males and 80 participants were females. Majority suffered from upper respiratory tract infections among males (23.1%) and females (25%) respectively. Conclusion: The study further suggests that NCD epidemic is spreading to rural areas where necessary health infrastructure is insufficient. MMUs can bring a significant change in the public health system, which needs to re-orient its priorities.

Contemporary short-term peri-operative outcomes of open primary retroperitoneal lymph node dissection.

To provide current peri-operative outcomes and short-term complication rates for open primary retroperitoneal lymph node dissection (RPLND), with analysis of risk factors for complications. Using the Indiana University Testicular Cancer database, we performed a retrospective analysis of all patients who underwent open primary RPLND over the study period (2018-2021). The primary outcomes of interest were the preoperative profile of patients undergoing surgery, complication rates, and identification of risk factors associated with complications. We used chi-squared, Fisher's exact and unpaired t-tests in our analyses. A total of 165 patients were identified. The median body mass index (BMI) was 28.6 kg/m2. Patients most often had clinical stage IIA (39%) or IIB testicular cancer (36%). The median estimated blood loss was 150 mL, with no transfusions required. Higher BMI was noted in patients that sustained any complication vs those with normal recovery (34.95 vs 28 kg/m2; P = 0.0042). The median length of hospital stay was 3 days. The overall complication rate was low (8.48%), with two major postoperative complications, including one case of chylous ascites (0.6%), and no deaths in the 30-day period. The study was limited by its retrospective design and short-term follow-up. We found that open primary RPLND has an acceptable morbidity profile, even among a predominantly overweight cohort. Low blood loss, short hospital stay, minimal chylous ascites risk, and rare major postoperative complications should be the benchmark for retroperitoneal lymph node dissection.

Morbimortality profile by COVID-19 in telework and on-site work in an oil and gas company in Brazil.

As a reflection of the health emergency caused by COVID-19, many countries adopted guidelines, which included activity restrictions. As a result, some companies maintained their activities with on-site work and telework. Analyzing the morbidity and mortality profile due to COVID-19 of workers in telework and on-site work in an oil and gas company. Cross-sectional, quantitative, and analytical study that included 8,394 workers diagnosed with COVID-19 at an oil and gas company in Brazil, from June 2020 to June 2021. The company's Surveillance Program database was used as an information source. The total prevalence of cases was 21.7%. For teleworking and face-to-face workers, they were 20.7% and 23.3%, respectively. There was a predominance of women (19.7%), white ethnicity/colour (64.7%), higher level position (52.6%), age group over 40 years (36.7%), married (53, 8%), working at the company for a period that ranges from 7 to 10 years (17%), administrative activity (68.5%), and a higher number of symptomatic workers and deaths in telework compared to on-site work. The results suggest that testing is important to refrain the virus spread in the company's work environments, as it allowed asymptomatic workers to be diagnosed with COVID-19. The study suggested that on-site work was not a transmission facilitator in the occupational environment, which points out the importance of preventive measures in the workplace and the adoption of remote work for the largest possible number of workers to improve the safety of employees, workers who remained in the on-site work modality.

An epidemiological study on morbidity profile among food handlers in Panaji city, Goa.

Access to safe and nutritious food is key to promoting good health. An estimated 600 million fall ill after eating contaminated food, for which food handlers may constitute a common source of contamination. In addition to unhealthy food handlers, disease carriers handling the food play an equally important role in transmitting these diseases and pose a significant threat to public health. This study, therefore, aimed to know the morbidity profile among the food handlers employed in various food establishments in Panaji city. Using stratified sampling techniques, we conducted a cross-sectional study among 227 participants selected from 12 food establishments. We did three visits to each food establishment. We excluded food handlers who were unavailable despite three visits at fortnightly intervals and those who did not consent to the study. We administered a pre-designed and pre-structured questionnaire to each participant. A general examination and laboratory investigations, including stool and urine routine, were performed on all participants. We performed descriptive and analytical statistics by using SPSS version 14. Out of the 227 study participants, 79 (34.8%) had at least one morbidity at the time of examination. None of the food handlers had received a single dose of typhoid, hepatitis A, or cholera vaccines. Most (74.4%) study participants did not administer deworming tablets. We found that the health status of the study participants was substandard. Food safety may be in peril among food handlers with lower education backgrounds with morbidities as they may have little understanding of the risk of microbial contamination of food. Therefore, it is essential to create awareness among them.

Predictors for selection of outpatient single-port robot-assisted laparoscopic radical prostatectomy.

To evaluate the different perioperative variables that may serve as important clinical predictors when selecting patients for outpatient single-port robot-assisted radical prostatectomy (SP-RARP). A retrospective review was performed on the Institutional Review Board-approved, prospectively maintained database to identify 485 consecutive patients who underwent SP-RARP between 2018 and 2023. A comparison analysis was performed on patients who were managed as outpatients vs inpatients following their respective SP-RARP. A separate analysis was performed after excluding patients with pre-planned admissions to identify the risk factors for unplanned admissions. All procedures were successfully completed without any conversion or additional ports. After excluding patients with pre-planned admissions, outpatient SP-RARP was successfully achieved in 86.6% with a median (interquartile range) length of stay of 4.6 (3.8-6.1) hours. Our multivariate regression analysis identified cardiac comorbidity and preoperative International Prostate Symptom Score (IPSS) as predictors of outpatient SP-RARP. In addition, the absence of cardiac comorbidity, previous abdominal surgery, and lower postoperative pain score were protective against the risk of unplanned admission. Furthermore, both inpatient and outpatient encounters had comparable 90-day rates of postoperative complication (P = 0.136) and hospital re-admission (P = 0.942). Outpatient management models could be successfully achieved in most patients who underwent SP-RARP (86.6%) while maintaining similarly low perioperative morbidity profile. Nevertheless, appropriate patient selection based on the baseline clinicodemographic characteristics remains essential to ensure the safety and ongoing success of outpatient SP-RARP.

An investigation on the prevalence and patterns of multi-morbidity among a group of slum-dwelling older women of Kolkata, India

BackgroundMulti-morbidity is a pervasive and growing issue worldwide. The prevalence of multi-morbidity varies across different populations and settings, but it is particularly common among older adults. It poses substantial physical, psychological, and socio-economic burdens on individuals, caregivers and healthcare systems. In this context, the present study aims to provide an insight on the prevalence and degree of multi-morbidity; and also, on the relationship between level of multi-morbidity and morbid conditions among a group of slum-dwelling older women.MethodsThis community based cross-sectional study was conducted in the slum areas of urban Kolkata, West Bengal, India. It includes total 500 older women, aged 60 years or above. Pre-tested schedules on so-demographic and morbidity profile have canvassed to obtain the information by door-to-door survey. To determine the relationship between the level of multi-morbidity and morbid conditions, correspondence analysis has performed.ResultsThe study revealed three most prevalent morbid conditions- back and/or joint pain, dental caries/cavity and hypertension. The overall prevalence of multi-morbidity was 95.8% in this group of older women. It was highly over-represented by the oldest-old age group (80 years and above). Majority were found to suffer from five simultaneous morbid conditions that accounted for 15.2% of the total respondents. All of the oldest-old women of this study reported to suffer from more than two medical conditions simultaneously. Three distinct groups were formed based on the inter-relationship between level of multi-morbidity and morbid conditions. The group 1 and 2 represents only 27.8% and 18% of the total sample. Whereas, group 3 comprises the highest level of morbidities (≥ 6) and 52.8% of total sample, and strongly related with general debilities, cardiac problems, asthma/COPD, gastrointestinal, musculoskeletal problems, neurological disorders, hypothyroidism and oral health issues.ConclusionThe findings confirmed the assertion that multi-morbidity in slum living older adults is a problem with high prevalence and complexity. This study proposes an easily replicable approach of understanding complex interaction of morbidities that can help further in identifying the healthcare needs of older adults to provide them with healthy and more productive life expectancy.

Is palliative care a utopia for older patients with organ failure, dementia or frailty? A qualitative study through the prism of emergency department admission

BackgroundNearly three out of four older people will use the emergency department (ED) during their last year of life. However, most of them do not benefit from palliative care. Providing palliative care is a real challenge for ED clinicians who are trained in acute, life-saving medicine. Our aim is to understand the ED’s role in providing palliative care for this population.MethodsWe designed a qualitative study based on 1) interviews – conducted with older patients (≥ 75 years) with a palliative profile and their informal caregivers – and 2) focus groups – conducted with ED and primary care nurses and physicians. Palliative profiles were defined by the Supportive and Palliative Indicators tool (SPICT). Qualitative data was collected in French-speaking Belgium between July 2021 and July 2022. We used a constant inductive and comparative analysis.ResultsFive older patients with a palliative profile, four informal caregivers, 55 primary and ED caregivers participated in this study. A priori, the participants did not perceive any role for the ED in palliative care. In fact, there is widespread discomfort with caring for older patients and providing palliative care. This is explained by multiple areas of tensions. Palliative care is an approach fraught with pitfalls, i.e.: knowledge and know-how gaps, their implementation depends on patients’(co)morbidity profile and professional values, experiences and type of practice. In ED, there are constant tensions between emergency and palliative care requirements, i.e.: performance, clockwork and needs for standardised procedures versus relational care, time and diversity of palliative care projects. However, even though the ED’s role in palliative care is not recognised at first sight, we highlighted four roles assumed by ED caregivers: 1) Investigator, 2) Objectifier, 3) Palliative care provider, and 4) Decision-maker on the intensity of care. A common perception among participants was that ED caregivers can assist in the early identification of patients with a palliative profile.ConclusionsCurrently, there is widespread discomfort regarding ED caregivers caring for older patients and providing palliative care. Nonetheless, ED caregivers play four roles in palliative care for older patients. In the future, ED caregivers might also perform the role of early identifier.

Study of the morbidity profile including depression among the elderly in the rural area, East Bangalore

Study of the morbidity profile including depression among the elderly in the rural area, East Bangalore

Morbidity profile and pharmaceutical management of adult outpatients between primary and tertiary care levels in Sri Lanka: a dual-centre, comparative study

BackgroundOutpatient care is central to both primary and tertiary levels in a health system. However, evidence is limited on outpatient differences between these levels, especially in South Asia. This study aimed to describe and compare the morbidity profile (presenting morbidities, comorbidities, multimorbidity) and pharmaceutical management (patterns, indicators) of adult outpatients between a primary and tertiary care outpatient department (OPD) in Sri Lanka.MethodsA comparative study was conducted by recruiting 737 adult outpatients visiting a primary care and a tertiary care facility in the Kandy district. A self-administered questionnaire and a data sheet were used to collect outpatient and prescription data. Following standard categorisations, Chi-square tests and Mann‒Whitney U tests were employed for comparisons.ResultsOutpatient cohorts were predominated by females and middle-aged individuals. The median duration of presenting symptoms was higher in tertiary care OPD (10 days, interquartile range: 57) than in primary care (3 days, interquartile range: 12). The most common systemic complaint in primary care OPD was respiratory symptoms (32.4%), whereas it was dermatological symptoms (30.2%) in tertiary care. The self-reported prevalence of noncommunicable diseases (NCDs) was 37.9% (95% CI: 33.2–42.8) in tertiary care OPD and 33.2% (95% CI: 28.5–38.3) in primary care; individual disease differences were significant only for diabetes (19.7% vs. 12.8%). The multimorbidity in tertiary care OPD was 19.0% (95% CI: 15.3–23.1), while it was 15.9% (95% CI: 12.4–20.0) in primary care. Medicines per encounter at primary care OPD (3.86, 95% CI: 3.73–3.99) was higher than that at tertiary care (3.47, 95% CI: 3.31–3.63). Medicines per encounter were highest for constitutional and respiratory symptoms in both settings. Overall prescribing of corticosteroids (62.7%), vitamin supplements (45.8%), anti-allergic (55.3%) and anti-asthmatic (31.3%) drugs was higher in the primary care OPD, and the two former drugs did not match the morbidity profile. The proportion of antibiotics prescribed did not differ significantly between OPDs. Subgroup analyses of drug categories by morbidity largely followed these overall differences.ConclusionsThe morbidities between primary and tertiary care OPDs differed in duration and type but not in terms of multimorbidity or most comorbidities. Pharmaceutical management also varied in terms of medicines per encounter and prescribed categories. This evidence supports planning in healthcare and provides directions for future research in primary care.

Characteristics of Patients Attending the Child and Adolescent Psychiatric Outpatient Clinic of a Tertiary Care Hospital in North India

Background: The psychiatric morbidity profile of children and adolescents is very different from that of adults. Failure of early identification and timely intervention of psychiatric disorders adversely affects the developmental trajectory of children to becoming a healthy adult. Objectives: To study the clinico-demographic profile of patients attending the child & adolescent psychiatric OPD and to estimate the frequency of various psychiatric disorders among them. Methodology: In this retrospective file review study, all patients attending the child and adolescent psychiatry clinic of a tertiary care hospital between Jan 2018- June 2022 were taken. Data collection was done using a semi-structured proforma and ICD-10 was used to make psychiatric diagnoses. Statistical analysis was done by using SPSS 16 (Version 25.0). Results: The total number of cases visiting child psychiatry OPD during the study period was 1199 with an average of 240 cases per year. The mean age was found to be 12 years, with gender distribution revealing male preponderance (58.4%). Around 64% of the participants were 63.8%) were in the age range 10 to 15 years. Most subjects (59.4%) were Hindu by religion and hailed from urban areas (52.4%). Epilepsy (23.9%) was the most prevalent psychiatric disorder, followed by intellectual disability (16.8%), anxiety disorder (14.1%), hyperkinetic and conduct disorder (8.8%), and schizophrenia & other psychotic disorders (10.3%). Conclusion: This study is one of the few ones conducted in a tertiary care hospital in North India. Children in poor nations receive less mental health and psychiatric care than adults do. Our research indicates that Indian clinics may need to improve their offerings for conditions like depression, specific learning disorders, communication disorders, and hyperkinetic disorders. The study also emphasizes the need for more child psychologists special educators, and strengthened counseling services in schools

Groundwater Hardness and Alkalinity As Risk Factors for Kidney Stone Disease in Alwar, India: An Ecological Study.

Rajasthan is a semi-arid state in India where people still use groundwater for drinking purposes. However, the quality of groundwater as compared to standards have not been studied in any details. This ecological study was done to study the groundwater quality parameters in the stone-belt states, compare the quality of groundwater in Alwar with the rest of Rajasthan, and study the morbidity profile of surgical in-patients in the same district, with special emphasis on kidney stone disease (KSDs). The morbidity profile of patients coming to the surgery department of a tertiary teaching hospital between January 2002 and June 2023 was obtained from the medical records department, and water quality data was obtained from the publicly available Water Resources Information System (WRIS) groundwater dataset for the year 2023. The dataset provided detailed information on the chemical parameters of water samples throughout the country that were evaluated to estimate the quality of groundwater. It was found that the groundwater in Alwar is non-potable due to the presence of iron, alkalinity, magnesium, and total dissolved solids (TDS). Iron was estimated to be much higher than the acceptable limit of the Bureau of Indian Standards (BIS) drinking-water quality guidelines (0.3 mg/L). Similarly, most of the chemical parameters in the groundwaters of Rajasthan significantly exceeded the national average. The median electrical conductivity, fluoride, magnesium, sodium, hardness, alkalinity, and turbidity were found to be 1680 μS/cm, 1.05 parts per million (PPM), 41 PPM, 233 PPM, 330 PPM, 310 PPM, 988 PPM, respectively, which are above the WHO recommendations for drinking water guidelines. The levels of iron and total alkalinity were significantly higher in the study district as compared to the rest of the state. Also, magnesium hardness and TDS levels were very high in the groundwater of the entire state of Rajasthan, making the population vulnerable to KSDs in the long run.

Permanent and Persistent Atrial Fibrillations Are Independent Risk Factors of Mortality after Severe COVID-19.

Background: The new coronavirus disease (COVID-19), a pandemic infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), had a deep global influence on morbidity and mortality profiles. Comorbidities, especially cardiovascular diseases, were identified to strongly modify the clinical course of COVID-19. However, the prognostic role of incident or prevalent atrial fibrillation has not been fully explained. The aim of this study was to evaluate the association between atrial fibrillation and outcomes following hospitalization in patients with severe COVID-19. Methods: We analyzed 199 patients (72 female, median age 70 years) with severe COVID-19 hospitalized between November 2020 and February 2021, due to SARS-CoV-2 infection. The study cohort included 68 patients with a history of AF (34 patients with paroxysmal AF, 19 with permanent AF, 15 patients with persistent AF), and 51 patients presented with AF during hospitalization. Results: Overall mortality during 90 days from the admission to hospital was 41% (n = 82). Non-survivors were older, had significantly elevated inflammation markers (CRP, WBC, procalcitonin, IL-6), NT-proBNP and D-dimer on the first day of hospitalization, lower left ventricular ejection fraction and worse kidney function, as compared to those who stayed alive during the follow-up. Among the hospitalized patients with COVID-19, a history of AF and the presence of AF during hospitalization contributed to higher mortality. Patients with permanent and persistent AF were at the highest risk of death. Different presentations of AF (any history of AF, the subtypes of AF-paroxysmal, permanent, persistent-and the presence of AF during hospitalization) were included in multivariate analysis, aiming to identify independent risk factors of death in the study period. We found that AF was related to worse prognosis, and persistent or permanent forms represented an independent predictor of mortality. Conclusions: Different clinical presentations of AF have varying impacts on survival in severe COVID-19. Mortality in hospitalized patients with severe COVID-19 was higher among patients with a history of AF, especially with persistent and permanent types of AF, and with AF present during hospitalization.