Morbidity Profile Research Articles

Primary cryotherapy for localized prostate cancer treatment

Introduction Prostate cryotherapy is an available treatment option for localized prostate cancer (PC) included on minimal invasive therapies but still under evaluation. We started our cryotherapy program in 2008 for selected patients with localized PC. Our objective is to evaluate the oncologic and functional outcomes of primary cryotherapy in men with clinically localized PC. Subjects and Methods We retrospectively evaluated all patients who underwent primary cryotherapy for localized PC treatment at our center between January 2008 and December 2017. In order to downsize prostates between 40 and 60cc neoadjuvant 3-month hormonal therapy was administered. Primary endpoint was biochemical progression-free survival (BPFS) rate as defined by the Phoenix criteria. Secondary endpoints were cancer-specific survival (CSS), overall survival (OS), patient reported functional outcomes and complication rates. Factors influencing de BPFS were evaluated individually using Kaplan–Meyer and Cox regression models and in a multivariate model using Cox regression. Results During the mentioned period, a total of 177 men were treated with cryotherapy. With a mean follow-up of 60 months (SD 32.9), the Kaplan–Meier analysis shows an overall BPFS rate was 67%. BPFS by risk group was 70.2%, 70.3% and 50.0% for the low, intermediate and high risk groups, respectively (p = 0.925). Overall time to BR was 93.67 months (SD 2.84, IC95%: 88.10–99.24): 95.91 (SD 3,44), 93.23 (SD 4.81) and 89.77 (SD 6.67) months for the low, intermediate and high risk groups, respectively. In both univariate and multivariate analysis, the only predictor of biochemical progression was de PSA nadir (HR 1.56 IC95%: 1.50–1.63). Continence was fully maintained in 95% of patients after the procedure. Postoperative complications included UTI (17.5%), hematuria (9.6%), perineal hematoma (11%) and postoperative pain (4.5%). No fistulas were reported. 8.5% of patients had acute urinary retention solved conservatively. Conclusion Cryotherapy is a safe option for selected patients with localized prostate cancer that provides competitive oncologic outcomes and a low morbidity profile.

Gamma Knife Radiosurgery for Berry Aneurysms: Quo Vadis.

Background Intracranial aneurysms are vascular malformations with significant mortality and morbidity profile. Various treatment modalities have been developed to positively impact the outcome profile with gradual shift to the minimally invasive treatment modalities. Gamma knife radiosurgery (GKRS) is an established primary treatment modality for various intracranial arteriovenous malformations (AVMs); however, its efficacy for berry aneurysmal obliteration has been historically dismal. Objective The aim of this study is to evaluate the factors responsible for poor radio surgical outcome for intracranial aneurysms. Methods The literature is reviewed for the differential efficacy of GKRS for aneurysm and AVM. Results Though both are vascular malformations, aneurysm and AVM have inherent differences in angioarchitecture, intracranial location, surrounding neighborhood, radio-sensitivity, and latency for obliteration. The major difference arises because of surrounding neighborhood of connective tissue stroma which stabilizes the irradiated pathology. Conclusion Though considered radioresistant, aneurysms show promising results with animal models of radiosurgery. The future lies in two hypothetical improvements: with a supporting neighborhood or sensitization of the vessel wall that may change the natural history of an aneurysm, especially an unruptured one.

Assessment of Nutrition, Morbidity & Immunization Status of Children (24 to 59 months) attending a Rural Medical College Hospital of West Bengal

Background: Nearly half of India’s children - 43% are underweight, 45% are stunted and 20% are wasted;26.3 million cases of ARI were reported in 2011 with an incidence rate of 2179 per lakh population; 10.6 million cases of diarrhoea with 1293 deaths were reported in 2011; fully immunized coverage in the age-group of 12-23 month old children was 61%.. This study was conducted to assess the morbidity profile, under nutrition and immunization status of 24 to 59 months old children in a medical college hospital of West Bengal. Methods: An Institution based cross sectional study was conducted among 450 children of 24 – 59 months, attended Paediatric Out Patient Department and Immunization Clinic of Midnapore Medical College & Hospital, from July to September 2013 using a predesigned pretested schedule. Results: the prevalence of underweight, wasting and stunting was 42.44%, 20.22% and 51.78% respectively. Boys suffered more than girls in all three indicators. Acute Respiratory Infections (54.22%) and diarrhea (52.66%) were the common morbidities; 79.33% were fully immunized; 14.67% were partially immunized and 6% were unimmunized. Conclusion: The problem of under-nutrition, common morbidities and low immunization amongst pre-school children needs to be addressed through comprehensive preventive, promotive, curative and social measures.

Myocardial Infarction after Kidney Transplantation: A Risk and Specific Profile Analysis from a Nationwide French Medical Information Database.

Introduction: Renal transplant recipients have a high peri-operative risk for cardiovascular events. The post-transplantation period also carries a risk of myocardial infarction (MI). Coronary artery disease (CAD) is a leading cause of death in these patients. We aimed to assess the risk of MI, the specific morbidity profile of MI after transplantation as well as the long-term prognosis after MI in renal transplantation (RT) patients regarding cardiovascular (CV) death and all-cause death. Methods: From a French national medical information database, all of the patients seen in French hospitals in 2013 with at least 5-years follow-up were retrospectively identified and patients without transplantation but with previous dialysis at baseline were excluded. There were 17,526 patients with RT and 3,288,857 with no RT. Results: Among these patients, 1020 in the RT group (5.8%), and 93,320 in the non-RT group (2.8%) suffered acute MI during a median follow-up of 5.4 years. After multivariable adjustment, risk of MI was higher in RT patients than in non-RT patients (HR 1.45, IC 95% 1.35–1.55). The mean age was 59.5 years for transplant patients with MI, and 70.6 years for the reference population with MI (p < 0.0001). MI patients with RT (vs. non RT patients) were more likely to have hypertension, diabetes dyslipidemia, and peripheral artery disease (76.0% vs. 48.1%, 38.7% vs. 25.2%, 33.2% vs. 23.2%, and 31.2% vs. 17.3%, respectively, p < 0.0001). Incidence of non ST-elevation MI (NSTEMI) was higher in RT patients while incidence of ST-elevation MI (STEMI) was higher in patients without RT. In unadjusted analysis, risk of all-cause death and CV death within the first month after MI were higher in patients without RT (18% vs. 11.1% p < 0.0001 and 12.3% vs. 7.8%, p < 0.0001, respectively). However, multivariable analysis indicated that risk of all-cause death was higher in patients with RT than in those with no RT (adjusted HR 1.15 IC 95% 1.03–1.28). Conclusions: MI is not an uncommon complication after RT (incidence of around 5.8% after 5 years). RT is independently associated with a 45% higher risk of MI than in patients without RT, with a predominance of NSTEMI. MI in patients with RT is independently associated with a 15% higher risk of all-cause death than that in patients with MI and no RT.

Polimedicação em adultos e idosos cadastrados na Estratégia Saúde da Família

Introdução: Verifica-se, no contexto global, a modificação do perfil da morbimortalidade em decorrência das transições demográfica e epidemiológica, relacionadas ao aumento do número de idosos e de doenças crônicas não-transmissíveis. Nesse cenário, a polimedicação tem se tornado frequente e, por conseguinte, seus danos são visualizados. O uso de múltiplos medicamentos amplia o risco de prescrições potencialmente inapropriadas, o que propicia interações farmacológicas, eventos adversos a medicamentos e hospitalizações. Soma-se a isso o ônus ao sistema de saúde e à assistência médica. Objetivo: Identificar os fatores associados à polimedicação em adultos mais velhos e idosos. Métodos: Trata-se de um estudo transversal e quantitativo, realizado em 2018 e 2019, com n=147 adultos (45-59 anos) e n=153 idosos (≥60 anos), cadastrados na Estratégia Saúde da Família (ESF) no município de Três Lagoas/MS. Foram coletados dados de caracterização sociodemográfica, estilo de vida, rede de apoio social e informações sobre saúde. Questionou-se o número de fármacos de uso contínuo tomados por dia, sendo considerada polifarmácia a utilização de cinco ou mais medicamentos. Foi conduzida uma regressão logística binomial para identificar os fatores associados à polifarmácia. Resultados: A prevalência de polifarmácia foi 10,2% (IC95% = [6,3%-16,2%]) para os adultos e 17,0% (IC95% = [11,9%-23,7%]) para os idosos. Estiveram associados à polifarmácia para o grupo de adultos o aumento da idade (OR=1,32; IC95%=1,10-1,59) e não possuir companheiro (OR=6,52; IC95%=1,59-26,81). Já para o grupo de idosos, os fatores associados foram ter sofrido pelo menos uma queda no último ano (OR=3,33; IC95%=1,13-9,85), ser tabagista (OR=5,04; IC95%=1,30-19,62), avaliar a saúde como regular (OR=4,10; IC95%=1,16-14,54) ou ruim/muito ruim (OR=6,59; IC95%=1,31-33,08). O consumo de álcool foi inversamente associado à polifarmácia (OR=0,15; IC95%=0,02-0,98) nos idosos. Conclusões: Diante dos potenciais riscos oferecidos pela polimedicação, torna-se imprescindível a distinção dos grupos em condição de maior vulnerabilidade ao uso de múltiplos medicamentos e um acompanhamento mais cauteloso, a fim de assegurar maior segurança na prescrição de fármacos na atenção primária e o aprimoramento do cuidado.

Permanent urethral ligation after AUS cuff erosion: Is it ready for prime time?

Although artificial urinary sphincter (AUS) has long been the gold standard treatment for severe stress urinary incontinence, poor tissue quality in patients with prior cuff erosions may preclude this option. Formal supravesical diversion and/or bladder neck closure comprise alternative salvage options but are associated with significant morbidity and mortality. We review our experience with permanent urethral ligation (PUL) among patients deemed not to be candidates for AUS replacement following cuff erosion. From a single-center database of 396 patients undergoing AUS from 2014 to 2020, 20 men underwent PUL with suprapubic tube (SPT) diversion. Clinical characteristics and outcomes were evaluated. Quality of life (QOL) was assessed using chart review, Michigan Incontinence Symptom Index (M-ISI), and Patient Global Impression of Improvement (PGI-I). PUL resulted in continence in 18 (90%) men; 15 after the initial surgery and three after repeat ligation. Patients were elderly (average age 75) with significant comorbidities. A total of 11 (55.5%) patients experienced complications in the 90-day postoperative period (seven Clavien-Dindo Grade II, four Grade III). Over an average follow-up of 30.3 months (interquartile range: 15.75-48.75), four patients underwent cystectomy and one underwent perineal urethrostomy. In the remaining patients managed by PUL, 13 had satisfactory M-ISI scores and indicated overall improvement on PGI-I. For men with AUS cuff erosion who are poor candidates for replacement, PUL with chronic SPT drainage represents an acceptable alternative option to restore continence and improve QOL. Though complications are not uncommon, the morbidity profile still compares favorably to more invasive formal urinary diversion.

Total Percutaneous Femoral Approach for Branched Custom-Made Device Endovascular Repair of Thoracoabdominal Aneurysm.

Thoracoabdominal aortic aneurysm (TAAA) is a challenging vascular condition to manage. Traditionally, open surgical repair has been the standard of treatment. Endovascular repair for TAAA has gained much popularity because it is a minimally invasive approach that results in better mortality and morbidity profiles. We report a case of TAAA successfully treated with a custom-made multi-branch device through a total femoral approach with the use of a steerable sheath for branch cannulation and deployment of bridging stents to targeted visceral vessels. This approach avoided complications related to upper extremity access, such as stroke, and allowed shorter operative time with better workstation ergonomics.

340 EXPANDING THE ROLE OF POEM TO ESOPHAGEAL EPIPHRENIC DIVERTICULA—FEASIBLE, SAFE AND EFFECTIVE.

Abstract Epiphrenic diverticula (ED) is a rare disorder which can be associated with significant surgical morbidity. Presence of an esophageal motility disorder, often achalasia, is classically associated with ED with some arguing that symptoms are primarily attributed to the motility disorder rather than the diverticula itself. The role of peroral endoscopic myotomy (POEM) is expanding for palliation of achalasia. The objective of our study is to investigate the outcomes of POEM in patients with epiphrenic diverticula. Methods A retrospective analysis of a prospectively maintained database was conducted in a tertiary care institution between April 2014 and July 2019. A total of 217 patients receiving a POEM during the study time period were identified with 13 patients having ED. Video recordings of POEM with and without ED were compared for technical differences. Patient demographics, prior esophageal procedures and epiphrenic diverticula characteristics were collected. Primary outcome was post-operative Eckardt scores. We also explored integrated resting pressure (IRP) on manometry, barium column height and width, complications and patient reported outcomes. Standard statistical methods were applied using R. Results Among 13 patients with ED (median age 74.2, 69% male), 7 small and 6 large diverticula were identified. No post-operative complications were noted. The median Eckardt score significantly decreased from 8 [IQR 5–9] pre POEM to 0 [IQR 0–2] post POEM, with similar improvements in median IRPs (24.5 mmHg [IQR 16.9–31.3] vs. 4.3 mmHg [IQR 2.4–7.6], 1 min barium column height (9.2 cm [IQR 6.3–17.9] vs. 3.2 cm [IQR 0–7.1] and 1 min barium column width (3.3 cm [IQR 2.7–3.5] vs. 0.75 cm [IQR 0–3.7]. Post-operative pH studies were conducted in 7 (53.8%) patients demonstrating a DeMeester score of more than 14.72 in 5 (71.4%) patients. Conclusion We demonstrate that POEM is technically feasible, safe and associated with excellent outcomes in patients with small and large diverticula. In our study cohort no further surgical therapy was required to address the diverticula. Reflux was managed medically. Considering its low morbidity profile POEM should be considered for therapy in selected patients with epiphrenic diverticula.

Morbidity and mortality due to surgical congenital malformations from the perspective of surgical neonatal ICU outside a maternity service: a retrospective cohort study.

To describe the characteristics of patients treated at a level III surgical Neonatal Intensive Care Unit outside of a maternity service and analyze possible risk factors for mortality in this population. A retrospective cohort study evaluating patients admitted to a level III surgical Neonatal Intensive Care Unit from June/2015 to November/2017. Univariate analysis was performed by the Chi-square test and T-student test or Mann-Whitney test. Multivariate analysis by logistic regression was performed including in the model the variables with a P-value <0.2 in univariate analysis. Kaplan-Meier curve and Log-Rank test were performed using the variables that were statistically associated with death in the multivariate analysis. A significance level of a=5% and an error B=80% were adopted. During this period, 246 patients were admitted to this service. 58 (23.8%) patients died, with a mean time until death of 18 days. Half of the patients had a clinical diagnosis of sepsis (50.6%), blood culture was positive in 25.2%, and gram-positive bacteria (48.4%) were the main pathogens isolated. The variables that remained in the final model after multivariate analysis were diagnosis of congenital heart disease (OR = 4.5; p = 0.016), clinical diagnosis of sepsis (OR = 8.1; p = 0.000), and isolation of gram-positive bacteria in blood culture (OR = 3.9; p = 0.006). The level III surgical Neonatal Intensive Care Unit outside of a maternity service has a different profile of morbidity and mortality, and death was associated with the diagnosis of congenital heart disease, the clinical diagnosis of sepsis, and the isolation of gram-positive bacteria in the blood culture.

Study of morbidity and mortality profile among low birth weight neonates in sick newborn care unit of a rural medical college and hospital.

Introduction: Low birth weight is one of the major health problems in children both in developed and developing countries. Birth asphyxia, neonatal sepsis, hypothermia, hypoglycemia, hyperbilirubinemia, hypocalcemia, MAS, NEC, polycythemia, IVH, meningitis, apnea, BPD, etc are the major risk factors for LBW babies morbidity and mortality. This study was conducted in a tertiary care center to find out morbidity and mortality profiles among low birth weight neonates and short-term neurodevelopmental outcome. A cross-sectional observational study. 404 low birth weight babies admitted from 1st June 2016 to 31st May 2017. Methods: Both clinical and laboratory data of all the patients were retrieved, compiled, and analyzed. Results: Out of 404 LBW 38 (9.4%) were ELBW,134 (33.2%) were VLBW and rest 232 (57.4%) were between 1500-&lt;2500gm weight, 88 (21.8%) were preterm and IUGR, 219 (54.2%) were male and rest 185 (45.8%) were female. Major cause of morbidity includes hypoglycemia (17.6%), RDS (13.1%), HIE (29.5%), NEC (5.7%), Sepsis (47.8%), hyperbilirubinemia (31.9%), PDA (2.5%), Apnea (5.9%), IVH (1.25%), congenital anomalies (5.9%) etc. Conclusion: In the present series the mortality rate was (23.5%) was high. Sepsis, RDS, Birth Asphyxia, and Apnea were the main causes of morbidity and mortality among low birth weight babies. Proper asepsis, judicious use of antibiotics, timely intervention like CPAP, etc reduce the mortality. Proper counseling while discharge regarding feeding, warmth care, asepsis, danger sign and need for follow up plays a pivotal role in the neurodevelopmental outcome.

Profile of Ocular morbidities observed at medical outreaches in Ogun State, Southwest Nigeria

Profile of Ocular morbidities observed at medical outreaches in Ogun State, Southwest Nigeria

Transrectal versus transperineal prostate biopsy under intravenous anaesthesia: a clinical, microbiological and cost analysis of 2048 cases over 11 years at a tertiary institution.

Transrectal (TR) and transperineal (TP) approaches for prostate biopsy have different morbidity profiles. Our institution transitioned to a preference for multiparametric MRI-based triage and TP biopsy since 2014. The aim of this study was to compare clinical, microbiological and health economic outcomes between TR and TP prostate biopsy. A consecutive cohort study considered prostate biopsies over an 11 year period. Hospital presentations across the region within 30 days of biopsy were analysed for details and subsequent outcomes according to biopsy approach. Cost for each encounter (routine and unplanned) were analysed and generalised linear models applied, as well as cost implications for inclusion of mpMRI-based triage and TP biopsy preference. In total, 2048 prostate biopsies were performed. Similar re-presentation rates per occurred for each biopsy approach (90 patients, TR 4.8%, TP 3.8%, p = 0.29), with 23 patients presenting more than once (119 total presentations). Presentations after TR biopsy were more likely to be of infectious aetiology (TR 2.92%, TP 0.26% de novo, p < 0.001) and result in hospital admission (TR 43/49, 93.4%; TP 14/24, 58.3%; p = 0.007) for similar rates of urinary retention (TR 2.76% vs TP 3.63%, p = 1). The mean overall cost (biopsy and re-presentations) was higher for the TP group (p < 0.001), adjusted for year and age, but reduced over time and was similar for patients who re-presented (p = 0.98). Incorporation of mpMRI (with subsequently avoided biopsies), TP biopsy and re-presentations resulted in AU$783.27 saving per biopsy. TR biopsy resulted in more infectious complications and hospital admissions than TP biopsy for similar rates of re-presentation and urinary retention. TP biopsy costs reduced over time and use in conjunction with mpMRI provides an overall cost saving. Routine TP biopsy is safe and feasible, with further cost savings expected with other approaches (local anaesthetic) under investigation.

Prospective observational study of clinical profile in tertiary care center, Hyderabad

Background: Population specific, systematic comprehensive strategies are needed to reduce the morbidity and mortality of the neonates at the national level. Neonatal age group usually contributes to a major disease burden. Objective: The objective of the study was to identify the morbidity and mortality patterns in our neonatal tertiary care referral center. Materials and Methods: This was a prospective observational study done over a period of 1 year, 1 month from January 2019 to January 2020. Results: Admissions in early 7 days were more at 86.4% to after 7 days at 13.6%. Males were 50.9% with almost equal to female population 49.1%; preterm and low birth weight (LBW) babies were 49.3% and 49.75%, respectively, and term babies more than 2.5 kg babies were 50.7% and 51.25%. The LBW babies were admitted about 28.07% and 26.98% inborn and outborn babies. In preterm babies, more babies admitted in 34 weeks–37 weeks gestational age, 16.50% and 15.56% in inborn and outborn babies, respectively. As per morbidity profile, in inborn babies, the common reasons for admission were respiratory distress 22.09% and neonatal jaundice contributing about 22.03%. The common causes of admission in outborn were sepsis which was 27.45% and hypoxic ischemic encephalopathy which was contributing about 20%. Conclusion: In our study, we found that major portion of the babies were preterm and LBW babies. This shows changing trend toward preterm delivery. It is good in the sense of antenatal steroid coverage which was 80–90% but antenatal magnesium sulfate covered in 39% outborn babies only. Prematurity, infections, asphyxia, and neonatal jaundice were the leading cause of admissions into our neonatal unit.

PROSPECTIVE OBSERVATIONAL STUDY OF CLINICAL PROFILE IN TERTIARY CARE CENTER, HYDERABAD

Background: Population specific, systematic comprehensive strategies are needed to reduce the morbidity and mortality of the neonates at the national level. Neonatal age group usually contributes to a major disease burden. Objective: The objective of the study was to identify the morbidity and mortality patterns in our neonatal tertiary care referral center. Materials and Methods: This was a prospective observational study done over a period of 1 year, 1 month from January 2019 to January 2020. Results: Admissions in early 7 days were more at 86.4% to after 7 days at 13.6%. Males were 50.9% with almost equal to female population 49.1%; preterm and low birth weight (LBW) babies were 49.3% and 49.75%, respectively, and term babies more than 2.5 kg babies were 50.7% and 51.25%. The LBW babies were admitted about 28.07% and 26.98% inborn and outborn babies. In preterm babies, more babies admitted in 34 weeks–37 weeks gestational age, 16.50% and 15.56% in inborn and outborn babies, respectively. As per morbidity profile, in inborn babies, the common reasons for admission were respiratory distress 22.09% and neonatal jaundice contributing about 22.03%. The common causes of admission in outborn were sepsis which was 27.45% and hypoxic ischemic encephalopathy which was contributing about 20%. Conclusion: In our study, we found that major portion of the babies were preterm and LBW babies. This shows changing trend toward preterm delivery. It is good in the sense of antenatal steroid coverage which was 80–90% but antenatal magnesium sulfate covered in 39% outborn babies only. Prematurity, infections, asphyxia, and neonatal jaundice were the leading cause of admissions into our neonatal unit.

Hybrid Anterior Cervical Discectomy and Fusion and Cervical Disc Arthroplasty: An Analysis of Short-Term Complications, Reoperations, and Readmissions.

Study Design:Retrospective cohort study.Objectives:Although cervical disc arthroplasty (CDA) has become a well-established and effective treatment for symptomatic cervical degeneration, many patients with multilevel disease are not good candidates for CDA at all levels. For such patients, hybrid surgery (HS)—a combination of adjacent anterior cervical discectomy and fusion (ACDF) and CDA—may be more appropriate. Given the novelty of HS and the relative dearth of studies adequately assessing short-term perioperative complications, this current study sought to assess the short-term morbidity profile of HS, differences in operative duration, length of stay (LOS), and readmission and reoperation rates and reasons relative to a 2-level ACDF cohort.Methods:All patients who underwent HS and 2-level ACDF were identified between 2011 and 2018 using a large, prospectively collected registry. Baseline patient characteristics and postoperative complications were compared using bivariate and/or multivariate analysis.Results:A total of 390 patients undergoing HS were identified. Two-level procedures were the most common (74.9%). Patients undergoing HS were more likely to be younger, male, and have fewer comorbidities. There were no differences between HS and 2-level ACDF in rates of any postoperative complication, transfusion, readmissions, and operative duration. However, HS had a decreased LOS (0.5 days), relative to a 2-level ACDF. HS patients had low rates of reoperation (1.28%) with 1 case for hematoma evacuation and another for revision CDA.Conclusions:This study represents one of the largest cohorts of patients undergoing HS reported to date. Patients undergoing HS are not at increased risk of perioperative complications relative to a 2-level ACDF and may benefit from shorter LOS.

Health care utilization and out of pocket expenditure in a rural area of Kerala: a cross sectional study

Background: Out-of-pocket expenditure in health has substantial negative side effects. They may lead to impoverishment. The knowledge of pattern of health care utilization and out of pocket expenditure is imperative for policy making in health care. Objectives of this study were to study utilization pattern of health care services of the population in a rural area of Thrissur district and study of the self-reported chronic morbidity profile and out of pocket expenditure for chronic diseases among the population.Methods: A community based cross sectional study was conducted in Tholur panchayath area of Thrissur district of Kerala. The calculated sample size was 552 households. House hold was considered as primary sampling units. All family members of the house hold were included in the study. Cluster sampling method was adopted. Data was collected using a pre tested semi-structured questionnaire.Results: A total of 809 individuals from 583 households were found to have chronic diseases. Among them, 54.8% were utilizing private health facility for their treatment. Majority (86%) were following modern medicine system for treatment. Health insurance was availed by 26.6 % of the study participants. Most common reported morbidity was combination of hypertension, diabetes mellitus, and hypercholesterolemia. The total median out of pocket expenditure for chronic diseases was found to be 5000 Indian Rupees. It was found that 41.6% of the total income of study participants was spent for health care of chronic diseases which indicate catastrophic health expenditure.Conclusions: The burden of chronic disease is high and the private hospitals are approached more by the study population for treatment rather than government hospitals. Health insurance coverage is low, and social assistance availed for treatment is marginal. These factors lead to high out of pocket expenditure amounting to catastrophic health expenditure.

Pre-existing traits associated with Covid-19 illness severity.

Certain individuals, when infected by SARS-CoV-2, tend to develop the more severe forms of Covid-19 illness for reasons that remain unclear. To determine the demographic and clinical characteristics associated with increased severity of Covid-19 infection. Retrospective observational study. We curated data from the electronic health record, and used multivariable logistic regression to examine the association of pre-existing traits with a Covid-19 illness severity defined by level of required care: need for hospital admission, need for intensive care, and need for intubation. A large, multihospital healthcare system in Southern California. All patients with confirmed Covid-19 infection (N = 442). Of all patients studied, 48% required hospitalization, 17% required intensive care, and 12% required intubation. In multivariable-adjusted analyses, patients requiring a higher levels of care were more likely to be older (OR 1.5 per 10 years, P<0.001), male (OR 2.0, P = 0.001), African American (OR 2.1, P = 0.011), obese (OR 2.0, P = 0.021), with diabetes mellitus (OR 1.8, P = 0.037), and with a higher comorbidity index (OR 1.8 per SD, P<0.001). Several clinical associations were more pronounced in younger compared to older patients (Pinteraction<0.05). Of all hospitalized patients, males required higher levels of care (OR 2.5, P = 0.003) irrespective of age, race, or morbidity profile. In our healthcare system, greater Covid-19 illness severity is seen in patients who are older, male, African American, obese, with diabetes, and with greater overall comorbidity burden. Certain comorbidities paradoxically augment risk to a greater extent in younger patients. In hospitalized patients, male sex is the main determinant of needing more intensive care. Further investigation is needed to understand the mechanisms underlying these findings.

Cardiovascular risk factors among oil refinery workers: ecological study

Monitoring the health of workers is indispensable to develop indicators to identify potential risk factors and the workload impact on illness and characterize their morbidity profile. To identify modifiable and non-modifiable cardiovascular risk factors among employees of an oil refinery with fixed work schedule or allocated to shifts. Ecological, exploratory, descriptive and quantitative study with data retrieved from the company's record system. We performed time series analysis of the prevalence of risk factors in the period from 2008 through 2017. We found an increasing trend in the prevalence of hypertension and diabetes and a decreasing trend for high cholesterol, high LDL, low HDL, smoking and coronary artery risk. The prevalence of hypertension increased, while that of all other risk factors, except for diabetes, decreased in 2017 by comparison to 2008. The analyzed sample is at medium risk for cardiovascular disease despite their young age, high educational level and available resources. We call attention to the need to systematize workplace health promotion programs.

Intervention and Mechanisms of Alanyl-glutamine for Inflammation, Nutrition, and Enteropathy: A Randomized Controlled Trial.

Objective:Determine the minimum dosage of alanyl-glutamine (Ala-Gln) required to improve gut integrity and growth in children at risk of environmental enteropathy (EE).Methods:This was a double-blinded randomized placebo-controlled dose-response trial. We enrolled 140 children residing in a low-income community in Fortaleza, Brazil. Participants were 2 to 60 months old and had weight-for-age (WAZ), height-for-age (HAZ), or weight-for-height (WHZ) z-scores less than −1. We randomized children to 10 days of nutritional supplementation: Ala-Gln at 3 g/day, Ala-Gln at 6 g/day, Ala-Gln at 12 g/day, or an isonitrogenous dose of glycine (Gly) placebo at 12.5 g/day. Our primary outcome was urinary lactulose-mannitol excretion testing. Secondary outcomes were anthropometry, fecal markers of inflammation, urine metabolic profiles, and malabsorption (spot fecal energy).Results:Of 140 children, 103 completed 120 days of follow-up (24% dropout). In the group receiving the highest dose of Ala-Gln, we detected a modest improvement in urinary lactulose excretion from 0.19% on day 1 to 0.17% on day 10 (P=0.05). We observed significant but transient improvements in WHZ at day 10 in 2 Ala-Gln groups, and in WHZ and WAZ in all Ala-Gln groups at day 30. We detected no effects on fecal inflammatory markers, diarrheal morbidity, or urine metabolic profiles; but did observe modest reductions in fecal energy and fecal lactoferrin in participants receiving Ala-Gln.Conclusions:Intermediate dose Ala-Gln promotes short-term improvement in gut integrity and ponderal growth in children at risk of EE. Lower doses produced improvements in ponderal growth in the absence of enhanced gut integrity.

The differential impact of neuropathic, musculoskeletal and neurovascular orofacial pain on psychosocial function.

While the psychosocial morbidity of orofacial pain (OFP) is widely recognized, the differential impact of musculoskeletal, neuropathic and neurovascular symptoms on pain and psychosocial function in individuals with and without coexisting OFP conditions is unclear. This was a comparative cross-sectional study of 350 consecutive patients attending an OFP clinic; 244 completed standardized self-report measures of pain experience, mood, and generic and oral health-related quality of life (HRQoL). The impact of musculoskeletal, neuropathic and neurovascular symptoms on measures was assessed using linear and logistic generalized linear models. Two hundred patients were diagnosed with a neuropathic condition: 125 with musculoskeletal pain and 101 with (neurovascular) headache disorders. 23% of patients presented with multiple OFP conditions; this was more common in patients with neurovascular (62%) than neuropathic (21%) and/or musculoskeletal orofacial symptoms (28%). Patients with neurovascular symptoms experienced significantly higher levels of pain, evidenced less pain self-efficacy and had poorer overall health. Neuropathic OFP was significantly associated with greater psychological and social oral health disability. Multiple OFP symptoms were not linked to pain severity or psychosocial function, although health scores were worse for patients with neurovascular pain and neuropathic/musculoskeletal symptoms compared with patients with only neurovascular symptoms. The profile and degree of psychosocial morbidity in patients with OFP is significantly related to the types of presenting orofacial symptoms. Patients with neurovascular pain present with higher pain levels and have poorer health while those with neuropathic pain have higher oral functional morbidity; both may require more complex multidisciplinary management.