Lower-class Patients Research Articles

Aesthetic Perceptions Regarding a Thyroidectomy Scar and Transvestibular Approach in Brazil.

We investigated motivation levels across the general Brazilian population and subgroups and their willingness to spend for surgery without a cervical scar. This random-sample survey was performed by a specialized third-party research institute. In this study, we created a hypothetical thyroidectomy scenario, and the transcervical and transoral endoscopic thyroidectomy vestibular approach (TOETVA) were used. The survey included sociocultural data and questions regarding participants' surgical preferences. Data were obtained from 1250 participants; 42.4% were of the opinion that a cervical scar affects social or professional life. Young and childless women were most likely to be affected (p <0.001). All respondents accepted the transoral approach to avoid cervical scarring. However, 30.7% and 31.9% of respondents maintained their preference for TOETVA despite understanding the risks of a hypothetical increase in complications and unfavorable oncological outcomes and 98.6% were of the opinion that this approach was likely associated with greater postoperative pain. Only 16.2% were unwilling to spend for TOETVA. The variable that most affected patients' willingness to spend was a salary greater than 10 Brazilian minimum wages (odds ratio 9.797, 95% confidence interval, p <0.005). Upper class respondents were 10 times more likely to spend for TOETVA than lower class patients. This study highlights patients' interest in TOETVA. Cervical scar perception is affected by concerned about appearance, particularly in certain societal subgroups. Our study population showed significant motivation to undergo TOETVA, which was emphasized by their acceptance of the complication rate, poor postoperative outcomes, greater postoperative pain, and willingness to spend on surgery with an invisible scar. 4 Laryngoscope, 134:3862-3867, 2024.

Textbook outcome as a composite measure of quality in hepaticopancreatic surgery.

Textbook outcome (TO) is a valuable metric to assess postoperative outcomes. The aim of this study was to assess TO in patients undergoing hepatopancreatic surgery. This was a retrospective cohort NSQIP study from 2015 to 2018. TOs are defined as no complication or mortality and length of stay within the 75th percentile. This study included 44 235 patients. Of those patients, 61% underwent pancreatic surgery (PS) and 39% hepatic surgery (HS). The most common surgical procedure was pancreaticoduodenectomy (16 464), followed by partial hepatectomy (11 817), distal pancreatectomy (8292), hemihepatectomy (4247), hepatic trisegmentectomy (1366) and total pancreatectomy (706). TO was more common for HS than PS, 47% versus 40%, p < .001. TO was more common for younger (0-65, OR: 1.60; CI: 1.30-1.96, p < .001), female (OR: 1.23; CI: 1.17-1.29, p < .001), white (OR: 1.10; CI: 1.01-1.19, p = .022), and lower ASA class (OR: 2.11; CI: 1.54-2.90, p < .001) patients. For patients undergoing HS TO was more common after partial lobectomy than trisegmentectomy and lobectomy (OR: 1.36; CI: 1.18-1.57, p < .001). For those undergoing PS, there was a lower likelihood of TO for those who are obese/morbidly obese compared to normal-weight patients (OR: 0.73; CI: 0.67-0.79, p < .001). Unlike HS, TO for patients undergoing PS was not associated with the type of surgical procedure. TO is a composite that can be applied to a national data set to analyze outcome quality. In HS, more complex surgical procedures are associated with a decreased likelihood of TO. In PS, TO are similar regardless of the procedure but less common in obese or morbidly obese patients.

Perception of Patients towards dental treatment during COVID-19

This study identifies different factors influencing the patient’s decision to receive dental treatments during the ongo-ing pandemic and identifies their expectations at the dental office during Covid-19. A cross-sectional study was conducted among 306 people in a dental institute. A questionnaire was used to collect primary demographic data. It consisted of questions concerning patient attitude regarding the utilization of dental services and expectations from the dental setup during the pandemic. The chi-square test was used to analyze the association between variables with a significance level set at p≤0.05. The mean age of the study population was 37±5.3 years, with the majority being males (52%). Many female patients (60.76%) and those from the lower middle class (38.59%) were appre-hensive about getting the disease during their visit. Covid19 was not considered a threat among adoles-cents/middle-aged (47.27%) and upper lower-class patients (41.81%). Spending extra during this period was ac-ceptable by 65.7% of patients, though a few (16.3%) responded or felt that the hospital should be considerate and bear the expenses. They (38.9%) had no specific complaints about the cleanliness issue of the hospital premises. All the above results were significant statistically (p≤0.05). Though apprehension of contracting the disease was observed among many patients, their dental problems were considered a priority, influencing their visit to the dental hospital

To Study of Clinical Profile of Patients with Alcoholic Liver Disease with Special Reference to Their Sociodemographic Status

Background: In the present time alcohol consumption has become a cause of concern owing to its high mortality and morbidity rate due to pathological causes and accidents manifested as a consequence of intake beyond limits. Alcohol consumption is referred to as “ingestion of more than two drinks in a single sitting or more than four to five times per week. Aim: To assess the clinical profile of patients with alcoholic liver disease with special reference to their sociodemographic status. Material and methods: Present study was a Hospital based observational study undertaken at a tertiary care center under the departments of Medicine from 1 January 2021 to 30 June 2022. All the patients admitted through the alcoholic liver disease which are further supported by clinical examination radiological evidence were involved in this study. The ultrasonography, radiographic parameters, biochemical, serologic and clinical were the diagnostic aids for liver cirrhosis all were done and further analysed. Thus all data was analysed using Openepi version 2.3.1.software. Results: It was observed that majority of patients were males which accounts for 49 (96.08%) and the females were only 2 (3.92%). married patients with ALD counted 39 (76.47%) and single status patients 9 which is 17.65% of total. Maximum number of patients belonging to lower socioeconomic status were identified as 29 (56.86%) and the lower middle-class patients were 5 (9.80%). 15(29.41%) were reported as the upper lower class patients and the minimum number of patients in the upper middle were found to be 2 (3.92%) in number. Conclusion: Alcoholic liver disease is not only a medical burden but also a social and psychological load, which commonly leads to hospitalization and unwanted out-of-pocket spending. Our results further emphasize the importance of the clinical profile of alcoholic patients, prevention of liver disease among society's most vulnerable segments and its effect on socioeconomic and psychosocial ...

Institutionalization of the insane in the Russian Baltic provinces: a case study of the Hospital for Mental and Nervous Diseases in Tartu, 1881-95.

This article studies the University of Tartu psychiatric hospital and its patient population in the Russian Baltic Province of Livonia in 1881-95, using the hospital's admission registry book as the primary source. Although it was a university clinic following the German academic tradition, both upper- and lower-class patients were admitted (25 and 75 per cent, respectively, of 2,184 hospitalizations), with a median stay of 70 days. Admission and length of stay often depended on a family's or community's financial capabilities. Considerably more men and unmarried patients were admitted, and 130 hospitalized women were diagnosed with female-specific illnesses. This study argues that gender and social class should be jointly analysed, as admission and discharge outcomes are influenced by both factors simultaneously.

Prevalence of severity and type of hearing loss in Rheumatoid Arthritis patients

Rheumatoid arthritis (RA) is a chronic heterogeneous autoimmune disease characterized by painful joint inflammation which may cause destructive bone erosions. It also affects the auditory system and cause hearing loss. Objective: To find out the prevalence of Severity and type of Hearing Loss in Rheumatoid Arthritis Patients. Methods: Cross sectional descriptive study was conducted to find the prevalence of Severity and type of Hearing Loss in Rheumatoid Arthritis Patients. The study was performed at DHQ Hospital Bhimber, Mayo Hospital Lahore. The duration of data collection was 6 months (April 2022 to September 2022). Non-probability convenient sampling technique was used for data collection. Patients of both gender with ages 30 to 50 years were included. Patients with rheumatoid arthritis with other co-morbid factors were excluded. Results: Out of 117 patients, there were 33 (28.2%) male patients and 84 (71.8%) female patients. Most patients were in age group 41-45 years 38 (32.5 %). There were 19 (16.2%) lower class patients, 93 (79.5%) middle class patients and 5 (4.3%) upper class patients. The prevalence of Hearing Loss in Rheumatoid Arthritis patients was high 70 (59.5%). Sensorineural hearing loss 66 (56.4) was most prevalent. Majority of them had mild to moderate degree hearing loss 50 (42.7%). Conclusion: The study showed the prevalence of Hearing Impairment in Rheumatoid Arthritis was high. The result of this study also concluded that majority of the patients had mild to moderate degree sensorineural hearing loss.

Peroral endoscopic myotomy is equally safe and highly effective treatment option in achalasia patients with both lower and higher ASA classification status.

The American Society of Anesthesiologists (ASA) physical status classification system was developed as a simple categorization of patients' physiological status that predicts the operative risk. Peroral endoscopic myotomy (POEM) is a less invasive alternative to surgical myotomy in achalasia. As such, POEM seems to be an appealing option for high-risk patients with achalasia. However, there are no studies which systematically analyzed the outcomes of POEM among patients with different ASA classes. Hence, we aimed to compare the safety and efficacy of POEM in patients with lower and higher ASA classes. Medical records of all achalasia patients who underwent POEM at our institution between April 2014 and May 2019 were reviewed. Patients were categorized arbitrarily into two groups, lower ASA class (ASA I and II combined) and higher ASA class (ASA class III and IV combined). Demographic and procedural details, timed barium swallow (TBE), high-resolution esophageal manometry (HREM), pH study findings and Eckardt scores were compared between the two groups. Baseline characteristics were compared using Chi-square test and two-sample t-test for categorical and continuous variables, respectively. A total of 144 patients met our study criteria (lower ASA class, n = 44; and higher ASA class, n = 100). Patients in higher ASA class were significantly more obese and older. More patients in lower ASA class had prior Heller myotomy and more patients in higher ASA Class had prior botulinum toxin injections. Procedural parameters were similar in both groups. Procedural complications were infrequent and were also similar in the two groups. The length of stay, 30-day readmission rate, reflux symptoms and esophageal pH study findings were also comparable between the two groups. Treatment success was similar in both groups, 97.7% in lower ASA class versus 92% in higher ASA class (p = 0.19). At 2-month follow-up, both groups had significant improvement in HREM and TBE parameters. POEM is a very safe and highly effective treatment option for achalasia patients with advanced ASA class similar to lower ASA class patients. POEM may be considered as the preferred choice for myotomy in these high-risk achalasia patients due to its low morbidity and high efficacy.

Emergency rigid bronchoscopy in two lower social class patients with mirror like complete pulmonary malignant atelectasis.

Several factors as cultural factors and social class other than biological and genetic factor can affect symptom perception in patients with malignant airway obstruction. Poor perception of dyspnoea can result in the delayed seeking of medical care so increase access to intensive care due to impeding respiratory failure. In patients issued from malignant airway obstruction, therapeutic bronchoscopy procedure can not affect the endotracheal extubation although immediate airway patency can be obtained. We reported the outcome of two patients from lower social classes admitted in intensive care and underwent emergency rigid bronchoscopy for malignant complete pulmonary atelectasis.

The Utility of Recycled Eyeglasses: A Pilot Study at the Los Angeles County Department of Health Services.

Background:The cost of eyeglasses is variably covered by medical insurance and thus is a significant barrier for patients in lower socioeconomic classes. We evaluated the efficacy of Recycle Vision (RV) at LAC+USC Medical Center, a monthly clinic run by volunteer medical students that provides free donated eyeglasses.Methods:A convenience sample of 30 patients was surveyed from August 1, 2019 to December 31, 2019. Patients’ prescriptions were matched with available eyeglasses based on spherical equivalent and axis of astigmatism using Winglasses software algorithm; patients selected glasses from these options based on subjective improvement of vision. All participants consented to a phone follow-up survey 1 month after initial visit to gauge satisfaction with glasses and rate difficulty in completing daily activities pre- and post-RV visit on a scale of 1 to 5 (5 being the greatest), with a 100% response rate.Results:Of the 30 study participants, 90% received eyeglasses from RV, with reported improvement in ease of daily activities of 3.96. 67% of respondents stated that if RV clinic did not exist, they would not have obtained glasses elsewhere; cost was the most commonly (70%) cited barrier. Upon follow-up, average likelihood of patients referring friends/family to RV was 4.07 (SD 1.14).Conclusion:The majority of RV patients received free eyeglasses and had subsequent improvement in their quality of life. This pilot study demonstrates that programs offering free eyeglasses can effectively correct refractive error and can offer a practical public health solution to improve functionality for underserved populations.

A retrospective observational study of clinical profile, diagnosis, management and outcome of abdominal tuberculosis in 30 patients

Background: Abdominal tuberculosis is found worldwide although prevalence rates are still highest in the developing countries. The sites of involvement of abdominal tuberculosis are peritoneum, lymph nodes, intestine and solid viscera. The objectives of this study were to describe the clinical profile of patients with abdominal tuberculosis, to review the use of diagnostic modalities, both non-invasive and invasive and to study the outcome of management of abdominal tuberculosis.Methods: This is an observational retrospective study of 30 patients with diagnosis of abdominal tuberculosis treated at university linked teaching hospital of South Gujarat from August 2015 to November 2017.Results: In our study, disease was found almost equally prevalent in both rural and urban areas affecting mostly lower socio-economical class. The mean age was 34 years (range from 13 to 62); male and female ratio was 2.33:1; the mean hospital stay was 09 days (range from 5 to 48 days). Abdominal pain was present in almost all cases, having chronic pain in 21 patients and acute in 9 patients. There were 05 (16.7%) patients found to be HIV positive in this study. There was mortality of 02 patients post operatively due to sepsis in those patients operated in emergency with peritonitis.Conclusions: Abdominal tuberculosis is prevalent in lower socioeconomic class patients and affects younger male patients more commonly. Most commonly intestinal and mesenteric disease presented with chronic abdominal pain and constitutional symptoms of tuberculosis.

Can heat therapy help patients with heart failure?

To review and analyze the clinical outcomes of thermal therapy (≤1.4°C increase in core body temperature) in patients with heart failure (HF). A systematic review and meta-analysis regarding the effects of thermal therapy on HF was done by searching PubMed, Ovid Medline, Ovid Embase, Scopus, and internal databases up to date (2019). Improvement in the New York Heart Association (NYHA) class: Ten studies with 310 patients showed significant improvement in NYHA class. Only 7 among 40 patients remained in Class IV and 99 patients in Class III from 155 patients. Increased patients in lower classes indicate that more patients showed improvement. Sixteen studies on 506 patients showed an overall improvement of 4.4% of left ventricular ejection fraction (LVEF). Four studies reported improved endothelial dysfunction by 1.7% increase in flow-mediated dilation (FMD) on 130 patients. Reduction in blood pressure: Thermal therapy reduced both systolic blood pressure (SBP) and diastolic blood pressure by 3.1% and 5.31%, respectively, in 431 patients of 15 studies. Decrease in cardiothoracic ratio (CTR): Eight studies reported an average of 5.55% reduction of CTR in a total of 347 patients. Improvement in oxidative stress markers: Plasma brain natriuretic peptide (BNP) levels significantly decreased (mean difference of 14.8 pg/dL) in 303 patients of 9 studies. Improvement of quality of life: Among 65 patients, thermal therapy reduced cardiac death and rehospitalization by 31.3%. A slight increase in core body temperature is a promising, noninvasive, effective, and complementary therapy for patients with HF. Further clinical studies are recommended.

Prevalence of Headache Disorders, their Impact on the Daily Lifestyle of the Patients, and the Correlation of their Demographic and Clinical Features with Headache Impact Test 6

Introduction: Headache disorders are common among people of all ethnic groups. Primary headache disorders include migraine, tension-type headache, cluster headache, and chronic daily headache syndrome. Secondary headaches include medication overuse headache. The aim of this study is to evaluate the prevalence of various types of headaches disorders, their impact on the daily lifestyle of the patients, and the correlation of their demographic and clinical features with Headache Impact Test 6 (HIT-6). Materials and methods: This prospective study was conducted at a tertiary care hospital in Karachi for a period of six months. 198 patients who came in the outpatient (OPD) department and had a diagnosis of headache were included in this study irrespective of their age and gender. The demographic features, clinical features, and the final diagnoses made by the attending physician using the International Classification of Headache Disorders II (ICHD-II) were recorded. The impact of headaches on the daily lifestyle of the patients was determined by using a six-item HIT-6 questionnaire. For continuous variables, the means and standard deviations were calculated. Whereas for categorical data, frequencies and percentages were calculated. Effect modifiers like demographic and clinical features were controlled through stratification, Fischer’s exact test was used and a p-value of ≤0.05 was taken as significant. Results: The mean age of the patients was 34.39±15.58 years. Age distribution showed 90 (45.45%) patients of eight to 30 years, 84 (42.42%) patients of 31-50 years, and 24 (12.12%) patients of 51-75 years of age. There were 69 (34.8%) male and 129 (65.2%) female patients. The unmarried patients were 81 (40.9%) and married patients were 117 (59.1%). The lower-class patients were 94 (47%), the working-class patients were 87 (43.9%), the middle-class patients were 15 (7.6%), and the upper-class patients were three (1.5%). Primary headache was diagnosed in 150 (75.8%), and the secondary headache was diagnosed in 48 (24.2%) patients. 45 (22.7%) patients had throbbing, 87 (43.9%) had stabbing, and 66 (33.3%) had pressing headache quality. Unilateral headache was in 108 (54.5%), and the bilateral headache was in 90 (45.5%) patients. Pulsatile headache was in 102 (51.5%), and the non-pulsatile headache was in 96 (48.5%) patients. 51 (25.8%) patients had approximately one hour, 42 (21.2%) patients had more than four hours, and 105 (53%) patients had a continuous headache. The frequency was two to three times per week in 51 (25.8%), daily in 81 (40.9%), and variable in 66 (33.3%) patients. The headache occurred in the morning in 39 (19.7%), in the afternoon in 12 (6.1%), in the evening in 24 (12.1%), in the night in 30 (15.2%), and variably in 93 (47%) patients. Headache was mild in 36 (18.2%), moderate in 93 (47%), and severe in 69 (34.8%) patients. Aura, nausea, vomiting, photophobia, phonophobia, runny nose, and lacrimation were also present in many patients. 78 (39.4%) patients had a tension-type headache, and 60 (30,3%) had a migraine while others had several different conditions. The average HIT-6 score was 65.86±7.506. The severe impact was found in 168 (84.8%) patients, substantial impact in nine (4.5%), some impact in 12 (6.1%), and no impact in nine (4.5%) patients. Stratification showed a significant relationship with age, marital status, socioeconomic status, quality of headache, site of headache, pulsatile/non-pulsatile feature, frequency of headache, the severity of headache, and nausea. Conclusions: Tension-type and migraine headaches are the most common headaches that mostly affect young to middle-aged married females of low socioeconomic status. Age, marital status, socioeconomic status, quality of headache, site of headache, pulsatile/non-pulsatile feature, frequency of headache, the severity of headache, and nausea are some of the determinants of the impact of headaches on daily life. Further studies are needed to validate these conclusions.

Latest Innovation in Surgical Management of Haemorrhoids

Haemorrhoids are one of the commonest ano rectal problems. Numerous techniques of surgical treatment from old standard Milligan Morgan Haemorrhoidectomy to Non-invasive modalities including IRC, DGHAL RAR(Doppler guided haemorrhoidal arterial ligation and Recto anal repair), MIPH, Radiofrequency to Laser haemorrhoidoplasty. DGHAL was safest but involves substantial basic investment and per case recurring cost of Single use Doppler probes. Thus it was becoming unapproachable to lower middle class and poor patients. Rest other modalities also involve substantial investment and also per case expenditure. Over the experience of over 4,520 procedures by DGHAL equipment we describe same results by DIGITALLY GUIDED HAEMORRHOIDAL ARTERIAL LIGATION (DGHAL) evidenced by use of vascular Doppler confirming artery and stoppage of sound after ligation with hardly any expenditure. This was planned with special reference to Diabetic patients where excisional surgery or even RAR also needed more invasive approach, thus LASER Haemorrhoidoplasty was preferable.

Predictive value of the augmentation index derived vascular age in patients with newly diagnosed atherosclerosis

Early detection of atherosclerosis, i.e., in occupational health screening programs could reduce the rate of cardiovascular events in the working population. Changes of the augmentation index (AIX) correlate with changes of the arterial stiffness induced by aging, atherosclerosis, or arterial hypertension and have a prognostic value for cardiovascular events. Their diagnostic yield should be increased by normalizing the AIX to age, in terms of a calculating the vascular age (VA). In this pilot study, 30 patients (mean age 65.3 ± 8.8 years, 21 male) with suspected coronary heart disease underwent a duplex ultrasound of the carotid arteries and a measurement of the ankle brachial index in addition to the coronary angiography. The AIX was recorded with a portable device (Vascular Explorer), and the VA was calculated. Atherosclerosis was found in 24 patients. They were older than the patients without atherosclerosis, but there was no age dependency found for the distribution pattern or severity of atherosclerosis. In patients with findings of atherosclerosis, the calculated VA was higher than the chronological age, and these differences were significant in patients below 65 years of age. Comparing patients in higher blood pressure classes with patients in lower classes, significantly higher AIX, VA, and differences to the chronological age were found. The VA, deduced from the noninvasively obtained AIX, is a promising candidate for screening programs for atherosclerosis, i.e., in occupational health screening programs.

Pattern of pediatric Ear, Nose and Throat diseases at Arthur Davison Children’s Hospital, Ndola, Zambia

Background: Ear, Nose and Throat (ENT) disorders are very common in children mainly due to increased number of risk factors for these disorders in our environment. However, there is a lack of data on paediatric ENT disorders from Zambian population. This study aimed at determining the pattern of common paediatric ENT diseases and their relationship with socio-demographic factors in a tertiary hospital, Arthur Davison Children’s Hospital (ADCH), in Ndola Zambia. Method: This was a retrospective hospital-based descriptive study involving review of medical records of patients’ aged0-14 years who presented to the ENT outpatient clinic of ADCH with various ENT disorders from January 2014 to December 2015.Results: Within the study period, a total of 988 children were seen. ENT diseases were found to be more common among male children (52.8%), the female to male ratio is1:1.12.There was no significant difference in age groups. Ear disorders (47.1%) were found to be the commonest group of ENT problems, followed by pharyngeal disorders (40.1%) and nasal disorders (12.8%). The most common otologic disorder was Earwax obstructing the tympanic membrane (28.8%).Among rhinologic disorders, Nasal Foreign Bodies (27.0%) were the commonest while Tonsillitis (42.8%) was the commonest Pharyngeal disorder. There were more patients in lower socio-economic classes than in the upper classes. Conclusion: This study has demonstrated the broad spectrum of ENT disorders as observed at ADCH over a period of 2 years. Improvement of health education, socio-economic status and health facilities will be helpful in reducing the frequency of ENT diseases.

Socioeconomic resources and survival in patients with metastatic breast cancer treated with palliative radiotherapy.

e18082Background: Studies have shown that socioeconomic (SE) disparities contribute to differences in cancer survival, with patients in lower SE classes consistently having poorer survival compared...

Effects of Individual Components of Metabolic Syndrome on GERD Prevalence in a National Study of 125,029 Patients: Diabetes, but Not Hypertension or Hyperlipidemia, Significantly Increases the Risk of GERD Independent of Obesity

Introduction: To identify epidemiologic factors associated with GERD, especially the components of the metabolic syndrome independent of obesity, including hypertension, hyperlipidemia and diabetes, after adjusting for obesity, a known risk factor for GERD. Methods: Analysis of limited access dataset of National Hospital Ambulatory Medical Care Survey (2006-2010). All patients with GERD were identified by ICD-9 diagnostic codes. Multiple factors were analyzed by multivariate logistic regression as independent risk factors for GERD, including age, socioeconomic status, smoking, urban status, and obesity (BMI >30). Also, individual components of metabolic syndrome were analyzed as independent risk factors for GERD after adjusting for obesity. Results: Among 125,029 analyzed patient visits, 1,860 patients had GERD. Patients >40 years old had significantly higher prevalence of GERD than patients <40 (OR 1.73 95% CI 1.56 to 1.92). Lower and lower middle class patients had significantly higher prevalence of GERD than upper class patients [(OR=1.47 CI: 1.29-1.67) and (OR=.16 CI: 1.01-1.32)], respectively]. Smokers and obese patients had significantly higher prevalence of GERD than non-smokers (OR=1.20 CI:1.04-1.40) and non-obese patients (OR=1.65 CI:1.47-1.88), respectively. Urban status did not influence prevalence of GERD (OR=0.88 CI: 0.77-1.02). Patients with metabolic syndrome had higher prevalence of GERD than obese patients (OR=1.34 CI: 1.08-1.78). However, among components of metabolic syndrome, only diabetes, but not hypertension or hyperlipidemia, significantly increased the risk of GERD in obese patients. Despite the importance of obesity in GERD, weight reduction and exercise counseling has lagged in obese patients with GERD compared to the general population (p=0.03 and p=<0.01). Conclusion: Older age, lower or lower middle income status, obesity, and smoking were associated with higher rates of GERD. Metabolic syndrome was identified as an independent risk factor for GERD after adjusting for obesity, but this increase was due to diabetes but not hypertension or hyperlipidemia. This study suggests that certain components of metabolic syndrome may contribute much more significantly to GERD than other components. These novel findings may have implications for the pathophysiology and treatment of GERD. These findings may identity patients at increased risk for GERD.

Poster #T169 EFFECT OF LONG-TERM TREATMENT WITH LURASIDONE OR RISPERIDONE ON METABOLIC SYNDROME STATUS IN PATIENTS WITH SCHIZOPHRENIA

One-hundred and twenty-nine lower class medical and psychiatric non-psychotic patients receiving psychiatric drug treatment were studied in an effort to ascertain differences between the completer and attriter groups. Emphasis was placed on patients attitudes and opinions toward their treatment situation and on their response to treatment.Patients who prematurely terminated treatment (attriters) were found to be more negative than completers toward their treatment environment and the personnel involved in it. This negativism was relative to their previous treatment experiences as well as to attitudes held by completing patients.Both prior “set” and the discrepancy between the patients' expectations and perceptions of treatment were involved in determining the patients' outcome in treatment. These results and their implications are discussed, and suggestions designed to make the lower class patient more amenable to some form of supportive psychopharmacotherapy are given.

Marketing Strategies of Corporate Hospitals

[Hospital is the organization that dreams up an idea of service offering (treatment), which will satisfy the customer’s (patient’s) expectations (of getting cured). The service is a combination of tangible and intangible aspect with the intangible aspect dominating the tangible aspect. A hospital offers an intangible service called health care, characterized by inseparability, intangibility, variability, perishability, and simultaneity.India is substantially under-invested in healthcare with 17% of the world's population, but only 6% of the beds. Meager public healthcare spending in India presents a big investment opportunity for private players. The growth in now focused on fast expansion into tier II & III cities in the country. The growth drivers are:• The services sector (which accounts for 55 per cent of GDP) will grow as economy is poised for stable growth of over 5%. Goldman Sachs estimates that the Indian economy is likely to grow at five per cent annually for the next 45 years. • The total expenditure on health per capita in India has increased from $19 in 2000 to $36 (at average exchange rates) in 2005. This incremental spending per capita was largely accounted for by private spending rather than public (government) spending (per capita spending by government increased from $ 4 to $ 7 during the same period).• It is predicted that medical tourism will grow into a 2 billion US$ (dollar) business by 2014. Patients are coming from neighboring countries (Sri Lanka, Nepal, Bangladesh, Afghanistan and Pakistan), as well from countries like UK, the US and the Middle East.NEED FOR THE STUDYThe corporate hospitals contribute about 7% of bed capacity. The increased incidence of chronic lifestyle diseases and substandard quality of care in public hospitals has forced even the lower middle class patients to spend beyond their means. In the last few years; the shift of the clientele to corporate hospitals has been overwhelming. The emergence of corporate hospitals as favored centers of health care for foreigners is another positive development. All these developments are posing challenges to the corporate hospitals to maintain high standard in delivery of services to improve and retain image. They require operational excellence and marketing effectiveness, to attract patients, and satisfy them.The review leads to the following conclusions:• Hospital should have marketing orientation to succeed. • Total quality management for improving and delivering quality services is important.• Patient satisfaction and feedback should be major concerns. Equally important is employee satisfaction and feedback. • The benefits like brand equity and profitability can be measured.

Connective tissue growth factor (CTGF/CCN2): diagnostic and prognostic value in acute heart failure

As a mediator of ECM homeostasis, connective tissue growth factor (CTGF) appears to be involved in adverse structural remodeling processes in the heart. However, the diagnostic and prognostic value of CTGF levels in acute heart failure (AHF) in addition to natriuretic peptide testing has not yet been evaluated. A total of 212 patients presenting with acute dyspnea and/or peripheral edema to the Emergency Department were evaluated. CTGF and NT-proBNP plasma levels were measured at the initial presentation. All patients were followed up to 1 and 5 years. The first endpoint tested was the diagnostic non-inferiority of combined CTGF plus NT-proBNP compared to NT-proBNP alone for AHF diagnosis. Afterwards, the additional diagnostic value of CTGF plus NT-proBNP was tested. CTGF levels were higher in NYHA class III/IV and AHA/ACC class C/D patients compared to lower class patients (p = 0.04). Patients with HFREF revealed highest CTGF levels (median 93.3 pg/ml, IQR 18.2-972 pg/ml, n = 48) compared to patients with a normal heart function (i.e., without HFREF and HFPEF) (median 25.9, IQR <1-82.2 pg/ml, n = 37) (p < 0.05), followed by patients with HFPEF (median 82.2 pg/ml, IQR 11.5-447 pg/ml, n = 32) as assessed by echocardiography. Finally, CTGF levels were higher in patients with AHF (median 77.3 pg/ml, IQR 22.5-1012 pg/ml, n = 66) compared to those without (p = 0.002). CTGF plus NT-proBNP was non-inferior to NT-proBNP testing alone for AHF diagnosis (AUC difference 0.01, p > 0.05). CTGF plus NT-proBNP improved the diagnostic capacity for AHF (accuracy 82 %, specificity 83 %, positive predictive value 66 %, net reclassification improvement +0.11) compared to NT-proBNP alone (p = 0.0001). CTGF levels were not able to differentiate prognostic outcomes after 1 and 5 years. Additional CTGF measurements might lead to a better discrimination of higher functional and structural heart failure stages and might identify patients of an increased risk for an acute cardiac decompensation.