scholarly journals Socio-economic variations in the clinical presentation, etiology and outcome of infective endocarditis in the ESC-EORP EURO-ENDO (European Infective Endocarditis) registry: a prospective cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Sengupta ◽  
B Prendergast ◽  
S Furnaz ◽  
R Ronderos ◽  
A Almaghraby ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Clinical Presentation ◽  
Income Group ◽  
Economic Factors ◽  
Middle Income ◽  
Middle Income Group ◽  
Group 3 ◽  
Group 2 ◽  
Socio Economic Factors ◽  
Group 1

Abstract Background Infective endocarditis (IE) is a life threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socio-economic factors may influence variations in epidemiology, clinical presentation, investigation and management (and their consequence upon clinical outcomes) in a large international multi-centre registry. Methods The ESC-EORPEURO-ENDO registry comprises a prospective cohort of 3116 adult patients admitted to 156 hospitals in 40 countries with IE between January 2016 and March 2018. We analysed the complete dataset to assess potentially important determinants of variation according to World Bank economic stratification (high income (Group 1) [73.8%]; upper-middle income (Group 2) [17.1%]; lower-middle income (Group 3)[9.1%]). Results Patients in Group 3 were younger (median age [IQR]: Group 1 - 66 [54–75] years; Group 2 - 57 [40–68] years; Group 3 - 33 [26–43] years; p<0.001) with a higher prevalence of smoking, intravenous drug use and human immunodeficiency virus (HIV) infection (all p<0.001). Group 3 patients with IE presented later (median [IQR) days since symptom onset: Group 1 - 12 [3–35]; Group 2 - 20 [6–51]; Group 3 - 31 [12–62]; p<0.001) and were more likely to develop congestive heart failure (13.6%; 11.3%; and 22.6%, respectively; p<0.001), septic shock (8.3%; 11.1%; 13.4%; p=0.007), and persistent fever for greater than 7 days (9.6%; 14.4%; 27.9%; p<0.001) following hospital admission. Surgery was performed less frequently in Group 3 (75.4%, 76.8% and 51.3% in Groups 1, 2 and 3, respectively; p<0.001) and mortality was highest in the poorest countries (14.6%; 23.6% and 23.7%, respectively; p<0.001). Conclusion Socio-economic factors influence the clinical profile of patients presenting with IE across the world. Despite being younger, patients from the poorest countries presented with more frequent complications and higher mortality associated with delayed diagnosis and less frequent use of surgery. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals The Monetary Value of Human Lives Lost to Suicide in the African Continent: Beating the African War Drums

Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 84
Author(s):  
Joses M. Kirigia ◽  
Rosenabi D.K. Muthuri ◽  
Newton G. Muthuri
Keyword(s):  
Discount Rate ◽  
Economic Burden ◽  
Years Of Life Lost ◽  
African Continent ◽  
Middle Income ◽  
Middle Income Countries ◽  
Monetary Value ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Suicide is an important public health problem in the African continent whose economic burden remains largely unknown. This study estimated the monetary value of human lives lost due to suicide in the African continent in 2017. Methods: The human capital approach was applied to monetarily value the years of life lost due to premature mortality from suicide deaths (SD) among 54 African countries. A 3% discount rate was used to convert future losses into their present values. The sensitivity of monetary value of human lives lost to changes in discount rate and average life expectancy was tested. Results: The 75,505 human lives lost from suicide had a grand total monetary value of International Dollars (Int$) 6,989,963,325; and an average present value of Int$ 92,576 per SD. About 31.1% of the total monetary value of SD was borne by high-income and upper-middle-income countries (Group 1); 54.4% by lower-middle-income countries (Group 2); and 14.5% by low-income countries (Group 3). The average monetary value per human life lost from SD was Int$ 234,244 for Group 1, Int$ 109,545 for Group 2 and Int$ 32,223 for Group 3. Conclusions: Evidence shows that suicide imposes a substantive economic burden on African economies. The evidence reinforces the case for increased investments to ensure universal coverage of promotive, preventive, curative and rehabilitative mental health services.

Association of Anticyclic Citrullinated Peptide Antibodies and/or Rheumatoid Factor Status and Clinical Presentation in Early Arthritis: Results from the ESPOIR Cohort

2014 ◽  
Vol 41 (8) ◽  
pp. 1614-1622 ◽  
Author(s):  
Gaël Mouterde ◽  
Cédric Lukas ◽  
Philippe Goupille ◽  
René-Marc Flipo ◽  
Nathalie Rincheval ◽  
...  
Keyword(s):  
Rheumatoid Factor ◽  
Radiographic Progression ◽  
Clinical Presentation ◽  
Early Arthritis ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Citrullinated Peptide ◽  
Anticyclic Citrullinated Peptide Antibodies ◽  
Group 1

Objective.To compare the initial clinical, biological, and radiographic findings of early arthritis by positivity for rheumatoid factor (RF) and/or anticyclic citrullinated peptide antibodies (anti-CCP), and to validate a patient profile based on this serologic information.Methods.The ESPOIR cohort comprises patients presenting synovitis of at least 2 joints for 6 weeks to 6 months. Patients underwent testing for IgM rheumatoid factor (IgM-RF) and anti-CCP2 antibodies and were divided into 4 groups: RF– and anti-CCP– (group 1), RF+ and anti-CCP– (group 2), RF– and anti-CCP+ (group 3), RF+ and anti-CCP+ (group 4). We compared the groups in terms of clinical, biological, and radiographic features (baseline scores and 6-month and 12-month progression).Results.Of the 813 recruited patients, 406 (50%) were in group 1, 91 (11.2%) in group 2, 34 (4.1%) in group 3, and 281 (34.6%) in group 4. Mean baseline erythrocyte sedimentation rate and C-reactive protein were higher for anti-CCP+ groups (groups 3 and 4) than for other groups (p < 0.001), and van der Heijde-modified Sharp score for radiographs was higher for group 4 than for other groups (p < 0.001). Clinical presentation was not consistently associated with serologic profile. Radiographic progression at 1 year was higher for anti-CCP+ groups than other groups (p < 0.001).Conclusion.The phenotype of patients with early arthritis with or without anti-CCP and/or RF positivity did not correspond to a particular clinical presentation. However, baseline acute-phase reactants and short-term radiographic progression were high in patients with anti-CCP positivity, which may be associated with the inflammatory process and progressive disease in patients with early arthritis.

scholarly journals Diabetes Mellitus and Dyslipidemia- A Detailed Analysis

2021 ◽  
Vol 12 (5) ◽  
pp. 101-106
Author(s):  
Brijesh Mukherjee ◽  
Monalisa Mohanty
Keyword(s):  
Serum Lipid ◽  
Diabetic Patients ◽  
Economic Factors ◽  
Good Glycemic Control ◽  
Education Levels ◽  
Group 2 ◽  
Sugar Levels ◽  
Structured Questionnaire ◽  
Socio Economic Factors ◽  
Group 1

Background: Diabetic atherosclerosis is a heterogeneous condition, and that dyslipidemia is only one aspect of the pathophysiology. However, dyslipidemia is the most readily measured and, at the present time, the most readily treated aspect of the problem. The occurrence of dyslipidemia can be reduced by good glycemic control. However poor awareness and other socio-economic factors is a major concern and pose a major hindrance in controlling blood sugar levels. Aims and Objective: This study was conducted to study the dyslipidemia pattern in diabetic patients and its association with other factors. Materials and Methods: The study included 500 subjects and was divided into two groups: Group 1(Diabetic) included 276 patients and Group 2 (Non-diabetic) included 224 patients. The study patients were screened using a pretested structured questionnaire. Fasting plasma glucose and serum lipid profile (cholesterol, TG, HDL) were estimated in automated analyzer (Erba Manheim EM 200). Results: In the current study, all characteristics of diabetes were correlated with each parameter and it was found that disproportionate body mass index, high waist girth was correlated with incidence of dyslipidemia. The education levels and financial background of the subjects were also studied and it was found to correlate well with diabetic dyslipidemia. Conclusion: Early diagnosis and treatment of dyslipidemia in diabetic patients can reduce the morbidity and mortality due to the disease.

scholarly journals The Indirect cost of illness in Africa

10.3823/2568 ◽  
2018 ◽  
Vol 11 ◽  
Author(s):  
Joses Muthuri Kirigia ◽  
Germano Mwiga Mwabu
Keyword(s):  
Indirect Cost ◽  
Cost Of Illness ◽  
Health System Strengthening ◽  
Age Group ◽  
Health Targets ◽  
Middle Income ◽  
Middle Income Countries ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: The current study estimated (a) the indirect costs associated with non-fatal disability and premature death across a wide range of diseases and health conditions in Africa in 2015 and (b) the potential savings that could be accrued if countries were to meet the 3 health targets of the substainable development goal (SDG) compared to the costs under the status quo. Methods: This study used the lost output or human capital approach to quantify the gross domestic product (GDP) losses associated with the disability-adjusted-life-years (DALYs) lost due to all causes by age group as well as by country economic classification (Group 1: 10 high/upper-middle income countries; Group 2: 17 lower-middle income countries; and Group 3: 27 low income countries). Results: The expected indirect cost of the 704,765,879 DALYs lost in Africa in 2015 was Int$ 2,983,187,560,197. Of this amount, 25.17%, 57.84% and 16.99% were incurred by the economies of the countries comprising Group 1, Group 2 and Group 3, respectively. Of the total continental indirect cost, 36.9%, 10.5%, 13.7%, 17.0%, 7.6%, 6.8% and 7.5% were associated with people aged 0-4, 5-14, 15-29, 30-49, 50-59, 60-69 and 70 years or older, respectively. Most of the total indirect cost (56.61%) was attributable to maternal conditions, AIDS, tuberculosis (TB), malaria, neglected tropicald diseases (NTDs), non-communicable diseases and traffic injuries. Approximately half (47%) of this cost could be avoided (or saved) every year if the 3 (health) targets of the SDG were fully met. Conclusion: The study estimated the total indirect cost of illness due to all causes by age group and country economic classification. The annual indirect cost is substantial. The findings contained in this paper suggest that health system strengthening should focus on both rich and poor countries, people of all ages and specific disease categories.  

scholarly journals Correlation between angioarchitectural characteristics of brain arteriovenous malformations and clinical presentation of 183 patients

2021 ◽  
Author(s):  
Ulysses Caus Batista ◽  
Benedito Jamilson Araujo Pereira ◽  
Andrei Fernandes Joaquim ◽  
Helder Tedeschi ◽  
Ronie Leo Piske
Keyword(s):  
Clinical Presentation ◽  
Low Flow ◽  
Neurological Deficits ◽  
Group 4 ◽  
Clinical Presentations ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Presentation Methods ◽  
Group 1

ABSTRACT Background: The correlation between angioarchitecture and clinical presentation of brain arteriovenous malformation (bAVM) remains a subject of debate. Objective: The main purpose of the present study was to assess the correlation between angioarchitectural characteristics of bAVM and clinical presentation. Methods: A retrospective review of all consecutive patients presenting a bAVM who underwent a cerebral angiography at Beneficencia Portuguesa Hospital in São Paulo between January 2006 and October 2016 was carried out. Patients were divided in five groups: group 1 - hemorrhage; group 2 - seizure; group 3 - headache; group 4 - progressive neurological deficits (PND); group 5 - incidental). Results: A total of 183 patients were included, with group 1 comprising 56 cases, group 2 49 cases, group 3 41 cases, group 4 28 cases, and group 5 9 cases. Regarding hemorrhage presentation, a statistical correlation was observed with female gender (P < 0.02), Spetzler-Martin 3B (P < .0015), and lesions with low flow (P < 0.04). A positive association was found between group 2 and age less than 36 years (P < 0.001), male sex (P < 0.018), presence of superficial lesions not classified as SM 3B (P < 0.002), presence of venous ectasia (p <0.03), and arterial steal phenomenon (P < 0.03). Group 4 was associated with older age (P < 0.01). Conclusions: Angioarchitectural characteristics can be correlated with some clinical presentations as well as with some clinical data, making it possible to create predictive models to differentiate clinical presentations.

scholarly journals Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries

2020 ◽  
Vol 5 (11) ◽  
pp. e002640
Author(s):  
Clara Kayei Chow ◽  
Tu Ngoc Nguyen ◽  
Simone Marschner ◽  
Rafael Diaz ◽  
Omar Rahman ◽  
...  
Keyword(s):  
Low Income ◽  
High Income ◽  
Low Income Countries ◽  
Major Adverse Cardiovascular Events ◽  
Cvd Risk ◽  
Middle Income ◽  
Urban Rural ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

ObjectivesWe aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.MethodsWe defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1—all three drug types were available and affordable, group 2—all three drugs were available but not affordable and group 3—all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors.ResultsOf 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7, 49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50).ConclusionLower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

Abnormal Haemostasis and Blood Viscosity in Malignant Hypertension

1984 ◽  
Vol 52 (03) ◽  
pp. 253-255 ◽  
Author(s):  
C Isles ◽  
G D O Lowe ◽  
B M Rankin ◽  
C D Forbes ◽  
N Lucie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Viscosity ◽  
Renal Damage ◽  
Antithrombin Iii ◽  
Plasma Viscosity ◽  
Malignant Hypertension ◽  
Fibrin Deposition ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

SummaryWe have previously shown abnormalities of haemostasis suggestive of intravascular coagulation in patients with malignant hypertension, a condition associated with retinopathy and renal fibrin deposition. To determine whether such abnormalities are specific to malignant hypertension, we have measured several haemostatic and haemorheological variables in 18 patients with malignant hypertension (Group 1), 18 matched healthy controls (Group 2), and 18 patients with non-malignant hypertension (Group 3) matched for renal pathology, blood pressure and serum creatinine with Group 1. Both Groups 1 and 3 had increased mean levels of fibrinogen, factor VIIIc, beta-thrombo- globulin, plasma viscosity and blood viscosity (corrected for haematocrit); and decreased mean levels of haematocrit, antithrombin III and platelet count. Mean levels of fast antiplasmin and alpha2-macroglobulin were elevated in Group 1 but not in Group 3. We conclude that most blood abnormalities are not specific to malignant hypertension; are also present in patients with non-malignant hypertension who have similar levels of blood pressure and renal damage; and might result from renal damage as well as promoting further renal damage by enhancing fibrin deposition. However increased levels of fibrinolytic inhibitors in malignant hypertension merit further investigation in relation to removal of renal fibrin.

Middle Income Group and Debt Fund

2011 ◽  
Vol 2 (3) ◽  
pp. 43-43
Author(s):  
Dr. Shakti Kumar ◽  
Keyword(s):  
Income Group ◽  
Middle Income ◽  
Middle Income Group

Features of postoperative period in patients with chronic venous insufficiency: phlebectomy versus thermal ablation

2020 ◽  
pp. 64-75
Author(s):  
E. Burleva ◽  
O. Smirnov ◽  
S. Tyurin
Keyword(s):  
Postoperative Period ◽  
Chronic Venous Insufficiency ◽  
Thermal Ablation ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Varicose Veins ◽  
Statistical Processing ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The purpose of the study was to conduct a comparative assessment of the course of the postoperative period after phlebectomy and thermal ablation in patients with varicose veins of the lower extremities in the system of the great saphenous vein (GSV) with class C2 of chronic venous insufficiency (CVI) — CEAP class C2. Materials and methods: 455 patients (455 limbs) with CEAP class C2. Group 1 (n = 154) received stripping + minimally invasive phlebectomy; Group 2 — endovenous laser ablation (EVLA) of GSV trunk + sclerotherapy of varicose veins; 3 group (n = 150) — radiofrequency ablation (RFA) of the GSV + sclerotherapy. All patients were united by a single tactical solution — the elimination of pathological vertical reflux in GSV. In each group, patients were with similar hemodynamic profile were selected (Group 1 = 63; Group 2 = 61; Group 3 = 61). The course of the postoperative period (from 2 days to 2 months) was compared for pain (visual analog scale — VAS), clinical symptoms of chronic venous insufficiency, degree of satisfaction (Darvall questionnaire), and duration of disability. Statistical processing was carried out using Excel programs for Windows XP, MedCalc® (version 11.4.2.0., Mariakerke, Belgium). Results: Postoperative pain is more pronounced (during day 1 for Group 1–4.0, Group 2–3.0, Group 3–2.0) and more prolonged (up to 4 days) after open surgeries (p < 0.05). The dynamics of the clinical symptoms of CVI (including varicose syndrome and use of compression therapy) could not be fully evaluated in connection with the ongoing sclerotherapy procedures for patients of Groups 2 and 3. Satisfaction of patients with aesthetic aspects was higher than expected in all groups. Reliable statistical differences proved decrease in days of disability (Group 1–14; Group 2–4; Group 3–3) and earlier return to physical activities and work in patients after thermal ablation in comparison with phlebectomy. Conclusion: The study shows that all three methods for eliminating vertical reflux in the GSV can be proposed for a large category of patients with CEAP of class C3 and C2. Medical and social rehabilitation of patients using endovascular thermal ablation technologies proceeds faster, which is beneficial both for the patients and for society.

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