scholarly journals Importance of Geospatial Heterogeneity in Chronic Disease Burden for Policy Planning in an Urban Setting Using a Case Study of Singapore

Author(s):  
Ken Wei Tan ◽  
Joel R. Koo ◽  
Jue Tao Lim ◽  
Alex R. Cook ◽  
Borame L. Dickens

Chronic disease burdens continue to rise in highly dense urban environments where clustering of type II diabetes mellitus, acute myocardial infarction, stroke, or any combination of these three conditions is occurring. Many individuals suffering from these conditions will require longer-term care and access to clinics which specialize in managing their illness. With Singapore as a case study, we utilized census data in an agent-modeling approach at an individual level to estimate prevalence in 2020 and found high-risk clusters with >14,000 type II diabetes mellitus cases and 2000–2500 estimated stroke cases. For comorbidities, 10% of those with type II diabetes mellitus had a past acute myocardial infarction episode, while 6% had a past stroke. The western region of Singapore had the highest number of high-risk individuals at 173,000 with at least one chronic condition, followed by the east at 169,000 and the north with the least at 137,000. Such estimates can assist in healthcare resource planning, which requires these spatial distributions for evidence-based policymaking and to investigate why such heterogeneities exist. The methodologies presented can be utilized within any urban setting where census data exists.

2020 ◽  
Author(s):  
Richard P Bartlett ◽  
Alexandria Watkins

UNSTRUCTURED Background: This is an outpatient case study that examines two patients in the United States with unique cases that involve oncology, hypertension, Type II Diabetes Mellitus, and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), also known as COVID-19. This case study involves two patients in the outpatient setting - treated via telemedicine, with laboratory-confirmed SARS-CoV-2 infection in the West Texas region between March 29th, 2020, and May 14th, 2020. Case Report: The first patient is a 63-year-old female, non-smoker, who is diagnosed with Waldenstrom’s Macroglobulinemia (2012) and Primary Cutaneous Marginal Zone Lymphoma (2020) and the second patient is a 38-year-old male, non-smoker, who has the following comorbidities: Type II Diabetes Mellitus (DM), hypertension, and gout. Both patients were empirically started on budesonide 0.5mg nebulizer twice daily, clarithromycin (Biaxin) 500mg tab twice daily for ten days, Zinc 50mg tab twice daily, and aspirin 81mg tab daily. Both patients have fully recovered with no residual effects. Conclusion: The goal is to call attention to the success of proactive, early empirical treatment, combining a classic corticosteroid (budesonide) administered via a nebulizer and an oral macrolide antibiotic known as clarithromycin (Biaxin).


2021 ◽  
Vol 22 (3) ◽  
pp. 32-37
Author(s):  
A. A. Abdullaev ◽  
R. M. Gafurova ◽  
U. A. Islamova ◽  
R. G. Khabchabov ◽  
E. R. Makhmudova ◽  
...  

Goal — was to assess the quality of life of patients with coronary heart disease, concomitant type II diabetes mellitus and arterial hypertension at 2 years after coronary stenting. Material and methods. The study included 103 patients aged 44 to 67 years. Clinical and laboratory results were assessed after stenting of the coronary arteries, 2 years later in an outpatient setting. The patients were divided into two groups: the 1st group included 54 patients with ischemic heart disease, angina pectoris III–IV f.c. in combination with arterial hypertension; in the 2nd group — 49 patients with ischemic heart disease, angina pectoris III–IV f.k. in combination with arterial hypertension and type II diabetes mellitus. The study was carried out in accordance with Good Clinical Practice and Declaration of Helsinki principles. The study protocol was approved by the Ethics Committees of all participating clinical centers. Written informed consent was obtained from all participants prior to enrollment.Results. In our study, 103 patients with ischemic heart disease and angina pectoris III–IV f.c. Within 2 years after coronary artery stenting, 33 cases of myocardial infarction (32.0%) were registered. The quality of life improved to stable exertional angina pectoris I–II f.k. 34 patients (33.0%). At the same time, 39.8% did not change their quality of life. Myocardial infarction in the group with angina pectoris III–IV f.k. and arterial hypertension, developed in 12 (22.2%) patients, and in the group with angina pectoris III–IV f.c. and arterial hypertension + type II diabetes mellitus were registered in 21 (42.8%) patients, which is almost twice as high as in group 1, the same for improving the quality of life. That is, despite the stenting of the coronary arteries, the high incidence of complications in the form of myocardial infarction can be explained by a combination of concomitant diseases, in the form of arterial hypertension + type II diabetes mellitus. We are confident that type II diabetes mellitus has a greater impact on the quality of life and complications in patients who have undergone coronary stenting. At the same time, the risk of complications decreases with adequate control of arterial hypertension and type II diabetes mellitus — the transition of angina pectoris III–IV to I–II f.c. characterized by a significant improvement at p-0.0034; odds ratio 0.50; the confidence interval is 0.31–0.80. Conclusion. The improvement in the quality of life in patients with coronary heart disease and arterial hypertension after stenting of the coronary arteries in the long-term period is twice as good as in patients with coronary heart disease and arterial hypertension + type II diabetes mellitus. Arterial hypertension is a serious but manageable risk factor for the development of macrovascular and microvascular complications. The study demonstrated the effectiveness of correcting only arterial hypertension in terms of preventing cardiovascular and microvascular complications than the combination of arterial hypertension and type II diabetes mellitus, which significantly worsen the prognosis of the disease in patients with coronary artery disease after coronary artery stenting. This is reflected in the recommendations for stratification of the risk of arterial hypertension and type II diabetes mellitus.


Sign in / Sign up

Export Citation Format

Share Document