Cost analysis of treating cardiovascular diseases in a super-specialty hospital

Cardiovascular care is expensive; hence, economic evaluation is required to estimate resources being consumed and to ensure their optimal utilization. There is dearth of data regarding cost analysis of treating various diseases including cardiac diseases from developing countries. The study aimed to analyze resource consumption in treating cardio-vascular disease patients in a super-specialty hospital. An observational and descriptive study was carried out from April 2017 to June 2018 in the Department of Cardiology, Cardio-Thoracic (CT) Centre of All India Institute of Medical Sciences, New Delhi, India. As per World Health Organization, common cardiovascular diseases i.e. Coronary Artery Disease (CAD), Rheumatic Heart Disease (RHD), Cardiomyopathy, Congenital heart diseases, Cardiac Arrhythmias etc. were considered for cost analysis. Medical records of 100 admitted patients (Ward & Cardiac Care Unit) of cardiovascular diseases were studied till discharge and number of patient records for a particular CVD was identified using prevalence-based ratio of admitted CVD patient data. Traditional Costing and Time Driven Activity Based Costing (TDABC) methods were used for cost computation. Per bed per day cost incurred by the hospital for admitted patients in Cardiac Care Unit, adult and pediatric cardiology ward was calculated to be Indian Rupee (INR) 28,144 (US$ 434), INR 22,210 (US$ 342) and INR 18,774 (US$ 289), respectively. Inpatient cost constituted almost 70% of the total cost and equipment cost accounted for more than 50% of the inpatient cost followed by human resource cost (28%). Per patient cost of treating any CVD was computed to be INR 2,47,822 (US $ 3842). Cost of treating Rheumatic Heart Disease was the highest among all CVDs followed by Cardiomyopathy and other CVDs. Cost of treating cardiovascular diseases in India is less than what has been reported in developed countries. Findings of this study would aid policy makers considering recent radical changes and massive policy reforms ushered in by the Government of India in healthcare delivery.

MULTIMODAL IMAGING OF CORNEAL NEOVESSELS: OCT ANGIOGRAPHY IN COMPARISON TO FLUORESCEIN ANGIOGRAPHY ON 10 EYES AND REVIEW OF THE LITERATURE

Introduction:The use of OCT angiography for the analysis of neovessels of the ocular surface is currently at the experimental stage. Through this work we evaluate the benefits of OCTA in the detection of corneal neovessels, their depth and surface, the signs suggestive of activity / quiescence in comparison to fluorescein angiography. Materials And Methods:10 patients (10 eyes) with corneal neovessels (CNV) were prospectively recruited to Ophthalmology B at the Rabat Specialty Hospital between June and September 2019. All patients received OCT A fluorescein angiography (AF) at two-week intervals. Results:The results of the OCT A matched the AF data by showing immature neovessel (NV) characteristics for the early-diffusing NVs, allowing the study of the structure : trunk, numbers of segments, and fractal divisions, the existence of apical loop. As well as the detection of the flow level, exudative phenomena and associated lesions in high resolution OCT B. Discussion:Few studies have evaluated the OCTA in the evaluation of NVC, the published articles analyze the feasibility and reproducibility of this technique. Our initial analyzes suggest that scans provide better penetration and resolution of NVCs, but this requires direct comparative studies between OCTA systems used to scan the same eyes. The learning curve seemed fast for this technique. Conclusion :The evaluation of antiangiogenic treatments and the risk of graft rejection, it should be noted when interpreting OCTA scans of the anterior segment that artifacts may appear in dense scars areas in addition to motion artifacts.Future software enhancements and optimization for anterior segment acquisition may reduce these artifacts even more and improve the resolution of the image.

Highlighting Differences in Cancer Epidemiology in India: A Descriptive Report from a Private Sector Hospital-Based Cancer Registry in Delhi for the Years 2013 to 2017

Introduction Cancer continues to grow in number. Knowing the epidemiology helps in prevention and treatment. Existing hospital-based cancer registries (HBCRs) provide little data of private sector including patients for medical tourism. Objectives The aim of this study was to describe the distribution of cancer at a tertiary center in the private sector in North India for all cancer patients. Materials and Methods Cases were ascertained from the Oncology Outpatient Department of Max Super Specialty Hospital, Saket, between January 1, 2013, and December 31, 2017, and from pathology database since July 2015. They were abstracted into National Cancer Registry Program (NCRP) core pro forma. We conducted a descriptive analysis of distribution by age, gender, nationality, site, stage, and treatment. Results Among the 15,850 confirmed cases, 8,034 (51%) were males. Nearly 1.8% of patients were pediatric (<15 years) and 30.1% geriatric (>65 years). A high proportion of patients (13%) came from outside India and 27% from outside Delhi-National Capital Region. The most common cancers in males were prostate (10.9%), lung (10%), and mouth (7.6%). Stomach was the most common site of cancer in international male patients. Four of the top ten cancers in males were of the gastrointestinal tract (esophagus, stomach, colon, and rectum). The most common cancers in females were breast (37.4%), ovary (7.1%), and corpus uteri (5.6%). Tobacco-related cancers accounted for 36.9% of cancers in males and 11.3% in females. The composite stage in males was IV in 54%, followed by stage III (21%), stage II (15%), and stage I (10%). In females, stage IV was 33%, stage III was 23%, stage II was 28%, and stage I was 16%. As registry included outpatient record visits and pathology records, not all registered patients received treatment at Max Super Specialty Hospital. Overall, 49.8% of male patients and 49.7% of female patients received treatment at Max Super Specialty Hospital. Data quality metrics matched other national HBCRs. Conclusion We highlight the differences from other NCRP HBCRs, with prostate cancer being the top cancer in males and gastrointestinal cancers forming major proportion among all. Socioeconomic status of our patients, referral bias, and international medical tourism could be responsible.

Prevalence of dementia and its associated risk factors among elderly patient attending Outpatient Department of a tertiary care hospital in Lucknow

Background: Dementia is a broad category of brain diseases that causes a chronic, progressive and gradual decrease in cognitive function i.e. ability to think and remember that is great enough to affect a person’s daily functioning beyond what might be expected from normal ageing. According to American Psychiatric Association, “Dementia is a syndrome caused by a variety of brain illnesses that affect memory, thinking, behaviour and the ability to perform everyday activities”. Aim & Objectives: To assess the prevalence of dementia among the patients above 60 years of age attending the outpatient department of Tertiary care super specialty hospital. To assess the risk factors associated with occurrence of dementia in patients attending outpatient department of Tertiary care super specialty hospital. Settings and Design: Study design: - Cross-sectional observational study. Study area: - Tertiary care super-specialty hospital. Study setting: - Outpatient department (OPD)of Tertiary care super specialty hospital. Methods and Material: Study population: - Patients above 60 years of age and attending Outpatient Department of the tertiary care super specialty hospital. Duration of Study: - 4 months. Sample size:- 223 elderly participants from the registration counter of the Outpatient Department of tertiary care hospital. Statistical analysis used: Data was analysed using SPSS, version 24.0. Univariate Logistic Regression, Multivariate Logistic Regression, Odds Ratio. Results: The study was conducted on a total of 223 patients out of which only 210 patients completed the questionnaire and matched our criteria. Thus, 210 patients are analysed for the result. In our study which included the patients above 60 years of age out of which the maximum participants (52.4%) were of age group 65-75. In our study 66.2% participants had normal cognitive functioning while 33.8% of total participants were found to have dementia. Out of these 33.8% participants having impaired cognitive functioning, 13.8% and 20% had severe and borderline dementia respectively. Dementia was found to be more common in females. Conclusions: Statistically significant association of dementia has been found with female gender, rural residence, joint family and a greater number of family members, poor education, pan masala consumption, daytime drowsiness, and problem in sleep pattern, social intolerance and frequent fights.

Clinical Pattern of Pediatric Dermatoses Attending a Multi-Specialty Hospital

Introduction: Pediatric dermatoses deal with skin disease in children from birth to 18 years. This age group comprises significant physiological changes, and hence the pattern of disease including skin disease is unique to them. Skin diseases are influenced by the local climatic factor and socio-economic status which differ in different geographic areas including within the country. Objective: The objective of the study was to analyze the clinical spectrum of skin disease in children from 1 day to 18 years of age and to find any seasonal influence on the disease pattern. Methodology: The study was conducted retrospectively in a multi- specialty hospital from May 2014 to April 2015. Data of children from 1 day to 18 years of age were analyzed. Demographic details like age, sex, ethnicity was noted. The month and season of the presentation were also recorded. Patient with a confirmed clinical diagnosis and adequate data was included in the study. Patients were divided into 5 age groups; neonate (0 days to 1 month), infant (1 month to 2 years), young child (2-6 years), child (6-12 years), and adolescent (12-18 years). Data were entered in Microsoft excel and analysis was done with SPSS version 22 along with the Chi-square test. Result: There were 20.65% of pediatric patients out of 3292 patients visiting skin OPD. The male to female ratio was 1.63:1. The majority of the cases (47.8%) were in the adolescent age group. Infection and infestation were the predominant diagnosis (56.02%), followed by eczema (15.88%) and urticaria (6.47%). Among infection, fungal infection was seen as the majority (26.17%).Papular urticaria and urticaria were significantly (p-value <0.05) more common in summer, while scabies was more common in the spring season (p-value <0.05). Conclusion: Infection and infestation followed by eczema/dermatitis and urticaria were the three most common groups of dermatoses. There was a seasonal influence on a few common dermatoses like scabies, urticaria and papular urticaria.

Dynamics of contraceptive use among women attending multi-speciality hospital in Faridabad district of Haryana

Background: Population of India is growing at a very fast rate while its resources are limited which will lead to decrease in per capita availability of resources. Contraceptive methods are the simplest way to address this issue of population explosion by preventing the unwanted pregnancies. The objective of this study was to assess awareness and practices regarding contraceptive use and its determinants among women attending gynecology OPD of multi-specialty hospital in Faridabad district of Haryana. Methods: A cross-sectional study was planned among 200 patients from gynecology OPD in a multi-specialty hospital of Faridabad district of Haryana. The questionnaire consisted of questions about socio-demographic data and data related contractive awareness and practices. Data was analyzed by SPSS software version 21.0.Results: Mean age of study subjects was 29.4±4.3 years. Out of 200 participants, about one fourth (77.5%) were aware about contraception and more than half (59.5%) of them were using contraception methods. Factors like age and education status, occupation and area of residence were found to be statistically significantly (p<0.001) associated with contraception knowledge and practice. Barrier method was most common method of contraception followed by Oral contraceptive pills.Conclusions: This study concludes that knowledge about contraception was high as about one fourth (77.5%) were aware about contraception while practice of contraception was relatively low as compare to knowledge as two fifth (40.5%) of them were not using any contraception methods. So, there is a need to increase awareness about importance of contraception practice among study population.