Estimating the economic burden of typhoid in children and adults in Blantyre, Malawi: a costing cohort study

BackgroundTyphoid causes preventable death and disease. The World Health Organizationrecommends Typhoid Conjugate Vaccine for endemic countries, but introductiondecisions depend on cost-effectiveness. We estimated household and healthcareeconomic burdens of typhoid in Blantyre, Malawi.MethodsIn a prospective cohort of culture-confirmed typhoid cases at two primary- and areferral-level health facility, we collected direct medical, non-medical costs (2020 U.S. dollars) to healthcare provider, plus indirect costs to households.ResultsFrom July 2019-March 2020, of 109 cases, 63 (58%) were <15 years old, 44 (40%)were inpatients. Mean hospitalization length was 7.7 days (SD 4.1). For inpatients,mean total household and provider costs were $93.85 (95%CI: 68.87-118.84) and$296.52 (95%CI: 225.79-367.25), respectively. For outpatients, these costs were$19.05 (95%CI: 4.38-33.71) and $39.65 (95%CI: 33.93-45.39), respectively.Household costs were due mainly to direct non-medical and indirect costs, medicalcare was free. Catastrophic illness cost, defined as cost >40% of non-food monthlyhousehold expenditure, occurred in 48 (44%) households.ConclusionsTyphoid can be economically catastrophic for families, despite accessible free medicalcare. Typhoid is costly for government healthcare provision. These data make aneconomic case for TCV introduction in Malawi and the region and will be used to derivevaccine cost-effectiveness.

Embolic Cerebral Infarction in Atrial Fibrillation: A Simple Review Article

Stroke is known worldwide as the leading cause of premature death and disability. Developing countries are most exposed to the dual burden of infectious and non-communicable diseases. Poor people are increasingly affected by stroke due to changing risk factors in the population and, most tragically, not being able to afford the high costs of stroke treatment. Despite significant improvements in primary prevention and acute care over the last few decades, stroke remains a catastrophic illness. Unchangeable risk factors for stroke are some established and changeable risk factors for age, gender, race, ethnicity, heredity, and ischemic stroke.

Lung Targeted Lipopolymeric Microspheres of Dexamethasone for the Treatment of ARDS

Acute respiratory distress syndrome (ARDS), a catastrophic illness of multifactorial etiology, involves a rapid upsurge in inflammatory cytokines that leads to hypoxemic respiratory failure. Dexamethasone, a synthetic corticosteroid, mitigates the glucocorticoid-receptor-mediated inflammation and accelerates tissue homeostasis towards disease resolution. To minimize non-target organ side effects arising from frequent and chronic use of dexamethasone, we designed biodegradable, lung-targeted microspheres with sustained release profiles. Dexamethasone-loaded lipopolymeric microspheres of PLGA (Poly Lactic-co-Glycolic Acid) and DPPC (Dipalmitoylphosphatidylcholine) stabilized with vitamin E TPGS (D-α-tocopheryl polyethylene glycol succinate) were prepared by a single emulsion technique that had a mean diameter of 8.83 ± 0.32 μm and were spherical in shape as revealed from electron microscopy imaging. Pharmacokinetic and biodistribution patterns studied in the lungs, liver, and spleen of Wistar rats showed high selectivity and targeting efficiency for the lung tissue (re 13.98). As a proof-of-concept, in vivo efficacy of the microspheres was tested in the lipopolysaccharide-induced ARDS model in rats. Inflammation markers such as IL-1β, IL-6, and TNF-α, quantified in the bronchoalveolar lavage fluid indicated major improvement in rats treated with dexamethasone microspheres by intravenous route. Additionally, the microspheres substantially inhibited the protein infiltration, neutrophil accumulation and lipid peroxidation in the lungs of ARDS bearing rats, suggesting a reduction in oxidative stress. Histopathology showed decreased damage to the pulmonary tissue upon treatment with the dexamethasone-loaded microspheres. The multipronged formulation technology approach can thus serve as a potential treatment modality for reducing lung inflammation in ARDS. An improved therapeutic profile would help to reduce the dose, dosing frequency and, eventually, the toxicity.

Effect of introducing biologics to patients with rheumatoid arthritis on the risk of venous thromboembolism: a nationwide cohort study

In the United States, 100,000–300,000 patients die from venous thromboembolism (VTE) each year, with more than 500,000 people related hospitalizations. While in Europe, 500,000 people die from VTE each year. Patients with rheumatoid arthritis are at increased risk of VTE. The use of biologics in patients with rheumatoid arthritis may be associated with an increased risk of VTE. We identified all patients who had been newly approved for Catastrophic Illness Card of rheumatoid arthritis extracted the claims data from the National Health Insurance research database and Registry for Catastrophic Illness Patient Database from 2003 to 2016. VTE was defined as the presence of inpatient VTE diagnostic codes (including DVT or PE) according to the discharge diagnosis protocol. An analysis of VTE variables indicated that the incidence of VTE in the biologic group (14.33/10,000 person-years) was higher than that in the conventional drug group (12.61/10,000 person-years). As assessed by the Cox proportional hazards model, the relative HR for VTE in the biologic group (HR: 1.11; 95% CI 0.79–1.55) versus that in the conventional drug group did not reach a significant difference. In conclusion, this study found no significant differences in risk were observed between the use of conventional DMARDs and biologics.

Effect of multidisciplinary team care on survival of oesophageal cancer patients: a retrospective nationwide cohort study

Oesophageal cancer is the sixth leading cause of cancer death worldwide. This nationwide study analyses the survival results of oesophageal cancer under multidisciplinary team (MDT) care. We enrolled oesophageal cancer patients diagnosed between 2010 and 2015 with follow-up for at least 1 year. This study performed propensity score matching with a ratio of 1:1 between MDT participants and non-MDT participants. We performed conditional Cox proportional hazards model to research relative risk of survival and associated factors of survival. The adjusted survival curves were plotted. 8184 newly diagnosed oesophageal cancer patients were included. The favourable survival factors include participant status of MDT, gender, monthly salary, urbanization level, other catastrophic illness, stage of cancer, treatment methods, and service volume of physicians (P < 0.05). MDT participants showed lower risk of death (HR = 0.73; 95% CI 0.67–0.79). Further stratification analysis revealed that the incorporation of an MDT reduced the death risk of patients with stages 2, 3, and 4 cancer, with the greatest reduction observed in patients with stage 3 cancer (HR = 0.72; 95% CI 0.67–0.79). The risk of death was lower for oesophageal cancer patients who enrolled in MDT care.

Perceptions of COVID-19 Disease Among Patients in Isolation Ward

Objective: To explore the perceptions about COVID – 19 disease among patients admitted in Isolation ward and to improve management ideas. Methodology: This qualitative cross sectional interview based study was conducted at Isolation ward, Pakistan Institute of Medical Sciences Islamabad from April to June 2020. Patients who were reported positive for SARS COV-2 through nasopharyngeal or oropharyngeal swabs and were admitted for at least one day in isolation ward, were included in the study. Patients who were too ill to talk for the interview and those who could not survive the disease were excluded. After taking informed consent and following the standard operating procedures (SOPs) of Corona Isolation ward; data was obtained by conducting in depth interviews arranged as per patients’ convenience on mobile calls. Data was analyzed using Narrative Analysis. Themes were delineated and organized to groups for understanding. Results: Twenty two patients participated with the mean age of 34.64±7.26 years. Majority of the patients had anxiety and fear for the COVID-19 disease however also were hopeful to face it. The delineated themes were anxiety & depression, fear, hopefulness & moving forward, health facilities & related issues, living in isolation and physiological disturbances like sleep, appetite, smoking or addiction, exercise. Conclusion: Covid-19 patients depict mixed perceptions while admitted in Isolation ward and this provide us an insight to this catastrophic illness. Their experiences help the health authorities to address this issue.

Lack of association between erythropoietin treatment and risk of depression in patients with end-stage kidney disease on maintenance dialysis: a nationwide database study in Taiwan

Background: Patients with end-stage kidney disease (ESKD), have been associated with higher risk of developing depression. Erythropoietin (EPO), frequently used for the treatment of anemia in ESKD patients, has been shown to have neuroprotective and antidepressant effects. In this study, we examined whether EPO treatment changed the risk of depression in ESKD patients. Methods: In a nationwide population-based cohort in Taiwan from 1998 to 2013, patients with a diagnosis of ESKD on maintenance dialysis and aged greater than 18 years were classified into EPO treatment group or non-EPO treatment group. All patients were followed up until the diagnosis of depressive disorder or the end of the study period. Results: In this cohort (13,067 patients in the EPO and 67,258 patients in the non-EPO group), 5569 patients were diagnosed as depressive disorder in the follow-up period. We found the risk of depression in EPO group was not significantly different from that in non-EPO group (adjusted hazard ratio = 0.98, 95% confidence interval 0.92–1.04, p = 0.499) after adjusting for sex, age, certification year of catastrophic illness for ESKD, physical co-morbidities, and use of benzodiazepines. Conclusion: In summary, using the nationwide reimbursement data in Taiwan, we found that EPO treatment in ESKD patients was not associated with their general risk of developing depression.

Continuity of Care Is Associated with Medical Costs and Inpatient Days in Children with Cerebral Palsy

Background: Children with cerebral palsy (CP) place a considerable burden on medical costs and add to an increased number of inpatient days in Taiwan. Continuity of care (COC) has not been investigated in this population thus far. Materials and Methods: We designed a retrospective population-based cohort study using Taiwan’s National Health Insurance Research Database. Patients aged 0 to 18 years with CP catastrophic illness certificates were enrolled. We investigated the association of COC index (COCI) with medical costs and inpatient days. We also investigated the possible clinical characteristics affecting the outcome. Results: Over five years, children with CP with low COCI levels had higher medical costs and more inpatient days than did those with high COCI levels. Younger age at CP diagnosis, more inpatient visits one year before obtaining a catastrophic illness certificate, pneumonia, and nasogastric tube use increased medical expenses and length of hospital stay. Conclusions: Improving COC reduces medical costs and the number of inpatient days in children with CP. Certain characteristics also influence these outcomes.

Financing healthcare in low-income developing countries: A challenge for equity in health

Low-income developing countries remain challenged by the increasing demand for essential healthcare combined with governments’ inability to mobilize and allocate adequate financing to health systems. According to their country specific contexts, they need to improve the equity and efficiency of their health systems, in particular their public sector management, and increase their governmental health spending through enhanced domestic resource mobilization and more efficiency in public spending. They need to sustain external assistance and implement social protection policies that decrease out-of-pocket payments, thereby preventing people with catastrophic illness from becoming impoverished. Economic growth and increased health spending alone are not enough to scale-up healthcare coverage and achieve better health outcomes. These must be combined with accountability of results, transparent management of public funds, and multisectoral efforts with community involvement at implementation level.

The incidence of collagen-associated adverse events in pediatric population with the use of Fluoroquinolones: a nationwide cohort study in Taiwan

Background: To evaluate the safety of using fluoroquinolones (FQs) in pediatric population in Taiwan.Methods: Patients aged 0~18-year-old with FQs prescriptions ≥3 consecutive days during year 2000 to 2013 were selected from the National Health Insurance Research Database, 4-time case number were selected as controls. We evaluated the patient’s outcome after the use of FQs by reviewing a newly diagnosis of the following collagen-associated adverse events by ICD-9-CM codes, covering tendons rupture, retinal detachments, gastrointestinal tract perforation, aortic aneurysm or dissection.Results: Of the enrolled patients (n=167,105), collagen-associated adverse effects developed in 85 cases (0.051%) in 6-month tracking, including 0.051% in the FQs study cohort (17 in 33,421) and 0.051% (68 in 133,684) in the FQs free comparison cohort. The crude HR for collagen-associated adverse events in the FQs group was 0.997 (0.586-1.696; p=0.990). After adjusting for age, sex, catastrophic illness, low-income household, seasons, levels of urbanization, and healthcare, the corrected HR in 6-month tracking with FQs was 1.360 (95% CI; 0.795-2.326; p=0.261).Conclusions: There is no significant difference of collagen-associated adverse effects between FQs group and FQs free group from our data. We propose that FQs for pediatric population in clinical practice may be not so harmful as previous references reported.