Limited English Proficient Patient Visits and Emergency Department Admission Rates for Ambulatory Care Sensitive Conditions in California: a Retrospective Cohort Study

BackgroundLittle is known about the risk of admission for emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) by limited English proficient (LEP) patients.ObjectiveEstimate admission rates from ED for ACSCs comparing LEP and English proficient (EP) patients and examine how these rates vary at hospitals with a high versus low proportion of LEP patients.DesignRetrospective cohort study of California’s 2017 inpatient and ED administrative dataParticipantsCommunity-dwelling individuals ≥ 18 years without a primary diagnosis of pregnancy or childbirth. LEP patients had a principal language other than English.Main MeasuresWe used a series of linear probability models with incremental sets of covariates, including patient demographics, primary diagnosis, and Elixhauser comorbidities, to examine admission rate for visits of LEP versus EP patients. We then added an interaction covariate for high versus low LEP-serving hospital. We estimated models with and without hospital-level random effects.Key ResultsThese analyses included 9,641,689 ED visits; 14.7% were for LEP patients. . Observed rate of admission for all ACSC ED visits was higher for LEP than for EP patients (26.2% vs. 25.2; p value < .001). Adjusted rate of admission was not statistically significant (27.3% [95% CI 25.4–29.3%] vs. 26.2% [95% CI 24.3–28.1%]). For COPD, the difference was significant (36.8% [95% CI 35.0–38.6%] vs. 33.3% [95% CI 31.7–34.9%]). Difference in adjusted admission rate for LEP versus EP visits did not differ in high versus low LEP-serving hospitals.ConclusionsIn adjusted analyses, LEP was not a risk factor for admission for most ACSCs. This finding was observed in both high and low LEP-serving hospitals.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06523-5.KEY WORDS: limited English proficiency, health disparities, ambulatory care sensitive conditions     

Evaluation of Cissampelos pareira. Against Gastric Cancer and Enzymes Associated with Carcinogen Metabolism

Abstract

The current study is an effort to identify the effect of a hydroalcohol (50% ethanol) extract of roots of Cissampelos pareira. (L.) Hirsuta (Menispermaceae) (CPE) in forestomach cancer and on carcinogen metabolizing phase I and phase II enzymes along with antioxidant enzymes. In forestomach, the activities of glutathione S.-transferase (GST), DT-diaphorase (DTD), and superoxide dismutase (SOD) increased significantly and dose-dependently. The protective effect of CPE was studied against benzo(a.)pyrene [B(a.)P]-induced gastric cancer in mice, and the tumor incidence was reduced and the mean number of tumors and the tumor multiplicity were reduced significantly and dose-dependently. The modulatory effect of CPE was also examined on carcinogen metabolizing phase I and phase II enzymes, antioxidant enzymes, glutathione content, lactate dehydrogenase, and lipid peroxidation in liver. Significant increases in the levels of acid-soluble sulfhydryl (–SH) and cytochrome P₄₅₀ contents and in enzyme activities of cytochrome P₄₅₀ reductase, cytochrome b₅ reductase, GST, DTD, SOD, catalase, glutathione (GSH) peroxidase, and GSH reductase but decreased malondialdehyde (MDA) were observed. Butylated hydroxyanisole (BHA) showed an increase in hepatic levels of GSH content, cytochrome b₅, DTD, GST, glutathione reductase (GR), and catalase, whereas MDA formation was inhibited significantly. BHA also showed increased levels of DTD, GST, and SOD significantly in forestomach. The enhanced GSH level and enzyme activities involved in xenobiotic metabolism and maintaining antioxidant status of cells are suggestive of a chemopreventive efficacy of Cissampelos pareira. against chemotoxicity, including carcinogenicity.     

Cricopharyngeal achalasia — a rare cause of dysphagia

Cricopharyngeal achalasia is a rare clinical entity in which upper esophageal sphincter (cricopharyngeus) does not open adequately during swallowing leading to dysphagia. Barium swallow reveals a smooth posterior impression of cricopharyngeus at C6 level. We report cricopharyngeal achalasia in a 68 year male who was managed with dilatation.     

Transient hypoimmunoglobulinemia G

Summary A child with transient hypogammglobulinemia is described. The possible etiological factors are discussed in the light of known causes. From the Department of Pediatrics, All India Institute of Medical Sciences, New Delhi-16.