Efficacy of misoprostol (twice daily dosage) in acute healing of duodenal ulcer

This study was undertaken to evaluate the efficacy of misoprostol taken twice daily for the healing of duodenal ulcer. Three hundred thirty patients with endoscopically proven duodenal ulcer participated in a multicenter, double-blind, controlled trial comparing placebo with misoprostol 200 μg and 400 μg twice daily for up to four weeks. Patient characteristics were similar in all three treatment groups. Ulcers were between 0.3 cm and 2.0 cm in length. Healing was determined by endoscopy at two weeks; if ulcers were not healed, endoscopy was repeated at four weeks. All patients were given Al(OH)₃ antacid (up to 54 meq a day) to be used as needed for pain. Healing rates at four weeks for a total of 280 evaluable patients in the three treatment groups were as follows: misoprostol 400 μg bid, 65.4%; misoprostol 200 μg bid, 52.9%; and placebo, 42.2%. Misoprostol 400 μg bid was superior to placebo (P=0.002) in healing ulcers. However, the healing rate for misoprostol 200 μg bid did not differ significantly from placebo. The percentage of nonsmokers who healed at four weeks was higher than that of smokers in both misoprostoltreatment groups, although the difference was not analyzed for statistical significance. There were no differences in antacid consumption or pain relief among the three experimental groups during the study. Diarrhea was the most common side effect but was mild and self-limiting, occurring in 8.9%, 5.9%, and 1.8% of the misoprostol 400 μg, 200 μg, and placebo groups, respectively. These results indicate that misoprostol 400 μg, 200 μg, and for four weeks is effective and safe for the treatment of duodenal ulcers.     

Relationships of the dexamethasone suppression test to clinical severity and degree of melancholia

Investigators continue to debate whether the Dexamethasone Suppression Test (DST) reflects clinical severity or degree of melancholia ("endogeneity"). To evaluate this question, we studied 73 drug-free inpatients diagnosed with Schedule for Affective Disorders and Schizophrenia/Research Diagnostic Criteria (SADS/RDC) as having major depressive disorder (MDD). We compared absolute and dichotomous DST values (DST suppression versus nonsuppression) with absolute and dichotomous measures of endogeneity (as measured by operationally defined RDC items) and with Hamilton Rating Scale for Depression (HRSD) scores that were collected immediately prior to treatment. We found that degree of endogeneity correlated moderately (r = 0.27) but significantly (p = 0.02) with absolute DST values; DST nonsuppression increased proportionately with changes in categorical endogenous subtype (0% of the nonendogenous patients were nonsuppressives, 52% of probable endogenous, and 61% of subjects definitely endogenous); mean values for maximum DST concentrations increased steadily with categorical endogeneity (nonendogenous, 1.44 microgram/dl; probable endogenous, 7.65 micrograms/dl; definite, 10.93 micrograms/dl; p = 0.01); HRSD scores correlated more strongly (r = 0.45, p = 0.000) with maximum DST levels than did the degree of endogeneity. Age and weight changes did not account for the relationship of endogeneity to DST values. These data suggest that maximum postdexamethasone plasma cortisol levels reflect overall severity of depression and endogeneity and that endogeneity per se is highly confounded with severity.     

Family planning increase in some African countries

Governments in sub-Saharan Africa, recognizing the economic and health benefits of slower population growth, have begun to adopt explicit policies aimed at reducing growth rates. More countries also are providing support to family planning programs. In 1985, more than 70% of the 402 million people living in sub-Saharan Africa lived in countries which have government-supported family planning programs. Yet, the coverage of many of these programs has been and remains limited. Reflecting low demand as well as problems in supplying contraceptive services, results from national-level surveys conducted in 10 countries between 1977-82 as part of the World Fertility Survey (WFS) program showed that approximately 5% of the currently married women aged 15-49 in these countries were using contraceptive methods. More encouraging are the results of surveys conducted in Botswana, Kenya, and Zimbabwe in 1984 as part of the international Contraceptive Prevalence Survey (CPS) program which demonstrate that family planning programs in Africa can be very successful. The CPS data show that substantial proportions of currently married women aged 15-49 in all 3 countries are currently practicing family planning. The level of current use of contraception reported in the CPSs in Botswana, Kenya, and Zimbabwe lay to rest the myth that women in sub-Saharan Africa are unwilling to use family planning. The majority of current users in all 3 countries use modern contraceptive methods. Most nonusers in the 3 countries know at least 1 family planning method. Male approval of family planning also seems to be common, although men are reported to be somewhat more likely than their wives to disapprove of family planning. Despite the fact that there is relatively widespread adoption of modern contraceptive method in Zimbabwe and Botswana as well as an increasing reliance on family planning methods in Kenya, the CPS results show that women in these 3 countries continue to have and want large families. The mean number of children ever born to women aged 45-49 ranges from 6.8 children in Botswana to 8.2 children in Kenya. Interest in planning their families is widespread among women in the 3 countries despite the high fertility expectations.     

Pulmonary tuberculosis among contacts of patients with tuberculosis in an urban Indian population.

The study was conducted among 1810 contacts of 50 index "cases"/"suspects" of pulmonary tuberculosis including 312 household and 1498 neighbourhood contacts in the Jhansi city of Uttar Pradesh. The overall prevalence of radiologically active and bacteriologically confirmed tuberculosis was 2.9% and 1.1%. The prevalence rates of radiologically active and bacteriologically confirmed disease, although comparatively high in both the contact groups, were significantly higher in household (5.4% and 2.6%) than in neighbourhood contacts (2.3% and 0.8%). Significant differences in distribution of secondary cases among clusters were observed. Although higher prevalence rates were found in contacts of sputum positive source than in contacts of sputum negative source in both the contact groups, the statistical difference was observed to be insignificant. Case yield among contact symptomatics was 80.0% (30.8% cases and 49.2% suspects).     

Ephemeral pseudonym based de-identification system to reduce impact of inference attacks in healthcare information system

Health Services and Outcomes Research Methodology - As healthcare data is extremely sensitive, it poses a risk of invading individuals' privacy if stored or exported without proper security...     

Morbidity and Mortality Associated with Typhoid Fever Among Hospitalized Patients in Hyderabad District,Pakistan, 2017-2018: Retrospective Record Review

BackgroundHyderabad, Pakistan, was the first city to witness an outbreak of extensively drug resistant (XDR) typhoid fever. The outbreak strain is resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin, thus greatly limiting treatment options. However, despite over 5000 documented cases, information on mortality and morbidity has been limited.ObjectiveTo address the existing knowledge gap, this study aimed to assess the morbidity and mortality associated with XDR and non-XDR Salmonella serovar Typhi infections in Pakistan.MethodsWe reviewed the medical records of culture-confirmed typhoid cases in 5 hospitals in Hyderabad from October 1, 2016, to September 30, 2018. We recorded data on age, gender, onset of fever, physical examination, serological and microbiological test results, treatment before and during hospitalization, duration of hospitalization, complications, and deaths.ResultsA total of 1452 culture-confirmed typhoid cases, including 947 (66%) XDR typhoid cases and 505 (34%) non-XDR typhoid cases, were identified. Overall, ≥1 complications were reported in 360 (38%) patients with XDR typhoid and 89 (18%) patients with non-XDR typhoid (P<.001). Ileal perforation was the most commonly reported complication in both patients with XDR typhoid (n=210, 23%) and patients with non-XDR typhoid (n=71, 14%) (P<.001). Overall, mortality was documented among 17 (1.8%) patients with XDR S Typhi infections and 3 (0.6%) patients with non-XDR S Typhi infections (P=.06).ConclusionsAs this first XDR typhoid outbreak continues to spread, the increased duration of illness before hospitalization and increased rate of complications have important implications for clinical care and medical costs and heighten the importance of prevention and control measures.     

Shifting US Patterns of COVID-19 Mortality by Race and Ethnicity From June–December 2020

ObjectivesThe COVID-19 pandemic has disproportionately affected racial and ethnic minorities in the United States and has been devastating for residents of nursing homes (NHs). However, evidence on racial and ethnic disparities in COVID-19–related mortality rates within NHs and how that has changed over time has been limited. This study examines the impact of a high proportion of minority residents in NHs on COVID-19–related mortality rates over a 30-week period.DesignLongitudinal study.Setting and ParticipantsCenters for Medicare & Medicaid Services Nursing Home COVID-19 Public Use File data from 50 states from June 1, 2020, to December 27, 2020.MethodsWe linked data from 11,718 NHs to (1) Nursing Home Compare data, (2) the Long-Term Care: Facts on Care in the U.S., and (3) US county-level data on COVID cases and deaths. Our primary independent variable was proportion of minority residents (blacks and Hispanics) in NHs and its association with mortality rate over time.ResultsDuring the first 6 weeks from June 1, 2020, NHs with a higher proportion of black residents reported more COVID-19 deaths per 1000 followed by NHs with a higher proportion of Hispanic residents. Between 7 and 12 weeks, NHs with a higher proportion of Hispanic residents reported more deaths per 1000, followed by NHs with a higher proportion of black residents. However, after 23 weeks (mid-November 2020), NHs serving a higher proportion of white residents reported more deaths per 1000 than NHs serving a high proportion of black and Hispanic residents.Conclusions and ImplicationsThe disparities in COVID-19–related mortality for nursing homes serving minority residents is evident for the first 12 weeks of our study period. Policy interventions and the equitable distribution of vaccine are required to mitigate the impact of systemic racial injustice on health outcomes of people of color residing in NHs.     

Community Based Assessment of Unintentional Injuries in a Community Development Block of Purba Bardhaman District,West

BackgroundInjuries are a focus of public health practice because they pose a serious health threat and are preventable. Currently, injury accounts for 14% of all Disability Adjusted Life Years (DALYs) losses for the world''s entire population. In India, unintentional injuries within the home environment have not so far been recognized to the same extent as traffic and work-related injuries among all age groups. With this background, a community based epidemiological study was conducted with the aim to find out the prevalence and epidemiology of unintentional injuries.MethodsA cross-sectional study was conducted during July 2018 - June 2019 in Bhatar block of Purba Bardhaman District. Cluster random sampling was applied to select required sample of 555 individuals from 24 villages. The study tools used were a predesigned and pretested schedule developed by the researchers with the help of Guidelines for conducting community surveys on injuries by World Health Organization (WHO) and a checklist for assessing household level injury hazard. The study had approval from Institutional Ethics Committee. Chi square test and multivariable logistic regression were performed using SPSS V16.ResultsPrevalence of unintentional injury was 8.8 % in the preceding three months. Multivariable logistic regression revealed that those who were below 18 years of age, severely vulnerable to unintentional injuries and belonged to nuclear families had significantly higher odds of developing unintentional injuries at home.ConclusionUnintentional injury is prevalent in West Bengal. Dissemination of injury prevention information with special focus on household modification is an effective strategy to prevent unintentional injuries.     

Clinicopathological patterns of bladder carcinoma over 1 year: experience from University Hospital of Nepal

Purpose

To define the clinical and pathological patterns of urinary bladder carcinoma from the University Hospital of Nepal.

Methods

This is a retrospective analytical study. Patients with bladder mass who underwent surgery over 1 year and who had data record were included in the study. Demographic profile, type of surgery, findings on clinical examination, cystoscopy findings, histopathological report, tumor stage, and post-surgery adjuvant therapy were analyzed.

Results

Out of 86 patients who underwent transurethral resection of bladder tumor, 77 patients had biopsy-proven malignant bladder tumor. Urothelial cancer was present in 96.1%. Male were 78.6%. The mean age of diagnosis was 65.5?±?11.8 years. Non-muscle-invasive bladder cancer (NMIBC) was 3.7 times more common than muscle-invasive bladder cancer (MIBC). High-grade tumors (58.6%) were more common than low grade (41.4%). The detrusor muscle was present inthe biopsy specimen of 48 patients (64%). Re-TURBT within 2–6 weeks was considered based on histopathology reports for about half of the patients (45.3%). Upstaging and upgrading of the tumor was present in 5.8 and 5.8% of the patients, respectively. Residual tumor without upstaging and upgrading was present in 23.5%. One patient (1.3%) had Clavien–Dindo grade 1, three (4%) patients had grade 2 and two patients (2.7%) had grade 3b.

Conclusion

In the present study, patients with bladder cancer are younger than reported in other studies. Smokers are strongly predisposed. The histological pattern is similar to the Western and Asian populations. NMIBC and MIBC occur in proportion to that described as in other studies. We had a lower rate of recurrence, upstaging and upgrading. We had a lesser rate of acceptance for radical cystectomy in our patients.