Annual Endovascular Thrombectomy Case Volume and Thrombectomy-capable Hospitals of Korea in Acute Stroke Care / 예방의학회지

Objectives@#Although it is difficult to define the quality of stroke care, acute ischemic stroke (AIS) patients with moderate-to-severe neurological deficits may benefit from thrombectomy-capable hospitals (TCHs) that have a stroke unit, stroke specialists, and a substantial endovascular thrombectomy (EVT) case volume. @*Methods@#From national audit data collected between 2013 and 2016, potential EVT candidates arriving within 24 hours with a baseline National Institutes of Health Stroke Scale score ≥6 were identified. Hospitals were classified as TCHs (≥15 EVT case/y, stroke unit, and stroke specialists), primary stroke hospitals (PSHs) without EVT (PSHs-without-EVT, 0 case/y), and PSHs-with-EVT. Thirty-day and 1-year case-fatality rates (CFRs) were analyzed using random intercept multilevel logistic regression. @*Results@#Out of 35 004 AIS patients, 7954 (22.7%) EVT candidates were included in this study. The average 30-day CFR was 16.3% in PSHs-without-EVT, 14.8% in PSHs-with-EVT, and 11.0% in TCHs. The average 1-year CFR was 37.5% in PSHs-without-EVT, 31.3% in PSHs-with-EVT, and 26.2% in TCHs. In TCHs, a significant reduction was not found in the 30-day CFR (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.76 to 1.12), but was found in the 1-year CFR (OR, 0.84; 95% CI, 0.73 to 0.96). @*Conclusions@#The 1-year CFR was significantly reduced when EVT candidates were treated at TCHs. TCHs are not defined based solely on the number of EVTs, but also based on the presence of a stroke unit and stroke specialists. This supports the need for TCH certification in Korea and suggests that annual EVT case volume could be used to qualify TCHs.

Thrombocytopenia in children: a clinico-etiological profile in an urban tertiary care hospital

Background: Thrombocytopenia is a common haematological finding that we come across while managing a sick child. Etiological profile and presentation of thrombocytopenia varies among children. The objective of this study was to study the clinical and laboratory profile of children with thrombocytopenia, associated clinical complications and assess the relationship between platelet levels and severity of disease.Methods: The study was carried out in 644 children between 1 month and 12 years, admitted in Paediatric Department of Raja Rajeshwari medical college and hospital, Bangalore between August 2012 to August 2014.Results: The commonest causes of thrombocytopenia in our study were of infectious aetiology (86.6%). Among Infections Viral infections were the major cause in more than 78% of cases. Other causes included haematological problems, drug induced thrombocytopenia and connective tissue disorders. Bleeding manifestations were present in 33.07% of patients and the commonest bleeds were skin and mucous membranes. Bleeding manifestations were seen most commonly in children with a platelet count less than 50000/'l.Conclusions: Viral Infections were the commonest cause for thrombocytopenia in Children. Platelet count was neither predictive of bleeding manifestations nor predictive of need for platelet transfusion.

Performance evaluation of gated volumetric modulated arc therapy

Background: Aim of this study is to evaluate the accuracy of the gated volumetric modulated arc therapy [VMAT/RapidArc] using 2D planar dosimetry, DynaLog files and COMPASS 3D dosimetry system. Materials and Methods: Pre-treatment quality assurance of 10 gated VMAT plans was verified using 2D array and COMPASS 3D dosimetry system. Advantage of COMPASS over 2D planar is that it provides the clinical consequence of error in treatment delivery. Measurements were performed for non-gated and different phase gating window level [80%, 50%, 30% and 20%] to know the impact of gating in VMAT dose delivery. Results: In 2D planar dosimetry, gamma agreement index [GAI] for all measurements were more than 95%. DynaLog file analysis shows the average deviations between actual and expected positions of monitor units, gantry and multi-leaf collimator. The STDVs MU and gantry position were less than 0.10 MU and 0.33[degree sign] respectively. Root mean square [RMS] of the deviations of all leaves were less than 0.58 mm. The results from COMPASS show that 3D dose volume parameters for ten patients measured for different phase gating window level were within the tolerance level of +/-5%. Average 3D gamma of PTV and OAR's for different window level was less than 0.6. Conclusion: The results from this study show that gated VMAT delivery provided dose distributions equivalent to non-gated delivery to within clinically acceptable limits and COMPASS along with Matrix[Evolution] can be effectively used for pretreatment verification of gated VMAT plans

Association between Short Maternal Height and Low Birth Weight: a Hospital-based Study in Japan

Anthropometry measurements, such as height and weight, have recently been used to predict poorer birth outcomes. However, the relationship between maternal height and birth outcomes remains unclear. We examined the effect of shorter maternal height on low birth weight (LBW) among 17,150 pairs of Japanese mothers and newborns. Data for this analysis were collected from newborns who were delivered at a large hospital in Japan. Maternal height was the exposure variable, and LBW and admission to the neonatal intensive care unit were the outcome variables. Logistic regression models were used to estimate the associations. The shortest maternal height quartile (131.0-151.9 cm) was related to LBW (OR 1.91 [95% CI 1.64, 2.22]). The groups with the second (152.0-157.9 cm) and the third shortest maternal height quartiles (158.0-160.9 cm) were also related to LBW. A P trend with one quartile change also showed a significant relationship. The relationship between maternal height and NICU admission disappeared when the statistical model was adjusted for LBW. A newborn's small size was one factor in the relationship between shorter maternal height and NICU admission. In developed countries, shorter mothers provide a useful prenatal target to anticipate and plan for LBW newborns and NICU admission.

Horizontal Inequity in Elderly Health Care Utilization: Evidence from India

Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly.

Socioeconomic status and obesity in Cairo, Egypt: a heavy burden for all

Studies have generally shown a positive association between socioeconomic status [SES] and obesity in low-income countries, but few have tested this relationship in the Middle East where obesity prevalence is extraordinarily high and the nutrition profile more closely resembles developed world contexts. The objective of this study is to examine the SES-obesity association in Cairo, Egypt. Multinomial regression analyses were conducted and predicted probabilities were found for overweight and obesity status among adult men and women in a stratified analysis. Data were taken from the 2007 Cairo Urban Inequity Study which collected information on 3993 individuals from 50 neighborhoods in the Cairo Governorate. Five different measures of SES were utilized - education, household expenditures, household assets, subjective wealth, and father's education. No significant associations were found between most measures of SES and overweight/obesity in this population. Overweight and obesity are prevalent across the SES spectrum. These findings suggest that obesity programs and policies should be targeted at all SES groups in Cairo, although specific mechanisms may vary by SES and should be explored further in future studies