Association of Multimorbidity with Health Outcomes in the Chinese Middle-aged and Elderly Population / 中山大学学报(医学科学版)

ObjectiveTo analyze the multimorbidity and comorbid disease patterns among middle-aged and older adults aged 50 years and above in China and to study the prevalence， regional distribution， and relationship with health-related outcomes of major comorbid disease patterns. MethodsThe fourth national follow-up data of the China Health and Retirement Longitudinal Study （CHARLS） 2018 was used， including 13 774 respondents aged 50 years and older from 28 provincial units. We analyzed 14 patient-reported physician-diagnosed chronic diseases and multimorbidity combinations， reported prevalence， composition ratio， and regional distribution. Differences in health loss and risk factors between high morbidity groups were analyzed using chi-square tests and logistic regression. ResultsThe prevalence of multimorbidities among participants was 57.3%. The single disease with high prevalence included arthritis/rheumatism （6.47%）， hypertension （5.41%）， and gastric and digestive disorders （4.17%）； the binary multimorbidity combinations were arthritis + digestive disorders （3.06%）， arthritis + hypertension （2.61%）， and hypertension + hyperlipidemia （1.39%）； the triadic combinations were hypertension + digestive disorders + joint disorders （1.00%）. The prevalence of multimorbidity varied greatly between provinces， showing the characteristics of high in the west and north but low in the east and south China. Significant differences in the health loss caused by different multimorbidity combinations were noted， with the highest ADL loss （28.51%） and depression （77.68%） caused by the arthritis multimorbidity combinations （P<0.01）. The number of chronic diseases （OR=6.71， P<0.01）， age （OR=1.96， P<0.01）， and heavy alcohol consumption were comorbid risk factors for physical and mental health； exercise （OR=0.44， P<0.01） and sleep （OR=0.89， P<0.01） were protective factors for physical and mental health， and smoking cessation （OR=0.76， P<0.01） contributed to the relief of anxiety. ConclusionsThe prevalence of comorbid patterns showed a high clustering trend， and the health loss caused by major patterns varied greatly. Relevant health intervention strategies should prioritize the major multimorbidity combinations for targeted disease management and rehabilitation services.

COVID-19 Pandemic as a mass killer and existential public health emergency in Nigeria remains unproven: A viewpoint

Framing COVID­19 pandemic as mass killer and existential public health emergency/threat in Nigeria with 2,120 COVID­19­related deaths in over 14 months of the pandemic in the country is problematic, especially as other public health conditions kill more Nigerians annually. In 2018, for example, malaria and road traffic accident caused 97,200 and 38,902 deaths, respectively, while HIV/AIDS caused 43,000 deaths in 2019. Therefore, rushing into an extensive vaccination campaign projected to cost 540 billion naira when 76.03 billion naira was allocated for primary health services nationwide including other major immunization programs in the 2021 federal health budget could raise question of priority/effective spending. Especially with COVID-19 deaths relative to reported cases(case fatality ratio) declining to 1.30% by June 30, 2021 from 3.45% in April 2020 and daily mass deaths non-evident. Temporizing to understand how the pandemic evolves especially in jurisdictions with higher need could be cost­effective.

Clinical evaluation of bacterial colonization of bronchiectasis

Background: Bronchiectasis is a chronic pulmonary disease characterized by abnormal irreversible dilatation of one or more bronchi often with wall thickening. In Bronchiectasis initial colonization of the lower respiratory tract by different microorganisms as the first step leading to the inflammatory response. Persistence of microorganisms in the airways because of impairment in mucus clearance may lead to a vicious circle of events characterized by chronic bacterial colonization, persistent inflammatory reaction and progressive tissue damage and morbidity life. Aim of the study: To evaluate the Bronchial inflammatory response and its relationship to bacterial colonization in Bronchiectasis. Materials and methods: This study was done for a period of 7 months from February 2016 to August 2016 in Department of Thoracic Medicine, Government Villupuram Medical College and Hospital, Villupuram. The Bacterial flora from Lower Respiratory tract of Bronchiectasis patients who attended the Thoracic medicine outpatient department with diagnosis confirmed by a radiologist were studied. Bronchoalveolar lavage was done as an invasive procedure in 90 patients with bronchiectasis and from 6 patients admitted with chronic upper respiratory symptoms as laboratory control in Interleukin-8 estimation. Results: Among 90 study population, analysis showed females were 58% and males were 42%. Cylindrical bronchiectasis 53%, followed by cystic bronchiectasis 36% in predominance: and positive culture growth rate for sputum samples were 68% and BAL samples were 77%. The microorganisms isolated predominantly were H. influenza, Pseudomonas, Streptococci, Staphylococci, and etc. R. Nedunchezhian, A. Sundrarajaperumal, D. Ranganathan, V. Sundar. Clinical evaluation of bacterial colonization of bronchiectasis. IAIM, 2019; 6(6): 92-99. Page 93 Conclusion: Increased incidence of bronchiectasis in females (58%). Cylindrical bronchiectasis was the commonest type followed by Cystic bronchiectasis regarding etiology of Bronchiectasis, 42% of bronchiectasis was Idiopathic followed by post infectious 21%. With the concordant value of 75% for sputum culture and bronchoalveolar lavage fluid culture, the Sputum culture is the non-invasive, alternative technique for bronchoalveolar lavage fluid culture

Study of Serum Metabonomics and Formula-Pattern Correspondence in Coronary Heart Disease Patients Diagnosed as Phlegm or Blood Stasis Pattern Based on Ultra Performance Liquid Chromatography Mass Spectrometry / 中国结合医学杂志

<p><b>OBJECTIVES</b>To study the characteristics of serum metabonomics in coronary heart disease (CHD) patients diagnosed as phlegm or blood stasis pattern and explore effects of formula-pattern correspondence treatment.</p><p><b>METHODS</b>A total of 102 stable CHD patients were enrolled and divided into phlegm group (P group, n=52) and blood stasis group (BS group, n=50) according to pattern identifification. Gualou Xiebai Banxia Decoction (, GXBD) and Xuefu Zhuyu Decoction (, XZD) were used as drug interventions. Relevant indicators of metabonomics were observed by ultra performance liquid chromatography mass spectrometry (UPLC-MS) and pattern recognition.</p><p><b>RESULTS</b>Levels of amino acids and phosphatidylethanolamine (PE) in the CHD group were much higher than those in healthy control group, while the levels of unsaturated fatty acids, sphingosine, Lyso, phosphatidylcholine (PC) were signifificantly lower (P<0.01). Most of the differential metabolites between the CHD and the healthy groups were also common metabolites of phlegm and blood stasis. 7(Z), 10(Z)-hexadecadienoic acid and DPA were decreased in the P group and increased in the BS group. According to the quantity of retraced metabolites, improvement in metabonomics by formula-pattern correspondence was superior to that without correspondence in the BS group. Based on the varieties of metabolites, GXBD could improve the levels of docosapentaenoic acid (DPA), sphingomyelin (SM) (d34:1), and L-Lactic acid and XZD could ameliorate the levels of sphingosine and Vit E in the P group. In the BS group, GXBD could improve vitamin E level and XZD could make improvements in the levels of octadecanoic acid, phosphoglycerol, and SM (d34:1).</p><p><b>CONCLUSIONS</b>Phlegm and blood stasis in CHD patients present specifific differential metabolites, and share common metabolites. Remarkable differences have been displayed in pathological properties and severity of phlegm and blood stasis. Patients with phlegm are more likely to have lipid metabolism disorders. However, in patients with blood stasis, problems mainly lie in glucose, protein and fat metabolism and the injury of vascular cell membrane is relatively severe. The metabolic disorder is more complicated in blood stasis pattern than that in phlegm pattern. Compared with non-correspondence, improvement of differential metabolites is more comprehensive and targeted in formulapattern correspondence with a better effect.</p>

Pattern of Dermatological Cases Attending Skin-VD Outpatient Department in a Medical College Hospital of Bangladesh.

Background: The pattern of skin diseases varies from one country to another and even from region to region of the same country. We are geographically placed in the tropical region with natural outcome of communicable diseases. We conducted this cross sectional study in a tertiary hospital of Bangladesh keeping the proposition in mind that infectious diseases occupy maximum percentage among skin and venereal diseases in outpatients in Bangladesh. Objectives: To classify the diseases attending the Skin & VD outpatient department of Enam Medical College Hospital (EMCH) and to draw comments and recommendations on the basis of findings. Materials and Methods: All patients irrespective of age and sex attending the OPD of Skin-VD Department of Enam Medical College Hospital during a 2-year time-period (from January 2009 to December 2010) were included in the study. Structured questionnaire, check-list and face-to-face interview (whenever necessary) were used as tools of data collection. Statistical analyses were done by SPSS version Windows 11.1. Results: Total number of patients was 12100. Most of the patients were aged (>18 years; 64.28%), dominated by male (61.63%), married (56.1%), literate (71.11%), coming from far (>5 km; 63.5%) and of middle class origin (59.73%). Out of the total cases, maximum (23.42%) were diagnosed as eczema, followed by infectious diseases (17%), acne (8.69%) and psoriasis (6.36%). Conclusion: In this study we found infectious diseases to occupy the second position next to eczema and our findings nullify the proposition that infectious diseases occupy maximum percentage among skin and venereal diseases in outpatients in Bangladesh.

Disease Pattern and Health Seeking Behavior in Rural Bangladesh.

Knowledge about the existing disease pattern and health seeking behavior is essential to provide need based health care delivery to any population and to make the health care system more pro-poor. A community based cross sectional study was conducted among 493 systematically selected households in the Modhukhali Upazilla of Faridpur District to determine the prevailing disease pattern and health seeking behavior in rural Bangladesh. Data were collected through face-to-face interview of the selected respondents. More than half of the respondents gave history of illness of her or her family members during the preceding 15 days. Fever (33.2%), gastrointestinal diseases (24.9%) and respiratory diseases (17.8%) were the most reported complaints. Overall, there were no discernible differences in the likelihood of seeking traditional or any kind of care considering socio-demographic variables and prevailing disease types. Occupation of household head as day labor or in agriculture and suffering from gastrointestinal diseases positively predicted use of para-professionals. Use of un-qualified allopths was negatively predicted by the male gender or literacy of the household head and presence of gastrointestinal, respiratory and other types of diseases and positively predicted by occupation of the household head in agricultural field or as day labor. Use of qualified allopaths was positively predicted by respiratory, skin/eye/ENT and other types of diseases and also by standard of living and relationship of the respondents with household head and negatively predicted by agricultural or day labor work of the household head. Existence of several distinct therapeutic systems in a single cultural setting was found to be an important feature of health care system in the study area. This study concluded that it is important to develop a need based health care delivery system and actions should be taken to improve the overall scenario of health system of rural Bangladesh.

Carcinoma of stomach detected by routine transabdominal ultrasound

Assessment of the stomach is not commonly included in routine scanning protocol of upper abdominal ultrasound (USG). However, assessment of the stomach in patients presenting with epigastric pain can yield invaluable results. This paper presents, as an illustration, a case of carcinoma of stomach detected by transabdominal ultrasound. The diagnosis is confirmed by subsequent CT, upper endoscopy and operation.

An Overview of Renal Diseases in Children in Pokhara.

Objective: To determine the current pattern and prevalence of renal diseases in childhood in this region of Nepal. Material and Methods: A retrospective study of the renal diseases in children attending the Pediatric OPD and those hospitalised in Manipal Teaching Hospital, Pokhara was done over a period of 6 years (September 2000- September 2006). A detailed clinical and laboratory evaluation was performed at baseline. The children were managed according to disease diagnosed. These cases are under follow up and some have undergone surgical treatment. Results: 228 children (123 boys & 105girls) were diagnosed to have renal disease. Among them 39.5% had urinary tract infection (UTI), 30.7 % were suffering from acute glomerulonephritis (AGN), 17.5% were cases of nephrotic syndrome (NS) and 12 % had some other problems for example, 6.14% had genetic defects, 2.63% had renal Stone, 2.2% had pre-renal acute renal failure, unexplained recurrent hematuria in 1.3%. All the cases of UTI underwent through investigation and were treated accordingly. All cases of AGN are planned for follow up for 1½ yrs and among them 3 required biopsy till date. All cases of NS are under regular follow-ups and 2 have undergone biopsy. Renal stone was operated successfully. All cases of acute and chronic renal failures had required dialysis. Out of 5 (2.5%) chronic renal failures, 2 with end stage renal disease expired after repeated hemodialysis and three are still requiring dialysis. Among the obstructive uropathies, 43 % had renal stone, 36 % had posterior urethral valve and 21% VUR. Conclusion: It can be concluded that renal disease is not uncommon in children. It can be completely cured with proper and adequate treatment. Sometimes it has a bad prognosis when it reaches end stage renal disease. Early recognition, timely treatment and regular follow up are mandatory in management of children with renal diseases.

Diseases and Health Service Utilization Patterns of Geriatric Inpatients

BACKGROUND: Recently elderly people have increased in Korea and increased demands of medical service. This study was carried out to identify diseases and health service utilization patterns of geriatric inpatients to provide better understanding and basis planning to meet the needs of expanding geriatric population. METHOD: We use data of `Patient Survey in Korea` in 1999 and analyzed characteristics of disease structure and utilization patterns of health care service of 54,013 cases of discharged patients aged 65 years or more. RESULT: The proportion of the elderly in total discharged patients is 14.7%. Male to female ratio is 1:1.3 and most common age group was between 65 and 69 years old. 84.2% of elderly patients were admitted at secondary or tertiary health care facilities. The most common disease in geriatric inpatients is malig- nancy in male and vascular disease in female. The average duration of hospitalization is 14.2 days. They stay longer than the nation wide average hospital length and stay longest when they are admitted by mental and behavioral disorders. CONCLUSION: Geriatric patients are admitted mostly with chronic degenerative diseases such as neoplasm and vascular disease. Elders prefer to be admitted to tertiary hospitals and oriental hospitals. They stay more in hospital.

Observation of Social Background and Disease Patterns of Children in an Institute for Adoption(the 3rd report)

OBJECTIVE: A Study was undertaken to assess the family background of abandonment and clinical and social aspects in an institute for foreign adoption. The results were compared to the previous two reports from the institute. METHOD: A sample of 1,728 children from 1987 to 1992 formed the subjects of the study by the medical records in the institution. RESULTS: 1) The unmber of girls were more than that of male and ratio of male to female was 1:1.1, which was reduced compared to previous study. 2) The distribution less than one month of age was most commonly and increased compared to previous study. 3) The Place at birth was hospital most commonly. 4) The type of delivery was full-term one(61.5%) and tend to be increased. 5) Age distribution of monthers was from 16 years to 25 years mainly, 1,081 of them(62.5%) were from unmarried one and 409(37.4%) were from married one. 6) By classifying the cause of adoption, unmarried mothers occupied main one(62.5%), poverty(13.4%) extramarital relations(5.2%), divorce(2.9%) and death of parents in the order of frequency, tend to increased in unmarried mothers. 7) Disease pattern showed respiratory disease, jaundice, acute gastroenteritis, pneumonia, urinary tract infection, conjunctivitis in order of frequency. By care of foster mother at private home since 1988, the incidence of the transmissible disease was reduced. 8) Congenital anomalies were cleft and palate, hydrocele, umbilical hernia and congenital heart disease in order frequency. 9) Three hundred and eighty two babies were admitted to general hospital. The main disease were bhaline membrane disease. Jaundice, pneumonia and urinary tract disease, sepsis in the order of frequency. CONCLUSIONS: The ratio of male to female in the institution showed no definite difference and the age was tend to be younger. The cause of adoption was unmarried mother mainly. Respiratory disease in the institution and hyaline membrane disease in the hospitalized was most common.

Observation of Social Back Ground and Disease Patterns of Children in an Institute for Foreign Adoption

A study was made to see the family back ground abandonment of mother's right, clinical and laboratory examination(urinalysis, blood examination, tuberculous skin test, VDRL, PKU screening test and chest X-ray) on 1,793 infants and children in an institure for foreign adoption. The results were as follows: 1) Gilrs were much more predominant than boys with male to female ratio of 1 : 2.3. 2) Most of them were Korean and only ten were mixed blood, Five were Korean-white, five were Korean-negro. 3) Most of them were under one year of age(70%). 4) Mid-wife delivery was the most common birth place among known ones. 5) Most of deliveries were normal full term delivery(46.9%). 6) There was no difference in monthly distribution. Duration of admission was 2~3 months usually. 7) concerning the family background, most of them were unknown, 432 of them(24.8%) were from unmarried mother, 397 from married mother, and founding, parents dead or left home, divorced and unmarried father in order of decreasing frequency. 8) Age of mothers, between 21~25 years was most frequent. Most of unmarried mothers were between 20~22 years of age. 9) In order of birth, most of them were between 3~5th children. 10) Disease pattern; Upper respiratory tract disease was the most common, and diarrhea was the next. Skin and mucous membrane disease were frequently seen. There were 12 cases of tuberculosis and 18 cases of congenital syphilis. There developed 15 cases of pneumocystis carinii pneumonia. 11) On routine laboratory examination, there noted 85 cases of positive TB sin test, 18 cases of positive VDRL reaction. No positive case in PKU screening test.