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Objective To discern the demographic predictors in bipolar disorder (BD) manic patients receiving combination regimen, that is, lithium and antipsychotic, and to study the impact of a combination regimen on hospitalization length of stay (LOS) and total charges. Methods We used the nationwide inpatient sample (NIS) and included 1,435 adult inpatients with BD, manic episodes, and receiving lithium. Independent sample T-test with equality measures was used for LOS and total charges. Logistic regression model was used to find the odds ratio (OR) for the combination regimen to estimate the predictors with 95% CI. Results Among the inpatient sample, 34.5% received a combination regimen. There was statistically no significant difference between the combination regimen versus non-combination regimen cohorts by age and sex. A higher proportion of inpatients receiving combination regimen were from high-income families above 75th percentile (56.4%) and covered by private insurance (47.5%). Blacks (OR 2.00, 95% CI 1.43-2.82) and hispanic (OR 2.31, 95% CI 1.49-3.57) had higher odds of receiving a combination regimen compared to whites. The combination regimen significantly reduced LOS for BD, manic episode management by 2.8 days (95% CI 1.13-4.53 days, P < 0.001). There was statistically no significant mean difference in total charges (P = 0.495). Conclusion A combination regimen with lithium and antipsychotics significantly reduced LOS for BD manic episodes by 2.8 days compared to inpatients receiving lithium monotherapy. So, starting the combination regimen from the initial day of hospitalization should be considered as an effective model for faster response.
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Objectives We conducted a cross-sectional study to identify the demographic predictors of traumatic brain injury (TBI), and the risk of association of psychiatric comorbidities including alcohol use disorder (AUD) and TBI-related hospitalizations in the children and adolescent population. Methods We included 3,825,523 children and adolescent inpatients (age 8-18 years) using the nationwide inpatient sample (NIS) database (2010-2014), and 61,948 inpatients had a primary diagnosis of TBI. These inpatients were grouped by comorbid AUD (N = 2,644). Multivariable logistic regression model adjusted for demographics, and psychiatric comorbidities including other substance use disorders (SUDs) was used to evaluate the odds ratio (OR) of AUD as a risk factor for TBI-related hospitalization. Results The majority of the TBI inpatients were adolescents (12-18 years, 82.2%), males (71.2%), and whites (59.2%). Males had three times higher odds (95% CI 3.14-3.26) for TBI-related hospitalization compared to females. Among psychiatric comorbidities, mood (4.1%) and anxiety (2.2%) disorders were prevalent in TBI inpatients, and were not associated with increased odds for TBI-related hospitalization. Among SUD, alcohol and tobacco use (4.4% each), and cannabis use (3.5%) were prevalent, and among all substances, AUD was associated with higher odds (OR 3.5, 95% CI 3.35-3.67) of TBI-related hospitalization. These patients with TBI and comorbid AUD also had higher odds for abusing stimulants (OR 5.11, 95% CI 3.85-6.77), cannabis (OR 4.69, 95% CI 4.12-5.34), and tobacco (OR 3.77, 95% CI 3.34-4.27). Conclusion AUD is an independent risk factor for TBI-related hospitalization with an increased risk of 50% in the children and adolescent population compared to non-alcohol users. TBI inpatients with AUD are prevalent in white, and male adolescents. These at-risk populations are also at higher risk of comorbid mood disorders and increased substance use including stimulants, cannabis, and tobacco.
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BACKGROUND: Hormone receptor expression has been reported to be low in breast cancer patients from developing countries. The pattern of receptor expression from urban and rural areas is not well studied. MATERIALS AND METHODS: This is a retrospective analysis of 206 consecutive breast cancer patients presenting to a semi urban cancer centre from 2009-2010. The demographic and clinical variables included age, residential area (rural, semi urban, or urban), menopausal status, and clinical stage. The pathological variables included tumor type, the presence of ductal carcinoma in situ, lymphovascular invasion, and expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) receptors by immunohistochemical (IHC) analysis. RESULTS: The majority of patients were postmenopausal with the median age of 50 years. Invasive ductal carcinoma was the most common subtype (94%). The ER status was available in 101 (49.3%), PR in 99 (48.0%), and HER2 in 82 (39.8%) cases. In patients in whom this data were available, ER was positive in 44.6%, PR in 40.4%, and HER2 in 34.2%. Out of the 82 patients in whom data on all three receptors were available, 34.1% patients had triple negative tumors. Analysis of our data showed a trend toward increasing ER and PR expression with age but this was not statistically significant. The average age of menopause was between 40-50 years of age. CONCLUSION: This report is an important documentation of the pathological characteristics in a predominantly rural/semi urban population of Indian breast cancer patients. Further studies from other centers with a similar background are required to confirm these results.
