Search

Objective: To determine the pattern of drug use, adverse events (AEs), and quality of life (QOL) in hypopigmentary disorders of the skin. Methods: A prospective, observational study was conducted on 48 newly diagnosed and untreated participants with hypopigmentary disorders who attended the dermatology outpatient department (OPD) of a tertiary care hospital in Bangalore, India. The pattern of drug therapy and AEs to the therapy were analyzed using descriptive statistics. The dermatology life quality index (DLQI) score for QOL was assessed before and after treatment using analysis of variance (ANOVA). The participants were monitored every 30 d for three months to study the appropriateness and changes in prescription patterns, AEs, and QOL. Results: Male participants had a mean age of 36.69±15.58, while female participants had a mean age of 40.96±11.88. The different classes of drugs used were calcineurin inhibitors, growth factors, melanizing agents, glucocorticoids (GCs), antifungals, and anti-lepra drugs. QOL improved after treatment. The most common AEs include gastritis (16.6%) and acneiform eruption (10.41%). Conclusion: This study has helped in determining the different patterns of drugs used in hypopigmentary disorders and their positive impact on QOL. The individualized prescribing pattern could improve the clinical and psychosocial outcome of the disease in the future.

To compare safety and healthcare utilization after sleeve gastrectomy versus Roux-en-Y gastric bypass in a national Medicare cohort.Though bariatric surgery is increasing among Medicare beneficiaries, no long-term, national studies examining comparative effectiveness between procedures exist. Bariatric outcomes are needed for shared decision-making and coverage policy concerns identified by the cMS Medicare Evidence Development and Coverage Advisory Committee.Retrospective instrumental variable analysis of Medicare claims (2012-2017) for 30,105 bariatric surgery patients entitled due to disability or age. We examined clinical safety outcomes (mortality, complications, and reinterventions), healthcare utilization [Emergency Department (ED) visits, rehospitalizations, and expenditures], and heterogeneity of treatment effect. We compared all outcomes between sleeve and bypass for each entitlement group at 30 days, 1 year, and 3 years.Among the disabled (n = 21,595), sleeve was associated with lower 3-year mortality [2.1% vs 3.2%, absolute risk reduction (ARR) 95% confidence interval (CI): -2.2% to -0.03%], complications (22.2% vs 27.7%, ARR 95%CI: -8.5% to -2.6%), reinterventions (20.1% vs 27.7%, ARR 95%CI: -10.7% to -4.6%), ED utilization (71.6% vs 77.1%, ARR 95%CI: -8.5% to -2.4%), and rehospitalizations (47.4% vs 52.3%, ARR 95%Ci: -8.0% to -1.7%). Cumulative expenditures were $46,277 after sleeve and $48,211 after bypass (P = 0.22). Among the elderly (n = 8510), sleeve was associated with lower 3-year complications (20.1% vs 24.7%, ARR 95%CI: -7.6% to -1.7%), reinterventions (14.0% vs 21.9%, ARR 95%CI: -10.7% to -5.2%), ED utilization (51.7% vs 57.2%, ARR 95%CI: -9.1% to -1.9%), and rehospitalizations (41.8% vs 45.8%, ARR 95%Ci: -7.5% to -0.5%). Expenditures were $38,632 after sleeve and $39,270 after bypass (P = 0.60). Procedure treatment effect significantly differed by entitlement for mortality, revision, and paraesophageal hernia repair.Bariatric surgery is safe, and healthcare utilization benefits of sleeve over bypass are preserved across both Medicare elderly and disabled subpopulations.

Objectives: The objectives of the study were to evaluate the knowledge, practice, and pattern of cosmetic use and their adverse reactions amongst medical, pharmacy, and physiotherapy undergraduates. Methods: This was a cross-sectional, questionnaire-based study conducted among 202 2nd-year medical (113), Pharmacy (51), and Physiotherapy (38) students of KIMS, Bangalore, India for a period of 1 month. Results obtained were analyzed using descriptive statistics. Results: About 75.2% of students were aware of cosmetics and their adverse reactions, still 36.7% of students will continue using them because they were convinced about them. Pharmacy students had less knowledge of the animal, alternate testing, and preventive measures compared to medical and physiotherapy students. Overall n=71, (35.1%) of students had adverse reactions from cosmetic usage, the most common product being fairness cream and the adverse reactions include itching, acne, and rashes. Conclusion: Overall, the undergraduate medical, pharmacy, and physiotherapy students had good insight and practice toward cosmetics and their adverse reactions, nevertheless the awareness of pharmacy students was comparatively less than medical and physiotherapy students. Hence, educational intervention on the effective, safe, and proper use of cosmetics in the future needs to be implemented especially among pharmacy students.

As survivorship following kidney transplant continues to improve, so does the probability of intervening on common surgical conditions, such as ventral or incisional hernia, in this population. Ventral hernia management is known to vary across institutions and this variation has an impact on patient outcomes. We sought to evaluate hospital level variation of ventral or incisional hernia repair (VIHR) in the kidney transplant population.We performed a retrospective review of 100% inpatient Medicare claims to identify patients who underwent kidney transplant between 2007 and 2018. The primary outcome was 1- and 3-year ventral or incisional risk- and reliability-adjusted VIHR rates. Patient and hospital characteristics were evaluated across risk- and reliability-adjusted VIHR rate tertiles. Models were adjusted for age, sex, race, and Elixhauser comorbidities.Overall, 139,741 patients underwent kidney transplant during the study period with a mean age (SD) of 51.6 (13.7) years. 84,717 (60.6%) were male, and 72,657 (52.0%) were white. Median follow up time was 5.4 years. 2098 (1.50%) patients underwent VIHR. the 1 year risk- and reliability-adjusted hernia repair rates were 0.49% (95% Conf idence Interval (CI) 0.48-0.51, range 0.31-0.59) in tertile 1, 0.63% (95% CI 0.62-0.63, range 0.59-0.68) in tertile 2, and 0.98 (95% CI 0.91-1.05, range 0.68-2.94) in tertile 3. Accordingly, compared to hospitals in tertile 1, the odds of post-transplant hernia repair tertile 2 hospitals were 1.78 (95% CI 1.37-2.31) and at tertile 3 hospitals 3.53 (95% CI 2.87-4.33).In a large cohort of Medicare patients undergoing kidney transplant, the overall cumulative incidence of hernia repair varied substantially across hospital tertiles. Patient and hospital characteristics varied across tertile, most notably in diabetes and obesity. Future research is needed to understand if program and surgeon level factors are contributing to the observed variation in treatment of this common disease.

In the United States, the Organ Procurement and Transplant Network (OPTN) uses 1-year mortality as the primary measure of transplant center quality. We sought to evaluate the reliability of mortality outcomes in lung transplantation and to compare statistical methods of program performance evaluation.We used the Standard Transplant Analysis and Research files from the United Network for Organ Sharing to identify lung transplant recipients from 2013 to 2018 in the United States. We stratified hospitals on the basis of 30-day, 1-year, and 5-year survival by risk adjustment, reliability adjustment with empirical Bayes technique, and hierarchical bayesian mixed effects models currently used by the OPTN. We measured variation in mortality rates and identification of performance outliers between techniques.We identified 12,769 recipients in 69 centers. Reliability adjustment reduced variation in hospital outcomes and had a large impact on hospital mortality rankings. For example, with 1-year mortality, 28% (5 hospitals) of the "best" hospitals (top 25%) and 18% (3 hospitals) of the "worst" hospitals (bottom 25%) were reclassified after reliability adjustment. The overall reliability of 1-year mortality was low at 0.42. Compared with the bayesian method used by the OPTN, reliability adjustment identified fewer outliers. The 5-year survival reached a higher reliability plateau with a lower volume of cases required.The reliability of 1-year mortality in lung transplantation is low, whereas 5-year survival estimates may be more reliable at lower case volumes. Reliability adjustment yielded more conservative measures of center performance and fewer outliers compared with current bayesian methods.

To compare out-of-pocket (OOP) costs for patients up to 3 years after bariatric surgery in a large, commercially-insured population.More information on OOP costs following bariatric surgery may affect patients' procedure choice.Retrospective study using the IBM MarketScan commercial claims database, representing patients nationally who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) January 1, 2011 to December 31, 2017. We compared total OOP costs after the surgical episode between the 2 procedures using difference-in-differences analysis adjusting for demographics, comorbidities, operative year, and insurance type.Of 63,674 patients, 64% underwent SG and 36% underwent RYGB. Adjusted OOP costs after SG were $1083, $1236, and $1266 postoperative years 1, 2, and 3. For RYGB, adjusted OOP costs were $1228, $1377, and $1369. In our primary analysis, SG OOP costs were $122 (95%CI: -$155 to -$90) less than RYGB year 1. This difference remained consistent at -$119 (95%CI: -$158 to -$79) year 2 and -$80 (95%CI: -$127 to -$35) year 3. These amounts were equivalent to relative differences of -7%, -7%, and -5% years 1, 2, and 3. Plan features contributing the most to differences were co-insurance years 1, 2, and 3.. The largest clinical contributors to differences were endoscopy and outpatient care year 1, outpatient care year 2, and emergency department use year 3.Our study is the first to examine the association between bariatric surgery procedure and OOP costs. Differences between procedures were approximately $100 per year which may be an important factor for some patients deciding whether to pursue SG or gastric bypass.

To characterize incidence and outcomes for bariatric surgery patients who give birth.Patients of childbearing age comprise 65% of bariatric surgery patients in the United States, yet data on how often patients conceive and obstetric outcomes are limited.Using the IBM MarketScan database, we performed a retrospective cohort study of female patients ages 18-52 undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass from 2011-2017. We determined incidence of births in the first two years after bariatric surgery using Kaplan-Meier estimates. We then restricted the cohort to those with full two-year follow-up to examine obstetric outcomes and bariatric-related reinterventions. We reported event rates of adverse obstetric outcomes and delivery type. Adverse obstetric outcomes include pregnancy complications, severe maternal morbidity, and delivery complications. We performed multivariable logistic regression to examine associations between birth and risk of reinterventions.Of 69,503 patients who underwent bariatric surgery, 1,464 gave birth. The incidence rate was 2.5 births per 100 patients in the 2 years after surgery. 85% of births occurred within 21 months after surgery. For 38,922 patients with full two-year follow-up, adverse obstetric event rates were 4.5% for gestational diabetes and 14.2% for hypertensive disorders. 48.5% were first-time Cesarean deliveries. Almost all reinterventions during pregnancy were biliary. Multivariable logistic regression analysis showed no association between post-bariatric birth and reintervention rate (OR: 0.93, 95%CI: 0.78-1.12).In this first national U.S. cohort, we find giving birth was common in the first 2 years after bariatric surgery and was not associated with increased risk of reinterventions. Clinicians should consider shifting the dialogue surrounding pregnancy after surgery to shared decisionmaking with maternal safety as one component.

Human community is in agony of grave metabolic disorder i.e., obesity/Sthaulya roga. It is inclined to become miserable because of the attenuated Dosha in the body. Sedentary lifestyle, hampered sexual life, extreme lassitude, will be prone to engulf the normalcy of an individual, which ultimately leads to decreased life span. It is widely recognized that obesity has emerged as an epidemic in developed nations. It continues to be an issue of great concern. In addition, we now face the emergence of obesity as a worldwide phenomenon, affecting affluent and ordinary group of class. Here in this case report the objective is to find out the efficacy of Vrikshamla (Garcinia Cambogia) in the management of Sthaulya (Obesity). Materials: A 32 years old male patient K/C/O obesity since three year. Accustomed him with sedentary lifestyle which leads to an drastic gain in the weight. Through physical findings, BMI of a patient is 32.3 and by investigations the diagnosis led to Sthaulya as well as dyslipidemia. The study was assessed by both subjective and objective criteria. The treatment plan opted was Ayurveda internal medicine “Vrikshamla are best in the management of Sthaulya, selected as per criteria and examined by means of Roga and Rogi Pariksha methods. Administered Vrikshamla 2gm per day for 60 days and subjective as well as objective parameters were Assessed based on before and after treatment. Discussion: Difference in the values of subjective and objective parameters, illustrate all the clinical observations in respect of incidences of Nidana, Lakshana and percentage of relief in the subject. Conclusion: In the present research work undertaken, Vrikshamla an herbal formulation prove its efficacy against dyslipidaemia.

IMPORTANCE: Sleeve gastrectomy and gastric bypass are the most common bariatric surgical procedures in the world; however, their long-term medication discontinuation and comorbidity resolution remain unclear. OBJECTIVE: To compare the incidence of medication discontinuation and restart of diabetes, hypertension, and hyperlipidemia medications up to 5 years after sleeve gastrectomy or gastric bypass. DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness research study of adult Medicare beneficiaries who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass between January 1, 2012, to December 31, 2018, and had a claim for diabetes, hypertension, or hyperlipidemia medication in the 6 months before surgery with a corresponding diagnosis used instrumental-variable survival analysis to estimate the cumulative incidence of medication discontinuation and restart. Data analyses were performed from February to June 2021. EXPOSURES: Laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. MAIN OUTCOMES AND MEASURES: The primary outcome was discontinuation of diabetes, hypertension, and hyperlipidemia medication for any reason. Among patients who discontinued medication, the adjusted cumulative incidence of restarting medication was calculated up to 5 years after discontinuation. RESULTS: Of the 95 405 patients included, 71 348 (74.8%) were women and the mean (SD) age was 56.6 (11.8) years. Gastric bypass compared with sleeve gastrectomy was associated with a slightly higher 5-year cumulative incidence of medication discontinuation among 30 588 patients with diabetes medication use and diagnosis at the time of surgery (74.7% [95% CI, 74.6%-74.9%] vs 72.0% [95% CI, 71.8%-72.2%]), 52 081 patients with antihypertensive medication use and diagnosis at the time of surgery (53.3% [95% CI, 53.2%-53.4%] vs 49.4% [95% CI, 49.3%-49.5%]), and 35 055 patients with lipid-lowering medication use and diagnosis at the time of surgery (64.6% [95% CI, 64.5%-64.8%] vs 61.2% [95% CI, 61.1%-61.3%]). Among the subset of patients who discontinued medication, gastric bypass was also associated with a slightly lower incidence of medication restart up to 5 years after discontinuation. Specifically, the 5-year cumulative incidence of medication restart was lower after gastric bypass compared with sleeve gastrectomy among 19 599 patients who discontinued their diabetes medication after surgery (30.4% [95% CI, 30.2%-30.5%] vs 35.6% [95% CI, 35.4%-35.9%]), 21 611 patients who discontinued their antihypertensive medication after surgery (67.2% [95% CI, 66.9%-67.4%] vs 70.6% [95% CI, 70.3%-70.9%]), and 18 546 patients who discontinued their lipid-lowering medication after surgery (46.2% [95% CI, 46.2%-46.3%] vs 52.5% [95% CI, 52.2%-52.7%]). CONCLUSIONS AND RELEVANCE: Findings of this study suggest that, compared with sleeve gastrectomy, gastric bypass was associated with a slightly higher incidence of medication discontinuation and a slightly lower incidence of medication restart among patients who discontinued medication. Long-term trials are needed to explain the mechanisms and factors associated with differences in medication discontinuation and comorbidity resolution after bariatric surgery.

OBJECTIVE To evaluate the association of historical racist housing policies and modern-day healthcare outcomes. SUMMARY OF BACKGROUND DATA In 1933 the United States Government Home Owners Loan Corporation (HOLC) used racial composition of neighborhoods to determine creditworthiness and labeled them "Best", "Still Desirable", "Definitely Declining", and "Hazardous." Although efforts have been made to reverse these racist policies that structurally disadvantage those living in exposed neighborhoods, the lasting legacy on modern day healthcare outcomes is uncertain. METHODS We performed a cross-sectional retrospective review of 212,179 Medicare beneficiaries' living in 171,930 unique neighborhoods historically labeled by the HOLC who underwent 1 of 5 of common surgical procedures - coronary artery bypass, appendectomy, colectomy, cholecystectomy, and hernia repair - between 2012 and 2018. We compared 30-day mortality, complications, and readmissions across HOLC grade and Area Deprivation Index (ADI) of each neighborhood. Outcomes were risk-adjusted using a multivariable logistical regression model accounting for patient factors (age, sex, Elixhauser comorbidities), admission type (elective, urgent, emergency), type of operation, and each neighborhoods ADI; a modern day measure of neighborhood disadvantage that includes education, employment, housing-quality, and poverty measures. RESULTS Overall, 212,179 Medicare beneficiaries (mean age, 71.2 years; 54.2% women) resided in 171,930 unique neighborhoods historically graded by the HOLC. Outcomes worsened in a stepwise fashion across HOLC neighborhoods. Overall, 30-day postoperative mortality was 5.4% in "Best" neighborhoods, 5.8% in "Still Desirable", 6.1% in "Definitely Declining", and 6.4% in "Hazardous" (Best vs Hazardous Odds Ration: 1.23, 95% CI: 1.13-1.24, P < 0.001). The same stepwise pattern was seen from "Best" to "Hazardous" neighborhoods for complications (30.5% vs 32.2%; OR: 1.12 [95% CI: 1.07-1.17]; P < 0.001) and Readmissions (16.3% vs 17.1%; OR: 1.06 [95% CI: 1.01-1.11]; P = 0.023). After controlling for modern day deprivation using ADI, the patterns persisted with "Hazardous" neighborhoods having higher mortality (OR: 1.17 [95% CI: 1.08-1.27]; P < 0.001) and complications (OR: 1.07 [95% CI: 1.02-1.12]; P = 0.003), but not for readmissions (OR: 1.02 [95% CI: 0.97-1.07]; P = 0.546). CONCLUSIONS Patients residing in neighborhoods previously "redlined" or labeled "Hazardous" were more likely to experience worse outcomes after inpatient hospitalization compared to those living in "Best" neighborhoods, even after taking into account modern day measures of neighborhood disadvantage.

In recent years’ obesity which is one among the metabolic syndrome is a leading health problem which can be corelated to dyslipidaemia – “prayaha snehat meda pravaradhyet”, implying the factor that excessive sneha(oleation) is responsible for excessive production of meda dhatu (fatty tissue) and such excessively accumulated meda dhatu (fatty tissue) causing avarodha (obliteration) of other dhatu(tissues) leading to medoroga(dyslipidaemia) or else it is taken as sthoulya (Obesity). Obesity is always associated with dyslipidaemia and other such metabolic disorders. There is an exact explanation to this pathology in Ayurveda and our acharyas have mentioned proper shamana aushadi (alleviating therapy) which can tackle both obesity as well as dyslipidaemia together. Hence our aim for this case report is to find out the efficacy of Vrikshamla (Garcinia Cambogia) in the management of sthoulya (Obesity) and dyslipidaemia and objectives that were assessed are body weight, BMI, body circumference and lipid profile of the patient. A 32-year-old male patient was a known case of obesity and diagnosed with dyslipidaemia based on the laboratory investigation. Patient was not a known case of any other metabolic disorders and administered with shamana aushadi (alleviating therapy) vrikshamla 2gms per day for 60 days. Patient was assessed before and after treatment with the subjective and objective parameters were taken up for the study which showed the drastic improvement in weight reduction of 6kgs and BMI was reduced to 29.2 from 32.2 and shows better results in lipid profile as well. Drug Vrikshamala (extract) which has amla(sour), katu(pungent) and madhura(sweet) rasa(taste) with laghu(lightness) and usna(hot) guna(properties) in predominance and having the kapha medohara property helps in agnisam dhukshana (stimulate digestive power) and does the ama sanchaya, clears the srotorodha (obstruction of channels) was profoundly successful in reducing weight, BMI and lipid profile of a patient. Thus vrikshamala shows a better efficacy against sthoulya(obesity) and in dyslipidemia.

This cohort study evaluates trends in the adoption of robotic surgery among Medicare beneficiaries and privately insured patients for common general surgical procedures.

In current years, the application of medicinal plants for the cancer prevention and treatment has gained more interest for the researchers due to the presence of phytoconstituents and lesser side effects. In the current finding, tropical medicinal plant Colocasia esculenta leaves was selected for its cytotoxic potential and apoptosis inducing effect against Pa-1 ovarian cancer cell lines. MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-dipenyltetrazolium bromide] assays were carried out to know the cytotoxic activity and apoptosis effect was examined using flow cytometry of C. esculenta leaves of ethanol extract. The cytotoxicity was observed highest, showing the IC50 concentration at 93.2 μg/mL of the leaf extract of C. esculenta on Pa-1 ovarian cancer cell line and observed dose dependent action against the concentrations. Apoptosis inducing effect of the extract showed 63.63% of late apoptotic cells and 11.22% of early apoptotic cells of Annexin V and PI compared to the standard drug Cisplatin (15uM) showing 41.76% of late apoptotic cells and 46.42% of early apoptotic cells. C. esculenta leaves of ethanol extract have potential for development as therapeutic principle for cytotoxicity on Pa-1 ovarian cancer cell line after further investigation.

OBJECTIVE To assess risk-adjusted outcomes and participant perceptions following a statewide coaching program for bariatric surgeons. SUMMARY OF BACKGROUND DATA Coaching has emerged as a new approach for improving individual surgeon performance, but lacks evidence linking to clinical outcomes. METHODS This program took place between October 2015 and February 2018 in the Michigan Bariatric Surgery Collaborative. Surgeons were categorized as coach, participant, or nonparticipant for an interrupted time series analysis. Multilevel logistic regression models included patient characteristics, time trends, and number of sessions. Risk-adjusted overall and surgical complication rates are reported, as are within-group relative risk ratios and 95% confidence intervals. We also compared operative times and report risk differences and 95% confidence intervals. Iterative thematic analysis of semi-structured interviews examined participant and coach perceptions of the program. RESULTS The coaching program was viewed favorably by most surgeons and many participants described numerous technical and nontechnical practice changes. The program was not associated with significant change in risk-adjusted complications with relative risks for coaches, participants, and nonparticipants of 0.99 (0.62-1.37), 0.91 (0.64-1.17), and 1.15 (0.83-1.47), respectively. Operative times did improve for participants, but not coaches or nonparticipants, with risk differences of -14.0 (-22.3, -5.7), -1.0 (-4.5, 2.4), and -2.6 (-6.9, 1.7). Future coaching programmatic design should consider dose-complexity matching, hierarchical leveling, and optimizing video review. CONCLUSIONS This statewide surgical coaching program was perceived as valuable and surgeons reported numerous practice changes. Operative times improved, but there was no significant improvement in risk-adjusted outcomes.