Madras Medical College

Background: Heart failure (HF) is a complex clinical condition requiring resource-intensive management and substantial health expenditure. The adverse economic impact of medical care on patients or financial burden is increasingly recognised as a significant non-clinical entity affecting HF management in low-and middle-income countries (LMIC). We explored the factors associated with Financial Burden (FB) in HF patients in India. Methods: We recruited HF patients from 21 hospitals across India, selected to reflect regional diversity and varying stages of epidemiological transition. Trained personnel collected clinical and economic data using a validated and structured questionnaire. Expenditures were recorded in Indian rupees (INR) and converted to international dollars (INT$). Results: We recruited 1,859 participants. Nearly one-third of participants (30.2%) were women. The mean age was 55.9 (11.3) years, and the mean duration of formal education was 11.3 (3.8) years. Health insurance coverage was reported in one-third (32.2%) of the study population. The average annual out-of-pocket (OOP) expenditure was INR 1,06,566 (INT$ 4,709.10), constituting 92.6% (95% CI: 92.5-92.7) of the total health expenditure. Compared to the previous year, a decline in monthly income was reported by 32.3% of individuals and 36.2% of households. Catastrophic health spending (CHS) and distress financing (DF) were observed in 37.7% (35.5-39.9) and 17.7% (15.9-19.4) of the households, respectively. However, CHS and DF were lower [30.8% (26.2-35.4) and 13.6% (10.2-17.0), respectively] among those with health insurance compared to the uninsured [40.3% (37.6-43.0) and 18.9% (16.7-21.1), respectively]. Conclusion: Seven out of 10 HF patients in India lack financial health protection. OOP expenditures, accounting for over 90% of total health spending, contribute significantly to economic distress in HF patients. Financial burden, affecting more than one-third of HF patients, carries profound implications for individual well-being. Addressing this financial burden, including CHS and DF, is essential for improving clinical outcomes and ensuring health equity.

Background: The unmet need for contraception remains a significant public health concern in rural India, despite high awareness of family planning methods. Aims and Objectives: This study aimed to estimate the prevalence of unmet need for contraception and identify factors associated with non-use among rural women aged 15–45 years. Materials and Methods: A community-based cross-sectional study was conducted from January to December 2020 in the rural field practice area of Chengalpattu Medical College, Tamil Nadu. Using multistage sampling, 268 eligible women aged 15–45 years were interviewed with a pre-tested semi-structured questionnaire. Unmet need for contraception was defined using standard Demographic and Health Surveys (DHS) criteria. Data were analyzed using descriptive statistics and logistic regression. Results: Awareness of contraception was high (91.0%). More than half of the women were current contraceptive users (54.85%), predominantly female sterilization (67.35%). The overall unmet need for contraception was 25.37%, mainly for spacing births (67.65%). Higher unmet need was observed among women aged 21–25 years (41.67%), those married at ≥21 years (32.24%), women with parity ≤2 (34.27%), and women with one living child (51.55%). Unmet need was significantly higher among women not involved in family planning decisions (63.64%), those unaware of contraceptive methods (50.00%), and those reporting lack of perceived availability (44.68%). Multivariable analysis identified age at first childbirth ≥23 years, lack of female participation in decision-making, poor awareness, perceived non-availability of services, and longer duration of marriage as independent predictors of unmet need. Conclusion: Despite high awareness, the unmet need for contraception remains substantial, particularly for spacing methods. Strengthening early counseling, improving access to spacing methods, and promoting shared decision-making are crucial to reducing unmet need in rural settings.

Background: High-grade gliomas (HGG) are aggressive central nervous system tumors with a poor prognosis. Techniques such as intensity-modulated radiotherapy (IMRT) aim to improve dose conformity and spare normal tissues compared to three-dimensional conformal radiotherapy (3DCRT). Aims and Objectives: The aim is to assess the dosimetry and treatment quality of 3DCRT versus IMRT in HGG. Materials and Methods: In this prospective study, 30 patients were allocated to 3DCRT (n=15) or IMRT (n=15). Both groups received 59.4 Gy in 33 fractions with concurrent and adjuvant temozolomide. Dosimetric parameters of the planning target volume (PTV) and organs at risk were analyzed. Acute neurological toxicities were assessed. Statistical analysis used Mann–Whitney U and Chi-square/Fisher’s exact tests. Results: Baseline characteristics were comparable (P>0.05). IMRT showed significantly lower PTV Dmax (64.56 vs. 65.69 Gy), Dmean (61.67 vs. 62.57 Gy), D2 (63.23 vs. 64.78 Gy), and D50 (61.65 vs. 62.62 Gy) (all P=0.01). IMRT significantly reduced doses to critical structures, including brain Dmax (62.54 vs. 65.07 Gy), brainstem Dmean (27.74 vs. 32.12 Gy), optic chiasm Dmean (32.91 vs. 45.03 Gy), and pituitary Dmean (28.67 vs. 44.00 Gy) (P≤0.05). Hippocampal and temporal lobe doses were also lower with IMRT. Right cochlea doses were reduced with IMRT (Dmean 26.20 vs. 49.76 Gy, P=0.05). Left eye and lens doses were higher with IMRT (P=0.01). Conformity index was significantly better with IMRT (1.52 vs. 1.61, P=0.003), whereas homogeneity index was similar (P=0.54). Acute neurological toxicities showed no significant differences (P>0.05). Conclusion: IMRT offers superior dose distribution and organ sparing compared to 3DCRT, with comparable toxicity profiles. Larger studies with long-term follow-up are needed.

Disseminated fungal infection (DFI) is the presence of a fungal pathogen in the blood and/or any other deep-seated site due to vascular spread. It represents a rare but life-threatening infectious complication in immunocompromised patients. In this case report, we present a 19-year-old male with weakness of the limbs, headache, and slurred speech. He was a known case of endobronchial fungal infection with worsening neurological symptoms. Motor examination revealed reduced tone and strength, while respiratory examination revealed bilaterally decreased air entry. Fundoscopic examination revealed papilledema. Immunological evaluation demonstrated elevated IgE and IgG levels and a reduced CD16/56 natural killer cell count, indicating defective innate immunity. Radiological examination, including computed tomography (CT), positron emission tomography-computed tomography (PET-CT), and magnetic resonance imaging (MRI), demonstrated nodules with opacities and mediastinal and cervical lymphadenopathy in the chest, as well as multiple supratentorial and infratentorial lesions, extensive edema, and nodular leptomeningeal thickening on neuroimaging. The patient is hypothesized to have dysfunctional ryanodine receptors (RyR) rather than typical CGD. The patient was managed with antifungal therapy along with antiepileptic and antiedema drugs.

Abstract Introduction: Systematic studies on mortality patterns with respect to demographics and causative diseases will serve as important tools for monitoring disease burden, identifying diseases requiring prioritized attention and formulating health policies accordingly. The present study aimed to determine the causes of mortality over a period of 1 year in a tertiary care hospital, Chennai, Tamil Nadu, India. Methods: This hospital-based retrospective descriptive (observational) mortality study was conducted during the period, May 2023–April 2024. All deceased in-patients case sheets were collected from the Medical Record Department. All data including clinical, demographic and cause of death were retrieved using a structured format. Cause of mortality was categorized according to the International Classification of Diseases, 11 th Revision. Statistical analysis was carried out using SPSS version 15. Results: A total of 140,793 admissions, of which 7954 were deaths with a mortality rate of 5.6%. The present study is the first of its kind to describe mortality patterns in a government tertiary hospital in southern India. Detailed analysis of the cause of death in this study was carried out for 7752, which included 5169 (66.7%) males and 2583 (33.3%) females. Age group 51–60 years had the highest number of deaths 1880 (24.3%). Higher deaths (54.4%: n = 4220) occurred within 3 days and around three-fourths of the deaths (75.7%: n = 5870) occurred within the first week of admission to the hospital. The primary individual five leading causes of death were: stroke 1096 (14.1%), followed by cancer 698 (9%), ischemic heart diseases 630 (8.1%), decompensated chronic liver disease 610 (7.9%), and road traffic accident 598 (7.7%). Conclusion: The mortality pattern in this study shows a predominance of stroke, cancer and cardiovascular disease as the causes. This observation highlights the rising burden of noncommunicable diseases and their impact on mortality.