Ruxmaniben Deepchand Gardi Medical College

This prospective cohort study assessed the financial burden of extrapulmonary tuberculosis (EPTB) in India, revealing substantial costs across disease manifestations. Among 200 confirmed EPTB patients, those with pleuritis, meningitis, and other severe forms, incurred significantly higher out-of-pocket (OOP) and indirect costs than lymphadenitis patients. Over 90% of meningitis and 80% of pleuritis patients experienced catastrophic health expenditures (CHE), defined as costs exceeding 20% of annual income. Up to 42% of patients were pushed below the poverty line. Asset-based inequality analysis showed that lower socioeconomic groups faced a disproportionate cost burden. The cost of diagnostic tests and the less severe nature of EPTB lymphadenitis may delay seeking care until patients' ability to work is affected. Factors such as low income, comorbidities, diagnostic delays, and reduced working capacity were associated with CHE. Notably, presumptive non-TB patients also incurred significant OOP and productivity losses during their diagnostic journeys, despite ultimately receiving non-TB diagnoses. These findings highlight the need for universal health coverage and enhanced financial protection strategies to mitigate the economic impact of EPTB and similar chronic conditions.

BackgroundEmpirical antibiotic prescribing during the COVID-19 pandemic may have accelerated antimicrobial resistance, particularly in resource-constrained settings with limited diagnostic and stewardship capacity. This study characterized antibiotic prescribing patterns and identified predictors among hospitalized COVID-19 patients in rural Central India.MethodsThis retrospective observational study included 951 laboratory-confirmed COVID-19 patients (aged ≥18 years, hospitalized ≥48 hours) admitted between March 2020 and December 2021. Antibiotic use was assessed using WHO ATC/DDD methodology and Drug Utilization 90% (DU90%) analysis. Predictors of antibiotic prescription were evaluated using multivariable logistic regression. Empirical prescribing was defined as antibiotic initiation without microbiological confirmation.ResultsAmong 951 patients (mean age 53 ± 15.8 years; 64% male), 54% had ≥1 comorbidity and 74% required oxygen; 20% required mechanical ventilation. Antibiotics were prescribed to 90% (858/951); 46% received two agents and 8% ≥3 agents. The DU90% segment consisted of WHO “Watch” antibiotics, mainly amoxicillin-clavulanate (40.87 g/100 patient-days), doxycycline (18.26), and azithromycin (17.12). However, the use of meropenem (4.04 DDD gm/100 patients) a WHO Reserve group carbapenem is particularly alarming. Elevated C-reactive protein (>10 mg/dL) was the strongest predictor of antibiotic use (adjusted OR 29.28, 95% CI 17.53–48.89; p<0.001). Antibiotic recipients had longer median hospital stays (11 vs 8 days). Overall mortality was 26%.ConclusionsEmpirical antibiotic use was extremely high and driven by WHO “Watch” and “reserve” group agents, largely associated with elevated CRP in the absence of culture testing. Strengthening diagnostics and stewardship programs is urgently needed to reduce unnecessary broad-spectrum antibiotic exposure.

Introduction: Hypertensive emergencies represent life-threatening conditions characterised by acute elevations in blood pressure with evidence of target organ damage. They remain a significant contributor to cardiovascular, neurological, and renal morbidity and mortality, often leading to hospitalisation. Early detection of end-organ involvement is therefore crucial to prevent irreversible damage and improve clinical outcomes. Aim: To study the association between patients presenting with hypertensive emergency in the Medical Intensive Care Unit (MICU) and target end-organ damage across different genders and age groups. Materials and Methods: The present cross-sectional study was conducted among adult patients aged 18-80 years presenting with blood pressure ≥180/120 mmHg at R. D. Gardi Medical College and Charitable Hospital, Ujjain, Madhya Pradesh, India, over a period of six months, from June 2024 to November 2024. Demographic data, medical history, and other clinical information, including Electrocardiography (ECG), Two Dimensional (2D) echocardiography, chest X-ray, funduscopic examination, ultrasonography of the abdomen, and neuroimaging studies, were collected. Data were analysed using SPSS software (Statistical Package for the Social Sciences (SPSS) Inc., Chicago, IL), version 29.0.10, with a p-value <0.05 considered statistically significant. Results: Among the 96 patients, 58 (60%) were male and 38 (40%) were female. The mean {±Standard Deviation (SD)} age was 58.66±12.62 years (range: 18-80 years). A past history of hypertension was present in 58 (60.4%) patients, with a mean duration of 6.51±4.34 years (range: 1-20 years). The most common forms of acute target organ damage were Cerebrovascular Accident (CVA) with retinopathy in 24 patients (25%), followed by Myocardial Infarction (MI) with retinopathy in 15 (15.6%), retinopathy alone in 13 (13.5%), retinopathy with pulmonary oedema and acute heart failure in 11 (11.5%), and MI alone in 10 patients (10.4%). Conclusion: Hypertensive emergencies were more frequent among middle-aged and elderly males, most of whom had a prior history of hypertension. CVAs and retinopathy were the leading complications, followed by MI either alone or in combination with retinopathy. Strengthening early detection and ensuring strict blood pressure control are essential to reduce the burden of target organ damage in these patients.

Background: Demographic surveillance provides essential insights into fertility, mortality, migration, and maternal and child health indicators, particularly in rural populations where localized data are often limited. National demographic estimates may mask important micro-level variations, highlighting the need for block-level surveillance to support decentralized planning and targeted public health interventions.Aim and Objectives: To analyse and compare demographic characteristics and birth-related events across three rural blocks, Tarana, Mahidpur, and Ghatiya of Ujjain district, using routine demographic surveillance data for the year 2023. The objectives included comparison of live births, childbirth characteristics, mortality patterns, and migration trends, along with evaluation of block-wise demographic indicators.Methodology: This retrospective cross-sectional record-based study was conducted using demographic surveillance data from 60 adopted rural villages under the field practice area of the Tertiary Medical College of Madhya Pradesh. Universal sampling was applied, and all recorded live births, deaths, immigration, and emigration events between 1 January and 30 December 2023 were included. Data were extracted using a structured format, analysed using SPSS software, and summarized using descriptive and inferential statistics, including chi-square tests for block-wise comparisons.Results: The study covered a population of 99,067 and recorded 1,439 live births and 405 deaths, resulting in a crude birth rate of 14.5 per 1000 and a crude death rate of 4.09 per 1000. Ghatiya showed the lowest mortality, highest natural increase, and highest net migration rate, indicating stronger population growth dynamics. Institutional deliveries were predominant across all blocks, and normal vaginal delivery was the most common mode. Female migration constituted the majority of migration events. However, sex ratios at birth were low across all blocks, indicating gender imbalance.Conclusion: The study highlights significant inter-block demographic variations and demonstrates the utility of routine demographic surveillance in identifying localized population trends. Regular surveillance can support evidence-based planning, strengthen maternal and child health programs, and enable targeted public health interventions at block and district levels.