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 Birth asphyxia, also known as perinatal hypoxia-ischaemia, is a significant cause of neonatal morbidity and mortality. It occurs when a newborn experiences insufficient oxygen during birth, potentially leading to multisystem injury including renal dysfunction and disruption of calcium homeostasis. Understanding the impact of birth asphyxia on renal function and serum calcium levels is critical for early detection and timely intervention. Materials and Methods Of 185 term neonates assessed for eligibility (27 excluded—congenital anomalies n=10; septicemia n=9; respiratory distress syndrome n=8; see flow chart), a total of 158 term neonates with birth asphyxia were enrolled. Renal function parameters (serum creatinine, serum urea) and serum calcium levels were measured at admission (within 2 hours of birth), at approximately 48±4 hours and at approximately 72±4 hours of life. All samples were analysed on a Beckman Coulter AU480 automated analyser by a blinded technician. Data were analysed in SPSS V.25 (IBM); descriptive tests included independent-samples t-tests (or Mann–Whitney U for non-normal data) and χ² tests as appropriate and multivariate logistic regression was used to adjust for potential confounders; there were no missing data. Acute kidney injury (AKI) was defined using modified neonatal KDIGO (kidney disease: improving global outcomes) criteria based on serum creatinine values and urine output, and hypocalcaemia was defined as serum calcium <8.0 mg/dL. Results AKI was observed in 88/158 (55.7%) neonates and hypocalcaemia in 92/158 (58.2%). Elevated serum creatinine was noted in 110/158 (69.6%) and elevated urea in 104/158 (65.8%) neonates. These abnormalities were more common in neonates with severe asphyxia. Serum creatinine and urea levels peaked at 48 hours, while serum calcium levels declined significantly within the first 48 hours, particularly in severe cases. Conclusion A high incidence of AKI and hypocalcaemia was found in neonates with birth asphyxia. These findings highlight the importance of routine biochemical monitoring and early intervention to mitigate complications and improve neonatal outcomes.
OBJECTIVES:Non-communicable diseases (NCDs) such as hypertension, obesity, and chronic kidney disease are increasingly recognized among adolescents, particularly in low- and middle-income settings like India, where the epidemiologic transition is well underway. However, robust regional data for semi-urban and rural populations remain sparse. This study assessed the prevalence and determinants of hypertension, obesity, and proteinuria among school-going adolescents in Bikaner, Rajasthan. METHODS:We conducted a cross-sectional study between April 2017 and January 2018 in three randomly selected schools in Bikaner. Adolescents aged 13-19 years were recruited using a multi-stage cluster random sampling technique, with parental consent and participant assent. Standardized anthropometry, blood pressure measurement (AAP 2017 definitions), and dipstick urinalysis for proteinuria/glycosuria were performed. Generalised Mixed Linear models was used to assess predictors of hypertension. RESULTS:Among 1,082 participants (mean age: 16 ± 2 years; 58.7 % male), the prevalence of overall hypertension was 24.7 %, with an additional 8.3 % exhibiting elevated blood pressure. BMI-based overweight and obesity were observed in 9.3 % and 2.9 %, respectively, while central obesity was present in 49.3 %. Dipstick proteinuria (≥1+) was found in 4.3 %. Multivariable analysis identified age, male sex, central obesity, increasing BMI, and dipstick proteinuria as independent predictors of hypertension. Family history of hypertension, diabetes, and thyroid disease were also associated. CONCLUSIONS:There is a strikingly high prevalence of hypertension and central adiposity among adolescents in this semi-urban population, with early clustering of cardiovascular and renal risk factors. These findings underscore the urgent need for targeted school-based screening and preventive interventions in similar transitional settings across India.
Cardiovascular disease (CVD) is a leading and preventable cause of maternal mortality in low and middle-income countries (LMICs), yet most management guidelines rely on data from high-income countries. Robust, nationally representative data on pregnant women with heart disease (PWHD) are limited in India, underscoring the need for locally relevant evidence to guide clinical practice and policy. The National Pregnancy and Cardiac Disease Study in India (NPAC-India) is a multiphase national initiative, and this paper describes the protocol for Phase 1, a prospective multicenter observational study initiated at 56 sites across India. All consecutive pregnant women presenting for antenatal care with known or newly diagnosed cardiovascular diseases, including congenital or acquired structural heart disease, cardiac arrhythmia, ischemic heart disease, aortopathies, or pulmonary vascular disease, will be enrolled from July 2024. Clinical details related to antenatal, intranatal, and postnatal care will be systematically documented. All study participants will be followed up for 6 months after the end of their pregnancy. The primary outcome is a composite of maternal cardiac events during pregnancy and up to 6 weeks postpartum. The secondary outcomes cover obstetric and fetal parameters. The study will evaluate the predictive accuracy of widely used general and lesion-specific risk assessment tools in the Indian population and explore the development and validation of a population-specific risk stratification model. The NPAC-India study is expected to facilitate the development of evidence-based, locally tailored guidelines for managing heart disease in pregnancy, thereby reducing maternal and fetal risks in India. The generation of national data may strengthen clinical care, improve resource allocation, and inform public health policy.
Introduction: To identify the causes of fever with rash in adults and analyze their epidemiological spectrum. Material and Methods: This two-year prospective observational study included 200 adults (>18 years) presenting with fever and rash at the dermatology department of B.J. Medical College, Ahmedabad. After informed consent, demographic data, clinical history, photographs, and detailed dermatologic and systemic examinations were recorded. Results: Of 200 patients, 112(56%) were males and 88(44%) females, with a mean age of 34.4 years. Maculopapular rash was most common (35%), followed by diffuse erythematous rash with desquamation (19%), petechial/purpuric rash (17%), vesiculobullous rash (12%), nodular rash (10%), and urticarial rash (7%). Infections were the leading cause (57.5%), with drug reactions accounting for 19.5%, and the rest (23%) were attributed to less common etiologies like Acute cutaneous lupus erythematosus, urticarial vasculitis, and Sweet’s syndrome. Common symptoms include headache, joint pain, and malaise. Viral infections showed lymphopenia (60.56%), bacterial infections neutrophilia (68.51%), and drug reactions eosinophilia (72.55%). Diagnostic tests correlated well with clinical and routine laboratory findings. Conclusion: Fever with rash in adults requires a structured diagnostic approach. Careful clinical evaluation with basic tests such as complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) is cost-effective and useful.
