Differences in Life Expectancy and Age-Specific Mortality between the Large Cities of Ukraine

The aim of this paper is to identify the age-specifi c characteristics of the mortality in the large cities of Ukraine and their contributions to the changes in life expectancy in these cities. The article presents the results of a comparative analysis of the dynamics of life expectancy from 2002 through 2019 in six cities: Kyiv, Kharkiv, Odesa, Dnipro, and Donetsk. It is shown that most of the large cities have generally experienced higher life expectancy than other urban settlements in Ukraine, but there is a signifi cant variation in the levels and changes in life expectancy across cities. Overall, the study established the vanguard position of Lviv and Kyiv in terms of life expectancy, although these cities, as well as Kharkiv, showed a slower increase in life expectancy in 2002-2019. In contrast, Dnipro and Odesa, as well as Donetsk (up to 2014) having lower life expectancy and wider diff erences by sex demonstrated the pronounced improvement in life expectancy during that period. In recent years, there has been a trend towards narrowing the gap between cities, and this convergence is occurring more rapidly among men than among women. In 2002, the gap between cities with the highest and lowest life expectancy was 5.4 years for males and 2.6 years for females while in 2019 it was reduced to 2 years for men and 1.6 years for women. We made a decomposition of diff erences in life expectancy at birth between the cities in 2002 and 2019 to assess the age-specifi c mortality contributions into disparities between urban areas. The results have revealed that across almost all cities these diff erences are mainly driven by excess mortality in working ages. Also, we found that excess mortality in the middle working ages and under 1 year of age appeared to be the important factors of lower life expectancy in Donetsk compared to Lviv and Kyiv. Odesa and Dnipro are lagging behind by survival rate not only in the older but also in young working age groups, and Kharkiv has slightly higher mortality among older people (in comparison to Lviv and Kyiv). Th e conclusion is made that the main gradient of diff erences in life expectancy between the large cities has been determined mainly by deaths in working ages, i.e. mostly driven by health-related behavior and lifestyle. Nevertheless, a gradual shift in urban life expectancy diff erences is now taking place towards mortality in older age groups, i.e. more determined by the eff ectiveness of treatment of chronic diseases. Th e issue of data quality is also considered. In particular, the confi dence interval of the probability of dying in the fi rst year of life in the six selected cities is estimated to determine the accuracy of these indicators.

RADIOLOGIC- PATHOLOGIC CORRELATION OF DEPTH OF INVASION IN TONGUE CARCINOMA

Introduction: th In tongue carcinoma according to AJCC 8 guidelines depth of invasion is included in staging, therefore there is need of imaging which can accurately assess the pretreatment stage of tumor. The objective of this study was to correlate the depth of invasion reporting by MRI and postoperative HPR. Methods: In MRI DOI was measured by drawing perpendicular lines from the reference line to the point of maximal tumor projection in the tongue medially, histologically DOI was measured from the level of the basement membrane of the closest adjacent normal mucosa. Results: Paired t test was done on the DOI of MRI and HPR. The two tailed P value is less than 0.0001. This difference is considered to be extremely statistically signicant. The mean of group one (DOI-MRI) minus Group 2 (DOI-HPR) equals 6.860. 95% condence interval of this difference is from 5.200 to 8.520. Conclusion: In our study we nd there is statiscally signicant difference between DOI reports in MRI and postoperative HPR.

ASSOCIATION OF GENDER, ALCOHOLISM, PAN CHEWING, HYPERCHOLESTEROLEMIAAND HYPERTENSION WITH GASTRO ESOPHAGEAL REFLUX DISEASE (GERD) AND UPPER GI ENDOSCOPIC FINDINGS IN GERD- A CASE CONTROL STUDY

This was a case control study conducted in a tertiary care hospital in Kerala to nd out the factors that can cause GERD among 138 subjects after getting Institutional Ethics Committee permission and Informed consent from the subjects. Data was collected with the help of questionnaire and also from the medical records. Data was analysed in the SPSS software; proportions and Odds ratio with 95% condence interval were calculated. Pan chewing and Hypercholesterolemia were found to be associated with GERD and 24% of the patients had Barrett’s esophagus on upper GI endoscopy

CLIENT SATISFACTION TOWARDS TRANSPORTATION AND LOGISTICS SERVICES PROVIDERS, TAMIL NADU

Background: The present study focuses on the client satisfaction towards the usage of logistics service providers. The client satisfaction is the similar terminology that's sounds customer satisfaction. The client satisfaction is a term frequently used in marketing, is a measure of how products and services supplied by a transportation and logistics services providers meet or surpass customer expectation. Methodology: In this study, the researcher used descriptive research design. The primary data is collected using a structured questionnaire. The secondary was collected from journals, magazines, project reports, websites and etc. There are 299 registered transportation and logistics service providers in Tamil Nadu. The population of the study would be the customers (clients), who have approached these above companies for service. The population would be innite. The sample size was conned from the Demorgan's table. From the Demorgan's table, the 384 samples are necessary for innite population with 95 per cent of condence level and 5 per cent of condence interval. The researcher has issued 400 questionnaires and received around 391 questionnaires from customers of the transportation and logistics service providers. The remaining nine questionnaires from customers of the transportation and logistics service providers were biased. Results: From the study it was found that the tracking and tracing of cargo as well as the transit time are the major factors considered while selecting the forwarder. Exporters also look for clearance and consolidation service provided by the forwarder. By focusing on these factors, the organization can retain existing customers as well as develop new ones.

INTRAOPERATIVE GLUCOSE LEVELIN NON-DIABETIC PATIENT UNDERGOING ELECTIVE MAJOR SURGERY UNDER GENERALANAESTHESIA RECEIVING DIFFERENT CRYSTALLOID SOLUTIONS AS MAINTENANCE FLUID (A COMPARISON BETWEEN NS AND RL)

INTRODUCTION: The present study was undertaken to observe the effect of different maintenance uid regimen on intraoperative blood glucose levels in non-diabetic patients undergoing elective major surgery under general anesthesia. AIMS AND OBJECTIVES: This study was conducted to observe the effect of different maintenance uids in intraoperative blood glucose levels of non-diabetic patients undergoing elective major non-cardiac surgery under general anesthesia. MATERIALS AND METHODS: The present study was conducted in the Department of Anesthesiology of Assam Medical College, Dibrugarh for a period of one year. Hospital based observational study. Patients undergoing elective major surgeries at operation theatres of Department of General Surgery of Assam Medical College & Hospital, Dibrugarh. One (1) year from July 2015 to June 2016. RESULT: The mean difference of capillary blood glucose level between baseline and 1.5 hours after intubation for those procedures lasted that long in Group N was 22.87 mg/dl with a 95% condence interval of 103.83-108.61 while in Group R it was 26.82 mg/dl with a 95% condence interval of 108.41-111.59. The mean difference of capillary blood glucose level between baseline and 2 hours after intubation for those procedures lasted that long in Group N was 34.14 mg/dl with a 95% condence interval of 117.29–117.71 while in Group R it was 34.07 with a 95% condence interval of 116.38–118.12. CONCLUSION: This study we can come to a conclusion that though there is a rising trend in change in intraoperative capillary blood glucose level in both the solutions used perioperatively, yet the mean change in intraoperative capillary blood glucose level in non-diabetic patients undergoing major surgeries under general anaesthesia receiving either 0.9% sodium chloride or Ringer's lactate solutions as maintenance uid perioperatively, is comparable, yet needs larger groups of study

IN-HOSPITAL MORTALITY OF ACUTE KIDNEY INJURY: AN EXPERIENCE FROM SOUTH RAJASTHAN.

INTRODUCTION: There are few studies on in-hospital mortality among medical intensive care unit (MICU) patients with acute kidney injury (AKI). We assessed the clinical characteristics of AKI at MICU admission, its impact on mortality during the current hospitalization, and whether the inuence of AKI varied in subgroups of AKI patients. METHODS: We identied all adult aged 12 years and above having medical etiology related community acquired AKI who were admitted to MICU at Pacic Medical College and Hospital, Udaipur, India; from 2015 to 2019. AKI was dened based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria; based on serum creatinine (SCr). Dialysis requiring AKI (D-AKI) was dened as needing acute dialysis at or after MICU admission. Among 2440 MICU patients; 516 patients (21.1%) had AKI. We analyzed in-hospital mortality for subgroups of AKI: stage1, stage2 and stage3: with different etiology, comorbidity levels, acute risk factors, primary hospital diagnosis, and treatment with mechanical ventilation, vasopressors and dialysis. RESULTS: Maximum number of AKI patients (57.8%) were in KDIGO Stage3, while stage1 and stage2 had 17.8% and 24.4% respectively. 51.4% patients were male, median age was 54.81 years and average length of ICU stay was 11.73 days. The most common primary diagnosis and etiology was sepsis (31.4%), the most common acute risk factor was hypovolemia (18.8%), the common chronic comorbidity were diabetes (17.0%) and hypertension (10.0%). The most common presenting symptoms was oliguria (43.8 %), while commonest sign on admission was edema (28.1%). Common indications for dialysis were oliguria (75%), hyperkalemia (38.2%), refractory uid overload (36.2%) and metabolic acidosis (35.2%). Overall common critical care treatment required in AKI patients were acute dialysis (58.9%), vasopressor support (16.5%) and ventilator support (14%). The requirement of dialysis was 0.0%, 4.8% and 100%; among stage1, stage2 and stage3 respectively. The overall AKI mortality was 9.9% (95% condence interval (CI) 7% to 12% ). The associations between AKI and mortality were 10.87% (95% CI 5% to 17%) for the AKI-stage1, 13.49% (95% CI 8% to 19% ) for the AKI-stage2 and 8.05% (95% CI 5% to 11%) for the AKI-stage3. The mortality in D-AKI group was 8.6% (95% CI 5 % to 12 %) compared to the mortality in ND-AKI group 11.8% (95% CI 7 % to 16 %). The association between AKI and in-hospital mortality was evident in all subgroups of AKI; association was more pronounced in stage2 AKI, mostly due to worsening of complications which suggests that KDIGO stage2 AKI is a transition zone among D-AKI and ND-AKI groups. Further, it may be needed to lower the threshold for dialysis criteria in AKI. CONCLUSIONS: Any degree of AKI was associated with increased mortality. Timely and early initiation of dialysis in AKI was an important prognostic factor for the reduction of in-hospital mortality.

DETERMINING NEW ANTHROPOMETRIC MARKERS FOR SCREENING TYPE 2 DM IN A CARIBBEAN REGION.

The prevalence of Diabetes Mellitus (DM) in the Caribbean is high. BMI has been criticized as a measure for predicting T2 DM development because it does not discern between fat mass and muscle mass, nor does it reect an individual's fat distribution. The primary objective of the study was to determine the association between Indices using height, waist, hip, thigh, arm, and wrist circumference (cm) with development of T2 DM by comparing it to existing markers in test subjects and assessing their feasibility as predictive indicators for the development of Type 2 DM. In a cross-sectional study, a total of 331 subjects were involved in the study utilizing health centers and health camps in St Kitts (West Indies). Height was measured using Stadiometer, Weight using a calibrated digital weighing scale. Waist, hip, thigh, arm, and wrist circumference (cm) was measured using calibrated tape. ABI (Arav Body Index) is measured using a ratio of Waist and Combined Thigh & Height, Thigh to waist ratio (TWR) and Wrist to arm ratio (WAR) was compared to WHtR, WHR and BMI. ABI had the highest AUROC value among the ve adiposity indices (0.803, 95% condence interval [CI], 0.755 to 0.851; 0.785, 95% CI, 0.735 to 0.835 for WHtR; WHtR (0.785), WTR (0.672), WAR (0.652) and BMI (0.626). The cutoff values for ABI were 0.43. Among subjects with ABI less than 0.42, 83.8% (129) did not have type 2 DM and ABI more than 0.48, 90.2 % (51) had T2 DM. Hence, higher ABI strongly correlates with development of T2 DM. We conclude that ABI could be a more reliable tool for identifying individuals at risk of developing type 2 DM. This will help at-risk individuals to take preventive measures like lifestyle modication.

A STUDY ON FACTORS ASSOCIATED WITH HOSPITALISATION AMONG TUBERCULOSIS PATIENTS AND THEIR OUTCOME:A CROSS SECTIONAL STUDY IN DEPARTMENT OF PULMONARY MEDICINE IN A TERTIARY CARE CENTRE

Objectives: To investigate factors associated with hospitalization among TB patients, factors that lead to longer hospitalization time, outcome of hospitalized TB patients,the predictors of poor treatment outcomes and mortality in a cohort of hospitalized TB patients in the Department of Pulmonary Medicine, IPGME&R, Kolkata. Methods:A cross-sectional study was conducted among205 adult patients diagnosed with tuberculosis as per selection criteria were included in this study. Out of these participants,106 patients are cases who are indoor TB patients in the Department of Pulmonary Medicine, IPGME&R and 99 patients are controls who are TB patients attending the outdoor of Department of pulmonary Medicine,IPGME&R. Results:As per the case and control analysis, factors which are statistically signicant in hospitalisation of TB patients are respiratory failure, hypotension, persistent fever, Hypoalbuminemia, hydropneumothorax, pneumothorax, Pyopneumothorax, Empyema, Anemia, low BMI <18 and pulmonary TB given in the table below in the order of signicance as per p value,Odds ratio and 95% condence interval. Conclusion:Early case detection and effective treatment of tuberculosis and ensuring regularity of treatment adherence would probably lead to reduction of hospitalization and TB related mortality.

STUDY ON EFFICACY AND SAFETY OF RIPASUDIL HYDROCHLORIDE IN TREATMENT OF NEWLY DIAGNOSED PRIMARY OPEN ANGLE GLAUCOMA

Aim: The study aims at evaluating the lowering effect of Intraocular pressure (IOP) and tolerability of Ripasudil(0.4%) ophthalmic solution, a selective rho kinase1 inhibitor, as monotherapy in newly diagnosed primary open angle glaucoma patients. Background: Glaucoma is a chronic progressive optic neuropathy causing irreversible blindness around the world. Current treatment strategy stems from concept of lowering IOP, which is a key modiable risk factor. Ripasudil also known as K 115,is the world's rst Rho-associated coiled-coil-containing protein Kinase 1(ROCK1) inhibitor that lowers IOP by directly acting on trabecular meshwork,increasing conventional outow. Methods: This prospective, interventional study included 53 patients of newly diagnosed primary open angle glaucoma.0.4% Ripasudil ophthalmic solution was instilled twice a day as the primary treatment. The primary endpoint was the degree of IOPreduction after 6 months of treatment, whereas the secondary end points were percentage of patients reaching the predened target IOP and incidence of adverse effects. Results: We examined 53 eyes of 53 primary open angle glaucoma patients. The IOP reduction (relative percentage IOP reduction)from baseline was -2.3 mm Hg(-1.7 to -2.9 mm Hg,95%condence interval ,P<0.001).The predetermined target IOPwas achieved by 54.7% population(29 among 53 patients).The most common adverse effects noted were conjunctival hyperaemia (54.7% of patients),allergic conjunctivitis(35.8% of patients) punctate keratitis(11.32% of patients), blepharitis(15.09% of patients), headache(24.5% of patients), bradycardia(9.43% of patients). Conclusion: Administration of 0.4% Ripasudil ophthalmic solution monotherapy revealed IOPlowering effect and acceptable safety prole in POAG patients. As ROCK inhibitors are novel anti-glaucoma drug, more data and studies are needed to establish best practices for the treatment of the patients.

RISK STRATIFICATION OF HEART FAILURE BY ISCHEMIC MITRAL REGURGITATION IN PATIENT WITH MYOCARDIAL INFARCTION

One of the important complications which causes the increase of mortality and economic burden on patient is the ischemic MR. Its main pathophysiology is the remodeling of the LV after MI which causes the hemodynamic load and heart failure. However, the data on relationship between ischemic MR and duration of heart failure is very few. We prospectively studied 300 patients who admitted for acute myocardial infarction in our hospital. All patients were assessed by echocardiography and graded MR as mild, moderate, and severe according to regurgitant jet area which is less than 20%, 20 – 40%, and more than 40% of the left atrial area, respectively. The median duration of follow up was 1 year (range 6-12 months). Mild and moderate or severe ischemic MR was present in 40.2 and 6.4% of patients respectively. The hazard ratios for HF were 2.9 (95% condence interval (CI), 1.9–4.3; P<.001) and 3.7 (95% condence interval (CI), 2.1-6.5; P<.001) in patients with mild and moderate or severe ischemic MR respectively, with compared to patients without ischemic MR, after adjusting for ejection fraction and other clinical variables like age, sex, Killip class, previous infarction, hypertension, diabetes mellitus, anterior wall infarction, ST elevation infarction and coronary revascularization. In patients with mild ischemic MR, the adjusted hazard ratio for death was 1.1 (95% CI 0.7-1.7; P=.42), where as in moderate or severe ischemic MR it was 2.1 (95% CI 1.3-3.5; P=.02).