Ultrasound findings in knee of patients of osteoarthritis and their correlation with pain

Background: Osteoarthritis (OA) is a common joint disorder, with the knee being one of the most frequently involved sites. Conventional radiography (CR), hitherto the primary imaging tool in OA, shows late and indirect findings. Ultrasound (US), on the other hand, offers the possibility to depict different structures within the knee. The main objectives of this study is to asses correlation of Ultrasonography (USG) findings of OA knees and pain assessed in each knee using a numerical rating scale (NRS) from 0 to 10.Methods: This study was a single center cross sectional observational study. Patients presenting to rheumatology clinic between February 2017 to March 2017 and satisfying ACR clinical criteria for osteoarthritis of knees were taken. Pain assessed in each knee using NRS. USG evaluation of painful knee was done using standard protocols.Results: In this study, 9 patients and 17 knees were examined. The mean age was 65.7 yrs with more females (66%) as compared to males (33.3%), mean disease duration was 6 yrs with majority of patients (88%) on pain reliever medications (NSAIDS). Ultrasound showed that synovitis and osteophytes has negative correlation with pain score (r=-0.06, r-.09). Presence of cartilage loss had slightly higher correlation with pain score (r=0.18). The meniscal protrusion (r value 0.15) is associated slight correlation with pain score.Conclusions: Ultrasound can assess many soft tissue pathologies which cannot be seen on conventional radiography, however the importance of these soft tissue pathologies is uncertain and remains to be determined. In this study we could not find any significant correlation between pain and ultrasound findings

Biosimilar etanercept: a real world safety and patient related outcomes from a single centre

Background: Biosimilars are expected to provide affordable and quality treatment equivalent to the biologics in various rheumatic disorders. Presently, the data available on the safety and effectiveness of biosimilars is very scarce. The objective of the present study was to assess the safety profile of intended biosimilar of etanercept developed by Intas pharmaceuticals Ltd. (Intacept) in Rheumatoid arthritis (RA), spondyloarthropathy (SpA), ankylosing Spondylitis (AS), juvenile idiopathic arthritis (JIA) and psoriatic arthritis (PsA).Methods: In single center, retrospective observational study, all patients were enrolled in routine clinical practice     who received Intended biosimilar of Etanercept (Intacept) and the following data was collected. Basic demographic profile, disease and duration of therapy, any adverse event, patient’s global assessment of disease activity on visual analogue scale (0 to 100), patient’s overall experience with Intended biosimilar etanercept (Intacept).Results: Total 70 patients were enrolled (41males and 29 females) having RA (42), AS (11), SpA (13), JIA (2) AND PsA (2). The mean duration of follow up was 8±1.7 months. 10% patients reported adverse events like injection site pain (4.29%), fever (2.86%), redness (1.42%) and weight gain (1.42%). 45% patients had LTBI screen positive and were initiated on chemoprophylaxis with Rifampicin and INH 4weeks prior to Intacept. About 24% of patients dropped due to various reasons like affordability issue (5.7%), inadequate response (8.6%), no response (10%) and side effects (5.7%). 51.4% patients observed more than 50% improvement in global disease activity with Intacept while 10% patients did not get any response with the treatment. 77.2% patients perceived the overall therapy with Intacept as excellent, very good, good or OK while 22.8% patients rated Intacept therapy as non-satisfactory.Conclusions: The study leads to the conclusion that Intended biosimilar of etanercept (Intacept) was safe and well tolerated in various rheumatic disorders in a real-world scenario

Adaptation and human migration, and evidence of agriculture coincident with changes in the Indian summer monsoon during the Holocene

Human societies have evolved through a complex system of climate and ecological interactions. Known records suggest intimate relationship of adaptations, mitigations and migrations to climate extremes leaving their impacts on human societies. The northwestern part of India provides such an example, where human civilizations flourished in the early Holocene along the major fluvial systems when the Indian summer (southwest) monsoon was much stronger and rainfall was higher over the Indian land mass. Summers were thus wetter, conducive to agriculture and ecodiversity. Changes in the early civilizations in the Indian subcontinent had a close relation to changes in the monsoon climate over the past 10,000 years. The summer monsoon has weakened over the last 7000 years since its peak intensification in the early Holocene (10,000-7000 cal yrs BP). Discrete intervals of dry phases in the summer monsoon are visible in the proxy record of the monsoon winds from the marine sediments of the Arabian Sea, which had significant impact on human settlements in South Asia. The strongest aridity in the Indian subcontinent and extended periods of droughts at ca 5000- 4000 cal yrs BP seems to have triggered eastward human migrations towards the Ganga plain. Other times of monsoon weakening during the Holocene are coincident with the initial development of ponds, reservoirs and other rainwater harvesting structures that may have served as an adaptation to climate change

Epi InfoTM a mHealth tool for primary field data collection in subsample population of Uttarakhand- A cross sectional study.

Background: A deficient data is among the biggest obstacle facing planners and policy makers. Health data collection in the developing world is often hampered by the high costs and inefficiencies of traditional large-scale paper-based surveys. mHealth using Epi-Info is most appropriate tool to create, share, deploy health surveys and for strengthening of health systems. The program runs on free and open software, is easy to use, and can be downloaded to handheld devices to be used by workers in the field.  Objectives: To find out the usefulness and limitations of data collection for mHealth by use of Epi InfoTM software.  Methods: The devices used Epi Info 7.1.5 (Android version), which has been modeled as a database with variables of the traditional form. A cross sectional survey among adolescents regarding their health needs was carried out in a sample of 200 adolescents (purposive sampling) of rural hilly (Jaunpur block of Tehri Garhwal district) and plain (Doiwala block of Dehradun district) areas of Uttarakhand by the use of Android tablets with Epi InfoTM.  Results: It was found that adolescent questionnaire tool developed in Epi InfoTM android tablet application is a powerful tool for data collection having numerable practical advantages like: Interview Time Tracking (ITT) that gives the reality check in field studies along with cases Geographical presentation by GIS mapping. In addition to this complete filling of data in field so no left over or guessing for data entry operator, paperless, bio-friendly. Despite of Tablet cost, it is cost effective as tablet can be repeatedly used for other surveys.  Conclusions: Epi InfoTM is a developing open access software for primary data collection and analyzing data from the field, with advantageous benefits of epidemiological surveys

Prevalence of Hepatitis B and Hepatitis C Virus Infection in Patients with Advanced Renal Failure: A Tertiary Care Centre Study from North Indian Population

Abstract: Viral hepatitis (Hepatitis B Virus (HBV) & Hepatitis C Virus (HCV)) related liver disease is a leading cause of morbidity and mortality especially in the patients with advanced renal failure who are treated with dialysis, and this is due to high number of blood transfusion sessions and/or cross contamination from the dialysis circuits. Aims & Objectives: This study aimed to determine the prevalence of HBV and HCV infections in patients with advanced renal failure (ARF). Materials & Methods: A cross-sectional study was done in joint collaboration of Department of Nephrology and Department of Gastroenterology, KGMU, Lucknow, from June 2018 to June 2020 among, CRF patients. Clinical data such as age, gender, duration of dialysis; number of transfusions, Serum sample was collected from each patient. Serological markers for HBV and HCV were determined with ELISA by using commercial diagnostic kits. HCV-RNA and HBV-DNA were determined quantitatively by polymerase chain reaction (PCR) assay. Results: A total 934 patients with advanced renal failure attended the nephrology OPD. Out of 934 patients, 65 (6.96%) patients screened positive for HBV/HCV infection. The results of this study also showed that the prevalence of viral hepatitis infection in the haemodialysis (HD) and without HD patients is 8.25% and 6.3% respectively. Conclusion: It has been found that viral infections, particularly HBV and HCV infections are common in advanced renal failure patients who are on HD

Utajony fosfaturyczny guz mezenchymalny kory kości udowej powodujący osteomalację onkogenną — problemy diagnostyczne i skutki kliniczne

Background: Tumor induced osteomalacia (TIO) are extremely rare paraneoplastic syndrome with less than 300 reported cases. This report highlights the pitfalls and challenges in diagnosing and localizing TIO in patients with refractory and resistant osteomalacia. Patient and methods: 41- year gentleman with 4-year history of musculoskeletal weakness and pathologic fractures presented in wheelchair bound incapacitated state of 1-year duration. Investigations were significant for severe hypophosphatemia, severe phosphaturia, normal serum calcium, reduced 1,25-dihydroxy vitamin-D, elevated ALP, elevated intact parathyroid hormone (iPTH), and pseudo-fractures involving pelvis and bilateral femur. Whole body MRI and 99mTc methylene diphosphonate bone-scan were also normal. Whole body FDG-PET scan involving all 4 limbs revealed a small FDG avid lesion at lateral border of lower end of left femur (SUV max 3.9), which was well characterized on 3-dimensional CT reconstruction. Plasma C-terminal fibroblast growth factor (FGF)-23 was 698 RU/ mL (normal < 150 RU/ml). Wide surgical excision of the tumor was done. Histopathology confirmed mesenchymal tumor of mixed connective tissue variant. Serum phosphorous normalized post-surgery day-1. High dose oral calcium and vitamin-D was continued. FGF-23 normalized post surgery (73RU/ml). Physical strength improved significantly and now he is able to walk independently. Conclusion: TIO is frequently confused with normocalcemic hyperparathyroidism and vitamin-D resistant rickets/osteomalacia, which increases patient morbidity. Imaging for tumor localization should involve whole body from head to tip of digits, cause these tumors are notoriously small and frequently involve digits of hands and legs. Complete surgical removal of the localized tumor is key to good clinical outcomes.Wstęp: Osteomalacja wywołana obecnością guza (tumor-induced osteomalacia, TIO) to niezwykle rzadki zespół paraneoplastyczny. Opisano dotąd tylko niecałe 300 przypadków tego zespołu. W niniejszej pracy zwrócono uwagę na błędy i problemy przy diagnozowaniu i lokalizowaniu TIO u chorych z oporną na leczenie osteomalacją. Materiał i metody: W pracy przedstawiono przypadek chorego w wieku 41 lat, u którego od 4 lat występowały złamania patologiczne i osłabienie układu mięśniowo-szkieletowego prowadzące do niepełnosprawności, w wyniku czego chory od roku korzystał z wózka inwalidzkiego. W badaniach stwierdzono ciężką hipofosfatemię, ciężką fosfaturię, prawidłowe stężenie wapnia w surowicy, zmniejszo­ne stężenie witaminy 1,25-dihydroksy D, podwyższoną aktywność fosfatazy zasadowej, zwiększone stężenie parathormonu w postaci całkowitej cząsteczki (intact parathyroid hormone, iPTH) oraz złamania rzekome w obrębie miednicy i obu kości udowych. W badaniu MRI całego ciała oraz scyntygrafii kości z użyciem difosforanu metylenu znakowanego technetem 99mTc nie stwierdzono nieprawidłowości. W obrazie badania FDG-PET obejmującego wszystkie 4 kończyny zauważono niewielką zmianę o zwiększonym wychwycie FDG na bocznej powierzchni dolnego końca lewej kości udowej (SUV maks. 3,9), którą dobrze scharakteryzowano w trójwymiarowej rekon­strukcji CT. Stężenie C-końcowego peptydu czynnika wzrostu fibroblastów-23 (fibroblast growth factor-23, FGF-23) wynosiło 698 RU/ml (norma &lt; 150 RU/ml). Guz usunięto chirurgicznie z szerokim marginesem. W badaniu histopatologicznym potwierdzono rozpoznanie guza mezenchymalnego — wariant mieszanej tkanki łącznej. W pierwszym dniu po operacji stwierdzono normalizację stężenia fosforu w surowicy. Kontynuowano stosowanie dużych doustnych dawek wapnia i witaminy D. Również stężenie FGF-23 unormowało się po zabiegu (73 RU/ml). U chorego zwiększyła się siła fizycznej i obecnie może on chodzić samodzielnie. Wnioski: Osteomalacja wywołana obecnością guza (TIO) jest często mylona z normokalcemiczną nadczynnością przytarczyc i krzywicą/ osteomalacją oporną na leczenie witaminą D, co powoduje zwiększoną chorobowość pacjentów. Badania obrazowe w celu zlokalizowa­nia guza powinny obejmować całe ciało od czubka głowy po palce u stóp, ponieważ guzy te są zwykle małe i często umiejscawiają się w obrębie palców dłoni i stóp. Całkowite chirurgiczne usunięcie guza warunkuje uzyskanie dobrego efektu leczenia

Study of ambient air pollutants over Rishikesh at foothills of north-western Indian Himalaya

49-60Air quality parameters measured over Rishikesh city of Uttarakhand, where a large number of visitors and pilgrimage stay and pass by throughout the year are analyzed and studied. Such intensive human activities lead to the impacts and its manifestation on regional scale environment. Due to consistent infrastructure development and the increased vehicular emission due to transport, a large amount of particulate matters is added to the ambient environment and affects the air quality adversely. Here an attempt is made to understand the growth in level of ambient air pollutants through available measurement. In this study particulate matter (PM10), suspended particulate matters (SPMs) and the concentration of gaseous pollutants (SO2 and NO2) from 2011 to 2014 are measured and analyzed. It is observed that concentrations of the pollutants increase during pre-monsoon season as compared to the winter and monsoon seasons. In addition, PM10 and SPM concentrations are found about two times higher than the prescribed national standard. SO2 and NO2 levels are found within the limits as proposed by the Central Pollution Control Board (CPCB) New Delhi, India. A detailed statistical analysis is carried out on the basis of monthly mean values of the observed pollutants. The PM10 exhibits a significant positive correlation with SO2 and NO2 concentrations. In addition, back trajectories show partly long-term transport from North Africa, Saudi Arabia and central Asian region in contributing over the region with local emission that is considered to be the main and direct cause of increasing trend of the pollutants

Antimicrobial and cytotoxic activities of Barleria prionitis and Barleria grandiflora: A comparative study

Leaf juices as well as leaves of Barleria prionitis and Barleria grandiflora are being used by rural people across various regions of India in the treatment of oral ailments such as dental troubles, gum ailments, pyorrhoea, dental carries and mouth ulcers. Zone of inhibition and MIC values obtained for all the extracts suggest ethanolic extract of the herbs were more antimicrobial when compared to the aqueous extract. Results of biofilm suppression were found statistically significant (p<0.05) when compared to control. Cytotoxicity was evaluated by MTT assay on human gingival fibroblast and human dermal fibroblast cell lines for ethanolic extract of the herbs. CTC50 value was found to be more than 1,000 µg/mL for ethanolic extracts of both herbs. Chlorhexidine was found to be more cytotoxic with CTC50 value of 12.525 µg/mL. Ethanolic extract of B. prionitis and B. grandiflora found significantly cytotoxic (p<0.05) in comparison with control. Video Clip of Methodology: Cytotoxicity assay: 18 min 45 sec   Full Screen   Alternativ

Therapeutic radiological interventional procedures in hepatocellular carcinoma

Background: To improve the survival rate of patients with hepatocellular carcinoma (HCC) in whom surgery is not possible, various methods have been developed employing angiographic and percutaneous techniques. We analyzed our experience with various percutaneous therapeutic interventional techniques done for HCC in our center. Methods: Sixty-one patients with inoperable HCC (mean age 48.9 [SD 13.8] y; 47 men) were treated between January 1997 and December 2000 by transcatheter arterial chemoembolization (TACE) alone (22), TACE with percutaneous alcohol injection (PEI) (20), transcatheter arterial embolization (TAE) with steel coils and gel foam for gastrointestinal bleed (7), percutaneous radiofrequency ablation (1), percutaneous preoperative right portal vein embolization (3) and percutaneous preoperative tumor embolization to reduce blood loss at surgery (8). Results: In 42 patients treated by TACE and PEI and TACE alone, tumor necrosis was scored; over 50% necrosis was seen only after six and nine months in both treatment groups. The survival rates after six and nine months and the median survival were similar in the two groups. Of 7 cases treated with TAE with steel coils and gel foam, the gastrointestinal bleeding stopped in four; in the other three, bleeding did not stop completely although less transfusion was required. In the patient treated by radiofrequency ablation, follow-up contrast-enhanced CT did not show enhancing tumor mass. We noted left lobe enlargement after percutaneous preoperative right portal vein embolization, prior to right hepatectomy. Conclusion: In patients with HCC not amenable to surgical intervention, a variety of percutaneous therapeutic interventional techniques may be used