Association of clinical features, comorbidities and laboratory profile with outcomes among dengue patients admitted in a tertiary care hospital, Delhi NCR

Background: Dengue fever is an endemic disease across multiple countries. Dengue infection results in a wide spectrum of non-specific clinical manifestations with unpredictable clinical course and outcome. Objective of the study was to understand the association of different clinical features, comorbidities and laboratory profile with outcomes (ICU use, ventilation use and blood transfusion) among dengue patients admitted in a tertiary care hospital in Delhi, National Capital Region.Methods This cross-sectional study included 75 dengue patients with fever <1 week confirmed based on NS-1 antigen and/or IgM antibody positivity. Descriptive analysis was used.Results: Gender was not significantly associated with the outcomes. The duration of fever was significantly higher among those with ICU use (median: 6 versus 4 days; p=0.005), ventilator use (median: 5.5 versus 4.0 days; p=0.049] and blood transfusion (median: 6 versus 4 days; p=0.013). Dengue patients with co-morbidities (diabetes, hypertension, or chronic obstructive pulmonary disease) or co-infection had a significantly higher odds of the outcomes. The platelet level was significantly lower while liver enzymes were significantly higher among those with the outcomes.Conclusions: The clinical features, comorbidities and laboratory profile can help in identifying critical patients for ICU admission and timely intervention to improve outcome

Analysis of Oxford medial unicompartmental knee replacement using the minimally invasive technique in patients aged 60 and above: an independent prospective series

We present the outcome of an independent prospective series of phase-3 Oxford medial mobile-bearing unicompartmental knee replacement surgery. Eight surgeons performed the 154 procedures in a community-based hospital between 1998 and 2003 for patients aged 60 and above. Seventeen knees were revised; in 14 cases a total knee replacement was performed, in 3 cases a component of the unicompartmental knee prosthesis was revised, resulting in a survival rate of 89% during these 2–7 years follow-up interval. This study shows that mobile-bearing unicompartmental knee replacement using a minimally invasive technique is a demanding procedure. The study emphasises the importance of routine in surgical management and strict adherence to indications and operation technique used to reduce outcome failure

Source influence on emission pathways and ambient PM2.5 pollution over India (2015–2050)

India currently experiences degraded air quality, with future economic development leading to challenges for air quality management. Scenarios of sectoral emissions of fine particulate matter and its precursors were developed and evaluated for 2015–2050, under specific pathways of diffusion of cleaner and more energy efficiency technologies. The impacts of individual source-sectors on PM2.5 concentrations were assessed through GEOS-Chem model simulations of spatially and temporally resolved particulate matter concentrations, followed by population-weighted aggregation to national and state levels. PM2.5 pollution is a pan-India problem, with a regional character, not limited to urban areas or megacities. Under present-day emissions, levels in most states exceeded the national PM2.5 standard (40 µg/m3). Future evolution of emissions under current regulation or under promulgated or proposed regulation, yield deterioration in future air-quality in 2030 and 2050. Only under a scenario where more ambitious measures are introduced, promoting a total shift away from traditional biomass technologies and a very large shift (80–85 %) to non-fossil electricity generation was an overall reduction in PM2.5 concentrations below 2015 levels achieved. In this scenario, concentrations in 20 states and six union territories would fall below the national standard. However, even under this ambitious scenario, 10 states (including Delhi) would fail to comply with the national standard through to 2050. Under present day (2015) emissions, residential biomass fuel use for cooking and heating is the largest single sector influencing outdoor air pollution across most of India. Agricultural residue burning is the next most important source, especially in north-west and north India, while in eastern and peninsular India, coal burning in thermal power plants and industry are important contributors. The relative influence of anthropogenic dust and total dust is projected to increase in all future scenarios, largely from decreases in the influence of other PM2.5 sources. Overall, the findings suggest a large regional background of PM2.5 pollution (from residential biomass, agricultural residue burning and power plant and industrial coal), underlying that from local sources (transportation, brick kiln, distributed diesel) in highly polluted areas

Oxford Phase 3 unicompartmental knee arthroplasty: medium-term results of a minimally invasive surgical procedure

PURPOSE: In the last decade, a major increase in the use of and interest in unicompartmental knee arthroplasty (UKA) has developed. The Oxford Phase 3 UKA is implanted with a minimally invasive technique using newly developed instruments. The objective of this prospective study was to evaluate the outcome of UKA in patients with medial osteoarthritis of the knee in a high-volume unit. METHODS: Two-hundred and forty-four UKAs were performed with a minimally invasive approach. The median age was 72 (43-91) years. The median follow-up was 4.2 years (range 1-10.4 years). Fourteen patients died, and nine were considered to be lost to follow-up, but all had a well-functioning prosthesis in situ until their last follow-up. Pain, function and health-related quality of life were evaluated pre- and postoperatively using patient- and assessor-based outcome scores, as well as radiographic evidence. RESULTS: The mean Knee Society knee and function scores, WOMAC-scores, Oxford-score and VAS pain and satisfaction all improved. Nine knees required revision. Eleven patients required an additional arthroscopic procedure due to persisting pain secondary to intra-articular pathology, and four patients required manipulation under anaesthesia because of limited range of motion. The 7-year cumulative survival rate of the arthroplasty was 94.4%. A low incidence (21%) of a radiolucent line beneath the tibial component was observed at 5 years of follow-up. CONCLUSION: This study showed a high survival rate of the Oxford Phase 3 UKA. Patient satisfaction and functional performance were also very high. Major complication rate was low; in addition, the incidence of radiolucency under the tibial component, when compared to present literature, was low. When strict indication criteria are followed, excellent, durable, and in our opinion reliable, results can be expected for this procedur

Sub-acute care from an 'insiders' perspective

Letter to the EditorPrashant Tibrewa

Caffeine induced psychotic exacerbation

Prashant Tibrewal and Rohan Dhillo

Posterior dislocation of the Oxford knee meniscal bearing: a treatment option.

Unicompartmental knee replacement (UKR) is now established as a treatment for medial compartment arthritis. The Oxford UKR (Biomet Orthopedics, Inc, Warsaw, IN, USA) has a mobile-bearing system, which minimizes wear. This has been shown to provide excellent long-term results. Dislocation of the mobile-bearing device is rare with an incidence of 1 in 200 (0.5 %). The treatment usually involves exploration of the knee through the original anteromedial incision, removal of the dislocated bearing and rectification of the underlying cause for the dislocation. We describe two cases of a posterior dislocation in which the mobile bearing could not be retrieved and was left in situ. In both cases a good outcome was achieved. We conclude that in extremely rare cases where a dislocated bearing has migrated posteromedially and cannot be retrieved, it can be left in place rather than exploring the joint acutely through a separate posterior incision

Temazepam withdrawal induced psychosis

Jacob Alexander, Prashant Tibrewal and Robert Fantasi

Lamotrigine-induced tactile hallucination

Han Kyung Oh, Prashant Tibrewal, Rohan Dhillo