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

A complete transition to clean household energy can save one–quarter of the healthy life lost to particulate matter pollution exposure in India

Exposure to fine particulate matter (PM _2.5 ) is a leading contributor to the disease burden in India, largely due to widespread household solid fuel use. The transition from solid to clean fuels in households has the potential to substantially improve public health. India has implemented large initiatives to promote clean fuel access, but how these initiatives will reduce PM _2.5 exposure and the associated health benefits have not yet been established. We quantified the impacts of a transition of household energy from solid fuel use to liquefied petroleum gas (LPG) on public health in India from ambient and household PM _2.5 exposure. We estimate that the transition to LPG would reduce ambient PM _2.5 concentrations by 25%. Reduced exposure to total PM _2.5 results in a 29% reduction in the loss of healthy life, preventing 348 000 (95% uncertainty interval, UI: 284 000–373 000) premature mortalities every year. Achieving these benefits requires a complete transition to LPG. If access to LPG is restricted to within 15 km of urban centres, then the health benefits of the clean fuel transition are reduced by 50%. If half of original solid fuel users continue to use solid fuels in addition to LPG, then the health benefits of the clean fuel transition are reduced by 75%. As the exposure–outcome associations are non–linear, it is critical for air pollution studies to consider the disease burden attributed to total PM _2.5 exposure, and not only the portion attributed to either ambient or household PM _2.5 exposure. Our work shows that a transition to clean household energy can substantially improve public health in India, however, these large public health benefits are dependent on the complete transition to clean fuels for all

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

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

Functional Identification of Valerena-1,10-diene Synthase, a Terpene Synthase Catalyzing a Unique Chemical Cascade in the Biosynthesis of Biologically Active Sesquiterpenes in Valeriana officinalis

Valerian is an herbal preparation from the roots of Valeriana officinalis used as an anxiolytic and sedative and in the treatment of insomnia. The biological activities of valerian are attributed to valerenic acid and its putative biosynthetic precursor valerenadiene, sesquiterpenes, found in V. officinalis roots. These sesquiterpenes retain an isobutenyl side chain whose origin has been long recognized as enigmatic because a chemical rationalization for their biosynthesis has not been obvious. Using recently developed metabolomic and transcriptomic resources, we identified seven V. officinalis terpene synthase genes (VoTPSs), two that were functionally characterized as monoterpene synthases and three that preferred farnesyl diphosphate, the substrate for sesquiterpene synthases. The reaction products for two of the sesquiterpene synthases exhibiting root-specific expression were characterized by a combination of GC-MS and NMR in comparison to the terpenes accumulating in planta. VoTPS7 encodes for a synthase that biosynthesizes predominately germacrene C, whereas VoTPS1 catalyzes the conversion of farnesyl diphosphate to valerena-1,10-diene. Using a yeast expression system, specific labeled [13C]acetate, and NMR, we investigated the catalytic mechanism for VoTPS1 and provide evidence for the involvement of a caryophyllenyl carbocation, a cyclobutyl intermediate, in the biosynthesis of valerena-1,10-diene. We suggest a similar mechanism for the biosynthesis of several other biologically related isobutenyl-containing sesquiterpenes

Squamous cell cancers contain a side population of stem-like cells that are made chemosensitive by ABC transporter blockade

Cancers are a heterogeneous mix of cells, some of which exhibit cancer stem cell-like characteristics including ATP-dependent drug efflux and elevated tumorigenic potential. To determine whether aerodigestive squamous cell carcinomas (SCCs) contain a subpopulation of cancer stem cell-like cells, we performed Hoechst dye efflux assays using four independent cell lines. Results revealed the presence of a rare, drug effluxing stem cell-like side population (SP) of cells within all cell lines tested (SCC-SP cells). These cells resembled previously characterised epithelial stem cells, and SCC-SP cell abundance was positively correlated with overall cellular density and individual cell quiescence. Serial SCC-SP fractionation and passaging increased their relative abundance within the total cell population. Purified SCC-SP cells also exhibited increased clonogenic potential in secondary cultures and enhanced tumorigenicity in vivo. Despite this, SCC-SP cells remained chemotherapeutically sensitive upon ATP-dependent transporter inhibition. Overall, these findings suggest that the existence of ATP transporter-dependent cancer stem-like cells may be relatively common, particularly within established tumours. Future chemotherapeutic strategies should therefore consider coupling identification and targeting of this potential stem cell-like population with standard treatment methodologies

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