ABSTRACT
INTRODUCTION: A small proportion of patients presenting to the Emergency department (ED) of any hospital tend to take discharge against medical advice (DAMA) due to several patient related or hospital/service related reasons. Amongst these, orthopaedic patients are a special group due to their inability to mobilise independently due to injuries and have treatment needs which involve higher costs. The aim of the current study was to ascertain and analyse the reasons for orthopaedic walkouts at a tertiary care new private hospital. MATERIALS AND METHODS: This retrospective telephonic structured interview-based study was carried out on all orthopaedic patients taking DAMA during a one-year period from July 2016 to June 2017. They were telephonically interviewed with a structured questionnaire. Hospital and ED records were analysed for demographic as well as temporal characteristics. RESULTS: A total of 68 orthopaedic patients walked out of casualty against medical advice out of a total 775 (8.77%) orthopaedic patients presenting during the period as against 6.4% overall rate of DAMA for all specialties. The main reasons for DAMA were financial unaffordability of treatment (36.7%), preference for another orthopaedic surgeon (22%) and on advice of the patient's General Practitioner (16.1%). CONCLUSION: Unaffordability of treatment is a significant cause for walkouts amongst orthopaedic patients. Private hospitals need to recognise and implement processes by which these patients can be treated at affordable costs and with coverage either by medical insurance or robust charity programs. Patient education and awareness are important to encourage them to have insurance coverage.
ABSTRACT
Filariasis continues to be one of the endemic problems worldwide with 40% of the cases in India. We report a case of lymphatic filariasis in a 32-year old female who presented with a non-tender swelling over left upper arm. Blood sample showed no eosinophilia while the FNAC was diagnostic of W. bancrofti. Patient responded well with oral diethylcarbamazine. High index of suspicion of filariasis is indicated when dealing with a swelling of unknown cause especially in filariasis endemic areas.
ABSTRACT
Under conditions of vitamin B12 deficiency the marine phytoplankton Thalassiosira pseudonana secretes into the growth medium a protein (Gm protein) that binds B12 specifically with an affinity constant of 2 x 10(11) M(-1). When Gm protein was used as a B12-specific binder in radioassays for the direct determination of the vitamin, the detection limit of the technique approached 5 pg B12/mL. In its natural state, Gm protein is oligomeric having molecular weight of over 400 kDa. Modification of the solution environment of this protein produces unique changes in its tertiary and quaternary structure. The amino acid and submit composition of the protein is reported.
Subject(s)
Carrier Proteins/chemistry , Phytoplankton/chemistry , Porphyrins/metabolism , Vitamin B 12/analysis , Binding, Competitive , Carrier Proteins/metabolism , Chromatography, Gel , Chromatography, High Pressure Liquid , Corrinoids , Electrophoresis, Polyacrylamide Gel , Sensitivity and SpecificityABSTRACT
Vitamin B12-binding proteins were detected in the body fluids and/or tissues of horseshoe crabs (Limulus polyphemus), clams and sponges. Among the biological specimens tested the Limulus plasma was especially rich in free B12-binding proteins. Gel filtration experiments revealed that Limulus plasma contains two classes of B12-binding proteins. One class of proteins, molecular weight in excess of 100,000, bind B12 preferentially with affinity constant of 5 X 10(11)M-1. The second type of proteins, molecular weights around 50,000, bind B12 with specificity approaching that of mammalian intrinsic factors. The binding constant of these proteins for B12 is around 10(11)M-1.
