Clinical Outcomes and Global Health After Joint Debridement in Adult-Onset Septic Arthritis: A Prospective Observational Study.

PURPOSE: Despite several reports on risk factors for septic arthritis (SA) in adults, the outcomes on quality of life and joint function are sparsely reported. This study aimed to investigate the quality of life and joint function in adult patients treated for SA. METHODS: This prospective observational study enrolled clinically diagnosed adult SA patients and estimated Euroqol 5-dimension 5 levels (EQ-5D-5L) questionnaire, Euroqol Visual Analog Scale (EQ-VAS) and a validated tool for joint function at 1, 3, 6 and 12 months after debridement. RESULTS: Twenty seven patients (20 males/7 females) with 21 knees, four shoulders, and two elbows were evaluated. The mean age of the cases was 51(± 13.00) years. Three cases sustained mortality. EQ-5D-5L (P < 0.01) and EQ-VAS (P < 0.01) scores improved significantly between all time frames. Mean Knee society (P < 0.01), Shoulder QuickDASH, and Mayo elbow scores improved at all time frames. There was no difference in primary outcomes between early (< 14 days) and late (14 days or more) presentation. There was no difference in primary outcome measures between confirmed and suspected SA. Fifteen patients could ambulate without support, while 6 needed some support for walking at 1 year. CONCLUSION: Improved outcomes can be expected in quality of life and joint function in adults' septic arthritis at the end of 1 year after surgical treatment; however, the effects of delay in presentation need to be investigated further. Isolation of the microorganism from an infected joint has no bearing on the outcome measures.

Pseudo-winging of Scapula due to Ventral Scapular Osteochondroma: A Case Report and Literature Review.

INTRODUCTION: Osteochondroma is the most common benign tumor of bone. Scapula is a very rare site for its occurrence. CASE REPORT: A 6-year-old male presented with swelling over the left scapular region for 3 months, which was insidious in onset and gradually progressing. There was a single swelling of approximately 3 × 3 × 2 cm3 over medial border of the left scapula. It was hard in consistency with well-defined margin and irregular surface, non-tender, immobile, arising for the underlying bone, and non-adherent to skin. There was pseudo-winging of scapula. The patient was referred with an anteroposterior view radiograph and a computed tomography scan. A working diagnosis of ventral scapular osteochondroma was made. Excision of lesion was done in prone position. There was no pseudo-winging post-excision. Osteochondroma is rare for scapula. Further, pseudo-winging of scapula is seldom. CONCLUSION: Prone position with internal rotation of shoulder can make the surgery easy. Excision of the tumor helps get rid of pseudo-winging.

Modified Lateral Position for Achilles Tendon Surgeries: A Technical Tip.

Most Achilles tendon surgeries are performed with the patient in the prone position. Some advocate supine position but the access to the tendon is compromised. We describe an innovative technique wherein the patient is positioned lateral but the surgeon has full access to the Achilles tendon as if the patient were positioned prone. We consider that this technique could be easily reproduced and hence widely adopted.

UPLC-MS/MS method for determination of sofosbuvir in human plasma.

INTRODUCTION: A sensitive and rapid method for quantitation of Sofosbuvir in human plasma has been established using ultra performance liquid chromatography-electrospray ionization tandem mass spectrometry (UPLC-ESI-MS/MS). MATERIALS AND METHODS: Sofosbuvir d3 was used as an internal standard. Sofosbuvir and internal standard in plasma sample were extracted using ethyl acetate (liquid liquid extraction). A centrifuged upper layer was then evaporated and reconstituted with the mobile phase of 0.5% formic acid: methanol (30:70, v/v). The reconstituted samples were injected into a Gemini C18 (50×4.6mm, 5µm) column. RESULTS: Using MS/MS in the multiple reaction monitoring mode, Sofosbuvir and Sofosbuvir d3 were detected without severe interferences from human plasma matrix. Sofosbuvir produced a protonated precursor ion ([M+H]+) at m/z 428.35 and a corresponding product ion at m/z 279.26. The internal standard produced a protonated precursor ion ([M+H]+) at m/z 431.38 and a corresponding product ion at m/z 282.37. The calibration curves for the analyte was linear (R2≥0.9956, n=4) over the concentration range of 4.063-8000.010ng/mL. Stability studies revealed that Sofosbuvir was stable in plasma during bench top (7h at room temperature), in injector (20h), at the end of five successive freeze and thaw cycles and long term at -70°C±15°C for 15 days. CONCLUSION: The developed method was validated as per the guidelines of USFDA and the obtained results were found to be within the limits and could be successfully employed for the determination of Sofosbuvir in human plasma for regular and pharmacokinetic studies.

Chronopharmaceutics: as a clinically relevant drug delivery system.

Current research in the field of drug delivery devices, by which pulsatile release is achieved, has been intensified. In this article, an attempt has been made to discuss several types of drug delivery systems that show pulsatile drug delivery characteristics. As found frequently in the living body, many vital functions are regulated by pulsed or transient release of bioactive substances at a specific site and time. Thus it is important to develop new drug delivery devices to achieve pulsed delivery of a certain amount of drugs in order to mimic the function of the living systems, while minimizing undesired side-effects. Pulsatile delivery, which is meant as the liberation of drugs following programmed lag phases, has drawn increasing interest, especially in view of emerging chronotherapeutic approaches. This review article is an attempt to discuss various design strategies, chiefly including reservoir, capsular, and osmotic formulations, and drug delivery systems which cause the pulsed or triggered release of bioactive compounds induced due to certain stimuli like thermal, electrical, and magnetic.

Combined off-pump coronary artery bypass grafting and thyroidectomy.

A 70-year-old Indian woman presented with an acute anterior wall myocardial infarction and a large multinodular goiter causing tracheal compression and dyspnea. Coronary artery angiography revealed severe triple-vessel disease, with an 80% occlusion of the left main stem, necessitating early coronary artery bypass grafting combined with total thyroidectomy. The procedure was performed successfully. At the 1-year follow-up, the patient remains euthyroid and in New York Heart Association functional class I. This case provides further evidence that combined coronary artery bypass grafting and total thyroidectomy is both feasible and safe.

Systemic fungal infections in renal diseases.

Invasive fungal infections are a major challenge in the management of immunocompromised patients and those with renal dysfunction. These challenges are due to the immense morbidity and mortality in such situations. Also the management strategies for invasive mycosis in patients with renal dysfunction have narrow safety profile and involve high-cost. In this review we will discuss the issues involved in the management of invasive mycosis in the patients with renal dysfunction in the form of acute renal failure, chronic kidney disease, dialysis dependency of renal transplant recipients. We also emphasize that the use of Intravenous Liposomal Amphoterecin appears to be an effective alternative to the conventional Amphoterecin B for the treatment of invasive fungal infections in patients with renal dysfunction due to its greatly improved tolerability profile. Commercially two true liposomal preparations (Fungisome and Ambisome) are available. Judgement about the preferred formulation should be made on the basis of disease morbidity, severity of renal dysfunction and the cost involved.

Clinical profile of patients with complications following otitis media.

The paper deals with clinical profile of 56 patients with complications following otitis media. The clinically proved cases with complications were subjected to detailed radiology and bacteriology examination. The course of the disease was corelated with its clinical behaviour, microbial flora and treatment required.

Protein intake in Indian haemodialysis patients.

OBJECTIVES: Aim of our study was to find out the amount of protein consumed by Indian haemodialysis patients. METHODS: Twenty patients with endstage renal disease on regular haemodialysis at a major urban dialysis centre in India had their Kt/V and nPCR measured monthly for 4 months utilising urea kinetic methods. RESULTS: Despite an adequate amount of dialysis per session being delivered to almost all of these patients (19 out of 20 had a Kt/V greater than 1.2) none of our patients had an nPCR greater than 1 gm/kg/day and only 4 patients i.e. 20% had a protein intake greater than 0.8 gm/kg/day which is a cut off point below which mortality has been shown to increase dramatically. Most of the patients had a protein intake between 0.7-0.8 gm/kg/day which is alarmingly low. Patients who consumed non vegetarian food at least thrice a week did appear to have a significantly higher protein intake compared to the rest of the patients. CONCLUSION: We believe that these results are likely to be representative of other dialysis centers in India and that an intensive effort at dietary education aimed at increasing the protein intake in our haemodialysis patients is urgently required. The morbidity and mortality of dialysis patients is high and perhaps appropriate dietary intervention can help to reduce this.

Acute renal failure with neurological involvement in adults associated with measles virus isolation.

BACKGROUND: Three people with clinical manifestations of acute renal failure with neurological involvement of unknown cause were admitted to a hospital in Mumbai, India. We describe clinical presentations and investigations of the cause. METHODS: We analysed case reports and laboratory findings for the patients (age 37-43 years, two men, one woman) that were provided by the clinicians in charge. Serum and cerebrospinal fluid were tested for viral cause by IgM ELISA to Japanese encephalitis, West Nile fever, dengue, and measles. Samples were inoculated in vero-cell culture for virus isolation. The virus isolates were confirmed with indirect immunofluoresence with antimeasles immune sera and mouse monoclonal antibodies to measles HA and F proteins and with neutralisation tests using antimeasles immune sera. FINDINGS: Clinical features were fever, vomiting, oliguria or anuria, bilateral facial weakness, impaired hearing, blindness, proximal and distal areflexic limb paralysis, and respiratory paralysis. No patient had a macropapular rash. Blood urea nitrogen (4.64-27.8 mmol/L) and creatinine (601.1-1105.0 micromol/L) were high, and cerebrospinal fluid contained high concentrations of proteins and pleocytosis. Kidney biopsy samples in two patients showed severe interstitial nephritis. IgM antibodies to measles were found in blood and cerebrospinal fluid. Vero-cell cultures from serum and cerebrospinal fluid of one patient and cerebrospinal fluid of two patients, showed cytopathic effects characteristic of measles. INTERPRETATION: Unusual manifestations of acute renal failure with neurological involvement associated with measles virus in adults presenting without rash was confirmed. Our findings may affect the development of measles-elimination programmes.

Two unusual cases of foreign body larynx.

Two adult patients of foreign body larynx who presented to us with a short history of foreign body inhalation with severe respiratory distress are being reported. They underwent elective tracheostomy preoperatively for maintenance of airway and the foreign body was removed successfully. We conclude that preoperative tracheostomy can be attempted to secure a patient's airway before resorting to removal of foreign body lodged in the larynx.

Can general practitioners carry out drug delivery and periodic examination of leprosy patients in Raipur city?

An intervention study to improve the MDT coverage of leprosy patients by involving general practitioners (GPs) was carried out in Raipur city. Most of the GPs (84%) were willing to undertake drug delivery and periodic examination of the leprosy patients. After involving GPs, the proportion of the patients registered for treatment increased from 33% to 89.2%. The cohort regularity was 57% only which was lower than that found in the Upgraded Urban Leprosy Centre. Drug compliance as found out by the pill count was 91%. Most of the patients (87%) were happy with the services provided by the GPs.

EVALUATION OF A NEW ANAESTHESIA MACHINE (IN LOW FLOW CONDITION).

The performance of a new anaesthesia machine was evaluated under low flow anaesthetic technique for 7 months. An assessment under low flow conditions over a definitive period can highlight the drawbacks or advantages of a machine under stringent conditions. The overall performance was satisfactory in the sense that it proved to be an efficient, reliable and safe machine. Minimum flows of oxygen and nitrous oxide that could be achieved at steady state were 0.4 L/min and 0.5 L/min respectively. At these flows the machine monitors were accurate and one could safely administer anaesthesia with a significant amount of saving of nitrous oxide. The requirement of nitrous oxide fell from 2 cylinders in a day to 2 cylinders in a week.

Plasma lipid profile in gallstone patients from North India.

One hundred and thirty five patients with gallstones along with eighty nine matched controls were studied ultrasonographically to look for any association with hyperlipidemias. Plasma cholesterol and triglycerides were estimated by colorimetric methods and lipoproteins were classified according to Beaumont's classification. Male to female ratio in gallstone patients was 1:3. Mean plasma cholesterol and triglyceride values were higher in male gallstones patients as compared to controls (166.40 +/- 54.21 vs 40.26 +/- 32.80 mg/dl, p <0.01 and 182.65 +/- 84.49 vs 133.18 +/- 52.37 mg/dl, p <0.01 respectively). In female gallstone patients, on the other hand, only plasma triglyceride levels were raised as compared to control (182.65 +/- 84.49 vs 133.18 +/- 52.32 mg/dl, p <0.01). Prevalence of type IIb and type IV was 24.32% and 29.72% in male gallstone patients and 13.2 and 39.70% respectively in female gallstone patients. Thus, more than half of our gallstone patients had hyperlipidemia, the commonest types amongst them being type IIb and type IV.