Community-based study to describe the epidemiology of dengue infection in a large cantonment during one transmission season.

Background: Dengue is one of the most important vector-borne disease in India. It has been linked to monsoons when Aedes aegypti mosquitoes breed profusely in containers. No study exists in Armed Forces wherein a community-based sero-survey has described the epidemiology of dengue. The present study tries to fill this knowledge gap. Methods: A total of 422 participants were studied for one transmission season of July-December. Blood samples were collected for testing dengue IgG and IgM at the beginning and at end of the study period. The study participants were interviewed at least twice within this period of 6 months to assess clinical condition and follow-up. Point prevalence and incidence were measured. Distribution of presence or absence of symptoms was noted for positive as well as negative cases. Results: All participants were males. Average age was 31.75 years. Point prevalence at the beginning of transmission season was 11.6% (95% CI: 8.4%-14.6%) and 15.6% (95% CI: 12.1%-19.1%) towards the end. Incidence was found to be 147.4 per 1000 for 6 months. Forty percent of incident cases were asymptomatic. Conclusion: Healthcare planners and hospital commanders in stations across Armed Forces can use the prevalence and incidence figures obtained in this study as a general guide while planning for prevention and control of dengue. Also, this study points to the fact that dengue transmission in Delhi may have shifted earlier to months of April/May than the conventionally accepted season of July-December.

One stop neck lump clinic: a boon for quick diagnosis and early management.

INTRODUCTION: One-stop neck lump clinics (OSNLC) are gaining popularity worldwide especially in the UK hospitals following NICE recommendation. The main aim of this speciality clinic is a quick diagnosis and early management while simultaneously improving patient experience. OBJECTIVES: To analyse and compare the efficacy of OSNLC and general ENT/Head and neck clinic with specifics to a number of appointments required for formulating management plan and a number of 'one stop' visits. DESIGN: Retrospective observational study SETTING: Regional Head and Neck Cancer Center (Secondary care hospital) PARTICIPANTS: Patients referred by General practitioner with symptoms of a neck lump MAIN OUTCOME MEASURES: Patients seen in general ENT/Head and neck and OSNLC in 2 phases to understand the difference in a number of appointments, one-stop visits, the requirement of Ultrasound and efficiency of Fine needle aspiration. RESULTS AND CONCLUSIONS: Improved efficacy of OSNLC was noted as patients seen in the clinic required a lesser number of appointments, reached a faster diagnosis and management plan when compared to patients seen in general ENT clinic.

Acute renal failure in the ICU setting: A prospective observational study.

BACKGROUND: Acute renal failure (ARF) is a common entity in the intensive care unit (ICU) setting. There is scanty data regarding acute kidney injury (AKI) in ICUs from our country and no data from the service setting. METHODS: All patients admitted to the ICU of a tertiary care teaching hospital for six months were included in the study. They were divided into two groups: surg gr (admitted in surgical ICU) and med gr (admitted in medical ICU). During the stay in ICU, patients were observed for the development of AKI depending on the creatinine values and hourly urine output. Staging was done based upon the Risk Injury Failure Loss and End stage kidney (RIFLE) criteria. Relevant data associated with development of AKI was collected for correlation. RESULTS: 17.15% patients developed AKI after admission to the ICU 40% patients admitted with sepsis developed AKI. An increased susceptibility to develop AKI was found on day 4 of admission in both the groups. Of the patients who developed AKI, the surg gr of patients had a higher sequential organ failure assessment (SOFA) score both on day of admission (7.85 vs 5.65) and on the day of development of AKI (9.47 vs 6.18) as compared to the medical group. CONCLUSION: The incidence of ARF in our study was 17.2% with the patients of polytrauma/MODS being of major concern. The initial 3-4 days are the most critical and susceptible patients must be intensive monitored during this time for prevention of ARF. Medical ICU patients develop ARF at a low SOFA score in comparison to surgical ICU patients and thus need greater attention.

Non-suppurative Tissue Reaction to Polyether Ether Ketone Anchor in Rotator Cuff Repair.

Introduction: Interferential screws and anchors have played a major role in fixation of soft tissue to bony tunnel. With advent of time, there developed metal anchors, biodegradable anchors, bioinert anchors, etc. Biodegradable anchors had complications such as reactive synovitis, cyst formation, soft-tissue inflammation, and local osteolysis. Polyether ether ketone (PEEK) which was biologically inert and radiolucent was introduced to overcome the disadvantages of anchors. We present a case of non-suppurative tissue reaction to PEEK anchor following rotator cuff repair. Case Report: A 58-year-old male patient presented to us with signs of rotator cuff tear following injury to his shoulder. Magnetic resonance imaging depicted a massive cuff tear with retraction of cuff. Considering the degree of cuff tear, cuff was repaired with mini open method using two metallic suture anchor and two PEEK knotless bioraptor foot print suture anchor. Surgical wound healing was uneventful and suture was removed on 14th day following surgery. Three weeks following surgery, the patient had pain and rise in temperature over shoulder with raised erythrocyte sedimentation rate and C-reactive protein which subsided in 7 days with empirical antibiotics. Later, at 3 months, the patient had serous discharge from surgical site, on which exploration revealed pale yellow material vicinity to PEEK anchor. Other than pus cells in smear, discharge was negative to routine culture, grams stain, and cartridge-based nucleic acid amplification test for tuberculosis. Surprisingly, surrounding muscles were healthy, red in color, and contracting to stimulation. Following removal of both the PEEK anchors, local symptoms subsided with improvement in patients shoulder function. Conclusion: There were cases of tissue reaction to PEEK material in the literature such as osteolysis and cyst formation. In addition, non-suppurative inflammation can occur in response to PEEK material. Awareness about the non-suppurative inflammation property of PEEK material may help future surgeons to manage the condition better than us.