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Background@#Young age in osteonecrosis of the femoral head (ONFH) demands bone-preserving, short-stem arthroplasty. Several designs including neck-preserving stems and neck-resecting, shortened, standard stems are classified as short stems. There is a paucity of literature investigating risk factors and outcomes of intraoperative complications of neck preserving, short-stem arthroplasty in ONFH. @*Methods@#A total of 107 hips operated with METHA short-stem arthroplasty for ONFH were retrospectively evaluated. The mean age of patients was 43.7 years (range, 27–60 years). Nine patients had an intraoperative fracture. Seven hips received prophylactic cerclage wiring for poor bone quality. Patients were invited for clinical and radiological evaluation at the latest follow-up. @*Results@#The mean follow-up of patients was 47.2 months. Significant association with intraoperative fractures and the need for prophylactic cerclage wiring were found in steroids-, alcohol-, and chronic renal failure-induced ONFH. However, patient sex, body mass index, traumatic/idiopathic ONFH, previous implant in situ, prosthesis size, and single-sitting bilateral total hip replacement (THA) were not the risk factors. All hips showed signs of osteointegration at final follow-up. No revision was done during the study period for any cause. @*Conclusions@#METHA short-stem THA offers excellent functional and radiological outcomes in ONFH. However, precaution must be exercised in patients with steroids-, alcohol-, and renal disorders-induced ONFN due to poor bone quality and higher chances of intraoperative fractures. Also, additional measures such as the use of a high-speed burr and prophylactic cerclage wiring in ONFH may allow predictable and safe use of short stems.
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The aim of this study was to identify the SARS-CoV-2 lineages circulating in the pediatric population of India during the second wave of the pandemic. Clinical and demographic details linked with the nasopharyngeal/oropharyngeal swabs (NPS/OPS) collected from SARS-CoV-2 cases (n=583) aged 0-18 year and tested positive by real-time RT-PCR were retrieved from March to June 2021.Symptoms were reported among 37.2% of patients and 14.8% reported to be hospitalized. The E gene CT value had significant statistical difference at the point of sample collection when compared to that observed in the sequencing laboratory. Out of these 512 sequences 372 were VOCs, 51 were VOIs. Most common lineages observed were Delta, followed by Kappa, Alpha and B.1.36, seen in 65.82%, 9.96%, 6.83% and 4.68%, respectively in the study population. Overall, it was observed that Delta strain was the leading cause of SARS-CoV-2 infection in Indian children during the second wave of the pandemic. We emphasize on the need of continuous genomic surveillance in SARS-CoV-2 infection even amongst children.
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With millions of people getting affected with COVID-19 pandemic caused by a novel severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), people living with post COVID-19 Symptoms (PCS) are expected to rise in the future{middle dot} The present study aimed at assessing PCS comprehensively and its associated factors among COVID-19 recovered adult population in north India. MethodsIn a tertiary health centre at Delhi, an online based cross-sectional study was conducted using a semi-structured questionnaire, developed by employing a nominal group technique, in aged 18 years and above who were SARS-CoV-2 positive during the month of January to April 2021. Socio-demographic, various potential risk factors, including pre-existing morbidities, vaccination status, and severity of acute COVID-19 illness, information on acute illness for management and a spectrum of PCS were collected between June 16 to July 28, 2021. Each participant was contacted telephonically before sending the survey link. PCS were presented as relative frequency; chi-square test, odds ratio, including adjusted, were calculated to rule out association between PCS and potential predictors. ResultsA total of 773 of 1801 COVID recovered participants responded to the link reaching a participation rate of 42{middle dot}9%, with a median age of 34 years (IQR 27 to 44). Male respondents were 56{middle dot}4%. Around 33{middle dot}2% of them had PCS at four or more weeks, affecting almost all body organ systems. The most prevalent PCS were fatigue (79{middle dot}3%), pain in the joins (33{middle dot}4%), muscle (29{middle dot}9%), hair loss (28{middle dot}0%), headache (27{middle dot}2%), breathlessness (25{middle dot}3%), sleep disturbance (25{middle dot}3%) and cough (24{middle dot}9%). The prevalence of PCS was reduced to 12{middle dot}8% at 12 weeks after positive test. Factor such as female gender, older age, oxygen supplementation during the acute illness, working in healthcare care facilities, the severity of acute illness, and pre-existing co-morbid were risk factors for PCS. Further, vaccination (second dose) reduced the odds of developing PCS by 45% compared to unvaccinated participants (aOR 0{middle dot}65; 95%CI 0{middle dot}45-0{middle dot}96). Finally, 8{middle dot}3% of participants rated their overall health status was either poor or very poor following COVID-19 illness. ConclusionsThe PCS involves almost all organ systems, regardless of the severity of acute COVID-19 illness. Two doses of vaccine help to reduce development of PCS. Research in ContextO_ST_ABSEvidence before this studyC_ST_ABSAlthough the evidence is mounting in prolonged COVID-19 symptoms among COVID-19 survivors, to date, the full range of such post-COVID-19 symptoms (PCS) is not yet fully understood. There is a lack of studies that assessed PCS comprehensively among persons who have recovered from the COVID-19illness. For example, limited data are available on psychosocial, behavioral, and oral manifestations related to PCS. Further, there is a paucity of studies that included a wide range of determinants of PCS and the association of vaccination with the development of PCS across the world. Our study is the first such study conducted among COVID-19 recovered persons who with a majority of them employed in a tertiary health care institute of north India. Added value of this studyOur study, for the first time, investigated a wide range of post-COVID-19 manifestations among COVID-19 recovered persons in organ-specific and psychosocial behavioral aspects, making this the largest categorization of PCS currently (in total 16). The study included telephonic calls to each eligible candidate which helped in ensuring the COVID-19 status at the time of the study. Since the participants either were employees in the hospital or their dependents that enhance the accuracy of reporting PCS. The most prevalent symptom was unspecific PCS (85.6%), e.g., fatigue, followed by musculoskeletal manifestations (49{middle dot}8%), Ear, Nose and Throat symptoms (47{middle dot}5%), neurological (47{middle dot}0%), cardio-respiratory (42{middle dot}4%, gastrointestinal (36{middle dot}2%), ocular symptoms (31{middle dot}9%), dermatological symptoms (31{middle dot}5%), and cardio-vascular (24{middle dot}5%) symptoms, and mental health symptoms (23{middle dot}7%). The rest of the organ specific symptoms were observed in less than 20% of the respondents. Older age, female gender, pre-existing co-morbid, oxygen supplementation during acute illness, the severity of illness, working in health care institutions were associated with PCS. Vaccination after the second dose was protective against PCS compared to non-vaccinated participants. Further, our study also reported a rating of the overall health status among COVID survivors, whereby around 8.3% of them reported being a poor or very poor health. Implications of all the available evidencePCS affects a multi-organ organ system, irrespective of the severity of acute-phase COVID-19 illness and hospitalization. Such persistent COVID-19 symptoms, compounded by its heterogeneity among COVID survivors can pose a substantial burden to the affected individuals and their families and additional challenges for healthcare delivery and public health service. The current study shows that one in three individuals experience persistent COVID-19 symptoms. Since the COVID pandemic is still ongoing across the world, therefore, the number of people experiencing PCS is likely to be increased substantially further. An integrated PCS care strategy, but not limited to organ-specific healthcare disciplines, others such as psychosocial support, including counseling and education, rehabilitation, community-based rehabilitation programs will be required for management. Prioritization of PCS care to elder and co-morbid patients should be recommended. Expediting the vaccination drive will be helpful to reduce the development of persistent COVID-19 symptoms. Research, collaborative and multidisciplinary, is required to understand the underlying pathophysiology mechanism for PCS.
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BackgroundThe COVID-19 outbreak poses a global crisis in health care delivery system, including habilitation and rehabilitation services. In the present study, we shared our experiences on telerehabilitation services established primarily for students with visual disabilities (SwVD) amidst COVID-19 pandemic and its outputs. MethodsFollowing the lockdown declared on March 23, 2020, the rehabilitative team of a tertiary eye center in north India received information that many VCS were stranded in schools for the blind in Delhi, and feeling with anxiety and panic in absence of teachers. Shortly, the room for vision rehabilitation clinic was set-up for tele-facilities. The intended services was explained while disseminating the mobile numbers. A semi-structured questionnaire consisting of closed and open-ended was developed to record COVID-19 knowledge and concerns. Inductive content analysis was used to report the qualitative information. ResultsAs of June 30, 2020, a total of 492 clients contacted the team, with maximum from Delhi (41.5%), and predominantly males (78.8%). Around 80.3% of callers were VCS with age range of 11 to 30 years. The two most frequently encountered health needs were itching in eyes (36.1%) and headache (29%). Television news was the most used medium among callers to get COVID-19 information. Cough is a less frequently known mode of transmission (28%), similarly handwashing as a less known for prevention (17.2%). Eight concerns were recorded based on qualitative data analysis. ConclusionTele-rehabilitation provides valuable insights and has the potential to address various concerns, uncertainty, anxiety, and fear among SVD during the pandemic.
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Background@#Anteromedial osteoarthritis is a recognized indication for unicompartmental knee arthroplasty (UKA). Favorable postoperative outcomes largely depend on proper patient selection, correct implant positioning, and limb alignment. Computer navigation has a proven value over conventional systems in reducing mechanical errors in total knee arthroplasty (TKA). However, the lack of strong evidence impedes the universal use of computer navigation technology in UKA. Therefore, this study was proposed to investigate the accuracy of component positioning and limb alignment in computer navigated UKA and to observe the role of navigation in proper patient selection. @*Methods@#A total of 50 knees (38 patients) underwent computer navigated UKA between 2016 and 2018. All operations were performed by the senior surgeon using the same navigation system and implant type. The navigation system was used as a tool to aid patient selection: knees with preoperative residual varus > 5° on valgus stress and hyperextension > 10° were switched to navigated TKA. We measured the accuracy of component placement in sagittal and coronal planes on postoperative radiographs. Functional outcomes were also evaluated at the final follow-up (a minimum of 16 months). @*Results@#Nine patients had tibia vara and 14 patients had preoperative hyperextension deformity. We observed coronal outliers for the tibial component in 12% knees and for the femoral component in 10% knees. We also observed sagittal outliers for the tibial component in 14% knees and for the femoral component in 6% knees. There was a significant improvement in the functional score at the final follow-up. On multiple linear regression, no difference was found in functional scores of knees with or without tibia vara (p = 0.16) and with or without hyperextension (p = 0.25). @*Conclusions@#Our study further validates the role of computer navigation in desirable implant positioning and limb alignment. We encourage use of computer-assisted navigation as a tool for patient selection, as it allows intraoperative dynamic goniometry and provides real-time kinematic behavior of the knee to obviate pitfalls such as significant residual varus angulation and hyperextension that predispose early failure of UKA.
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The rapid emergence of coronavirus disease 2019 (COVID-19) as a global pandemic affecting millions of individuals globally has necessitated sensitive and high-throughput approaches for the diagnosis, surveillance and for determining the genetic epidemiology of SARS-CoV-2. In the present study, we used the COVIDSeq protocol, which involves multiplex-PCR, barcoding and sequencing of samples for high-throughput detection and deciphering the genetic epidemiology of SARS-CoV-2. We used the approach on 752 clinical samples in duplicates, amounting to a total of 1536 samples which could be sequenced on a single S4 sequencing flow cell on NovaSeq 6000. Our analysis suggests a high concordance between technical duplicates and a high concordance of detection of SARS-CoV-2 between the COVIDSeq as well as RT-PCR approaches. An in-depth analysis revealed a total of six samples in which COVIDSeq detected SARS-CoV-2 in high confidence which were negative in RT-PCR. Additionally, the assay could detect SARS-CoV-2 in 21 samples and 16 samples which were classified inconclusive and pan-sarbeco positive respectively suggesting that COVIDSeq could be used as a confirmatory test. The sequencing approach also enabled insights into the evolution and genetic epidemiology of the SARS-CoV-2 samples. The samples were classified into a total of 3 clades. This study reports two lineages B.1.112 and B.1.99 for the first time in India. This study also revealed 1,143 unique single nucleotide variants and added a total of 73 novel variants identified for the first time. To the best of our knowledge, this is the first report of the COVIDSeq approach for detection and genetic epidemiology of SARS-CoV-2. Our analysis suggests that COVIDSeq could be a potential high sensitivity assay for detection of SARS-CoV-2, with an additional advantage of enabling genetic epidemiology of SARS-CoV-2.
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CONTEXT: About 490 million cases of curable Reproductive Tract Infections (RTI) occur throughout the world, of which 79 million cases occur in India annually. Sexually Transmitted Infections/Reproductive Tract Infections (STI/RTI) confers a huge economic burden on the individual and the health system. Complications of RTI/STI are many, ranging from chronic pain syndrome to infertility. Most of these complications can be prevented by early diagnosis and treatment. AIMS: To assess knowledge, attitude and practices on STI/RTIs among married women aged 15-45 years in rural Haryana. SETTING AND DESIGN: Cross-sectional study, conducted in selected villages under the primary health centre Mandi, Sonepat, Haryana. SUBJECTS AND METHODS: Systematic sampling was used to cover 10 villages. In each village, every tenth house was sampled, taking first house from the center of the village. Face-to-face interview was conducted using pretested questionnaire. STATISTICAL ANALYSIS USED: Descriptive statistics and results were described in percentages. RESULTS: A total of 344 women were interviewed. About 44% women had never heard of STI/RTI. The prevalence of self-reported symptoms of STI/RTI was very high (60%). Only 40% of them opted for treatment and most common cause for not opting for treatment was that they considered it as a minor problem. Advice for use of condom during the treatment was received by only 20% of patients and only 26.5% of their husbands also received treatment. CONCLUSIONS: Overall knowledge, attitude and practices relating to STI/RTI among married women in rural Haryana was poor. The prevalence of self-reported STI/RTI was found to be high and treatment seeking behavior was poor.
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PURPOSE: The present study was conducted to evaluate the impact of scaling and root planing (SRP) on the C-reactive protein (CRP) levels of gingival crevicular fluid (GCF) and serum in chronic periodontitis patients with type 2 diabetes mellitus (T2DM-CP) or without type 2 diabetes mellitus (NDM-CP). METHODS: Forty-eight human participants were divided into two groups: an experimental (T2DM-CP) group (group I, n=24) comprising chronic periodontitis patients with random blood sugar > or =200 mg/dL and type 2 diabetes mellitus, and control (NDM-CP) group (group II, n=24) of those with chronic periodontitis and random blood sugar <200 without T2DM for the study. All subjects underwent nonsurgical periodontal therapy (NSPT) including complete SRP and subgingival debridement. Periodontal health parameters, plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), GCF volume (GCF vol), GCF-CRP, random blood glucose (RBS), glycated hemoglobin, and systemic inflammatory markers, serum CRP, total leukocyte count (TLC), neutrophil count (Neutr) and lymphocyte count (Lymph), were evaluated at baseline, 1 month, and 3 months after SRP. RESULTS: NSPT resulted in statistically significant improvement in periodontal health parameters (PI, GI, PPD, CAL, GCF vol), CRP levels in serum as well as GCF of both groups I and II. The mean improvement in periodontal health parameters (PI, GI, PPD, CAL, GCF vol), CRP levels in serum and GCF was greater in group I than group II after NSPT. There was nonsignificant increase in GCF-CRP, TLC, Lymph, and RBS, and a significant increase in Neutr and Serum CRP in group II at 1 month. The Serum CRP level of 20 out of 24 group II patients had also increased at 1 month. CONCLUSIONS: The CRP levels in both GCF and serum were higher in T2DM-CP patients than in NDM-CP patients. Although there was a significant improvement in both the groups, greater improvement was observed in both GCF and serum samples of T2DM-CP patients.
