How accurate are infrared-only and rain gauge-adjusted multi-satellite precipitation products in the southwest monsoon precipitation estimation across India?

A dense network of rain gauges and considerably large variability of the southwest monsoon precipitation across the country make India a suitable test-bed to evaluate any satellite-based precipitation product. In this paper, three real-time infrared-only precipitation products derived from the INSAT-3D satellite namely, INSAT Multispectral Rainfall (IMR), Corrected IMR (IMC) and Hydro-Estimator (HEM) and three rain gauge-adjusted Global Precipitation Measurement (GPM)-based multi-satellite precipitation products namely, Integrated Multi-satellitE Retrievals for GPM (IMERG), Global Satellite Mapping of Precipitation (GSMaP) and an Indian merged satellite-gauge product (INMSG) have been evaluated over India at a daily timescale for the southwest monsoon seasons of 2020 and 2021. An evaluation against rain gauge-based gridded reference dataset shows noticeable reduction of bias in IMC product over IMR, primarily over the orographic regions. However, INSAT-3D infrared-only precipitation retrieval algorithms have limitations in shallow and convective precipitation estimation. Among rain gauge-adjusted multi-satellite products, INMSG is shown to be the best product in the monsoon precipitation estimation over India due to use of rather larger number of rain gauges than IMERG and GSMaP products. All satellite-derived precipitation products, i.e. infrared-only and gauge-adjusted multi-satellite products underestimate heavy monsoon precipitation by 50-70%. The bias decomposition analysis indicates that a simple statistical bias correction would considerably improve the performance of the INSAT-3D precipitation products over the central India, but the same might not work over the west coast due to rather larger contributions of both positive and negative hit bias components. Although rain gauge-adjusted multi-satellite precipitation products show very small or negligible total biases in the monsoon precipitation estimation, positive and negative hit bias components are considerable over the west coast and central India. Furthermore, rain gauge-adjusted multi-satellite precipitation products underestimate very heavy to extremely heavy precipitation with larger magnitudes than the INSAT-3D derived precipitation products over the central India. Among the rain gauge-adjusted multi-satellite precipitation products, INMSG has smaller bias and error than IMERG and GSMaP products for very heavy to extremely heavy monsoon precipitation over the west coast and central India. Preliminary results of this study would be useful for end users in choosing a better precipitation product for real-time and research applications as well as for algorithm developers in further improving these products.

A comparative analysis between fixed bearing total knee arthroplasty (PFC Sigma) and rotating platform total knee arthroplasty (PFC-RP) with minimum 3-year follow-up.

BACKGROUND: Since the introduction of mobile bearing total knee designs nearly 30 years back, many studies have been done to evaluate its long-term result. Comparison with fixed bearing designs has been done in the past, but the studies were confounded by variables such as disease, surgeon, bone quality, pain tolerance, etc. We attempt to eliminate these variables in this study. METHODS: A total of 50 patients who had bilateral arthritis of the knee with similar deformity and pre-operative range of motion on both sides agreed to have one knee replaced with mobile bearing total knee design (PFC-RP) and the other with a fixed bearing design (PFC Sigma) were prospectively evaluated. Comparative analysis of both the designs was done at a mean follow-up of 40 months, minimizing patient, surgeon and observer related bias. Clinical and radiographic outcome, survival and complication rates were compared. RESULTS: At a mean follow-up of 40 months (range 36-47 months), no benefit of mobile bearing (PFC-RP) over fixed bearing design (PFC Sigma) could be demonstrated with respect to Knee Society scores, pain scores, range of flexion, subject preference or patello-femoral complication rates. Radiographs showed no difference in prosthetic alignment. No patient required a revision surgery till last follow-up. CONCLUSIONS: Our study demonstrated no advantage of the mobile-bearing arthroplasty over fixed bearing arthroplasty with regard to clinical results at short-term follow-up. However, longer follow-up is necessary to confirm whether these results are sustained.

Building Resilience to Climate Change: Pilot Evaluation of the Impact of India's First Heat Action Plan on All-Cause Mortality.

Background: Ahmedabad implemented South Asia's first heat action plan (HAP) after a 2010 heatwave. This study evaluates the HAP's impact on all-cause mortality in 2014-2015 relative to a 2007-2010 baseline. Methods: We analyzed daily maximum temperature (T max)-mortality relationships before and after HAP. We estimated rate ratios (RRs) for daily mortality using distributed lag nonlinear models and mortality incidence rates (IRs) for HAP warning days, comparing pre- and post-HAP periods, and calculated incidence rate ratios (IRRs). We estimated the number of deaths avoided after HAP implementation using pre- and post-HAP IRs. Results: The maximum pre-HAP RR was 2.34 (95%CI 1.98-2.76) at 47°C (lag 0), and the maximum post-HAP RR was 1.25 (1.02-1.53) estimated at 47°C (lag 0). Post-to-pre-HAP nonlagged mortality IRR for T max over 40°C was 0.95 (0.73-1.22) and 0.73 (0.29-1.81) for T max over 45°C. An estimated 1,190 (95%CI 162-2,218) average annualized deaths were avoided in the post-HAP period. Conclusion: Extreme heat and HAP warnings after implementation were associated with decreased summertime all-cause mortality rates, with largest declines at highest temperatures. Ahmedabad's plan can serve as a guide for other cities attempting to increase resilience to extreme heat.

Treatment of flexion-type supracondylar humeral fracture in children.

PURPOSE: To assess the results of treatment for flexion-type supracondylar humeral fracture in children. METHODS: The treatment of 14 children with flexion-type supracondylar humeral fracture was reviewed. Severity was classified according to the Gartland system for extension-type fractures. Type-I fractures were treated with immobilisation in an extension cast. For type-II and -III fractures, closed reduction was first attempted followed by percutaneous pinning. If closed reduction failed, open reduction and internal fixation was performed. RESULTS: Patients were followed up for at least one year (range, 14-36 months). Treatment results were excellent in 7 patients, good in 4, fair in 3, and poor in none. Patients were pain-free and satisfied and none suffered any activity restriction. CONCLUSION: Closed reduction and percutaneous pinning is a good treatment option for type-II and -III flexion-type supracondylar humeral fractures.

One- or two-stage bilateral total hip arthroplasty: a prospective, randomised, controlled study in an Asian population.

We compared the safety and outcome of one-stage bilateral total hip arthroplasty with those of a two-stage procedure during different admissions in a prospective, randomised controlled trial in an Asian population. Of 168 patients included in the study, 83 had a single- and 85 a two-stage procedure. Most of the patients (59.9%) suffered from inflammatory arthritis. The intra-operative complications, early systemic complications, the operating time, positioning of the components, the functional score, restoration of limb length and survival rates at 96 months were similar in the two groups. The total estimated blood loss was significantly lower in patients undergoing a one-stage procedure than in patients who had a two-stage procedure, but the transfusion requirements were significantly higher in the former group (p=0.001). The hospital stay was significantly shorter in the one-stage group, 7.25 days (sd 1.30; 5 to 20) compared with 10 days (sd 1.65; 8 to 24) in the two-stage group (p=0.023). We believe that a one-stage procedure is safe and appropriate in our population.

An unusual presentation of eosinophilic granuloma in an adult: a case report.

Eosinophilic granuloma is the most common and benign form of a rare proliferative disorder: Langerhans' cell histiocytosis. Spinal involvement is rare and only 15 adult cases have been reported. We present an unusual variant of eosinophilic granuloma in a 25-year-old woman with radiological evidence of vertebra plana. Plain radiography, magnetic resonance imaging, bone scan, and blood tests were carried out, and a specimen was taken from L4 using computed tomography-guided biopsy. Gram staining, acid fast bacillus smear, bacterial and fungal cultures were negative. Histological examination of the biopsy showed features of eosinophilic granuloma with aggregates of Langerhans histiocytes. The patient was treated with low-grade radiotherapy at 150 cGy per day for 7 days. She was asymptomatic at one-year follow-up although the radiological picture was unchanged.

A comparison of fixed-bearing and mobile-bearing total knee arthroplasty at a minimum follow-up of 4.5 years.

BACKGROUND: Durable long-term independent results with the Low Contact Stress rotating-platform (mobile-bearing) and the Insall Burstein-II (fixed-bearing) total knee prostheses have been reported, but no studies describing either the mid-term or long-term results and comparing the two prostheses are available, to our knowledge. METHODS: Thirty-two patients who had bilateral arthritis of the knee with similar deformity and preoperative range of motion on both sides and who agreed to have one knee replaced with a mobile-bearing total knee design and the other with a fixed-bearing design were prospectively evaluated. Comparative analysis of both designs was done at a mean follow-up period of six years, minimizing patient, surgeon, and observer-related bias. Clinical and radiographic outcome, survival, and complication rates were compared. RESULTS: Patients with osteoarthritis had better function scores and range of motion compared with patients with rheumatoid arthritis. However, with the numbers available, no benefit of mobile-bearing over fixed-bearing designs could be demonstrated with respect to Knee Society scores, range of flexion, subject preference, or patellofemoral complication rates. Radiographs showed no difference in prosthetic alignment. Two knees with a mobile-bearing prosthesis required a reoperation: one had an early revision because of bearing dislocation and another required conversion to an arthrodesis to treat a deep infection. CONCLUSIONS: We found no advantage of the mobile-bearing arthroplasty over the fixed-bearing arthroplasty with regard to the clinical results at mid-term follow-up. The risk of bearing subluxation and dislocation in knees with the mobile-bearing prosthesis is a cause for concern and may necessitate early revision. LEVEL OF EVIDENCE: Therapeutic Level II.

Haemarthroses after total knee arthroplasty caused by an isolated platelet factor 3 availability defect.

We present seven patients with recurrent haemarthroses after total knee arthroplasty, caused by an inherent platelet function defect. These patients developed painful knee swelling, persistent bleeding and/or wound breakdown, a platelet factor 3 availability defect being identified in all cases. Surgical exploration, with joint debridement, lavage and synovectomy, was performed in four patients who did not improve with conservative therapy. Histopathological examination of synovium revealed a focal synovial reaction with histiocytic infiltration, and occasional foreign-body giant cells. One patient required an early revision because of aseptic loosening of their tibial component. The condition was treated by single-donor platelet transfusions with good results. The diagnosis, management, and relevance of this disorder are discussed.

Bilateral anterior dislocation of the shoulders with proximal humeral fractures: a case report.

Bilateral simultaneous anterior dislocation of the shoulders with bilateral 3-part fracture of the proximal humeri is unusual. A 42-year-old man presented with pain and restriction of movement on both shoulders. He was injured by a heavy object falling over his back while he was leaning forward holding an overhead bar. His arms were abducted and externally rotated. The injury was not correctly diagnosed, and the patient was treated with repeated manipulations and splintage for 2 weeks. Radiological examination revealed bilateral anterior dislocation of the shoulders with displaced 3-part fractures of the proximal humeri involving the shaft, greater tuberosity, and head. The patient was treated with open reduction and internal fixation through a deltopectoral approach using multiple Kirschner wires. The shoulders were kept immobilised for 3 weeks until the removal of the wires. The patient was able to resume work 3 months after surgery. He had an excellent and comfortable range of motion in both shoulders at one-year follow-up.

Primary pyogenic abscess of the psoas muscle.

Nine children who were less than nine years old and had a primary pyogenic abscess of the psoas muscle were treated in a five-year period. This rare lesion often simulated septic arthritis of the hip. Ultrasonography was found to be the most reliable and easily performed diagnostic study. Because of the rarity of the lesion, the diagnosis requires a high index of suspicion. The best treatment is early operative drainage and administration of systemic antibiotics.

The 'Delhi active test' for detection of anterior cruciate ligament tears.

All the described tests for the detection of anterior cruciate ligament (ACL) tear are passive tests. For obese or muscular built patients these tests are cumbersome and often unsuitable. We describe for the first time a new method, the 'Delhi active test', by which a torn ACL can be detected irrespective of the size or build of the patient. The results of this test are reproducible and the diagnostic accuracy is comparable with other tests. We suggest that the 'Delhi active test' be used as one of the routine clinical methods to detect the torn ACL.

Ulnar translocation after excision of giant cell tumour of distal radius.

Translocation of the ipsilateral ulna has been carried out in six cases after radical resection of a giant cell tumour of the distal radius. The carpo-ulnar junction united readily in all cases. Union of the radio-ulnar junction is often delayed, but this can be overcome by the addition of cancellous grafts at the time of ulnar translocation. All the patients had very good forearm rotation and an acceptable appearance. There were no significant complications.

Morphological variations of the ulnar styloid process.

P.A. radiographs of both wrists were taken in 400 normal individuals to study the configuration of the styloid process of the ulna. Five different morphological variations were noticed, the commonest being an elongated process (102 wrists). Medially deviated (41 wrists), parrot beaked (27 wrists) and hypertrophic (16 wrists) patterns were less common. One person had bilateral unfused separate ossification centres for the ulnar styloid. There was no correlation between the length of the styloid process and ulnar variance.

Comparative study of knee function after patellectomy and osteosynthesis with a tension band wire following patellar fractures.

In order to assess the relative merits of patellectomy and osteosynthesis with tension band wires in patellar fractures, 66 patients given patellectomy and 30 given tension band wiring for almost identical fractures of the patella have been analysed. Following patellectomy only about half the patients achieved excellent results while after osteosynthesis excellent results were in 80%. We, therefore, recommend that whenever possible patellar fractures should be treated by accurate reduction and tension band wiring. When needed patellectomy should be performed without hesitation as the operation produces a negligible number of poor results, although excellent results will be achieved in only about half the cases.

Microstructural organization of carbon induced neotendon.

Experiments have been conducted in guinea pigs to replace the calcaneal tendon with carbon fibers. The new tendon formed has been studied macroscopically, histologically and by scanning electron microscopy, and shows a close resemblance to the normal tendinous structure but is adherent to the surrounding tissues. It is suggested that the surface characteristics of carbon fibers play an important role in that these attract and allow fibrinous exudate to spread on their surface, into which fibroblasts grow. This, together with the large surface area available, is probably responsible for the orderly longitudinal arrangement of collagen fibers parallel to the carbon fiber implant.

Modified Phemister grafting in potentially infected non-union of tibial shaft fractures.

Modified Phemister bone grafting consisting of the raising of an osteoperiosteal flap, bone petalling and a cancellous onlay graft for non-union of tibial shaft fractures was tried in 43 cases. Thirty-eight out of 43 fractures united after one bone grafting procedure, giving a success rate of 88%. The procedure can even be used in the presence of low-grade, active infection. This method of bone grafting is simple and has no significant complications. Knee motion recovers well but ankle and toe stiffness do not improve appreciably from the preoperative status. We recommend that Phemister grafting be performed early.

Value of osteomedullography in the early diagnosis of non-union in tibial diaphyseal fractures.

Osteomedullography was performed in 17 diaphyseal fractures of the tibia at ten to 12 weeks from injury to assess the reliability and sensitivity of the procedure in predicting non-union. It was found to be accurate in more than 80% of cases in predicting the ultimate outcome early in the course of fracture healing.

Gastric teratoma in infants--a report of two cases.

Gastric teratoma is an exceeding rare lesion seen most often in male infants. Two cases of gastric teratoma, the first in a three and half month male, and the second in a one year old male child are reported. In the first case, the tumour was more solid, while in the second case it was a solid-cystic mass. These two cases represent the additions to the few, limited, known gastric teratomas reported in the world literature.

Radiotherapy for desmoplastic fibroma of bone: a case report.

Desmoplastic fibroma is a rare benign tumour of bone. Diagnosis is not easy and is often made by excluding other tumours. Histopathological diagnosis of this tumour is also sometimes not easy. The treatment modalities for this tumour are non-uniform and often controversial. In the present case surgical options were left aside because the patient did not consent to surgery, so radiotherapy was used, with success at 3-year follow-up. This case is presented here along with a review of relevant literature.

Congenital diaphragmatic hernia: a retrospective autopsy study.

Congenital diaphragmatic hernia is one of the acute pediatric surgical emergencies and an important cause of perinatal mortality. Its incidence varies from 1 in 2000 to 1 in 5000 live-births, with a greater incidence in stillbirths and abortions. Non-operative mortality is generally reported as 100% and early diagnosis is imperative. A retrospective study of all infant and neonatal autopsies done during last 30 years (1960 to 1989) was conducted. Ten cases of congenital diaphragmatic hernia were encountered among 588 autopsies and its incidence was 1.7% of all infant and neonatal autopsies, dying due to varying causes. The male:female ratio was 7:3, while maternal factors showed no consistent relationship. All cases had left-sided posterolateral diaphragmatic defects. Dyspnea, cyanosis and dextrocardia was the classical triad present in more than 50% cases. The commonest herniated contents were the small intestinal loops and the left lobe of liver. Associated congenital multiple anomalies related to neural axis, skull, vertebral column and cardiovascular system were noted in 30% cases and were major contributory factors for perinatal mortality.