Assessment of Disease Activity in Rheumatoid Arthritis: A Comparative Study of Clinical and Laboratory Evaluation with Musculoskeletal Ultrasonography Assessment.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory disease and musculoskeletal ultrasonography (USG) is gaining popularity for assessing the disease activity bed side, objectively and cost effectively. There is paucity of such studies from India which establish the correlation between RA disease activity and musculoskeletal USG. OBJECTIVE: The objective of this study was to compare the disease activity scores in RA patients, assessed by 'clinical and laboratory evaluation' with 'musculoskeletal ultrasound scoring of the affected joints. METHODOLOGY: It was a cross sectional study conducted from December 2015to May 2017. We enrolled the diagnosed patients of RA, having at least one USG assessable joint with definite clinical synovitis. Disease activity was assessed by swollen joint count, tender joint count, Clinical Disease Activity Index (CDAI), Disease Activity Score (DAS) 28 ESR and DAS 28 CRP. Musculoskeletal USG was performed by experienced radiologist. Grayscale scores (GSUS) and Power Doppler scores (PDUS) were calculated in 22 joints as per SONAR criteria and each joint was examined as per standardized score. RESULTS: Our study showed that DAS 28 CRP, DAS 28 ESR, CDAI, tender joint count and swollen joints count had positive correlation (p<0.001) with various ;musculoskeletal USG scores, whereas ESR and CRP failed to show any significant correlation.;Conclusion:;;GSUS-PDUS can be used for diagnosing joint space narrowing, joint effusion, and synovial thickening.;PD may become a cost-effective alternative to gadolinium enhanced MRI.;Strong correlation exists between USG and physical examination of joint swelling as;well as disease activity scores in RA patients.

Ohio Presents Opportunities For Understanding Hospital Alignment With Public Health Agencies On Community Health Assessments.

Multisector collaboration is critical for improving population health. Improving alignment between nonprofit hospitals and local health departments is one promising approach to achieving health improvement, and a number of states are exploring policies to facilitate such collaboration. Using public documents, we evaluated the alignment between Ohio nonprofit hospitals and local health departments in the community health needs they identify and those they prioritize. The top three needs identified by hospitals and health departments were mental health, substance use, and obesity. Alignment across organizations was high among the top needs, but it varied more among less commonly identified needs. Alignment related to social determinants of health was low, with health departments being more responsive to social determinants than hospitals. Given the different strengths and capacities of hospitals and health departments, this divergence may be in the best interests of the communities they serve. Community benefit policies should consider how to promote collaboration between hospitals and health departments while also encouraging organizations to use their own expertise to meet community needs.

Last Breath in the Emergency Department.

BACKGROUND: Early and aggressive time to intervention has been shown to increase the odds of survival and decrease mortality in critically ill patients. Since emergency medicine is a nascent specialty in India, a review and assessment of the mortality profile in the Emergency Department (ED) would help improve the quality of care. AIMS: The aim of the study is to determine the mortality profile and causes of preventable deaths at large ED in South India. METHODS: This retrospective chart review was conducted between January and December 2017. Patients admitted with Triage priority 1 and priority 2 of our ED, who died, despite treatment, were recruited in the study. Two ED consultants blinded from each other, independently audited all the charts to determine preventable and nonpreventable causes of death. RESULTS: There were a total of 69,369 patients during the study period who presented to the ED. Despite resuscitation 189 (0.7%) died, the mortality rate was 2.43%. Cardiac-related (32%) and sepsis-related (31%) causes were the most common cause of death, 23.8% were due to preventable causes and 16.9% of which were due to inappropriate management. In patients with sepsis, the odds of death due to preventable causes were significantly high (odds ratio 4.31, 95% confidence intervals: 1.96-9.47; P < 0.001). CONCLUSIONS: Cardiac- and sepsis-related causes of death, together accounted for most of the mortality. In patients with sepsis, the odds of death due to preventable causes were more than four times higher than those without preventable causes.

Hospitalist Versus Subspecialist Perspectives on Reasons, Timing, and Impact of Consultation.

BACKGROUND: Hospitalists frequently consult medical subspecialists in the management of inpatients. Given the potential impact on health resource utilization, it is important to understand the working relationship between these groups. METHODS: A cross-sectional survey of hospitalists, n = 655, and subspecialists across Ohio (nephrologists and endocrinologists), n = 293, was conducted to investigate perceptions and communication about reasons, timing, and impact of hospital consultations. RESULTS: Survey response rate was 13.3%. Hospitalists were more likely to report subspecialty request to serve as admitting physician with subsequent consultation 63.2% versus 26.7%, p < .001. Hospitalists with a daily workload ≥15 patients per day were more likely to report that this impeded their ability to manage details of patient care versus hospitalists with <15 patients per day, 53.2% versus 24.1%, p = .02, and resulted in subspecialty consultation for problems manageable by the hospitalist, 38.3% versus 6.9%, p = .003. Hospitalists were less likely than subspecialists to report major impact from consultation 50.0% versus 81.0%, p = .001 and they were more likely to report direct communication for urgent consults 97.3% versus 48.8%, p < .001. CONCLUSIONS: Future work should be aimed at addressing hospitalist workload, improving communication, and ensuring appropriate need and timing of consultation.

Loss of the tumor suppressor Pten promotes proliferation of Drosophila melanogaster cells in vitro and gives rise to continuous cell lines.

In vivo analysis of Drosophila melanogaster has enhanced our understanding of many biological processes, notably the mechanisms of heredity and development. While in vivo analysis of mutants has been a strength of the field, analyzing fly cells in culture is valuable for cell biological, biochemical and whole genome approaches in which large numbers of homogeneous cells are required. An efficient genetic method to derive Drosophila cell lines using expression of an oncogenic form of Ras (Ras(V12)) has been developed. Mutations in tumor suppressors, which are known to cause cell hyperproliferation in vivo, could provide another method for generating Drosophila cell lines. Here we screened Drosophila tumor suppressor mutations to test if they promoted cell proliferation in vitro. We generated primary cultures and determined when patches of proliferating cells first emerged. These cells emerged on average at 37 days in wild-type cultures. Using this assay we found that a Pten mutation had a strong effect. Patches of proliferating cells appeared on average at 11 days and the cultures became confluent in about 3 weeks, which is similar to the timeframe for cultures expressing Ras(V12). Three Pten mutant cell lines were generated and these have now been cultured for between 250 and 630 cell doublings suggesting the life of the mutant cells is likely to be indefinite. We conclude that the use of Pten mutants is a powerful means to derive new Drosophila cell lines.