Effects of self-management,education and specific exercises,delivered by health professionals,in patients with osteoarthritis of the knee

Background  

An education self-management program for people with osteoarthritis (OA) of the knee was designed to be delivered by health professionals, incorporating their knowledge and expertise. Improvement in quality of life, health status and pain in response to this program has previously been demonstrated in an uncontrolled pilot study. To more rigorously test the effectiveness of the program we will undertake a randomised controlled trial of people with OA of the knee offering specific self-administered exercises and education, in accordance with the principles of self-management.     

Outbreak of Scrub Typhus in Jammu – A Report

Background

Jammu is scrub typhus prone. Scrub typhus is often seen when troops move out of permanent locations.

Methods

In a prospective study cases of fever reporting to the local military hospital from July to October 2002 were examined clinically, investigated and categorised as scrub typhus when Weil Felix readings were above 1:160.

Results

Twelve cases of scrub typhus were diagnosed during the period of study. The clinical features included fever, malaise and conjunctival congestion. However rashes were rare and only one had an eschar. Multisystem complications occurred in one patient. There was a spatial and temporal clustering of cases. Control of outbreak was carried out by 25% benzyl benzoate impregnation of clothing, clearing of scrub, residual spray with malathion and antirodent measures.

Conclusion

Scrub typhus outbreaks have been noted whenever troops move out of permanent locations to scrub areas.Key Words: Scrub typhus, Mites, Eschar     

Inappropriate Use of Hospital Beds in a Tertiary Care Service Hospital

Background

The cost of medical care is continuing to rise and cost containment measures need to focus on inappropriate hospitalization. Armed Forces Medical Services ensure universal access to its consumers but continuous increase in patient load is stretching the capability of service hospitals. The present study was undertaken to determine the rate of inappropriate hospitalization in a large tertiary care service hospital.

Methods

Appropriateness Evaluation Protocol (AEP) was used to assess the appropriateness of hospital days, the study being carried out in the acute medical and acute surgical wards of the hospital on randomly selected days over a period of three months. Results: Inappropriate patient days were found to be 29.48% during the study period, with 34% of acute surgical patient days and 24.4% of acute medical patient days found to be inappropriate. No statistically significant difference was observed in the rate of inappropriate hospital stay between serving personnel and ex-servicemen. 31.25% non local patients as compared to 25.81% of local patients were found to have inappropriate hospital stays, though the difference was not found to be statistically significant. 60.71% of inappropriate stays were found in the initial period of admission (1-5 days), the phenomenon being observed both in the acute surgical and acute medical wards.

Conclusion

The study shows that the rate of inappropriate patient days is quite high among the study population and regular utilization reviews need to be carried out to conserve health care resources available with the service hospitals.Key Words: Appropriateness Evaluation Protocol (AEP), Inappropriate patient days (IPD)     

Differential trafficking of the Niemann-Pick C1 and 2 proteins highlights distinct roles in late endocytic lipid trafficking

The cellular location of Niemann-Pick C2 protein (NPC2) in cultured human fibroblasts and Chinese hamster ovary cells was examined immunocytochemically and in living cells by expression of a functional red fluorescent protein chimeric analogue. Results : NPC2 is present in the lysosomes of both cholesterol-depleted and -replenished cells, unlike Niemann-Pick C1 protein (NPC1) which is recruited to late endosomes only upon uptake of low-density lipoprotein. With mobilization of cholesterol from lysosomes, immunocytochemical detection of NPC2 in lysosomes is greatly diminished, whereas NPC1 remains in the late endosomal compartment. We found a partial overlap in the trafficking and organellar sites of accumulation of NPC2 and NPC1. In living cells, NPC2 traffics with NPC1 in late endosomal tubules. However, in contrast to NPC1, which remains either in late endosomal vesicles and tubules or at the peripheries of cholesterol-laden lysosomes, NPC2 moves into the central core of lysosomes. Glycolipid analysis reveals that, in contrast to null mutant NPC1 cells, which accumulate G_M2 ganglioside only at the plasma membrane, with no endocytic storage, absence of NPC2 protein in null mutant NPC2 cells does not block internalization of G_M2 into endocytic vesicles. This difference in the cellular distribution of G_M2 in NPC1 and NPC2 null mutants is the first report of a variation in the phenotypic expression of these genotypically distinct lesions.
Conclusion : We speculate that while NPC1 may play a major role in the sorting of glycolipids as well as cholesterol within the late endosomes, NPC2 primarily plays a role in the egress of cholesterol and, potentially, glycolipids from lysosomes. These proteins appear not to be integrated into a tightly bound biological complex, but rather represent separate functional entities that complement each other.     

A REVIEW OF CASUALTY PENSIONARY AWARDS : ENTITLEMENT AND ASSESSMENT

Armed Forces personnel and their families are entitled to causalty pensionary awards in the form of disability pension, special or family pension when disability or death has been due to service factors. In this article an effort has been made to make the medical officers in general and medical boards in particular aware of the existing entitlement rules, assessment guidelines, channel of processing and various authorities empowered to decide these claims. Some of the areas needing special consideration by medical boards have been highlighted.KEY WORDS: Casualty pensionary awards, Medical adviser (pensions), Entitlement, Disability, Assessment