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Medically Speaking

All you need to know about joint replacement surgery

Dr Ishwar Bohra



During the coronavirus infection, elective surgeries are recommended to be halted briefly. Elective surgery or elective procedure is a surgery that is scheduled in advance as it does not involve a medical emergency. Especially, elderly people and those who are already suffering from health conditions such as diabetes, cardiovascular diseases and lungs or kidney related issues are more at risk. These people should avoid surgery as long as possible to avoid infection because during a hospital stay or post-surgery recovery time such as physiotherapy or follow-up dressing may increase the risk of infection. However, if the doctor has advised you for replacement surgery, then don’t be afraid to get under the knife due to Covid-19.

What is joint replacement surgery?

Joint replacement is an elective surgical procedure that a patient and doctor can plan as per their convenience. During surgery, the damaged joint is removed and replaced with a prosthetic joint which is called prosthesis. The prosthesis is designed to replicate the movement of a normal, healthy joint. Hip and knee replacements are the most commonly performed joint replacements but replacement surgery can also be performed on other joints including ankle, wrist, shoulder and elbow.

When do you need it?

There are many non-surgical treatments available for joint problems such as physical therapy, medication, injections and new biological treatments including hyaluronic injections and natural treatments like PRP. Surgery is suggested when non-surgical treatment does not provide comfort to the patient.

Damaged joint, stiffness, joint pain and their restricted movement impact the quality of life. To diagnose your condition an orthopedic surgeon will perform a thorough examination of your joint, analyse X-ray, MRI and CT Scan and conduct a physical test. Joint replacement is the best solution if the problem is serious. If you don’t get a joint replacement surgery on time, the risk of deformities develops inside and outside the joint increases as muscles, ligaments and other structures start becoming weak and losing their function.

Those patients go for a surgery like infected revision surgery or the ones who were planning to undergo second stage revision surgery and cannot wait further. Patients who are in extreme pain and not responding to any nonoperative measures should undergo surgery with due risk otherwise too much use of painkillers may damage the kidney and have other side effects which can be life-threatening. Those with significant knee deformity and stress fracture also need to undergo surgery as this is a case of semi-emergency.

A patient with periprosthetic fracture (fracture around previous joint replacement) is also an emergency case and needs to revise joint replacement or fix the fracture according to its pattern.

How safe is it during Covid-19?

 In any epidemic phase, the risk of infection increases significantly, which can also increase the risk of complications due to the surgery by 20%. You may be vulnerable to infection at the time of surgery or during post-operative care. Most big hospitals have come up with the idea of establishing a Non-Covid-19 Care (NCC) zone and Covid-19 care zone to minimise the chance of catching infection during hospital visits and surgeries. You can choose stand-alone health care units for non-Covid-19 treatments.

Initially, the medical body was thinking that the pandemic would end in a few months. But the current scenario is telling a different story. This new virus will continue to be amongst us for some time. There is no point in delaying urgent joint replacement surgeries.

Hospitals and clinics are providing safe, effective care for people with joint replacement cases who needed urgent surgical care. During the pandemic hospitals and clinics are taking necessary precautions, including:

1. Wearing a mask is mandatory for all patients, visitors and hospital staff

2. Screening patients and employees upon arrival

3. Isolating Covid-19 patients from other patients to contain infection

4. Practicing social distancing in waiting rooms and other parts of the hospital

5. Testing every patient for Covid-19 prior to the surgery.

Are the surgeries expensive during pandemic?

During Covid-19, the cost for any surgery will be higher than before as special precautions are being taken in terms of PPE equipment for the entire surgical staff, mandatory Covid-19 test and extra sanitisation procedures do make a surgery a little expensive. But surgeons and hospitals are offering daycare elective surgery, wherein a patient can leave without staying the night in the hospital which brings surgery cost down to an affordable range. Patient follow-up care may be adjusted to include phone and video calls in addition to hospital visits.

Post operative Care

Recovery in joint replacement surgery is faster than before due to advanced technologies but you must take these precautions:

1. After discharge from the hospital, isolate yourself in a room at home

2. Stay away from your family member for two to three weeks

3. Stop smoking immediately as it slows down the healing and recovery process

4. Follow-up with the doctor regularly.

Special Note

You may need physiotherapy to normalise the joint movement. But during Covid-19, avoid taking a physiotherapy session as physiotherapists offer such sessions to many people — and that can increase the risk of infection. You can do light exercises or walk in your house under the guidance of a doctor or physiotherapist.

The writer is a Senior Consultant, Joint Replacement Surgeon at BLK Super Specialty Hospital, New Delhi.

Medically Speaking

New blood test predicts which Covid patients at severe risk



Amid the ongoing battle with Covid-19, scientists have developed a score that can accurately predict which patients will develop a severe form of coronavirus. The measurement, called the Dublin-Boston score, is designed to enable clinicians to make more informed decisions when identifying patients who may benefit from therapies, such as steroids, and admission to intensive care units. Until this study, no Covid-19-specific prognostic scores were available to guide clinical decision-making.

 According to the findings, published in the journal EBioMedicine, the DublinBoston score can now accurately predict how severe the infection will be on Day 7 after measuring the patient’s blood for the first four days.

 “The Dublin-Boston score is easily calculated and can be applied to all hospitalised Covid-19 patients,” said study author Gerry McElvaney from the RCSI University in Ireland. 

The blood test works by measuring the levels of two molecules that send messages to the body’s immune system and control inflammation.

 One of these molecules, interleukin (IL)-6, is pro-inflammatory, and a different one, called IL-10, is anti-inflammatory. The levels of both are altered in severe Covid-19 patients. 

Based on the changes in the ratio of these two molecules over time, the researchers developed a point system where each 1-point increase was associated with 5.6 times increased odds for a more severe outcome.

 “More informed prognosis could help determine when to escalate or de-escalate care, a key component of the efficient allocation of resources during the current pandemic,” McElvaney said.

 “The score may also have a role in evaluating whether new therapies designed to decrease inflammation in Covid-19 actually provide benefit,” McElvaney added.

 With IANS inputs

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Medically Speaking

Delhi to be quack-free in 2021: New DMC chief

Shalini Bhardwaj



Dr Arun Gupta has been re-elected as president of the Delhi Medical Council (DMC) for a second fiveyear term. Dr Gupta, a practising paediatrician for the last 30 years, worked for digitising medical processes during his previous tenure.

 Speaking of the DMC’s current goals, he said, “One of the mandates is to eradicate quackery. We have decided that by the end of the year 2021, Delhi will become the first anti-quackery state in India. We are working on it in collaboration with the Delhi Government. We don’t have any authentic data yet but more than 20,000 quacks are in Delhi only.” 

The DMC is responsible for handling and settling medico-legal issues against doctors. Currently, there are over 72,000 doctors registered with the council.

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Medically Speaking

National Medical Commission starts its website

Shalini Bhardwaj



The National Medical Commission (NMC), constituted by the National Medical Commission Act, 2019, which came into force on 25 September, 2020, has launched its website. Citizens wishing to know about the National Medical Commission and its current medical working rules and regulations can log on to https://

 The NMC website also has highlights about its autonomous boards, members and organisational structure. The chairman of NMC is Dr Suresh Chandra Sharma and the commission has 33 members including the chairman, 10 ex-officio members and 22 part-time members. It also has four boards, the Under Graduate Medical Education Board, Post Graduate Medical Education Board, Medical Assessment and Rating Board, and Ethics and Medical Registration Board. The commission has 84 members from all over India as members of the medical advisory council.

 Cow dung chip will protect against mobile radiation: RKA chairman Rashtriya Kamdhenu Aayog (RKA) chairman, Vallabhbhai Kathiria, has launched a “chip” made of cow dung, claiming that it reduces radiation from mobile phones significantly.

 The chip, named Gausatva Kavach, has been manufactured by Rajkotbased Shrijee Gaushala. “This is a radiation chip. You can keep it in your mobile and it will reduce radiation. It will also keep you away from diseases,” said Vallabhbhai Kathiria during the launch of a nationwide campaign, ‘Kamdhenu Deepawali Abhiyan’

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Medically Speaking

India’s syringe makers to increase Covid-19 vaccine stocks

Shalini Bhardwaj



India is one of the largest syringe makers in the world when it comes to 0.5 ml auto-disable syringes for intramuscular vaccination. With the current race towards procuring and distributing a Covid-19 vaccine, syringe manufacturers in the country are ramping up their capacities further by over 30% to meet the expected rise in global demand.

ISCON, Becton Dickinson, and Hindustan Syringes and Medical Device (HMD) are the three major Indian medical device companies which manufacture the 0.5 ml auto-disable syringes which would be required to administer a Covid-19 vaccine. The companies together have planned to expand their capacities to manufacture 1.4 billion pieces per annum by June 2021 next year.

“We are planning to ramp up our capacity to a billion 0.5 ml AD syringes and offer 50% to the Government of India and 50% as exports, which amounts to 200-250 million by June 2021 and another 250 million from June to December 2021,” said Rajiv Nath, Managing Director of Hindustan Syringes and Medical Devices Ltd.

“We have 70 million AD syringes in stock against our orders of standard immunisation campaign and can offer 100 million to Government of India by end of 2020, if needed,” he added.

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Medically Speaking

Efficacy of three primary diets in drug-resistant epilepsy



Epilepsy that fails to get controlled by two antiseizure drugs is unlikely to respond to the addition of other medications. These children are designated to have drugresistant epilepsy. The principal treatment options for these children include either surgery or starting them on a ketogenic diet.

 The choice of surgery cannot be exercised in all patients: Epilepsy surgery is curative in specific diseases, and in certain conditions, it may be associated with permanent disabilities. Also, the expertise for performing epilepsy surgery is available only in a few centres across the country. The other option includes initiating a ketogenic diet.

 There are three main methods of providing these diets. The classical ketogenic diet often requires the patient to get admitted to the hospital, strict adherence to protocol and weighing the food items. The modified Atkins diet is less severe than the ketogenic diet. The low glycemic index therapy diet requires only minor diet modifications. So far, there has been adequate evidence about the efficacy of the ketogenic diet and the modified Atkins diet.

 The child neurology division of the department of paediatrics, All India Institute of Medical Sciences, carried out a first-of-itskind trial (The DIET Trial). They compared the three primary dietary therapies. This research showed that the seizure burden reduced by more than 50% in 67% of children receiving a ketogenic diet, 52% receiving a modified Atkins diet, and 59% of patients receiving a low glycemic index therapy diet. Also, the side effects were least with a low glycemic index therapy diet. 

Thus, this study adds a modified Atkins diet and low glycemic index therapy diet to the armamentarium for the management of drugresistant epilepsy. The added benefit is that since the study has been conducted in India, it can benefit a large population of drug-resistant epilepsy with local dietary menus. 

The writer is chief, child neurology at AIIMS.

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Medically Speaking

What happens when corona meets toxic air? CSIR to detect soon, says Dr Shekhar Mande

CSIR labs in Hyderabad and Chandigarh have collected samples from different locations and are working
on research regarding the effects of air pollution on the Covid-19 pandemic, says the CSIR Director General.

Shalini Bhardwaj



With experts saying that rising pollution levels can worsen the effects of Covid-19, the Council of Scientific and Industrial Research (CSIR) has started its own research on the matter at the National Environmental Engineering Research Institute (NEERI), Nagpur. Director General of CSIR, Dr Shekhar C. Mande, speaks on the subject and about other Covid-related developments like the “Feluda test”, in an exclusive interview with The Daily Guardian. Excerpts: 

Q. Is CSIR going to do research on the link between air pollution and Covid-19?

 A. Of course, but the research will take some time to accomplish. Our labs are working on it already and the National Environmental Engineering Research Institute (NEERI) in Nagpur has started some work too.

 Q. When is CSIR expected to complete its research on whether Covid-19 is air-borne or not?

 A. Researchers have started compiling the results of the airborne study. They are conducting this research at two centres in Hyderabad and Chandigarh. Samples for the study have been collected from various places of India, from places like ICUs, hospital corridors, waiting rooms, places where healthcare workers are most at risk, high rise structures, etc. We are detecting how far this virus can travel. We have taken samples multiple times and are still sampling from different locations with different distances from patients, 4ft, 8ft and 12ft. Now, we have to wait for the results which are expected to come in the next ten days. 

Q. CSIR has tied-up with the UP government. Which projects are the CSIR going to focus on? 

A. We are going to work with the UP government on the types of projects which are required. If they have some ambitious plans on agriculture, the pharma industry or the environment, we will work as a knowledge partner. We are proposing some documents along with the UP government on pharma and we will be doing many other projects too. 

Q. When will “Feluda” come to the market? How does it work? 

A. It’s almost ready to enter the market. Feluda stands for FnCas9 Editor Linked Uniform Detection Assay. It detects active Covid-19 infection by using a CRISPR CAS 9-based readout on a paper strip. Detection takes place in less than an hour. It doesn’t require a real-time PCR machine, will be cheap, and can be performed at the point of care settings where a simple PCR machine is present. The virus has regenetic material RNA and we need to detect that particular RNA. We first do a reaction called RT-PCR (Reverse Transcription Polymerase Chain Reaction) in which we make DNA from RNA and amplify those copies of DNA. Then there is an enzyme which actually tries to match with the virus. It goes to the correct site and identifies the sequence for Covid. A paper strip is dipped into a solution, and if it is Covid-19 RNA, then you get a band that can be seen. The test gives its results in 45 minutes.

 Q. What should be the comprehensive distribution and delivery mechanism for vaccines?

 A. The Government of India is coming up with a very comprehensive plan and will take very considered decisions as a high priority. Those plans are pretty much in place and the people who have drawn these plans are technical experts in their area and therefore it’s going to be very robust. 

Q. In your opinion, who should get the vaccine first?

 A. People who are at high risk should get the vaccine first because they are handling Covid-19 patients every day. They deserve to get the vaccine first.

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