Introduction. Serial objective assessment of disease activity in Rheumatoid Arthritis (RA) is imperative to achieve remission. The CDAI score appears more practical than DAS-28 in routine assessment of disease activity in RA patients. Objective. To evaluate correlation and agreement of the DAS-28 with CDAI in RA patients. Methods. A total of 200 patients of RA were evaluated by DAS-28 and CDAI and divided into 4 categories of disease activity i.e. Group-I: Remission (DAS-28 < 2.6; CDAI < 2.8), Group II: Low disease activity (DAS-28 = 2.6–3.2; CDAI = 2.8–10), Group III: Moderate disease activity (DAS-28 = 3.2– 5.1; CDAI = 10–22), Group IV: High disease activity (DAS-28 > 5.1; CDAI > 22). DAS-28 was compared to CDAI in each group using spearman correlation coefficient and kappa statistics. Results. Group I shows mean DAS-28 of 1.99 ± 0.38; mean CDAI of 0.90 ± 0.65, (P = 0.0001). Group II shows mean DAS-28 of 3.04 ± 0.17; mean CDAI of 6.45 ± 02.35, (P = 0.0001). Group III shows mean DAS-28 of 4.25 ± 0.58; mean CDAI of 16.46 ± 3.31 (P < 0.0001). Group IV shows mean DAS-28 of 6.38 ± 0.87; mean CDAI of 38.56 ± 11.88 (P < 0.0001). Kappa statistics (κ) of the above comparison was 0.533. Conclusion. Our findings indicate that CDAI—a composite score that employs only clinical variables and omits assessment of Acute Phase Reactant (APR), has moderate to good correlation (Kappa value = 0.533) to DAS-28 for assessment of disease activity in RA patients.

Payment by results' (PbR) remuneration for healthcare services relies on the accurate conversion of diagnoses into Healthcare Resource Group (HRG) codes that are then reimbursed. Inconsistencies in documentation can result in inaccuracies in this process, with consequent implications for measuring activity, disease incidence and organisational performance. The aim of this study was to determine if clinician involvement increases accuracy in the coding of medical cases. Selected records of medical patients admitted to a London NHS trust between November and December 2016 were reviewed by a coding auditor and a clinician. Any changes to the codes and HRG tariff were noted. In total, 123 cases were considered. Changes in code were made on 68 instances, resulting in an overall increase in remuneration of £39,215; an average of £318 per patient. The primary HRG code was changed in 31 cases which accounted for £28,040 of the increase in tariff. In conclusion, clinician involvement can help with documentation ambiguities, thus improving the accuracy of the coding process in a medical setting. Although such collaborative working offers advantages for both the clinician and the coding team, further work is required to investigate the feasibility of this recommendation on a larger scale.

BackgroundIn this mini review, we discuss some of the atypical neurological manifestations of dengue virus and attempt to bring them to attention to highlight the neurotropic property of the dengue virus.MethodsCases were chosen from retrospective hospital and outpatient records of all patients seropositive for dengue who attended the neurology referral. Seven patients have been chosen as illustrative examples of dengue-associated neurological involvement. We discuss the various central and peripheral nervous system involvement of patients and discuss the relevant findings in them.ConclusionThrough this case series, we wish to highlight that the dengue virus can affect the nervous system at various targets, using multiple mechanisms of pathogenesis to generate a plethora of presentations. Hence, it is vital to be aware of its presentations to be able to diagnose dengue and treat it accordingly.

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Temporal lobe epilepsy (TLE) with enlargement of the amygdala (AE) is a distinct clinical entity with contrasting clinical features from TLE with hippocampal sclerosis (HS). The objectives of this systematic analysis were to study the clinical characteristics and treatment outcome of people with TLE with AE. Pubmed, Embase, Cochrane, Web of Science, Scopus, and Medline were searched using the keywords amygdala enlargement, temporal lobe epilepsy, epilepsy, and seizure in November 2020. We found 18 studies that satisfied the inclusion criteria. A total of 361 patients were included in this analysis. The mean age of onset was 36.2 years, and febrile seizure was uncommon compared to TLE with HS subjects. The type of aura and automatism was similar to TLE with HS, though less prevalent. Electroencephalography (EEG) was usually concordant with the side of AE. Anti‐seizure medications (ASM), surgical, and immunotherapy were used in different studies. 86 patients underwent surgery with Engel I outcome in 69.7%. Histopathology of the resected samples was predominantly dysplasia and gliosis. A group of patients that responded well to immunotherapy with subsequent reduction of amygdala volume (AMV) purported an autoimmune etiology of AE. Heterogeneity was the main drawback that prevented comparability among the studies. The methods of measurement of AMV also differed widely in the included studies, and standardization of its method is still lacking. This analysis suggests TLE with AE as a distinctive group of patients either due to a developmental anomaly or autoimmune etiology.