Role of miRNAs in T-cell activation and Th17/Treg-cell imbalance in acquired aplastic anemia

BACKGROUND

Altered T-cell repertoire with an aberrant T-cell activation and imbalance of the Th17/Treg cells has been reported in acquired aplastic anemia (aAA). miRNAs are well known to orchestrate T-cell activation and differentiation, however, their role in aAA is poorly characterized. The study aimed at identifying the profile of miRNAs likely to be involved in T-cell activation and the Th17/Treg-cell imbalance in aAA, to explore newer therapeutic targets.

METHODS

Five milliliters peripheral blood samples from 30 patients of aAA and 15 healthy controls were subjected to flow cytometry for evaluating Th17- and Treg-cell subsets. The differential expression of 7 selected miRNAs viz; hsa-miR-126-3p, miR-146b-5p, miR-155-5p, miR-16, miR-17, miR-326, and miR-181c was evaluated in the PB-MNCs. Expression analysis of the miRNAs was performed using qRT-PCR and fold change was calculated by 2-ΔΔCt method. The alterations in the target genes of deregulated miRNAs were assessed by qRT-PCR. The targets studied included various transcription factors, cytokines, and downstream proteins.

RESULTS

The absolute CD3+ lymphocytes were significantly elevated in the PB of aAA patients when compared with healthy controls (p < 0.0035), however, the CD4:CD8 ratio was unperturbed. Th17: Treg-cell ratio was altered in aAA patients (9.1 vs. 3.7%, p value <0.05), which correlated positively with disease severity and the PNH positive aAA. Across all severities of aAA, altered expression of the 07 miRNAs was noted in comparison to controls; upregulation of miR-155 (FC-2.174, p-value-0.0001), miR-146 (FC-2.006, p-value-0.0001), and miR-17 (FC-3.1, p-value-0.0001), and downregulation of miR-126 (FC-0.329, p-value-0.0001), miR-181c (FC-0.317, p-value-0.0001), miR-16 (FC-0.348, p-value-0.0001), and miR-326 (FC-0.334, p-value-0.0001). Target study for these miRNAs revealed an increased expression of transcription factors responsible for Th1 and Th17 differentiation (T-bet, RORϒt, IL-17, IL-6, and IFN-ϒ), T-cell activation (NFκB, MYC, and PIK3R2), downregulation of FOX-P3, and other regulatory downstream molecules like SHIP-1, ETS-1, IRAK-1, TRAF-6, and PTEN.

CONCLUSION

The study for the first time highlights the plausible role of different miRNAs in deregulating the Th17/Treg-cell imbalance in aAA, and comprehensively suggest the role of altered NF-kB and mTOR pathways in aAA. The axis may be actively explored for development of newer therapeutic targets in aAA.

Electroconvulsive Therapy in Transgender and Gender Diverse Population: A Case Report and Review of Literature

Objective

Present a case of a transgender and gender diverse (TGD) individual receiving gender affirming hormone therapy (GAHT) who presented with first episode bipolar mania and received electroconvulsive therapy (ECT). To understand the safety and efficacy of ECT in the TGD population including those receiving GAHT through literature review.

Materials and Methods

Case report using informed consent from an individual TGD patient who received ECT. A review of the literature was conducted using PubMed, Embase, and Medline.

Results

The case illustrated safe and effective ECT use in a TGD individual receiving GAHT. Eight studies were reviewed. GAHT has been reported to interfere with certain anaesthetic agents used in ECT. ECT appeared to be a safe and effective treatment in the TGD samples in those studies.

Conclusion

There is limited literature on the safety and efficacy of ECT for TGD individuals receiving GAHT. More research is required to address mental health inequalities in this population and to support safe and effective gender affirming treatment modalities.

Radiobiological analysis of VMAT treatment plan with flattened and flattening filter free photon beam: an EUD and TCP based comparative study

Background

This study aimed to evaluate the dosimetric and radiobiological differences between 6MV flattened filter (FF) and flattening filter free (FFF) using volumetric modulated arc (VMAT) technique for head and neck (H&N) cancer patients.

Materials and methods

Fifteen patients with H&N carcinoma were selected and treated with VMAT with FF (VMATFF) treatment plan. Retrospectively, additional VMAT treatment plans were developed using FFF beams (VMATFFF). Radiobiological parameters, such as equivalent uniform dose (EUD), tumor cure probability (TCP), and normal tissue complication probability (NTCP), were calculated using Niemierko's model for both VMATFF and VMATFFF. Correlation between dosimetric and radiobiological data were analyzed and compared.

Results

The conformity index (CI) was 0.975 ± 0.014 (VMATFF) and 0.964 ± 0. 019 (VMATFFF) with p ≥ 0.05. Statistically, there was an insignificant difference in the planning target volume (PTV) results for TCP (%) values, with values of 81.20 ± 0.88% (VMATFF) and 81.01 ± 0.92 (%) (VMATFF). Similarly, there was an insignificant difference in the EUD (Gy) values, which were 71.53 ± 0.33 Gy (VMATFF) and 71.46 ± 0.34 Gy (VMATFFF). The NTCP values for the spinal cord, left parotid, and right parotid were 6.54 × 10-07%, 8.04%, and 7.69%, respectively, in the case of VMATFF. For VMATFFF, the corresponding NTCP values for the spinal cord, parotids left, and parotid right were 3.09 × 10-07%, 6.57%, and 6.73%, respectively.

Conclusion

The EUD and Mean Dose to PTV were strongly correlated for VMATFFF. An increased mean dose to the PTV and greater TCP were reported for the VMATFF, which can enhance the delivery of the therapeutic dose to the target.

Protocol of systematic reviews on implementation research on cardiovascular diseases, diabetes mellitus and mental ailments in India

Introduction

The burden of non-communicable diseases (NCDs) is a major public health concern across the world. Various initiatives have tried to address these with varying degrees of success.

Objective

The objective is to assess and collate existing evidence in implementation research done in India on three broad domains of NCDs namely, cardiovascular diseases (CVD), diabetes mellitus (DM), and mental health (MH) in India.

Materials and methods

Three systematic review protocols have been drafted to explore and collate extant evidence of implementation research on cardiovascular diseases, diabetes mellitus, and mental health in India, in accordance with the PRISMA-P statement. Academic databases including PubMed, Embase and Science Direct will be searched. Search strategies will be formulated in iterative processes and in accordance with the formats that are specific to the databases that will be searched. In addition, grey literature and non-academic databases will also be explored. Data extracted from the selected studies will be analysed and a narrative summary of the selected articles, using the SWiM (Synthesis without meta-analysis) guidelines will be produced.

Intended Outcomes

The outputs of these systematic reviews could help in a better understanding of implementation research gaps and also how to address them. Apart from giving insights into how healthcare initiatives for CVDs, diabetes and mental health could be implemented in a better way, the study could also advocate the need to build and consolidate capacity for implementation research in the country.

Research Note: Effect of dietary xylo-oligosaccharide on growth performance, intestinal histomorphology, and specific cecal bacteria in broiler chickens

This study was conducted to evaluate the prebiotic effect of xylo-oligosaccharide (XOS) supplemented in a corn-soybean meal (SBM) based conventional diet on growth performance, intestinal histomorphology, and quantification of specific bacteria in the ceca of broilers. A total of 240 d of hatch Cobb 500 male broiler chicks were randomly assigned to 4 dietary treatments (corn-SBM-based control diet) containing 0, 0.05, 0.1, and 0.2% XOS. The broilers were raised for 21 d in 6 replicate cages, each containing 10 birds. Growth performance parameters were obtained weekly. Additionally, small intestinal tissues were collected to evaluate histomorphometry and whole ceca were collected to quantify bacterial populations on D21. The results showed that inclusion of XOS has similar body weight (BW), body weight gain (BWG), feed intake (FI), and feed conversion ratio (FCR) as the control group during the 21-day study. The results further indicate a tendency for the jejunum villus to crypt ratio (VH:CD) to increase in birds given 0.05 and 0.2% XOS (P = 0.08). Cecal bacteria quantification showed a linear increase in Bifidobacterium with increasing XOS levels (P < 0.0001) and a decrease Clostridium perfringens levels compared to birds fed the control diet (P < 0.0001). However, there were no differences in the total counts of Lactobacillus and E. coli. Together these results showed that while there were no differences in growth parameters up to 21 d, the histomorphology findings and the increase in Bifidobacterium, along with the reduction in C. perfringens observed in the XOS groups, suggest a beneficial impact of XOS inclusion on gut health. Further research with longer feeding periods and higher XOS levels should be conducted to explore potential positive effects on both growth and gut health parameters.

EARLY IMPLANT OUTCOMES IN ADULTS WITH DENTAL DECAY TREATED WITH PHOTODYNAMIC TREATMENT

A fast implant is a kind of implant to place in the cavity right away after dental extraction. These implants are shown to maintain cervical marrow and reduce the number of surgery operations required for patients. The Photodynamic treatment (PDT) uses antimicrobial processes to supplement nonsurgical periodontal therapy. Combined through the scaling and root planning (SRP), and PDT is more effective. This study aims to assess the effects of PDT on initial findings with dental implants (DI) placed in patients having gum disease with SRP against patients who do not at the 12-month follow-up point. An aggregate of 25 implants were inserted in 16 patients, 12 of whom were in the test group (TG) and 13 of whom were in the control group (CG). SRP is conducted toward rapid implant assignment in the control site, while PDT as an adjunct to SRP (SRP + PDT) is executed prior to instant implant insertion in test sites. At the beginning, 4 months, 8 months, and 12 months, gingival index, radiovisiographs, inquiring pocket intensity, clinical attachment level, and plaque index were obtained. Basic durability was assessed after implant insertion, and the recovery index was measured a week later. In this analysis, Analysis of Variance (ANOVA) technique is used to predict tooth decay earlier. The CG experienced 1.10 mm of mean marginal bone loss after the 12-month research period, compared to 0.97 mm for the (SRP + PDT) group. After reaching the CG and TG, the differences in plaque score and probe depth were noteworthy. Clinical indicators compared to the basis in a year revealed unquestionable improvement, including the probing depth gingival index, plaque index and clinical attachment level. Twelve months were spent monitoring the implants in both groups. The little bone loss improved, although it isn't clinically important. The endurance rate for rapid implants in the PDT grouping is the same as that of the group that underwent SRP. The impact of PTD is utilized as a supplement to SRP. Yet, the consequence is marginal. Because of the improved results with PDT, it is used successfully as an addition to SRP.

Psychological health of postmenopausal women: a bibliometric analysis in the recent decade

The aim of this study is to analyze the publication trends on the psychological health of postmenopausal women by performing a bibliometric and visualization analysis that can be used as a foundation for understanding current and future research plans. Publications were retrieved from Dimensions database from 2012 to June 2022. VOSviewer software was used for data mining and visualization. A total of 1718 papers were selected by keyword search and delimiting criteria. To evaluate the productive nations, authors, journals, articles and frequent joint citations, citation analysis, author keyword co-occurrence analysis, co-authorship analysis and co-citation analysis were performed. Results depict that the USA contributed the most papers (n = 457). Maximum articles (n = 192) were published in 2021. The highest number of articles are published in Menopause: The Journal of the North American Menopause Society and Climacteric: The Journal of the International Menopause Society. Out of the top 10 contributing organizations in the field, six organizations were from the USA. R. Nappi of Italy is the most productive author with 20 articles and 1138 citations. From the point of average citations per article, H. Joffe has the highest score (71.5). The data reported in this analysis contribute to discussions about the development, growth and current state of psychological health of postmenopausal women as well as its impact. These findings offer helpful guidance for researchers in choosing their potential fields of study and integrating different approaches to solve complicated issues, finding potential co-authors and choosing the right institutions for supporting academic studies or collaborative research.

Assessment of Treatment Plan Quality between Flattening Filter and Flattening Filter Free Photon Beam for Carcinoma of the Esophagus with IMRT Technique

Background

As compared to the flattened photon beam, removing the flattening filter (FF) from the head of a gantry decreases the average energy of the photon beam and increases the dose rate, leading to an impact on the quality of treatment plans.

Objective

This study aimed to compare the quality of intensity-modulated radiation therapy (IMRT) treatment plans for esophageal cancer with and without a flattened filter photon beam.

Material and Methods

In this analytical study, 12 patients, who had already been treated with a 6X FF photon beam, were treated based on new IMRT methods using a 6X the flattening filter-free (FFF) photon beam. Both 6X FF IMRT and 6X FFF IMRT plans used identical beam parameters and planning objectives. All plans were evaluated with planning indices and doses for organs at risk (OARs).

Results

Insignificant dose variation was for HI, CI, D_98%, and V_95% between FF and FFF photon beam IMRT plans. FF-based IMRT plan delivered a 15.51 % and 11.27% higher mean dose to both lungs and heart than the FFF plan, respectively. The integral dose (ID) for the heart and lungs was 11.21% and 15.51%, respectively, less in the IMRT plan with an FFF photon beam.

Conclusion

In contrast to the FF photon beam, a filtered photon beam-oriented IMRT plan provides significant OAR sparing without losing the quality of the treatment plan. High monitor units (MUs), low ID, and Beam on Time (BOT) are major highlights of the IMRT plan with FFF beam.

Evaluation of a dacitic (rhyolitic) tuff breccia use on performance, inflammatory, and antioxidant responses in broilers mildly challenged with Eimeria spp

The objective of the study was to investigate the effects of a dacitic tuff breccia (DTB) on Eimeria-infected broilers. A total of 600 one-day-old Cobb 500 male chickens were randomly assigned to 5 treatments with 10 replicates of 12 birds. Treatments were: an unchallenged control (UC), a challenged (CC) control (0% DTB), and 3 challenged groups with 0.125, 0.25, or 0.5% DTB. At d 14, birds in the CC and DTB groups were orally gavaged with mixed Eimeria spp., while the UC received water. Growth performance was evaluated during prechallenge, challenge, and postchallenge periods (0-14 d; 14-20 d; and 20-26 d, respectively). Gastrointestinal permeability was measured at 5 days postinfection (dpi). Intestinal histology and nutrient digestibility of dry matter (DM), crude protein (CP), and ileal digestible energy (IDE) were measured at 6 dpi. Liver activity of glutathione peroxidase (GSH-Px) was determined at 6 dpi, and concentrations of reduced (GSH) and oxidized glutathione (GSSG) were analyzed at 6 and 12 dpi. Data were analyzed using a linear mixed model analysis and Tukey's test (P ≤ 0.05). From 0 to 14 d, similar average daily gain (ADG) and average daily feed intake (ADFI, P > 0.05) were observed. Gain:feed ratio (GF) was higher in 0.125, 0.25, and 0.5% of DTB than the CC and UC (P < 0.001). From 14 to 20 d, the UC had the highest ADG, ADFI, and GF (P < 0.001). At 5 dpi, intestinal permeability was higher in the challenged groups than the UC. Additionally, the UC showed the highest apparent ileal digestibility of CP, whereas 0.125% DTB had higher CP digestibility than the CC and 0.5% DTB (P < 0.001). At 6 dpi, 0.125% DTB increased GSH-Px activity compared to the CC, 0.5% DTB, and UC (P < 0.001). At 12 dpi, 0.125% DTB showed increased GSH concentration compared to the CC, 0.25% DTB, and 0.5% DTB (P < 0.01). The mild coccidia infection negatively impacted growth performance, apparent ileal nutrient digestibility, intestinal histology, and gastrointestinal integrity in broilers. The use of 0.125% DTB exhibited potential in improving antioxidant responses, apparent ileal digestibility of CP, and growth performance.

Susceptibility of male reproductive system to bisphenol A, an endocrine disruptor: Updates from epidemiological and experimental evidence

Bisphenol A (BPA) is an omnipresent environmental pollutant. Despite being restrictions in-force for its utilization, it is widely being used in the production of polycarbonate plastics and epoxy resins. Direct, low-dose, and long-term exposure to BPA is expected when they are used in the packaging of food products and are used as containers for food consumption. Occupationally, workers are typically exposed to BPA at higher levels and for longer periods during the manufacturing process. BPA is a known endocrine disruptor chemical (EDC), that causes male infertility, which has a negative impact on human life from emotional, physical, and societal standpoints. To minimize the use of BPA in numerous consumer products, efforts and regulations are being made. Despite legislative limits in numerous nations, BPA is still found in consumer products. This paper examines BPA's overall male reproductive toxicity, including its impact on the hypothalamic-pituitary-testicular (HPT) axis, hormonal homeostasis, testicular steroidogenesis, sperm parameters, reproductive organs, and antioxidant defense system. Furthermore, this paper highlighted the role of non-monotonic dose-response (NMDR) in BPA exposure, which will help to improve the overall understanding of the harmful effects of BPA on the male reproductive system.

An Observational Study Depicting Role of p16 in Detecting Human Papilloma Virus in Oral and Oropharyngeal Cancer and Associated Factors

The longstanding phrase, traditional risk factors like-smoking, tobacco and alcohol are the only causative agents of oral and oropharyngeal squamous cell carcinoma (SCC) is changing now. Etiological divergence is taking place which we have to know to reach upon an exact cause of the disease. Human papilloma virus (HPV) infection is a well-established cause of oral cancer. Escalating incidence of HPV associated cancer has a strong impact on its management. So, a concern clinician needs to get aware for it. Among various types of HPV, HPV-16 is more frequently associated with oral cancers. HPV detection will become a game changer in management of oral cancers. HPV infection and p16 protein expression has a strong and consistent correlation. Therefore, immunohistochemical analysis of p16 protein can be a surrogate biomarker in high risk groups. This hospital based prospective observational study recruited 180 subjects of oral and oropharyngeal SCC. We underwent immunohistochemical analysis of p16 in biopsy specimen of subjects and studied HPV status and associated environmental, clinical and behavioral factors. We observed 9.4% (17/180) incidence of p16 positivity with female predominance. Our observations showed that its prevalence was higher in urban patients who were non tobacco users, had sexually transmitted disease, early stage (T1-T2), poorly differentiated SCC with nodal metastasis. We conclude that keeping in mind HPV as a cause of oral and oropharyngeal SCC, p16 should be use as a biomarker for its detection in high risk cases.

Does Fluence Smoothing Reduce the Complexity of the Intensity-Modulated Radiation Therapy Treatment Plan? A Dosimetric Analysis

Background

Intensity-modulated radiation therapy (IMRT) may have too many peaks and valleys, making the treatment plan undeliverable. When there are too many fluency differences between adjacent pixels in the X or Y directions, the X and Y smoothing factors are utilized as weighting factors to penalize this behavior. Generally, a high degree of complexity is accompanied by many monitor units (MUs), large number of segments, small sized segments, and complex segment shapes. The degree of plan delivery uncertainty can all increase with a higher detailed fluence map.

Aim

This study aims to evaluate the dosimetric effects of various smoothing levels on the planning target volume (PTV) and organs at risk (OARs) for cervix cancer.

Materials and Methods

IMRT treatment plans were re-optimized by combining several values of the X and Y penalty between 0 and 100. The dose-volume histogram assessed various dosimetric indicators for PTV and OARs. Additionally, gamma passing rates were evaluated and noted as an indicator of the complex treatment plan.

Results

At X = 60, Y = 60 fluence map penalty, the conformity index (CI) value reached its highest value of 0.996 ± 0.004. At X = 0, Y = 0, the homogeneity index (HI) was determined to have a maximum value of 0.0628 ± 0.0235. The highest and lowest MU values were 2424.30 ± 471.12 and 1087.80 ± 91.57, respectively, with X = 0, Y = 0 and X = 100, Y = 100. At X = 100, Y = 100, the gamma passing rate reaches its highest value of 99.28% ± 0.44% and minimum value of 85.93% ± 3.87% at X = 0, Y = 0.

Conclusion

The CI and HI values showed no discernible fluctuation, and the OAR doses were barely affected as smoothing was increased. When the smoothing factor was raised, the number of MUs sharply dropped, and a decrease in the number of segments and higher gamma passing rates were also seen.

Metastatic Trends in Breast Cancer According to Molecular Subtypes, Estrogen Receptor, Progesterone Receptor and Human Epidermal Growth Factor Receptor 2neu Status

Background : Breast cancer molecular subtypes have been established a close relationship with site specific metastasis, disease prognosis, selection of therapy and response to therapy. This study is the evaluation of primary tumor molecular determinants and its clinical outcome in association with metastatic behavior of breast cancer. Material and Methods: This prospective study was included 221 patients of breast cancer registered in the department between January 2016 to December 2018. Based upon hormonal status, patients with breast cancer were categorized into four groups i.e. luminal (ER+, PR+, HER 2neu-), HER 2neu enriched (ER-, PR-, HER 2neu+), triple positive (ER+, PR+, HER 2neu+) and triple negative (ER-, PR-, HER 2neu-). Metastatic sites were divided into skeleton and visceral (lung, liver, and brain). The study data was compiled using Microsoft Excel sheet and Chi-Square test was used to assess the association between categorical variables. P value less than 0.05 was considered as statistically significant. Results : The mean age of the patients was 48.21±11.4 years (ranging from 22 to 80 years). About 36.7% and 24.9% patients were diagnosed as stage III A and stage II B respectively. Majority of patients were categorized as luminal (43%), followed by 24%, 17.2% and 15.8% as triple negative, triple positive and HER 2neu enriched respectively. Metastasis to bone following breast cancer was observed in majority i.e. 11.8% cases. Lung and liver metastasis observed in 6.3% cases each whereas brain metastasis was observed in 0.9% cases only. The higher proportions of TNBC cases metastasized to bone (22.6%), liver (7.5%), lung (7.5%) and brain (1.9%). The association between metastasis and hormonal status was statistically highly significant for bone metastasis (p<0.05). Conclusion : Breast cancer molecular subtypes have been related to considerable distinction in pattern of distant spread. Bone is the most predominant site of metastases followed by liver lung and brain. Luminal and HER 2 neu enriched subtypes having greater propensity for visceral metastasis where as TNBC predominantly show bone metastasis in this study. Keywords: Breast cancer, molecular subtypes, site-specific metastasis

Feasibility and impact of a one-stop thyroid clinic in a low- and middle-income country

BACKGROUND

The study was done to evaluate the feasibility, safety and outcomes of a one-stop thyroid clinic (OSTC) in a low- and middle-income country (LMIC) setting.

METHODS

This was a prospective non-randomised case control study consisting of patients with thyroid nodules evaluated and managed at a tertiary referral centre in an LMIC between February 2019 and January 2020. Patients were divided into two groups based on the kind of preoperative evaluation protocol: OSTC group (n = 118) - OSTC protocol, and control group (CG, n = 108) - routine protocol.

RESULTS

Baseline clinical characteristics of the two groups including median age (p = 0.13) and gender distribution (p = 0.76) were comparable. The majority of patients in both groups belonged to a low-income group (46.6% vs 47.3%; p = 0.91), followed by a middle-income group (35.6% vs 30.5%; p = 0.41). The median number of outpatient department visits (1 vs 3 days; p = < 0.001), waiting time for neck ultrasonography (1 vs 3 days; p = < 0.0001), fine needle aspiration cytology (1 vs 2 days; p = < 0.0001), and out of pocket expenditure (INR 3 965 vs 6 624; p = < 0.001) was significantly less in the OSTC group compared to the CG. Patients in the OSTC group reported better satisfaction levels (p = < 0.0001). Accuracy of diagnosis did not differ between the two groups (p = 0.14).

CONCLUSION

OSTC practice is feasible, provides comparative clinical outcomes and seems cost effective in an LMIC. This protocol can be adopted as a routine practice in any health system.

Effect of nurse-led lifestyle modification follow up program on health outcomes and quality of life among post myocardial infarction patients: a randomized controlled trial

Funding Acknowledgements

Type of funding sources: None.

Background

India has among the world's highest burden of cardiovascular disease, potentially contributed by myocardial infarction. Despite growing trouble, there are no known post-discharge programs & randomized trials reporting health status outcomes & quality of life among post-myocardial infarction patients. Cardiac rehabilitation programs reduce mortality, therefore, it is crucial to understand the local burden of the disease, common challenges, public perceptions, develop timely & effective interventional programs.

Purpose

This study aimed to evaluate the effect of a nurse-led lifestyle modification follow-up program on health outcomes & quality of life among post-myocardial infarction patients.

Methods

A two-arm randomized controlled trial was adopted & 104 post-myocardial infarction patients were recruited from August to December 2021. An equal number of participants were randomly assigned to intervention & control group by random number table generator. The control group patients received routine care, while the intervention group was provided routine care along with a nurse-led lifestyle modification follow-up program(health education, educational booklet, & telephone follow- up). A low-cost intervention based on information-motivation-behavioural skill model was developed. It was designed according to the needs of patients to know their risk factors, help patients establish a knowledge base, & adapt to the post-illness lifestyle changes. Data were assessed & compared by using the demographic datasheet, health outcomes datasheet, & MacNew heart disease quality of life questionnaire. All evaluations were conducted at baseline after 12 weeks post-discharge, by face-to-face interview & biophysiological measurements.

Results

The nurse-led lifestyle modification follow-up program was convenient for clinical application. The intervention group showed a appreciable improvement in low density lipoprotein(p=0.045), systolic blood pressure(p=0.009), diastolic blood pressure(p=0.044), body mass index(p=0.043), and NT ProBNP(p=0.007). The program effectively improved the lifestyle behaviours thereby considerably improving the quality of life in all the subscales-physical, emotional & social (p&lt;0.001) after 12 weeks of discharge.

Conclusion

In the Indian context, it is a novel & extensive approach to improve access to health care and emphasizes post-discharge self-management. The greatest benefit of this program was allowing the intervention group participants to consult with us immediately. Since lifestyles vary among different individuals, we considered individuality when providing education & involving them in implementation of an intervention to enhance their confidence & ultimately achieve optimal health outcomes & quality of life. The findings of this study are important for health care professionals caring for post-myocardial infarction patients & direct incorporation of such programs into routine practice to reduce morbidity & mortality.

Hypercalcemia with methotrexate pneumonitis: A rare, important and intriguing adverse event

Methotrexate leading to hypercalcaemia is a rarely reported adverse event. We present three elderly patients with inflammatory arthritis who developed hypercalcemia probably due to methotrexate-induced granulomatous pneumonitis. All patients presented with worsening non-productive cough with dyspnea, nausea, loss of appetite, and confusion. Their clinical and radiologic features were consistent with methotrexate-induced pneumonitis. On evaluation, all patients concurrently had hypercalcemia with normal 25OH D3, and low PTH with markedly elevated levels of 1,25OH D3 seen in two patients. In all three patients, hypercalcemia and pneumonia responded to hydration, corticosteroids, and methotrexate withdrawal. There was no relapse of symptoms on long term follow-up. In these three patients with inflammatory arthritis, methotrexate-induced pneumonitis led to symptomatic hypercalcemia. Unless hypercalcemia is looked for and treated in this setting, the morbidity can be high.

AB1108 IMPACT OF THE FIRST WAVE OF THE COVID 19 PANDEMIC ON HEALTHCARE ACCESSIBILITY, DISEASE BEHAVIOUR, ANXIETY, AND PHYSICAL ACTIVITY IN RHEUMATIC DISEASE PATIENTS: AN ONLINE SURVEY AND POTENTIAL SOLUTIONS

Background

Coronavirus Disease (covid 19) negatively impacted psychosocial health, health care accessibility and exercise regimen but problem’s scope and potential solutions remain elusive. We conducted a patient based online survey to understand these impacts and discussed potential solutions.

Objectives

Assess impact of Covid 19 on rheumatological disease status, accessibility to health care, patient anxiety and behavior and continuation of physical activity during pandemic.

Methods

Google form (18-question) based questionnaire was sent via SMS/WhatsApp in Aug 2020, at height of first pandemic and responses were collected over next month.

Results

Only 339 /2700 patients (12.5 %) responded to the survey. Other authors (1)(2) have observed a similar low response rate to online surveys. We recognise questionnaires with fewer questions tend to generate more responses, which should be considered critical in constructing future health-related surveys. Patients’ global assessment of their disease score was 7/10, with 0 representing the worst disease status and10 representing best disease status, also 1/3 patients not felt need for rheumatological consultation during six months (March 2020- Aug 2020) of lockdown. These may imply adequate rheumatic disease control over long periods and during subsequent waves of pandemic, rheumatology patients can be shielded by avoiding non-urgent hospital follow up visits. Significant number of patients (20%) were unable to contact their rheumatologist, implying a significant impact of covid 19 and lockdown on rheumatology care, as suggested by other authors (1). As expected, there was switch to tele consultancy mode of communication, with 22 per cent of patients already using it within 3 months of its introduction, which appears to be a good indicator of future adaptability and feasibility of teleconsultation. Identifying specific profile of patients during physical consultation who can be easily managed via teleconsultation, may reduce unnecessary hospital visits while also improving healthcare delivery. 1/3 of our patients had anxiety about disease flare, and 41 %were concerned about increased risk of covid 19 infection as they were on immunosuppressive medications as noted by other authors (3). Improving access to health care and increasing public awareness could help alleviate this anxiety. Reaching out to isolated rheumatology patients through SMS / educational video may improve the sense of health security. Contrary to our expectations, overall medication adherence was reasonable, likely due to be management of supply chains by local authorities .15% completely stopped exercising and 25% reduced their exercise regimen by 50%. Shifting to home-based exercise, educational videos on physical therapy and online teleconsultation with physiotherapists could overall have positive impact.

Conclusion

Covid 19 has significantly impacted rheumatological patients in terms of increased anxiety, decreased healthcare accessibility and decreased exercise and physical activities. Modifications in teleconsultation methodology are needed in the future. Patients’ anxiety can be alleviated by educating them through digital and social media platforms and enrolling them in online patient support groups.

References

[1]Ganapati A, Padiyar S, Nair A, et al. Impact of COVID-19 Pandemic and Resultant Lockdown in India on Patients with Chronic Rheumatic Diseases: An Online Survey. Indian J Rheumatol. 2021;16(1):30. doi:10.4103/injr.injr_231_20

[2]McKee P, Irvine A, Riddell C, Ball E. IMPACT OF THE COVID PANDEMIC ON RHEUMATOLOGY PATIENTS IN NORTHERN IRELAND - A WEB BASED CROSS-SECTIONAL SURVEY OF PATIENT REPORTED OUTCOMES. Ulster Med J. 2021;90(3):197

[3]Hammad MAH, Eissa M, Dawa GA. Impact of coronavirus disease 2019 (COVID-19) pandemic on attitude, behavior, and mental health of patients with rheumatic diseases. Egypt Rheumatol Rehabil. 2020;47(1). doi:10.1186/s43166-020-00045-y

Disclosure of Interests

None declared

Axin2+ PDL Cells Directly Contribute to New Alveolar Bone Formation in Response to Orthodontic Tension Force

Wnt-β-catenin signaling plays a key role in orthodontic tooth movement (OTM), a common clinical practice for malocclusion correction. However, its targeted periodontal ligament (PDL) progenitor cells remain largely unclear. In this study, we first showed a synchronized increase in Wnt-β-catenin levels and Axin2+ PDL progenitor cell numbers during OTM using immunostaining of β-catenin in wild-type mice and X-gal staining in the Axin2-LacZ knock-in line. Next, we demonstrated time-dependent increases in Axin2+ PDL progenitors and their progeny cell numbers within PDL and alveolar bones during OTM using a one-time tamoxifen-induced Axin2 tracing line (Axin2CreERT2/+; R26RtdTomato/+). Coimmunostaining images displayed both early and late bone markers (such as RUNX2 and DMP1) in the Axin2Lin PDL cells. Conversely, ablation of Axin2+ PDL cells via one-time tamoxifen-induced diphtheria toxin subunit A (DTA) led to a drastic decrease in osteogenic activity (as reflected by alkaline phosphatase) in PDL and alveolar bone. There was also a decrease in new bone mass and a significant reduction in the mineral apposition rate on both the control side (to a moderate degree) and the OTM side (to a severe degree). Thus, we conclude that the Axin2+ PDL cells (the Wnt-targeted key cells) are highly sensitive to orthodontic tension force and play a critical role in OTM-induced PDL expansion and alveolar bone formation. Future drug development targeting the Axin2+ PDL progenitor cells may accelerate alveolar bone formation during orthodontic treatment.