Indian Rheumatology Association guidelines for the management of ANCA associated vasculitis

BACKGROUND

The ACR in 2021 and the EULAR in 2022 published recommendations for management of ANCA-associated vasculitis. Given the differences in the demographic, clinical profiles, and the socio-economic realities between various countries, there is a need for development of guidelines for the management of AAV for less economically developed regions of the world.

METHODS

These guidelines were made following the GRADE methodology. After the systematic literature review, recommendations were formulated and opinion was sought from the 18-member expert panel consisting of 17 clinicians and one patient representative.

RESULTS

Twenty recommendations were formulated. We recommend ANCA testing by ELISA over IIF. For remission induction in active GPA or MPA, we recommend use of intravenous cyclophosphamide or rituximab in combination with glucocorticoids. We conditionally recommend the use of reduced dose glucocorticoids over standard dose glucocorticoids for remission induction in active GPA or MPA. For remission maintenance in patients with GPA or MPA, we recommend the use of rituximab over azathioprine for at least 48 months from diagnosis. We conditionally recommend the use of plasma exchange in patients with severe renal vasculitis. For remission induction in EGPA, we recommend use of cyclophosphamide or rituximab in severe disease and mepolizumab or azathioprine or methotrexate or mycophenolate mofetil in non-severe disease.

CONCLUSIONS

These are the first ever Indian recommendations for the management of AAV. Despite our effort to formulate these recommendations based on high quality evidence, some recommendations were still based on low quality evidence but with high rate of agreement among expert panel members.

Effectiveness of 675-nm Wavelength Laser Therapy in the Treatment of Androgenetic Alopecia Among Indian Patients: Clinical Experimental Study

BACKGROUND

Androgenetic alopecia (AGA) is the most prevalent cause of hair loss around the world.

OBJECTIVE

The purpose of this study was to evaluate the efficacy of laser stimulation with a 675-nm wavelength for the treatment of AGA in male and female Indian patients.

METHODS

A total of 20 Indian healthy patients aged 23-57 years who presented a grade of alopecia stage I to stage V underwent one single pass with a 675-nm laser to the scalp area twice a week for a total of 8 sessions, followed by once a week for 4 sessions and once in 2 weeks for 2 sessions. There are 14 laser treatments in total. Macro- and dermatoscopic images have been acquired at T0 (baseline) and T1 (4 months). The vertex, frontal, and parietal areas of the scalp were evaluated. Many parameters were analyzed including hair count and hair density of terminal; mean thickness; vellus follicles; total follicular units; units with 1 hair, 2 hairs, 3 hairs, 4 hairs, and >4 hairs; unit density; and average hair/unit.

RESULTS

The macroimages and dermatoscopic evaluations showed good improvement over the entire treated area, with a clear increase in the number of hairs and hair thickness. General parameters such as hair count and hair density showed a percentage increase of around 17%. The hair mean thickness parameters showed a significant (P<.001) percentage increase of 13.91%. Similar results were obtained for terminal and vellus hair: terminal hair count and hair density significantly (P=.04 and P=.01, respectively) increased by 17.45%, vellus hair count increased by 16.67% (P=.06), and the density of vellus hair increased by 16.61% (P=.06).

CONCLUSIONS

The study findings demonstrate that the 675-nm laser system improved AGA in Indian patients, facilitating the anagen phase and improving hair density and other positive hair parameters.

Identification of the novel HLA-B*49:01:01:22 allele in an Indian renal transplant donor by next generation sequencing

HLA-B*49:01:01:22 differs from HLA-B*49:01:01:01 by a single nucleotide C->G change in intron 5 at gDNA 2451.

Indian immigrants' constructions of mental health and mental illness in the perinatal period: A qualitative study

AIM

The aim of this study is to explore how immigrant women and men from India construct mental health and mental illness in the perinatal period.

DESIGN

Qualitative interpretive design.

METHODS

Data were collected by conducting in-depth interviews with 19 participants. Photo elicitation, free listing and pile sorting were used during the interviews. Purposive sampling was used, and data were collected in 2018 and 2019. Data were analysed using thematic analysis.

FINDING/RESULTS

One major theme and three subthemes were identified. 'We do not talk about it' was the major theme and the subthemes: (1) 'living peacefully and feeling happy' described the views on mental health; (2) 'that's the elephant in the room still' captures how participants felt when talking about mental illness; and (3) 'why don't we talk about it' offers reasons why the Indian community does not talk about mental health and illness.

CONCLUSION

The findings of this study have highlighted the importance of understanding the impact of immigration and being culturally sensitive when assessing mental health in the perinatal period.

IMPACT

The findings of this study identify some of the reasons for non-disclosure of mental health issues by immigrants. Incorporating these findings during psychosocial assessment by health professionals in the perinatal period will help translate the cultural aspects into more effective communication.

PATIENT OR PUBLIC CONTRIBUTION

Patient and public contribution to the study was provided by the Community Stakeholders Group; these were members of the immigrant community from India who had expertise in mental health. They contributed to the study design and the key terms and phrases for the free list used in interviews.

MP, Singh A. Normative Radiographic Measurements of Scaphoid in a Sample Indian Population

Introduction  Wrist parameters measured on direct radiography are essential in diagnosing scaphoid-related pathologies and treatment. Although computed tomography has been used to establish normative for scaphoid measurement, no research has focused on Indian norms. This study aimed to determine the distribution and normal limits of parameters measured in our population's posteroanterior (PA) and direct lateral radiographs of the wrist. Materials and Methods  Two investigators conducted a prospective analysis of normal wrist radiographs in a single center. Radiology information system-picture archiving and communication system was used to collect standard digitized normal X-rays without significant osseous pathology over a year. The sample size was 600, distributed among age groups 18 to 30, 31 to 50, and 51 years and above. Scaphoid length, scaphoid width, scapholunate ratio, and scapholunate distance using both Cautilli and Gilula techniques were measured on a PA view, and scapholunate, radioscaphoid, and intrascaphoid angles were measured on a lateral view. As the lunate morphology is supposed to affect carpal kinematics with the scaphoid, the same was evaluated using the Viegas classification. Results  A total of eight measurements were documented. Scaphoid length, scaphoid width measurements, and lateral intrascaphoid angle were more in males than in females and were found to be statistically significant. No other parameters showed any significance in terms of age and relation to lunate morphology. Conclusion  The study offers a comprehensive analysis of measuring parameters specific to the Indian population. For the first time, the measurement of scapholunate distance was conducted utilizing two distinct methodologies. The normative intrascaphoid angle range and clinical implications were determined.

Normative Data of Carpal Bone Measurements in the Sample Adult Indian Population

Introduction  Radiography is the most often accessible and affordable imaging modality. Accurate assessments of wrist X-rays can aid in the diagnosis and prognostic evaluation of various wrist problems. This study aims to identify normal radiographic anthropometry reference values and variations of carpal bones and joints by gender and age in sample Indian population, with the potential to be clinically applicable. Materials and Methods  Two investigators conducted a prospective analysis of normal wrist radiographs in a single center. Radiology Information Systems and Picture Archiving and Communication Systems were used to collect standard digitized normal X-rays without significant osseous pathology over a year. We conducted measurements of length, angles, and indices in a standard posteroanterior and lateral wrist X-rays in order to establish the standard dimensions and variances based on age and gender. Results  A total of 18 measurements which included eight linear measurements, eight angles, and two ratios were documented. A total of 500 X-rays of 250 males and 250 females with 125 of each in two age groups of 20 and 40 years and 41 and 60 years were evaluated. Conclusion  This work is a comprehensive database of the Indian population measuring parameters in normal wrist radiographs of posteroanterior and lateral views. The results of our study indicate that men and younger individuals had a significantly higher carpal height ratio. The width of distal radial ulnar joint space was significantly lesser in older subjects. Additionally, males showed a significantly higher lunate uncovered ratio and radial height. When compared to the literature, the study revealed a significant positive ulnar variance in elderly people and women. However, we noted an overall increase in the percentage of positive ulnar variance individuals in our study. We also recorded a marginal increase in radial inclination with no variations across gender and age.

Characterisation of a novel HLA-A*33:33:02 allele in two members of a North Indian family

HLA-A*33:33:02 differs from HLA-A*33:33:01 by one synonymous nucleotide change C>T in exon 3 (TCC>TCT).

Identification of novel HLA-C*17:78 allele in North Indian individuals

HLA-C*17:78 differs from HLA-C*17:03:01:03 by one nucleotide change C>T in exon 3 (GCG>GTG).

Determining the Normal Glenoid Version in the Indian Population

Background  Glenoid version refers to the angle subtended by the glenoid with the scapula. On average, it is 0 ± 10 degrees with a slight propensity toward retroversion. Numerous factors such the dominance(handedness), gender, ethnicity, and pathology are known to affect version. Version has important consequences on the biomechanics of the shoulder joint and is altered in those with arthritis and shoulder joint instability. Aim  Our study aimed to determine the normal range of glenoid version in the population. Further, we aim to assess the relationship between gender and version. Settings and Design  We conducted a retrospective observational study in a tertiary referral hospital with a target sample size of 200 shoulders. Methods and Materials  The computed tomography images were retrospectively reviewed to determine the scapular shape and the glenoid version angle. Statistical Analysis  Statistical analysis was done using SPSS v.22 software with p -value less than 0.05 considered as significant. Results  The mean age of the individuals in our study was 44 years. In our study, irrespective of gender, most individuals had some degree of anteversion and males had lower degree of anteversion. Previous studies have shown that most normal individuals usually have retroverted shoulder joints. The mean glenoid version was significantly lower in the right than in the left shoulder and males had significantly lower mean glenoid version than females in both shoulders. Most individuals in our study had a flat scapular spine. Conclusion  This study shows that the Indian population may have a slight propensity toward anteversion and this has an important bearing on shoulder arthroplasty. Further, this study shows that significantly lower degrees of version are found on the right side and that the degree of version is significantly lower in males. Understanding the role of glenoid version in shoulder biomechanics will go a long way in the early identification of pathology, the preoperative planning of shoulder arthroplasty, and the operative restoration of a functional shoulder joint.

Association of accelerometer measured sedentary behavior patterns with cognitive functions in sedentary office workers: Insights from SMART-STEP study

BACKGROUND

High levels of sedentary behavior in workplaces are currently recognized as an independent risk factor for cognitive dysfunction and poor mental health. However, sedentary patterns vary between workdays and non-workdays, which may influence cognitive functions.

OBJECTIVE

The present study aimed to quantify and compare work and nonwork device-measured sedentary time (ST) and its association with cognitive function in Indian office workers.

METHODS

In an ongoing randomized controlled trial (SMART-STEP), the baseline data of 136 full-time office workers, including accelerometer-measured sedentary patterns and cognitive functions, were analyzed. The ST was measured using a hip-worn accelerometer (Actigraph wGT3X-BT) for seven days, and executive functions were measured using computer-based tests. Linear regression models were employed to analyze the relationships between ST and executive function measures.

RESULTS

The median daily ST of Indian office workers was 11.41 hours. The ST was greater on both workdays (11.43 hrs.) and non-workdays (11.14 hrs.) though different (F = 6.76, p = 0.001, ηp2 = 0.032). Office workers accumulate more prolonged sitting bouts (+21.36 min) during work days than non-workdays. No associations between device-measured ST and executive functions were observed.

CONCLUSION

Indian office workers exhibited high ST patterns, especially on workdays. Although lower than workdays, Indian office workers exhibited more ST patterns during non-workdays than did their Western counterparts. Culturally adaptable workplace and leisure time physical activity interventions are needed to address the high ST of Indian office workers.

Perceived powerlessness and self-harming behaviours in UK-based Bangladeshi, Indian and Pakistani women

This study investigated self-harming behaviours among UK-based women of Bangladeshi, Indian and Pakistani origin (UKBIP). Through purposive sampling, eight participants who had engaged in self-harm, specifically through cutting, were selected for semi-structured interviews. The qualitative data gathered from these interviews underwent analysis using interpretative phenomenological analysis (IPA), which involved analysis at individual and group levels. Consequently, three super-ordinate themes and nine sub-ordinate themes emerged. The themes were 'Powerlessness' ('Entrapment', 'Internalised Negativity' and 'Abused by my Environment'), 'Mitigation' ('Releasing my Overwhelming Emotions', 'Connecting to my Pain' and 'Addicted to Self-harm') and 'Self-harm is Wrong' ('It must be Hidden', 'What have I done to Myself?', and 'My Self-harm is Sinful'). This paper focuses specifically on the 'Powerless' theme, exploring its relevance to self-harming behaviours in UKBIP women. The analyses provided novel insights into the impact and significance of the South-Asian cultural values and beliefs on the relevance to self-harming experiences in UKBIP women.

Postpartum glycemic and cardiometabolic profile of women testing positive for gestational diabetes mellitus by International Association of Diabetes and Pregnancy Study Groups (IADPSG) but negative by alternate criteria: Insights from CHIP-F study

OBJECTIVE

To evaluate burden of postpartum diabetes and other cardiometabolic risk factors among women who test positive for gestational diabetes mellitus (GDM) by International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, but negative by alternate criteria.

METHODS

This prospective cross-sectional study was conducted from 2019 to 2022 and is a sub-study of the CHIP-F cohort (Cohort Study of Indian Women with Hyperglycemia in Pregnancy and their Families).

RESULTS

Study participants (n = 826; 183 with normoglycemia and 643 with GDM using IADPSG criteria) were evaluated at a median (IQR) postpartum interval of 31 (21-45) months. Using the United Kingdom National Institute of Health and Care Excellence (UK NICE), Canadian Diabetes Association (CDA), and Diabetes in Pregnancy Study Group India (DIPSI) criteria, 251 (39.0 %), 148 (23.0 %) and 384 (59.7 %) women who tested positive for GDM by IADPSG criteria, would have tested negative. The incidence of postpartum diabetes among such women was 30.4, 34.3, and 48.2 per 1000 women-years, respectively, which was significantly higher than those testing negative by both IADPSG and UK NICE (5.0 per 1000 women-years), IADPSG and CDA (9.2/1000 women-years) and IADPSG and DIPSI criteria (5.0/1000 women-years). The burden of obesity and metabolic syndrome was also significantly higher in such women.

CONCLUSIONS

We found a significant burden of postpartum diabetes and cardiometabolic risk factors among women who tested positive for GDM by IADPSG, but negative by alternate criteria. There are potential clinical implications of a "failed" diagnosis for future cardiometabolic diseases that need to be carefully examined.

Hunting can increase physical activity of Indigenous peoples in Canada: pixem re yecwme'nstut

This study examined whether Indigenous peoples could achieve the Canadian Physical Activity Guidelines (CPAG) for adults while engaging in the cultural practice of hunting. It was hypothesized that Indigenous hunters would achieve or surpass the physical activity (PA) thresholds set forth by the CPAG on days spent hunting. Step count and heart rate were recorded from six male participants during mule deer hunts and days spent on-reserve. Step count was not statistically different between days spent hunting (28 803 ± 10 657 steps) and on-reserve (15 086 ± 7536 steps) (p = 0.10). Time spent in light (257 ± 45 min; p = 0.04), moderate (118 ± 71 min; p = 0.03), and vigorous (45 ± 42 min; p = 0.04) activities while hunting was greater than on-reserve (light, 180 ± 86; moderate, 71 ± 73; vigorous, 7 ± 10 min). The duration of moderate-to-vigorous PA (119 ± 95 min) for an average day hunting nearly meets the weekly CPAG recommendation of 150 min per week and is 1.8× greater than on-reserve (67 ± 80 min). Data suggest that hunting is probably a viable mode of PA for Indigenous adults to achieve health benefits. A strength of this study is the 10 h of daily recording which includes vehicular transportation to remote hunting areas. The duration of very light/sedentary PA did not differ between hunting (233 ± 211 min) and on-reserve (327 ± 164 min; p = 0.10), and highlights the importance of modernized vehicles in traditional Indigenous activities. A larger sample size would facilitate greater exploration of transportation, as well as success of the hunt on PA. These data suggest that health researchers and clinicians should consider traditional activities such as hunting as a means for Indigenous adults to increase participation in sufficiently vigorous PA to incur health benefits.

Efficacy and Safety of adjunctive Perampanel in a prospective, real-world, Phase IV study in Indian patients aged ≥12 years for Treatment of focal-onset Epilepsy: Study 508

OBJECTIVE

ESPRITE (Study 508; NCT03836924) evaluated the real-world safety, tolerability, and efficacy of adjunctive perampanel in patients aged ≥12 years with focal-onset seizures (FOS), with or without focal to bilateral tonic-clonic seizures (FBTCS), in India.

METHODS

ESPRITE was a prospective, multicenter, single-arm, observational, Phase IV study with a 6-month Treatment Period. Patients were aged ≥12 years and had been prescribed perampanel for adjunctive treatment of FOS, with or without FBTCS. Assessments included incidence of treatment-emergent adverse events (TEAEs; primary endpoint), median percent reduction in seizure frequency per 28 days from baseline, 50% responder rates, and seizure-freedom rates.

RESULTS

Overall, 200 patients were enrolled (199 patients in the Safety Analysis Set and 174 patients who completed all visits in the main efficacy analyses). TEAEs (all mild or moderate in severity) were reported in 18.1% (n = 36/199) of patients (the most common were dizziness [3.0%] and irritability [2.0%]). TEAEs leading to discontinuation of perampanel were reported in 2.0% of patients; no deaths or serious TEAEs occurred. At 6 months, median percent reduction in seizure frequency was 100.0%, 50% responder rate was 83.3%, and seizure-freedom rate was 49.4%.

SIGNIFICANCE

Adjunctive perampanel (at a mean daily dose of 4 mg/day) was shown to be well tolerated and effective in patients aged ≥12 years with FOS, with or without FBTCS, from India.

PLAIN LANGUAGE SUMMARY

Many patients do not receive adequate treatment for epilepsy and need effective seizure control medications. In this 6-month clinical study, 199 patients from India, aged 12 years or older, added perampanel to the anti-seizure medications they were already taking. At 6 months, 49% of patients experienced no seizures since starting perampanel and seizure frequency was reduced by half in 83% of patients. Side effects occurred in 18% of patients (most commonly dizziness and irritability) and caused 2% to stop perampanel; no deaths were reported. Perampanel was an effective and generally safe added medication for patients with epilepsy from India.

The experience of self-harming behaviours that inflict external injuries to the body in UK-based Bangladeshi, Indian and Pakistani women: a literature review

Studies carried out on self-harm in the UK have consistently reported a higher level of self-harm among women with South Asian heritage resident in the UK when age-compared with other British women. The reasons for this variation are many including but not limited exclusively to family environment and gender role expectations. These studies have also shown that these women are also least likely to seek psychological support from mental health professionals again with a number of explanations including stigma against help-seeking, notions of shame and other culture-specific factors. However, previous studies have clustered this large group together based on geographical heritage, regardless of the differences between religious and heritage groups and have reported on all types of self-harming behaviours as similar and predominantly carried out quantitative studies which while providing important statistical data have not always looked at the meaning of this experience for the participants. This paper presents a review of the relevant literature within the area of self-harm among Bangladeshi, Indian, and Pakistani women living in the UK. It is noteworthy that many studies discussed are dated, this appears to reflect an apparent lack of recent interest in the topic.

'Self-harm is wrong': the experience of self-harming behaviours that inflict external injuries to the body in UK-based Bangladeshi, Indian and Pakistani women: an Interpretative Phenomenological Analysis

This study investigated the experience of self-harming behaviour that inflicts external injuries to the body in UK based Indian, Pakistani, and Bangladeshi (UKBIP) women. A total of eight participants were recruited via purposive sampling and semi-structured interviews were carried out. The interviews were analysed using Interpretative Phenomenological Analysis (IPA). Analyses were carried out on an individual and group level and three super-ordinate themes, and nine sub-ordinate themes emerged. The superordinate themes were: 'Powerlessness' ('Entrapment', 'Internalised Negativity' and 'Abused by my Environment'), 'Mitigation' ('Releasing my Overwhelming Emotions', 'Connecting to my Pain' and 'Addicted to Self-harm') and 'Self-harm is Wrong' ('It must be Hidden', 'What have I done to myself?' & 'My Self-harm is Sinful'). The analyses revealed novel insights on the impact and importance of some South-Asian cultural values and beliefs on the experience of self-harm in South-Asian women. This paper will focus on the third superordinate theme and related sub themes, that of 'Self-harm is Wrong'.

Genetic diversity and forensic statistical support for the 12 X-STR markers in the Malaysian Indian population using Qiagen Investigator® Argus X-12 QS kit

X-chromosome short tandem repeats (X-STRs) are useful for human identification, especially in complex kinship scenarios. Since forensic statistical parameters vary among populations and the X-STRs population data for the diverse population of Peninsular Malaysia's are unavailable, this attempt for Indians (n = 201) appears forensically relevant to support the 12 X-STRs markers' evidential value for human identification in Malaysia. The Qiagen Investigator® Argus X-12 QS kit showed that DXS10135 was the most polymorphic locus with high genetic diversity, polymorphism information richness, heterozygosity, and exclusion power. Based on allele frequencies, the strength of discrimination and mean exclusion chance (MECKrüger, MECKishida, MECDesmarais, and MECDesmaraisDuo) values for the Malaysian Indians were ≥0.999997790686228. As for haplotype frequencies, the overall discrimination power and mean exclusion probability (MECKrüger, MECKishida, MECDesmarais, and MECDesmaraisDuo) were ≥0.9999984801951. The genetic distance, neighbor-joining phylogenetic tree, and principal component analysis also supported the evidential value of the 12 X-STRs markers for forensic practical caseworks in Malaysia.

Dynamic Muscle Function Parameters in Indian Children and Adolescents with Type 1 Diabetes Mellitus: A Case-Control Study

Introduction

Recent evidence reveals that type 1 diabetes mellitus (T1DM) impairs muscle function (MF) in adolescents. However, despite its importance in physical well-being, data on dynamic MF in Indian children and adolescents (C and Y) with T1DM are scarce. We assessed MF using Jumping Mechanography (JM, a measurement method for motion analysis and assessment of muscle power and force). (1) To assess dynamic MF by JM in C and Y with T1DM as compared to healthy controls (2) To determine predictors of MF in children with T1DM.

Methods

A cross-sectional observational study on 266 children (133 - T1DM duration >1 year with no known comorbidities + 133 age and gender-matched healthy controls) aged 6-19 years. Anthropometry, body composition, and MF (maximum relative power Pmax/mass, maximum relative force Fmax/BW by JM) were recorded. The lean mass index (LMI) was calculated as lean mass (kg)/height (m2). HbA1c was assessed in T1DM. Independent sample t-test and linear regression were performed.

Results

MF parameters (Pmax/mass 33.5 ± 7.2 vs 38.0 ± 8.6 W/kg and Fmax/BW 10.5 ± 2.9 vs 11.4 ± 4.1 N/kg, P < 0.05) were significantly lower in T1DM group vs controls. Positive association of body mass index and LMI with both MF parameters and negative association of insulin requirement and HbA1c with Fmax was observed in T1DM. Predictors of MF identified were MMI (Pmax/mass:b = 1.6,95%CI = 0.6-2.6; Fmax/BW:b =2.0,95%CI = 1.6-2.4) and HbA1c (Pmax/mass:b = -2.1,95%CI = -4.5--0.5; Fmax/BW:b = -1.1,95%CI = -2.0--0.2) (P < 0.05).

Conclusion

C and Y with T1DM exhibits compromised muscle function. Poor glycaemic control increases the risk of having decreased MF, irrespective of diabetes duration and may contribute to sarcopenia in adulthood.

Mind Matters: Exploring the Intersection of Psychological Factors and Cognitive Abilities of University Students by Using ANN Model

Purpose

While previous studies have suggested close association of psychological variables of students withtheir higher-order cognitive abilities, such studies have largely been lacking for third world countries like India, with their unique socio-economic-cultural set of challenges. We aimed to investigate the relationship between psychological variables (depression, anxiety and stress) and cognitive functions among Indian students, and to predict cognitive performance as a function of these variables.

Patients and Methods

Four hundred and thirteen university students were systematically selected using purposive sampling. Widely used and validated offline questionnaires were used to assess their psychological and cognitive statuses. Correlational analyses were conducted to examine the associations between these variables. An Artificial Neural Network (ANN) model was applied to predict cognitive levels based on the scores of psychological variables.

Results

Correlational analyses revealed negative correlations between emotional distress and cognitive functioning. Principal Component Analysis (PCA) reduced the dimensionality of the input data, effectively capturing the variance with fewer features. The feature weight analysis indicated a balanced contribution of each mental health symptom, with particular emphasis on one of the symptoms. The ANN model demonstrated moderate predictive performance, explaining a portion of the variance in cognitive levels based on the psychological variables.

Conclusion

The study confirms significant associations between emotional statuses of university students with their cognitive abilities. Specifically, we provide evidence for the first time that in Indian students, self-reported higher levels of stress, anxiety, and depression are linked to lower performance in cognitive tests. The application of PCA and feature weight analysis provided deeper insights into the structure of the predictive model. Notably, use of the ANN model provided insights into predicting these cognitive domains as a function of the emotional attributes. Our results emphasize the importance of addressing mental health concerns and implementing interventions for the enhancement of cognitive functions in university students.

A Novel Mutation in Frabin (FGD4) Causing a Mild Phenotype of CMT4H in an Indian Patient

Charcot-Marie-Tooth disease 4H(CMT4H) is an autosomal recessive demyelinating form of CMT caused by FGD4/FRABIN mutations. CMT4H is characterized by early onset and slowly progressing motor and sensory deficits in the distal extremities, along with foot deformities. We describe a patient with CMT4H who presented with rapidly progressing flaccid quadriparesis during the postpartum period, which improved significantly with steroid therapy. Magnetic resonance imaging and ultrasonography demonstrated considerable nerve thickening with increased cross-sectional area in the peripheral nerves. A nerve biopsy revealed significant demyelination and myelin outfolding. This is the first report of an Indian patient with a novel homozygous nonsense c.1672C>T (p.Arg558Ter) mutation in the FGD4 gene, expanding the mutational and phenotypic spectrum of this disease.

Woodhouse-Sakati syndrome in an Indian patient with a novel pathogenic variant

Woodhouse-Sakati syndrome consists of hypogonadism, diabetes mellitus, alopecia, ECG abnormalities, and dystonia. This condition is caused by the loss of function of the DCAF17 gene. Most of the patients have been reported from Greater Middle Eastern countries. We report a 38 male from southern India who presented with syncope and massive hemoptysis due to ruptured bronchopulmonary collaterals. He also had alopecia, cataracts, recently diagnosed diabetes and hypogonadism. Whole exome sequencing showed a novel homozygous truncating variant in the DCAF17 gene. Despite embolization of the aortopulmonary collaterals, the patient died of recurrent hemoptysis.

Effect of Rhinoplasty on Various Angles of Nose on Ideal Position and Alignment in Indian Population

Study of anthropometric measurements of the nose makes possible a qualitative and quantitative analysis of surgical results. Analysis of pre- and post-operative changes in nasal tip projection, rotation and nasofrontal angle may also emphasize the fact of over correction or under correction of deformed nose to surgeon. Aim of our study to compare preoperative and postoperative nasal tip projection, rotation and nasofrontal angle after rhinoplasty. The present study was a 1.5 years prospective interventional study conducted at SMS Medical College, Jaipur, India from January 2021 to July 2022. Total 51 patients with external nasal deformity were included in our study. Pre-operative, immediate post-operative and 6 months follow-up nasofrontal, projection and nasolabial angle were recorded, compared and analyzed objectively. In our study significant improvements were observed in the nasolabial angle from 92.9 ± 16.4 to 101.6 ± 10.4 and 110.3 ± 9.8 and nasal tip projection from 0.74 ± 0.17 to 0.58 ± 0.11 and 0.52 ± 0.09 immediate post-op and at 6-months follow up respectively. Mean Nasofrontal angle at pre-op, intra-op and post-op 6 months was 132.5 ± 11.9, 135.4 ± 9.6 and 134.8 ± 9.4 and this difference was not found to be statistically significant. We would like to conclude that Indian noses which are predominantly small and shorter, our surgical procedure aimed at making them more prominent aesthetically on the face, so in the present study results were satisfactory in term of anthropometric parameter.

Genomic profile of diabetic retinopathy in a north indian cohort

BACKGROUND

Diabetic Retinopathy (DR) is one of the major microvascular complications of diabetes. Being a complex disease, it is important to delineate the genetic and environmental factors that influence the susceptibility to DR in a population. Therefore, the present study was designed to investigate the role of genetic and lifestyle risk factors associated with DR susceptibility in a North-Indian population.

METHODS

A total of 848 subjects were enrolled, comprising of DR cases (n = 414) and healthy controls (n = 434). The Sequenom MassARRAY technology was used to perform target genome analysis of 111 SNPs across 57 candidate genes and 14 intergenic region SNPs that are involved in the metabolic pathways associated with type 2 diabetes (T2D) and DR. Allele, genotype and haplotype frequencies were determined and compared among cases and controls. Logistic regression models were used to determine genotype-phenotype and phenotype-phenotype correlations.

RESULTS

The strongest association was observed with TCF7L2 rs12255372 T allele [p < 0.0001; odds ratio (OR) = 1.81 (1.44-2.27)] and rs11196205 C allele [p < 0.0008; OR = 1.62 (1.32-1.99)]. Genotype-phenotype and phenotype-phenotype correlations were found in the present study.

CONCLUSION

Our study provides strong evidence of association between the TCF7L2 variants and DR susceptibility.

Excess mortality in elderly hip fracture patients: An Indian experience

PURPOSE

Hip fractures in elderly have a high mortality. However, there is limited literature on the excess mortality seen in hip fractures compared to the normal population. The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population.

METHODS

There are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study. Patients were followed up for 1 year and the follow-up record was available for 279 patients. Mortality was assessed during the follow-up from chart review and/or by telephonic interview. One-year mortality of Indian population was obtained from public databases. Standardized mortality ratio (SMR) (observed mortality divided by expected mortality) was calculated. Kaplan-Meir analysis was used.

RESULTS

The overall 1-year mortality was 19.0% (53/279). Mortality increased with age (p < 0.001) and the highest mortality was seen in those above 80 years (aged 50 - 59 years: 5.0%, aged 60 - 69 years: 19.7%, aged 70 - 79 years: 15.8%, and aged over 80 years: 33.3%). Expected mortality of Indian population of similar age and gender profile was 3.7%, giving a SMR of 5.5. SMR for different age quintiles were: 3.9 (aged 50 - 59 years), 6.6 (aged 60 - 69 years), 2.2 (aged 70 - 79 years); and 2.0 (aged over 80 years). SMR in males and females were 5.7 and 5.3, respectively.

CONCLUSIONS

Indian patients sustaining hip fractures were about 5 times more likely to die than the general population. Although mortality rates increased with age, the highest excess mortality was seen in relatively younger patients. Hip fracture mortality was even higher than that of myocardial infarction, breast cancer, and cervical cancer.