Prevalence of presbyopia, spectacles coverage and barriers for unmet need among adult population of rural Jhajjar, Haryana

Background:

Presbyopia is a major cause for near visual impairment among adults. Presbyopia induced visual impairment can be corrected easily by spectacles. We aimed to study the prevalence of presbyopia among adults aged ≥35 years and spectacles coverage among them. We also studied the unmet need for presbyopia along with the barriers to uptake of services.

Methods:

This is a population-based cross-sectional study conducted among adults aged ≥35 years in a rural district of Haryana. Near vision assessment and semistructured interview schedule were administered by a team of trained ophthalmic assistant, social worker and health assistant.

Results:

A total of 3832 adults aged ≥35 years were enumerated, from which 3246 (84.7%) were examined. Prevalence of presbyopia was found to be 42.9% (95% confidence interval 41.2–44.6). Participants with increasing age, literacy and women had higher prevalence, and those that were employed and belonged to below poverty line economic status had lower prevalence of presbyopia. Spectacles coverage among presbyopes was found to be 25.8%. There was an inverse association between unmet need for presbyopia and women, increasing education status and office work. Lack of felt need and personal reasons were the most common barriers for unmet need due to presbyopia.

Conclusions:

There is high prevalence of presbyopia among adult population, with spectacles coverage being low. Awareness activities along with affordable, accessible and socially acceptable services for those affected with presbyopia would be one of the key components of management.

Evaluation of Interstitial Cells of Cajal-Like Cells at the Pelviureteric Junction in Children with Pelviureteric Junction Obstruction: A Prospective Study and Review of Literature

INTRODUCTION

The etiopathogenesis of pelviureteric junction obstruction (PUJO) has been debated. Recently, the role of interstitial cells of Cajal-like cells (ICC-LC)has been studied and reported to be the cause of this functional obstruction. We studied the histopathology and ICC-LC density at PUJ and compared it with that of PUJ of the control group and distal ureteric margin of the study group.

METHODS

A prospective study was conducted which included PUJO patients in the study group and the renal tumor patients in the control group. Histopathological examination (muscle hypertrophy and fibrosis) and immunohistochemistry (ICC-LC density) were done. The muscle hypertrophy, fibrosis, and ICC-LC density at the PUJ in both the groups were compared. A similar comparison was performed between the findings at the PUJ and the distal margin in the study group.

RESULTS

The study and control groups included 37 PUJO patients and 13 Wilms tumor patients. The ICC-LC density at PUJ in the study group was significantly lower than that in the control group (P < 0.001) and that at the distal resected margin of the study group (P < 0.001). Significantly increased muscle hypertrophy (P < 0.001) and fibrosis (P = 0.002) were seen at PUJ in the study group compared to the control group. No significant association was noted between the ICC-LC density and muscle hypertrophy at PUJ and the distal resected margin in the study group.

CONCLUSION

A significant decrease in the density of ICC-LC and increased fibrosis and muscle hypertrophy at PUJ in children with PUJO play a role in the etiopathogenesis of the disease.

Underweight, Overweight and Anaemia among Persons Aged 60 years or Older Residing in an Urban Resettlement Colony of Delhi: A Cross-sectional Study

Introduction: Nutritional deficiencies are common among elderly person aged 60 years or older. Elderly persons suffer the dual burden of overnutrition and undernutrition. These nutritional disorders can be corrected if diagnosed and managed at the earliest. Aim: To estimate the prevalence and factors associated with underweight, overweight, obesity and anaemia among elderly persons in an urban resettlement colony of Delhi, India. Materials and Methods: The present study was a crosssectional survey in which elderly persons who were residents of Dr Ambedkar Nagar, an urban resettlement colony in Dakshinpuri Extension of Delhi were recruited. The study period was from December 2019 to March 2020. A pretested semi-structured interview schedule was used to collect sociodemographic details. The anthropometric measurements, namely, height and weight were carried out as per standard practice. Capillary blood haemoglobin level was measured by a digital haemoglobinometer. Chi-square test for distribution and multivariable logistic regression for association were performed. Results: Data was collected from 959 participants, with a response rate of 91.2%. The prevalence (95%CI) of underweight, overweight and obesity were 15.5% (13.3, 18.0), 21.9% (19.3, 24.6) and 9.6% (7.7, 11.6), respectively. Persons aged 70 years or older and illiterate persons had increased chance of being underweight. Women had increased chance of being overweight or obese. The prevalence of anaemia among participants was 72.1% (95% CI 69.2% - 74.9%), using the cut-off of anaemia as haemoglobin levels <13 gm/dL in men, and <12 gm/dL in women. Conclusion: The prevalence of underweight, overweight/ obesity and anaemia among elderly persons in the study population was high. Community-based measures need to be taken to address them.

Development of age appropriate vision function questionnaire for children with visual impairment (CHVI-VFQ)

Purpose:

To develop a new age-appropriate visual function questionnaire for visually impaired children.

Methods:

The study was conducted in north India in 20,955 (97.3%) children ≤15 years who underwent visual acuity examination. Of these 20,955 children, a total of 722 children were referred with unaided visual acuity less than 6/12 in any eye. Among these referred children, parents in the age group of 5–9 years and children between 10 and 15 years underwent interviews using LV Prasad Functional Visual Questionnaire-20 (LVP FVQ 20) and Indian Visual Functioning Questionnaire-33 (IND VFQ-33). Following this, multiple steps were undertaken that involved expert opinion for the removal of items on basis of zero variance and factor analysis along with calculation of Cronbach’s alpha.

Results:

A Cronbach’ alpha of 0.834 was calculated for the younger age group and 0.931 for the higher age group of children.

Conclusion:

A new robust age-appropriate questionnaire was developed and it was observed that there was a significant change in median score (that was derived for various domains after calculating the median for the items in various domains asked pre- and post-intervention in the form of glasses or surgery) for quality of visual function in the visually impaired children. A significant change in functional vision of visually impaired children (P < 0.005) was observed in both age groups.

SARS-CoV-2 Seroprevalence in Individuals With Type 1 and Type 2 Diabetes Compared With Controls

OBJECTIVE

Data for the association between diabetes and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) susceptibility are conflicting. We aimed to evaluate this association using an analytical cross-sectional study design.

METHODS

Study participants were recruited from endocrine clinics of our hospital and belonged to 3 groups: group 1 (type 1 diabetes mellitus [T1DM]), group 2 (type 2 diabetes mellitus [T2DM]), and group 3 (controls). All participants submitted blood samples for SARS-CoV-2 S1/S2 immunoglobulin G antibody test (LIAISON; DiaSorin) and were interviewed for a history of documented infection.

RESULTS

We evaluated a total of 643 participants (T1DM, 149; T2DM, 160; control, 334; mean age, 37.9 ± 11.5 years). A total of 324 (50.4%) participants were seropositive for SARS-CoV-2. The seropositivity rate was significantly higher in the T1DM (55.7% vs 44.9%, P = .028) and T2DM (56.9% vs 44.9%, P = .013) groups than in the control group. The antibody levels in seropositive participants with T1DM and T2DM were not significantly different from those in seropositive controls. On multivariable analysis, low education status (odds ratio [OR], 1.41 [95% CI, 1.03-1.94]; P = .035), diabetes (OR, 1.68 [95% CI, 1.20-2.34]; P = .002), and overweight/obesity (OR, 1.52 [95% CI, 1.10-2.10]; P = .012) showed a significant association with SARS-CoV-2 seropositivity. The association between diabetes and SARS-CoV-2 seropositivity was found to further increase in participants with coexisting overweight/obesity (adjusted OR, 2.63 [95% CI, 1.54-4.47]; P < .001).

CONCLUSION

SARS-CoV-2 seropositivity, assessed before the onset of the national vaccination program, was significantly higher in participants with T1DM and T2DM than in controls. The antibody response did not differ between seropositive participants with and without diabetes. These findings point toward an increased SARS-CoV-2 susceptibility for patients with diabetes, in general, without any differential effect of the diabetes type.

Outcomes of surgical interventions for the treatment of limbal stem cell deficiency

Background & objectives:

In the current scenario, with availability of different surgical procedures for limbal stem cell deficiency (LSCD), there exists no common consensus as to the standardization of the management protocol for the same. In addition, there also exists diversity in the views about the clinical diagnosis, ancillary investigations and clinical parameters. The objective of the present study was to evaluate the reported outcomes of surgical interventions for the management of LSCD.

Methods:

A systematic review of published literature on limbal stem cell transplantation (LSCT) was performed using Ovid Medline, Embase and PubMed for a duration of 2009 to 2019. Original studies including prospective, retrospective case series and randomized controlled trials, articles in English language, articles with access to full text and studies with more than or at least 10 patients were included in this review. Data related to clinical and visual outcomes were evaluated, and pool estimates of different surgeries were calculated using random-effects model and individually using Pearson’s Chi-square test.

Results:

A total of 1133 abstracts were evaluated. Finally, 17 studies were included for the analysis. Among these 17 studies, direct limbal lenticule transplantation was performed in five studies, of which autologous tissue from the fellow eye [conjunctival limbal autograft (CLAU)], allograft from a cadaver/live donor [keratolimbal allograft (KLAL)/conjunctival limbal allograft (CLAL)] and combination of CLAU plus KLAL were done in one, three and one studies, respectively. The ex vivo expanded cultivated limbal epithelial transplantation (CLET) was reported in six studies and simple limbal epithelial transplantation (SLET) in four studies. Two were comparative studies comparing CLET and CLAL (living-related CLAL) with cadaveric KLAL, respectively. Outcome analysis of the included studies showed significant heterogeneity. Calculated pool rate for various types of surgeries was calculated. The pool estimate for CLAL was 67.56 per cent [95% confidence interval (CI), 41.75-93.36; I²=83.5%, P=0.002]. For KLAL, this value was 63.65 per cent (95% CI, 31.38-95.91; I²=92.4%, P=0.000). Pool estimate for CLET was 78.90 per cent (95% CI, 70.51-87.28; I²=73.6%, P=0.001). Corresponding values for SLET were 79.08 per cent (95% CI, 74.10-84.07; I²=0.0%, P=0.619). CLAU and combination of CLAU plus KLAL were done in one study each; hence, statistical analysis could not be done. The functional outcome in terms of gain in visual acuity post-operatively was better in KLAL (P<0.005) and SLET group as compared to CLET group.

Interpretation & conclusions:

The present analysis suggests that though the anatomical success rates were almost identical between SLET, CLET, CLAL, and KLAL procedures, the functional success rates were better following KLAL and SLET procedures as compared to CLET. Decision for LSCT for cases of ocular burns based on either clinical judgement of the surgeon or individual diagnosis remains a suitable option.

Suitability of Iron (Fe)-Doped Tungsten Oxide (WO3) Nanomaterials for Photocatalytic and Antibacterial Applications

Pure and “Fe ([Formula: see text][Formula: see text]wt.%)-doped” WO[Formula: see text] nanoparticles were prepared by facile microwave irradiation method and that was investigated for strong photo catalytic and antibacterial activity applications for the first time. The primary aim of this work is to reveal the great importance of oxygen vacancies ([Formula: see text] due to dopant (Fe[Formula: see text] for photo catalytic and antibacterial activity applications. This work also discusses the contribution of oxygen vacancies and their dependence on surface area and phase formation which are of great research interest for water purification and biological sciences. Herein, pure and “Fe ([Formula: see text][Formula: see text]wt.%)-doped” WO[Formula: see text] nanoparticles were successfully synthesized by facile microwave irradiation (MWI) method (2.45 GHz/240W/10min) in ambient atmosphere. The phase formation and the crystalline nature of the prepared products were evaluated using powder X-ray diffraction (XRD). It confirmed the phase formation of orthorhombic and monoclinic phase formations for the pure (WO[Formula: see text]H2O) and annealed samples (W[Formula: see text]O[Formula: see text] and WO[Formula: see text], respectively. Optical behavior of the samples from UV-Vis diffuse reflectance analysis revealed that W[Formula: see text]O[Formula: see text] has remarkable bandgap values (1.96[Formula: see text]eV) that clearly emphasizes the transfer of oxygen ions which helps in the movement of oxygen vacancies inside the crystalline domain. The morphological nature of the prepared products was observed by FE-SEM analysis and the average dimension was found to be 0.2–3.2[Formula: see text][Formula: see text]m and 2–4[Formula: see text][Formula: see text]m for the pure and annealed products, respectively. The specific surface area from BET analysis explored that W[Formula: see text]O[Formula: see text] having 55.16[Formula: see text]m2g[Formula: see text] was found to be higher than that of commercially available WO3. The photocatalytic behavior of the prepared compounds morphologies was investigated via Rhodamine B (RhB) degradation under visible light irradiation. These results showed “Fe-doped” annealed WO3 nanoparticles have degradation efficiency of 86.9% along with high stable nature. On the other hand, to identify the suitability of the prepared products for antibacterial activity, the microbial strains of Gram-positive Bacillus sp. and Gram-negative strains of Pseudomonassp. and Salmonellasp. were used for the antimicrobial assay[Formula: see text] The results indicated that W[Formula: see text]O[Formula: see text] showed enhanced antibacterial nature when compared to that of Stoichiometry tungsten oxide (WO[Formula: see text] nanomaterials. From these observations, this work emphasizes the importance of oxygen vacancies for antibacterial activity applications.

Underweight, Overweight, and Anemia among Elderly Persons in a rural area of Ballabgarh, Haryana

Background:

Underweight, overweight, and anemia are common public health problems among elderly individuals.

Objectives:

The current study was conducted in a rural area of Ballabgarh, Haryana, to estimate the prevalence of underweight, overweight, and anemia among elderly persons and to find their association with sociodemographic variables.

Materials and Methods:

A total of 420 elderly persons aged ≥60 years were selected by simple random sampling. Information on variables was collected by an interview schedule. Body mass index (BMI) was calculated from height and arm-span of elderly persons. Hemoglobin was estimated with HemoCue^® Hb 201⁺ system.

Results:

Of the total participants, 33.6% were underweight, 13.8% were overweight, 15.6% were obese, and 37.0% had normal BMI. None of the sociodemographic variables was found to be significantly associated with being underweight. Being female was significantly associated with being overweight/obese. The prevalence of anemia was 36.4%. None of the sociodemographic variables was associated with anemia.

Conclusions:

Underweight and anemia are common among elderly persons in rural areas. These need to be addressed through community-based interventions.

Prevalence of chronic obstructive pulmonary disease in India: A systematic review and meta-analysis

Background and Objective:

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide. There is a lack of national-level estimates on the magnitude of COPD in India. Hence, we estimated the prevalence of COPD among adults in India.

Methods:

We searched PubMed, Embase, Cochrane Library, Google Scholar, and Scopus and included community-based cross-sectional studies reporting data on the prevalence of COPD among adults based on spirometry. A random-effects model was used to estimate the pooled prevalence of COPD.

Results:

In the eight identified studies, (pooled sample of 8,569 individuals), the estimated prevalence was 7.4% (95% confidence interval: 5.0%–9.8%), I² = 95.4% (P < 0.001). The prevalence was higher among males, in the urban area, and the northern region.

Conclusion:

Adequate training and resources should be provided to diagnose COPD at primary health care level for early management. A nationwide population-based survey is indicated to provide reliable estimates of the burden to inform evidence-based community-based interventions.

Impact of SARS-CoV-2 on Progression of Glycemic and Cardiometabolic Variables and Changes in Insulin Indices: A Longitudinal Study

INTRODUCTION

We aimed to evaluate whether SARS-CoV-2 infection is associated with beta cell dysfunction and progression of glycemic and cardiometabolic variables in an established cohort.

METHODS

Study participants (n = 352, 46.9% men) underwent a detailed evaluation at two time points: (a) pre-COVID (2016-19) and (b) peri-COVID (2020-21). At the second visit, SARS-CoV-2 infection was determined on the basis of a quantitative S1/S2 IgG antibody test (DiaSorin Liaison) and/or a documented history of infection.

RESULTS

A total of 159 (45.2%) participants were seropositive for SARS-CoV-2, of whom 122 (76.7%) had mild/asymptomatic infection. Progression in body mass index (BMI) category [34 (21.4%) vs. 22 (11.4%), p = 0.011] was seen in a significantly higher proportion of the participants in the infected group compared to the non-infected group. Progression in glycemic and insulin indices [homeostasis model assessment of insulin resistance (HOMA-IR), Matsuda index, and oral disposition index (oDI)] categories was also evident in a larger proportion of participants in the infected group; however, the difference was not statistically significant. On logistic regression analysis, the association between SARS-CoV-2 infection and BMI category progression was statistically significant [fully adjusted OR 2.14 (95% CI, 1.18-3.90; p = 0.013)].

CONCLUSION

In this longitudinal study, predominant mild/asymptomatic SARS-CoV-2 infection was associated with increase in BMI, but not with worsening of beta cell function and insulin resistance, nor glycemic progression.

Efficacy and safety of fecal transplantation versus targeted therapies in ulcerative colitis: network meta-analysis

Aim: We conducted this network meta-analysis to compare the efficacy and safety of targeted pharmacotherapies and fecal microbial transplantation (FMT). Patients & methods: Nineteen studies were included and there was only one head-to-head randomized controlled trial (adalimumab vs vedolizumab). Results: All interventions, including FMT, were superior to a placebo in inducing clinical remission (except adalimumab - odds ratio 1.66; 95% CI: 0.97-2.85), clinical response and endoscopic remission. FMT was comparable with other agents in achieving all efficacy outcomes. Infliximab was ranked highest in inducing clinical remission (surface under the cumulative ranking, 0.8). There was no difference in safety outcomes between FMT and other targeted therapies. Conclusion: FMT is as efficacious and as safe as other targeted therapies in inducing clinical remission, clinical response and endoscopic remission. Further studies to assess the long-term benefits are needed in order to reach a definitive conclusion.

Efficacy of Daily Supplementation of Milk Fortified With Vitamin D2 for Three Months in Healthy School Children: A Randomized Placebo Controlled Trial

OBJECTIVE

To evaluate the efficacy of daily supplementation of 200 mL milk fortified with 240 IU of vitamin D2 (ergocalciferol).

DESIGN

Double-blind randomized controlled trial.

SETTINGS

School-based study in Delhi between October and December, 2019.

PARTICIPANTS

235 healthy children aged 10-14 years.

INTERVENTION

Daily supplementation of 200 mL milk fortified with 240 IU of ergocalciferol in intervention group (n=119) and 200 mL of plain milk in control group (n =116) for 3 months.

OUTCOME MEASURES

Change in serum 25 hydroxy vitamin D (25(OH)D), parathyroid hormone (PTH), bone formation and resorption markers, and urinary calcium creatinine ratio (U-Ca/CrR).

RESULTS

The mean (SD) baseline serum 25(OH) D level in control and fortification groups was 11.9 (3.8) and 11.4 (3.6) ng/mL (P=0.23), respectively. The serum 25(OH)D levels did not increase post-intervention with the dose used for fortification, but were significantly higher in intervention group as compared to control group [10.8 (3.4) vs 6.7 (3.5) ng/mL; P<0.001]. A higher proportion of secondary hyperparathyroidism was observed post-intervention in control (39%) than in intervention group (13.3%); P<0.001. Serum carboxy-terminal telopeptide levels were similar in both groups but the serum procollagen type1 N-terminal propeptide levels were higher in the control than intervention group (P<0.007), following supplementation.

CONCLUSIONS

Supplementation of milk fortified with approximately 240 IU vitamin D2 for three months did not achieve sufficient serum 25(OH)D levels in Indian children with vitamin D deficiency during winter.

An experimental study to evaluate the effect of low-intensity intradialytic exercises on serum urea, creatinine, and fatigue of chronic kidney disease patients undergoing hemodialysis

In chronic kidney disease (CKD) toxins accumulate in the muscles and cause fatigue, mental impairment, and muscle dysfunction (cramps). Exercise results in the opening of capillaries thereby increasing blood flow and allowing greater movement of urea and creatinine from the tissues to the vascular compartment and subsequent removal through dialysis. An experimental study of 64 CKD patients (32 each in experimental and control group), six low-intensity intra-dialytic exercises (IDE) were implemented for experimental group using video demonstration at 90 min after initiation of hemodialysis (HD) repeated thrice at an interval of 10 mins. Pre- and post-HD serum urea, creatinine, and fatigue levels were assessed at baseline, two, four and six weeks. Fatigue was measured using FACIT scale. Significant difference was found between the control and experimental group in serum urea, creatinine and fatigue levels (P = 0.007, P = 0.001, P = 0.001) at six weeks post HD. The experimental group showed a significant decrease in creatinine levels from baseline to six weeks (P = 0.04). Ninety-seven percent of patients were compliant to low-intensity IDE with patients feeling better and comfortable along with decrease in felt fatigue levels. No significant association was found between duration of illness, duration of maintenance HD and comorbidities and serum urea, serum creatinine, and fatigue levels (P = 0.5, P = 0.21, P = 0.78). The present study shows low-intensity IDE when performed regularly, was effective in decreasing serum urea, creatinine, and fatigue levels of CKD patients undergoing HD with vital signs remaining within the normal range. No overt complications were reported; hence, the exercises were safe.

Histologic Abnormalities of the Ascending Aorta: Effects on Aortic Remodeling after Intracardiac Repair of Tetralogy of Fallot

We evaluated aortic tissue specimens from patients undergoing tetralogy of Fallot repair, to determine whether histologic abnormalities affect postsurgical aortic remodeling and other patient-related variables. Using light microscopy, we studied full-thickness aortic wall tissue operatively excised from 118 consecutive patients undergoing intracardiac repair of tetralogy of Fallot. We performed multiple linear regression analysis to identify independent predictors of change in aortic root dimensions, which we measured with echocardiography after repair and every 3 months thereafter. Thirty histologically normal specimens were used as controls. Elastic fiber fragmentation was found in 74.6% of the abnormal specimens, mucoid extracellular matrix accumulation in 49.2%, smooth muscle cell nuclei loss in 39%, smooth muscle cell disorganization in 28.8%, and medial fibrosis in 52.5%. At a mean follow-up time of 83.55 ± 42.08 months, mean aortic sinotubular diameter decreased from 28.79 ± 9.15 to 27.16 ± 8.52 mm/m2 (r =-0.43; P <0.001). Aortic sinotubular diameter decreased by 0.6 mm/m2 among females (β =0.6, SE=0.31; P =0.05) and by 0.88 mm/m2 in patients who had elastic fiber fragmentation or loss (β =0.88, SE=0.38; P =0.02). In bivariate and multiple linear regression analysis, duration of follow-up emerged as an independent predictor of aortic remodeling. The aortic histopathologic changes in our patients had an independent negative impact on the degree of aortic remodeling after surgery. We observed the most improved aortic sinotubular diameter in patients who had either histologically normal aortas or aortas with elastic fragmentation.

Diastolic dyssynchrony assessment by gated myocardial perfusion-SPECT in subjects who underwent cardiac resynchronization therapy

BACKGROUND

Left ventricular diastolic dyssynchrony (LVDD) can be assessed by gated myocardial perfusion single-photon emission computed tomography (GMP-SPECT). LVDD is an area of interest in subjects who underwent cardiac resynchronization therapy (CRT). The aim of this post hoc analysis was to assess the role of LVDD in subjects with CRT who were followed up at 6-month period.

MATERIAL & METHODS

Left ventricular diastolic dyssynchrony was assessed by GMP-SPECT at baseline and after CRT procedure in 160 subjects from 10 different cardiological centers. CRT procedure was performed as per current guidelines. Outcomes were defined as improvement in ≥1 New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF) by 5%, and reduction in end-systolic volume (ESV) by 15% and 5% points in Minnesota Living with Heart Failure Questionnaire. LVDD was defined as diastolic phase standard deviation ≥40 ± 14°.

RESULTS

Improvement in NYHA functional class occurred in 105 (65.6%), LVEF in 74 (46.3%), decrease in ESV in 86 (53.8%), and Minnesota score in 85 (53.1%) cases. Baseline LV diastolic standard deviation was 53.53° ± 20.85 and at follow-up 40.44° ± 26.1283; (P < 0.001). LVDD was not associated with improvement in clinical outcomes at follow-up.

CONCLUSION

CRT improves both systolic and diastolic dyssynchrony values at 6-month follow-up. LVDD at baseline is correlated with cardiac functionality at follow-up, but not with overall favorable clinical outcomes.

Association of cognitive impairment with sleep quality, depression and cardiometabolic risk factors in individuals with type 2 diabetes mellitus: A cross sectional study

AIM

The aim of this study was to evaluate the association of cognitive impairment with sleep quality, depression, and cardiometabolic risk factors among participants with type 2 diabetes mellitus.

METHODS

Subjects underwent clinical interview to capture socio-demographic details, medical history, sleep quality, presence of depression, along with anthropometric and biochemical measurements. A detailed neuropsychological assessment [Montreal cognitive assessment scale (MoCA), Trail making A and B, Digit span, Spatial span, Letter Number Sequencing] was done. Cognitive impairment was defined as MoCA score of <23.

RESULTS

Participants (n=250, 50% women, 63.6% middle-age) had a mean (±SD) age of 53.6 (±9.1) years and HbA1c of 55.1±6.8mmol/mol (7.2±0.6%). Cognitive impairment was present in 57 (22.8%) participants. In the middle-age subgroup, cognitive impairment was higher (23.9%) than those in the fourth decade (6.3%), but comparable (24.0%) to the older age (60-70years) individuals. Diabetes-related vascular complications [Odds ratio (95% CI) 2.03 (1.05, 3.94)]; hypertension [2.00 (1.04, 3.84)], depression [2.37 (1.24, 4.55)] and lower education [2.73 (1.42, 5.23)] had a significant association with cognitive impairment on multivariate logistic regression analysis.

CONCLUSION

The high burden of cognitive impairment calls for an urgent need to establish longitudinal cohorts in midlife to understand this population's cognitive trajectories and see the influence of various bio-psychosocial variables.

Ultrasound liver elastography for the detection of liver fibrosis in patients with psoriasis and reactive arthritis on long-term methotrexate therapy: A cross-sectional study

Background

Long-term low-dose methotrexate therapy is associated with liver fibrosis. Although liver biopsy is the gold standard for detecting fibrosis, it is an invasive procedure associated with morbidity and mortality risks. Hence noninvasive imaging techniques such as transient elastography (TE) and shear wave elastography (SWE) have been studied to measure liver stiffness.

Aims

To assess the utility of TE and SWE in detecting fibrosis in patients with psoriasis and reactive arthritis on long-term methotrexate therapy.

Methods

A cross-sectional prospective study was undertaken on 54 patients with psoriasis and reactive arthritis who had received ≥1.5 g of methotrexate. Various clinical and biochemical [fibrosis 4 index (FIB4), aspartate-transaminase-to-platelet ratio index (APRI)] parameters were calculated and liver stiffness measurement (LSM) was done with TE and SWE. The degree of steatosis was measured using controlled attenuation parameter (CAP). Liver biopsy was done when indicated and was interpreted by a pathologist blinded to clinical and imaging results.

Results

Fifty four patients with a mean age of 40.3 years and a male-to-female ratio of 5:1 were included. The mean cumulative methotrexate dose was 3.04 g. The median FIB4, APRI, and gamma-glutamyl transpeptidase-to-platelet ratio values were 0.75, 0.23, and 0.15, respectively. The median LSM for TE and SWE was 5.3 and 7.32 kPa, respectively. SWE and TE showed a weak positive correlation (r = 0.26, P = 0.053). The mean CAP was 217 dB/m (area under the receiver operating characteristic = 0.70). In the 19 of 26 cases whose liver biopsies could be assessed, only 4 (21%) showed F1 fibrosis (Ishak staging). The median LSM on SWE was significantly higher in patients with a cumulative methotrexate dose ≥ 4 g when compared with those with a dose <4 g (9.85 vs 7.1, P = 0.02). Other parameters did not correlate with TE and SWE.

Limitations

The small sample size and the low number of cases with significant fibrosis on histopathology were the major limitations of this study.

Conclusion

Histologically detectable LF is uncommon in patients with psoriasis and reactive arthritis on long-term methotrexate therapy. Both TE and SWE are good at detecting the absence of fibrosis in these patients. In our study, SWE and TE values did not correlate with clinical, biochemical, or histopathological parameters.

Azathioprine weekly pulse versus methotrexate for the treatment of chronic plaque psoriasis: A randomized controlled trial

BACKGROUND

Methotrexate is the most commonly used drug in the treatment of psoriasis with good efficacy and safety. Recently, weekly azathioprine pulse has been shown to be effective in this disease.

AIM

The aim of this study is to compare the effectiveness and safety of weekly pulse doses of azathioprine and methotrexate for the treatment of chronic plaque psoriasis.

METHODS

In this randomized controlled trial, 80 patients with chronic plaque psoriasis were recruited. After detailed clinical and laboratory evaluation, patients were randomized to 2 groups to receive either weekly 300 mg azathioprine (n = 40) or 15 mg methotrexate every week (n = 40) for 20 weeks, following which the response to treatment and adverse effects were assessed. The patients were then followed up every 4 weeks for 3 months to determine any relapse.

RESULTS

Overall, 48 (60%) patients achieved PASI 75, while 36 (45%) and 59 (73.8%) patients achieved PASI 100 and 50, respectively. On intention to treat analysis, PASI ≥ 75 was achieved in 47.5% (19/40) patients in group 1 compared to 85% (34/40) patients in group 2 (p < 0.001). However, on per protocol analysis, PASI ≥ 75 was achieved in 86% (19/22) patients in group 1 and 92% (34/37) patients in group 2 (p = 0.497). Minor clinical and biochemical adverse effects were noted in both the groups, which were comparable. One (7.7%) patient in group 1 and 4 (17.4%) in group 2 relapsed during follow-up.

LIMITATIONS

Limitations of study include small sample size and short follow-up.

CONCLUSION

Weekly azathioprine pulse appears to be beneficial in the management of chronic plaque psoriasis. However, it is less effective than weekly methotrexate. It can thus be of use as a therapeutic option in patients with contraindication to methotrexate or other similar agents in this disease.

A retrospective comparative study of outcome with surgical excision and repair versus nonsurgical and ablative treatments for basal cell carcinoma

BACKGROUND

There are few studies on basal cell carcinoma (BCC) from India. Long-term follow-up is available in only one study and the aesthetic outcome of treatment has not been evaluated in Indian patients.

AIMS

In this retrospective study on BCC, we compared treatment failure, recurrence rates and aesthetic outcomes on long-term follow-up between surgical excision and repair, and nonsurgical and ablative treatments.

METHODS

Records of patients with BCC treated in the dermatologic surgery clinic over the past 10 years were analyzed. Patients with histopathologically confirmed BCC who could be contacted were evaluated for recurrence, treatment failure, overall satisfaction and aesthetic outcomes by global aesthetic improvement scale.

RESULTS

Out of 98 patients, 72 were contactable. Four patients received both nonsurgical and ablative treatments and surgical excision and repair sequentially and were excluded. The mean age of patients was 57.9 ± 15.8 years (24-90 years) and the male: female ratio was 1.6:1. The most common site involved was the face (72.1%) followed by trunk and scalp, and the most common type of BCC was the pigmented superficial type (33.8%), followed by the pigmented noduloulcerative type (16.2%). There was no significant difference between the groups in the number of high-risk cases. The mean follow-up period was 37.1 ± 31.4 (range, 4-120) months. Fifty one patients were treated with surgical excision and repair, and 17 with nonsurgical and ablative treatments (9-imiquimod, 5-cryotherapy, 4-radiotherapy). Treatment failure was seen in 5 (7.4%) patients, all in the nonsurgical and ablative treatments group (P = 0.0006). Recurrence was seen in 2 (2.9%) patients, both in the surgical excision and repair group (P > 0.05). Mean patient satisfaction was significantly higher with surgical excision and repair, though there was no significant difference in the Global Aesthetic Improvement Scale between the groups.

LIMITATIONS

The sample size was low. Only telephonic and pictorial assessments were done where the patient could not come for follow-up.

CONCLUSIONS

Surgical excision and repair was associated with better outcomes than nonsurgical and ablative treatments. Treatment failures and adverse events were high with nonsurgical and ablative treatments. The recurrence rate was low.