Are TomoFix Locking Plates Really Anatomical for Indian Population?

Purpose

The use of a TomoFix plate can be a challenge in Asian population who inherently have smaller tibial bones. This study aims to find out the normal proximal tibial morphometric measurements in Indian population and to compare the Medial Anterior Radius of Curvature (MAROC) of proximal tibia with the Proximal Part Radius of Curvature (PPROC) of the available TomoFix plates, to estimate conformity of the fit between them.

Methods

Retrospective Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) based proximal tibial measurements were performed on 824 knees, 664 females and 160 males (604 patients). The mean MAROC, mean MAROC in males and mean MAROC in females were compared to the PPROC of TomoFix plates.

Results

The radiological measurements revealed a mean AP length of 45.22 ± 3.79 mm, mean ML width of 69.04 ± 5.01 mm and mean MAROC of 21.88 ± 2.11 mm. The mean MAROC in males was 24.07 ± 2.1 mm, whereas in females it was 21.35 ± 1.75 mm. The mean MAROC, mean MAROC in males and mean MAROC in females when compared to the PPROC of Standard TomoFix plate (38 mm), Small TomoFix and Anatomical TomoFix plates (30 mm) showed a significant difference (p < 0.01), indicating that the radius of curvature of the plate does not match the radius of curvature of the anteromedial tibial plateau.

Conclusion

The TomoFix plates, including Small (Asian Version) and Anatomical plates, are relatively large for the Indian population. Our study may help the implant to designers develop a plate that will better suit the Indian population, improving results and reducing hardware-related complications of MOWHTO.

Molecular basis of DEL phenotype in the Indian population: Insights from next-generation sequencing analysis of two cases

The DEL phenotype represents an intriguing and challenging aspect of blood group serology. This condition is characterized by an extremely weak expression of the D antigen on red blood cells, to the extent that it often eludes detection through routine serological methods. Identifying the DEL phenotype necessitates more specialized techniques, such as adsorption and elution tests, to reveal the presence of the D antigen. This distinctive phenotype underscores the complexity and subtlety of blood group genetics and highlights the importance of using advanced methods to accurately classify individuals with this condition, as their ability to form anti-D antibodies can have clinical implications during transfusion and pregnancy scenarios. There is a paucity of data for the DEL phenotype in the Indian population, and the molecular basis has not been elucidated yet. Our investigation delves into the genetic underpinnings of two distinct DEL phenotype cases that pose challenges for resolution through conventional serological techniques. We employ next-generation amplicon sequencing to unravel the intricate genetic landscape underlying these cases. In the D-negative donor, the DEL phenotype was first identified serologically, which was subsequently confirmed by molecular analysis. In the second case, it was associated with an anti-D antibody in a D-positive patient. Initial data analysis unveiled a substantial reduction in coverage across the exonic segments of the RHD gene in both samples, suggesting the potential presence of RHD exon deletions. On both occasions, we identified a homozygous intronic RHD polymorphism that is well established to be linked to the RHD* 01EL.32/RHD*DEL32 variant.

Angiographic Patterns of Young Patients with Coronary Artery Disease in an Indian Population

BACKGROUND

The incidence of coronary artery disease has continued to rise in recent decades, even in the developing world, affecting a broad spectrum of the population including young adults less than forty years. This is attributable to the rise in prevalence of conventional risk factors like diabetes mellitus, hypertension, smoking, dyslipidemia, and obesity. Although a significant number of studies have been done on the angiographic profile of patients with coronary artery disease, only a few of these studies were done in young patients and most of the studies were limited to northern India.

AIMS AND OBJECTIVES

In this study, we aimed to determine the angiographic profile of young patients ≤ 40 years in a tertiary care centre in southern India.

MATERIALS AND METHODS

A retrospective analytic study was conducted at the Meditrina Specialist Hospital, Kollam, Kerala, India. Individuals of both genders with age ≤ 40 years who were diagnosed with coronary artery disease between June 2021 and May 2022 were included.

RESULTS

A total of 74 patients were included, out of which 62 were male and 12 were female. The mean ± SD age of the participants studied was 36.38 ± 3.99 years Amongst patients who had significant coronary artery disease, 24 (57.14%) had single vessel disease, 13 (31.00%) had double vessel disease, and 5 (11.86%) had triple vessel disease. The left anterior descending (LAD) artery was found to be the most frequently involved in all patterns of coronary artery disease (CAD). Male gender and diabetes were the most common risk factors for CAD present in 29.3% of patients studied.

CONCLUSION

Male gender and diabetes were responsible for the relatively high incidence of premature CAD in this study with single vessel disease being the most prevalent finding. The LAD artery was the most commonly affected followed by RCA and LCX with right PLB being the least vessel involved.

Structural effect of the H992D/H418D mutation of angiotensin-converting enzyme in the Indian population: implications for health and disease

The Non synonymous SNPs (nsSNPs) of the renin-angiotensin-system (RAS) pathway, unique to the Indian population were investigated in view of its importance as an endocrine system. nsSNPs of the RAS pathway genes were mined from the IndiGenome database. Damaging nsSNPs were predicted using SIFT, PredictSNP, SNP and GO, Snap2 and Protein Variation Effect Analyzer. Loss of function was predicted based on protein stability change using I mutant, PremPS and CONSURF. The structural impact of the nsSNPs was predicted using HOPE and Missense3d followed by modeling, refinement, and energy minimization. Molecular Dynamics studies were carried out using Gromacsv2021.1. 23 Indian nsSNPs of the RAS pathway genes were selected for structural analysis and 8 were predicted to be damaging. Further sequence analysis showed that HEMGH zinc binding motif changes to HEMGD in somatic ACE-C domain (sACE-C) H992D and Testis ACE (tACE) H418D resulted in loss of zinc coordination, which is essential for enzymatic activity in this metalloprotease. There was a loss of internal interactions around the zinc coordination residues in the protein structural network. This was also confirmed by Principal Component Analysis, Free Energy Landscape and residue contact maps. Both mutations lead to broadening of the AngI binding cavity. The H992D mutation in sACE-C is likely to be favorable for cardiovascular health, but may lead to renal abnormalities with secondary impact on the heart. H418D in tACE is potentially associated with male infertility.Communicated by Ramaswamy H. Sarma.

Spectrum of infections in different regimens of post-induction chemotherapy in acute myeloid leukemia (de-novo): A comparative retrospective study

Background

Patients diagnosed with acute myeloid leukemia (AML) face a heightened susceptibility to infections, which significantly elevates their risk of mortality and disability. The intensity of the chemotherapy treatment and its specific focus on inhibiting myeloid cell divisions render patients especially vulnerable, particularly during the early stages of chemotherapy. This vulnerability is compounded by the occurrence of repeated episodes of prolonged neutropenia, leaving patients highly susceptible to infections. The compromised immune systems of these individuals make them more susceptible to infections, which adversely affect their physical health and overall well-being. Consequently, our study aimed to investigate the range of infections experienced by patients with newly diagnosed AML undergoing different induction chemotherapy.

Methods

This was a comparative retrospective study, conducted at a tertiary hospital providing comprehensive cancer care in North India. All newly diagnosed patients with AML, who received induction chemotherapy from January 1, 2012 to November 1, 2022, were identified from the hospital database and included in this study.

Results

Four hundred and twenty AML patients treated with either high-intensity or low-intensity induction chemotherapy was observed in this study. It was found that patients who received high-intensity treatment had a higher rate of clinically and microbiologically documented infections, fever without a known cause, and more cases of febrile neutropenia than those who got low-intensity treatment. These differences between the two groups were particularly evident on day 14 (p = 0.0002) and persisted through day 28 (p = 0.005).

Conclusions

These findings underscore the effectiveness and downside of high-intensity induction chemotherapy regimens, as evidenced by the higher incidence of infections observed. Further investigation through prospective clinical studies is warranted to better evaluate and validate the efficacy of this approach.

The genomic landscape of CYP2D6 variation in the Indian population

Aim: The CYP2D6 gene is highly polymorphic, causing large interindividual variability in the metabolism of several clinically important drugs. Materials & methods: The authors investigated the diversity and distribution of CYP2D6 alleles in Indians using whole genome sequences (N = 1518). Functional consequences were assessed using pathogenicity scores and molecular dynamics simulations. Results: The analysis revealed population-specific CYP2D6 alleles (*86, *7, *111, *112, *113, *99) and remarkable differences in variant and phenotype frequencies with global populations. The authors observed that one in three Indians could benefit from a dose alteration for psychiatric drugs with accurate CYP2D6 phenotyping. Molecular dynamics simulations revealed large conformational fluctuations, confirming the predicted reduced function of *86 and *113 alleles. Conclusion: The findings emphasize the utility of comprehensive CYP2D6 profiling for aiding precision public health.

Electromyographic Assessment of Masticatory Muscles & their Asymmetries in Adult Indian Population

Objective

To study the surface electromyography (sEMG) and it is asymmetry under resting and dynamic conditions in masticatory muscles.

Materials and Methods

sEMG of the masticatory muscles (bilateral masseter & temporalis) was done in 61 healthy subjects (mean age 28.5 ± 8.8 years) with bilateral functional molar occlusal relationship. Root mean square (RMS) values sEMG for each activity (rest, clenching, maximum mouth opening (MMO), left and right excursion) for a 10 s period were recorded and analyzed. Indices for asymmetry of muscles, relative activity and resultant torque were assessed and analyzed.

Results

RMS values of sEMG during clenching were significantly higher for all masticatory muscles in males compared to females (p < 0.05). During excursive mandibular movement a statistically significant difference seen in ipsilateral temporalis muscle in males. sEMG of masticatory muscles during rest as well as functional activities of mandible was asymmetrical. A predominant masseteric activity was observed for all functional activities of mandible except during rest for which temporalis muscle activity was higher. Right sided torque was observed during rest, MMO and right lateral movements while a predominant left sided torque was present during left lateral movement and clenching.

Conclusion

sEMG values of masticatory muscles obtained in our study can be used as reference for healthy Indian population. A perfect muscular symmetry might be illusive and a controlled asymmetry criterion appears to be more useful which corresponds to reality.

Interdevice Agreement between a Smartphone and a Commercial Pupillometer

Background

The reliability of dynamic pupillometry parameters varies from one pupillometer to another, making it difficult to standardize the values for any particular device. Hence, further studies are required to evaluate the agreement of various pupillometer devices and explore their utility in routine clinical settings.

Aim

This study sought to evaluate the agreement between smartphone and commercial pupillometer measurements in routine clinical settings.

Methods

The study included pupillary measurements obtained by a single investigator from 100 healthy participants (200 eyes) with each pupillometer. Pupillary measurements taken by a smartphone pupillometry application (reflex pupillary light reflex analyzer by Brightlamp [Indianapolis, IN, USA]) were compared with a commercial pupillometer (neurological pupil index-200, NeurOptics Inc., Irvine, USA).

Results

The comparison of descriptive statistics revealed a statistically significant difference between the smartphone and commercial pupillometers for various parameters, including maximum diameter, minimum diameter, constriction velocity (CV), maximum CV, and dilatation velocity (P < 0.05), except for latency (P = 0.36). The intraclass correlation coefficient revealed poor agreement between the two devices (<0.50).

Conclusion

The measurements by smartphone pupillometry application were found to be unreliable, indicating that they may not be an ideal substitute for commercial pupillometers in their present form in the Indian population. Further studies with larger sample size as well as improvements in the processing and interpretation of the measurements by the software, are needed to determine its utility in routine clinical settings.

Association between vitamin D and knee osteoarthritis in Indian population: A systematic review and meta-analysis

Background

Vitamin D deficiency (VDD) has been implicated in knee osteoarthritis (KOA) development and progression. Prevalence of hypovitaminosis D and osteoporosis in KOA is widely reported in Indian population. However, there is no attempt to critically evaluate the outcome of these studies. We aimed a systematic review of these studies.

Methods

Pubmed, Google Scholar and Web of Science last updated March 2023, were searched. We reviewed eligible studies on the association between KOA and vitamin D levels in Indian and Asian population for comparison. The mean difference (MD) of vitamin D levels and odds ratio (OR) of vitamin D status were calculated. Data were interpreted by RevMan 5.4 software. The risk of bias was assessed using the Cochrane Risk of Bias tool.

Results

A total of 15 studies that involved 1503 KOA cases and 1609 controls were included. There was significantly reduced level of vitamin D in KOA (MD -8.68 ng/mL, 95%CI -12.21 to -5.15; P = <0.00001, I2 = 82 %) in Indian population. Similarly, in other Asian population significantly reduced vitamin D levels in KOA (MD 18.36 ng/mL, 95%CI -34.72 to -2.00; P = <0.00001, I2 = 100 %) was observed in KOA. VDD was found to be positively correlated with an increased risk of KOA.

Conclusion

Early diagnosis and management of VDD may provide the opportunity to delay the ongoing degenerative process of KOA and this study indicates the importance of screening VDD even in sunlight rich regions.

BRAF V600E Mutations and Beyond: A Molecular Perspective of Melanoma from a Tertiary Cancer Referral Center of India

Vaibhavi VengurlekarObjectives  Malignant melanoma demonstrates frequently occurring mutations of genes in the serine/threonine kinase pathway, namely BRAF, NRAS, and neurofibromin 1. There is rare documentation of a detailed analysis of these mutations in cases of melanoma among Indian patients. We present molecular features in cases of malignant melanoma, diagnosed at a tertiary cancer referral center in India, over a period of 8 years (2011-2018). Materials and Methods  This study was performed on formalin fixed paraffin embedded tissues of 88 histologically confirmed cases of malignant melanoma. BRAF gene alterations were studied by both Sanger sequencing and real-time polymerase chain reaction techniques ( n  = 74). Molecular testing for BRAF and NRAS gene alterations was accomplished in 74/88 cases (80%). Molecular test results were correlated with clinicopathological features using IBM SPSS Statistical software 25.0. Results  The age ranged from 13 to 79 years (median = 57), with a M:F ratio of 1.4:1. BRAF mutations were observed in 12/74 (16.21%) patients, including V600E ( n  = 7), A594T ( n  = 1), T599 = ( n  = 2), V600K ( n  = 1), and Q612P ( n  = 1), while NRAS mutations were observed in 6/38 (15.7%) patients. Among various subtypes, nodular melanoma was the most frequent subtype (33%) among cutaneous malignant melanomas. Among non-cutaneous melanomas, mucosal melanomas were observed in 37.5% of cases. Conclusion  This constitutes one of the few reports on comprehensive analysis of molecular alterations underlying melanomas in Indian patients. A larger sample size, with more extensive molecular markers, would yield additional information on the disease manifestation.

Impact of oral conditions on oral health-related quality of life among Indians- a systematic review and Meta-analysis

OBJECTIVE

This review assessed the impact of oral conditions on Oral Health Related Quality of Life among Indians.

METHODS

Databases, including PubMed and Scopus, CINAHL, Web of Science, PsycInfo were systematically searched for English Language studies conducted among Indians up to July 2022. Two independent reviewers assessed studies selected for retrieval for methodological quality using standardised quality assessment instruments for analytical cross-sectional studies in JBI SUMARI.

RESULTS

Fourty one publications were included in this review (N = 23,090). Studies includes both cross sectional study and Randomized Controlled Trials. Based on the JBI critical appraisal tools, the quality of the included studies was low to high. Twenty-six studies were considered for the meta-analysis. Individuals with dental caries [OR: 3.54 (95% CI 2.24- 5.60), ten studies, 4945 participants] and malocclusion [ OR: 5.44 (95% CI 1.61, 18.39), six studies, 3720 participants] had poor OHRQoL compared to individuals without oral conditions.

CONCLUSIONS

Despite the various definitions of the exposures and instruments used to assess Oral Health-Related Quality of Life, our review found that people with dental caries and malocclusion have a significantly higher experience of poor quality of life.

PROSPERO SYSTEMATIC REVIEW REGISTRATION NO

CRD42021277874.

Prevalence of novel gamma HPV types 223 and 225 in oral cavity and skin of Indian normal and neoplastic participants

Gamma-papillomaviruses, though traditionally classified as cutaneotropic, actual tissue tropism is largely unexplored. This study aimed to evaluate the tissue-specific prevalence of two novel-HPV 223 and 225 in samples of oral mucosa and keratinized epithelium of varied skin parts from 226 female and male subjects, with or without neoplastic/dysplastic lesions in oral cavity or cervix. The gamma-human papillomavirus (gamma-HPV) 223 and 225 DNA presences were determined by polymerase chain reaction (PCR) ursing the HPV type-specific primers and confirmed by Sanger sequencing. Viral load in the HPV 223 and HPV 225 positive samples were determined by absolute real-time quantification method. Alpha-HPV DNA prevalence was also checked in oral mucosa to ascertain coinfection status. Novel HPV 223 was present in 4.4% (10/226) oral mucosal samples of the study population; interestingly all were females with no prevalence in their corresponding skin swab samples. Whereas, the prevalence of HPV 225 was found both in the skin and oral mucosa of 28.2% (N = 37/131) female and 17.9% (N = 17/95) male participants. Alongside, HPV 223 viral load was found to be significantly higher (p = 0.02 < 0.05) in the oral mucosa of diseased participants, whereas, HPV 225 viral load was higher in the oral mucosa of normal participants. Our results suggest that gamma-HPV 223 has its prevalence only in the oral mucosal epithelium, whereas, HPV 225 has its prevalence on both mucosal and keratinized skin epithelium, indicating its dual tropism nature.

Normal dimensions of the lacrimal gland on magnetic resonance imaging in Indian adult population: a retrospective study

Introduction

the lacrimal gland size is affected by a variety of pathologic conditions like inflammatory, infections, neoplastic, autoimmune and granulomatous disorders. Earlier, the dimensions of the gland were estimated by extracting lacrimal glands from cadavers, later ultrasonography and computed tomography studies were used, but had limited soft tissue differentiation. The aim of this study was to retrospectively evaluate Magnetic Resonance Imaging (MRI) data from normal orbits and determine lacrimal gland dimensions.

Methods

five hundred and twelve (512) consecutive MRI brain contrast scans (of 240 females, of 272 males; age range 40±20 years) for non-orbital diseases were evaluated retrospectively. The mean axial length (AL), axial width (AW), coronal length (CL), and coronal width (CW) of each lacrimal gland were measured separately.

Results

five hundred and twelve (512) MRI brain contrast scans of 272 men and 240 women, with mean age of 40 ± 20 years were included. Right and left LG dimensions were similar, mean AL (13.2±1.35 mm versus 13.11±1.24 mm), mean AW [3.5±0.99 mm versus 3.3±0.82 mm], mean CL [16.3±2.5 mm versus 16.10±2.4 mm], and mean CW (4.15±0.89 mm versus 4.11±0.85 mm). The AL of both lacrimal glands and the CL and CW of right but not left lacrimal glands were significantly lower in women than in men. Age showed significant correlations with the AL and CL of both LGs.

Conclusion

in this study, evaluation of normal morphometric parameters of the lacrimal gland in Indian population was established. LG dimensions are smaller in women than men, as well as correlating with side and age.

Genetic landscape of human platelet antigen variants in the Indian population analysed from 1029 whole genomes

Genetic variants in human platelet antigens (HPAs) considered allo- or auto antigens are associated with various disorders, including neonatal alloimmune thrombocytopenia, platelet transfusion refractoriness and post-transfusion purpura. Although global differences in genotype frequencies were observed, the distributions of HPA variants in the Indian population are largely unknown. This study aims to explore the landscape of HPA variants in India to provide a basis for risk assessment and management of related complications. Population-specific frequencies of genetic variants associated with the 35 classes of HPAs (HPA-1 to HPA-35) were estimated by systematically analysing genomic variations of 1029 healthy Indian individuals as well as from global population genome datasets. Allele frequencies of the most clinically relevant HPA systems in the Indian population were found as follows, HPA-1a - 0.884, HPA-1b - 0.117, HPA-2a - 0.941, HPA-2b - 0.059, HPA-3a - 0.653, HPA-3b - 0.347, HPA-4a - 0.999, HPA-4b - 0.0010, HPA-5a - 0.923, HPA-5b - 0.077, HPA-6a - 0.998, HPA-6b - 0.002, HPA-15a - 0.582 and HPA-15b - 0.418. This study provides the first comprehensive analysis of HPA allele and genotype frequencies using large scale representative whole genome sequencing data of the Indian population.

Study of correlation between Visual Prostate Symptom Score and International Prostate Symptom Score in men with lower urinary tract symptoms with reference to Uroflowmetry parameters in Indian population

PURPOSE

International prostate symptom score (IPSS) is a complex questionnaire method for objective assessment of Lower urinary tract symptoms. So, there is a need to develop a simple and easy scoring system that could be easily used for illiterates and older aged patients.

MATERIALS AND METHODS

It was a prospective observational study with 202 participants, conducted at the department of urology of a tertiary care hospital in eastern India. The patients more than 50 years of age, attending urology OPD with Lower urinary tract symptoms were included in the study. Printed IPSS and VPSS questionnaires were given to the patient to answer.

RESULTS

Eighty-two percent (82%) of the higher education group and 97% of the lower education group needed assistance to answer IPSS questionnaires while 18% of the higher education group and 44% of the lower education group needed assistance to answer VPSS questionnaires. Sixty-four (64%) of patients in our study belong to the high education level while 36% of patients belong to the low education group. The mean age was 60.1 years. The mean IPSS and VPSS were 19 and 11 respectively. The mean PSA was 1.5 ng/ml. The time taken to fill VPSS questionnaire was much less than IPSS questionnaires. All the patients felt that VPSS was easier. Statistically significant (p-value < 0.05) correlation was found between total IPSS and total VPSS, Q2 IPSS and Q1 VPSS, Q7 IPSS and Q2 VPSS, Q5 IPSS and Q3 VPSS, and IPSS Qol and VPSS Qol. A negative correlation was found between Q3 VPSS and Qmax, and Q5 IPSS and Qmax.

CONCLUSIONS

VPSS can be used as an alternative tool to IPSS to assess LUTS, which uses pictograms instead of questionnaires, even in patients with limited education.

Genetic landscape of human neutrophil antigen variants in India from population-scale genomes

Antibodies against human neutrophil antigens (HNAs) play a significant role in various clinical conditions such as neonatal alloimmune neutropenia, transfusion-related acute lung injury, and other nonhemolytic transfusion reactions. This study aims to identify the genotype and allele frequencies of HNAs in the healthy Indian population. Ten genetic variants in four human genes encoding alleles of HNAs class I-V approved by the International Society of Blood Transfusion-Granulocyte Immunobiology Working Party were used in the analysis. Genetic variants from whole genome sequences of 1029 healthy Indian individuals corresponding to HNA alleles were analyzed. The frequencies of the variants were compared with global population datasets using an in-house computational pipeline. In HNA class I, allele frequencies of FCGR3B*01, FCGR3B*02, and FCGR3B*03 encoding HNA-1a, HNA-1b, and HNA-1c were 0.07, 0.8, and 0.13, respectively. HNA class 3 alleles namely SLC44A2*01 (encoding HNA-3a) and SLC44A2*02 (encoding HNA-3b) were found at allele frequencies of 0.78 and 0.22, respectively. The frequencies of ITGAM*01 encoding HNA-4a and ITGAM*02 encoding HNA-4a were 0.95 and 0.05, respectively. Furthermore, allele frequencies of HNA class 5 alleles were 0.32 for ITGAL*01 (encoding HNA-5a) and 0.68 for ITGAL*02 (encoding HNA-5b). Interestingly, it was also found that rs2230433 variant deciding the HNA class 5 alleles, was highly prevalent (78.2%) in the Indian population compared with other global populations. This study presents the first comprehensive report of HNA allele and genotype frequencies in the Indian population using population genome datasets of 1029 individuals. Significant difference was observed in the prevalence of HNA5a and HNA5b in India in comparison to other global populations.

Head and facial anthropometry of the Indian population for designing a spectacle frame

Purpose

To establish the normative data of the head and face measurements needed to design an appropriate spectacle frame for the Indian population.

Methods

Indian subjects between 20 and 40 years were included in the study. Thirteen parameters were measured using the direct and indirect methods using ImageJ software. Photographs of subjects were captured in the primary gaze position, with the head turned toward the subject's right and left by 90° from the primary gaze.

Results

The mean ± standard deviation of age was 27.6 ± 5.7; 55.38% were males. An independent t-test showed a significant difference in nose width (P = 0.001), inter-pupillary distance (P = 0.032), and body mass index (P = .012) between males and females. Inner inter-canthi distance (P = .265), outer inter-canthi distance (P = .509), and frontal angles (P = .536) showed no significant difference. There is a significant difference in face width compared with the other studies. The mean head width of males (154.168 ± 9.121) was wider than that of females (145.431 ± 8.923). This suggests a smaller distance between the temples of a spectacle frame for females.

Conclusion

Considering the above factors, there is a need for a customized spectacle frame design providing better optics, improved cosmesis, and comfort to the wearer.

Variation in normative values of major clinical biochemistry analytes in healthy reproductive-age women in India: A subset of data from a National Indian Council of Medical Research-Polycystic Ovary Syndrome task force study

OBJECTIVES

Clinical biochemistry reference intervals (RIs) play a crucial role in interpreting patient test results and making informed clinical decisions. Using data from an ongoing Indian Council of Medical Research-National task force study on healthy women, normative ranges for commonly analyzed biochemical analytes were established.

MATERIALS AND METHODS

A.

total of 13,181 women of reproductive age (18-40 years) were recruited from different urban and rural regions of the country, of which 9898 women signed an informed consent were included. Among these, women having features of hyperandrogenism, menstrual cycle irregularities, and comorbidities were excluded. RIs of 22 analytes were computed in the remaining 938 women controls. To estimate the 95% range of the reference distribution, the limits of the 2.5^th percentile and the 97.5^th percentile were used in the study.

RESULTS

Mean ± standard deviation of age and body mass index of participants was 30.12 ± 6.32 years and 22.8 ± 3.36 kg/m² respectively. Centiles (2.5^th-97.5^th) of liver function parameters, lipid parameters, glycaemic parameters, and renal parameters are presented. No significant difference in analytes was observed in relation to the area of residence, and age groups except in albumin (P = 0.03). The distribution of most of the parameters was consistent with the various RI studies conducted in India as well as other countries.

CONCLUSION

This is the first study generating biochemical RIs data among a large representative sample of healthy reproductive-age women recruited using a robust design across the country. The resource may serve as a reference range for common biochemical analytes for future in this age group.

Regional influence on the aesthetic preference of different Mongolian profiles: A comparative study of assessors from Northeast and Mainland India

OBJECTIVE

The purpose of this study was to determine the aesthetic preferences of three different groups-layperson, dentists, and orthodontists, with different ethnic and geographical backgrounds from North-eastern and Mainland India, and to evaluate whether there is any difference in the perception of facial profile aesthetics. The influence of one's ethnic and regional origin in the perception of facial profile aesthetics was evaluated in two populations of different backgrounds using VAS scale.

MATERIALS AND METHODS

Facial profile photos of 2 Mongolian descendants, 1 man and 1 woman having Class I (normal) profile were digitized and modified, sagittally, to obtain 7 sagittal variations of each profile. A total of 7 profile images were obtained for each of the male and female models. The photos were ranked by 240 participants from an aesthetic point of view between a score of 1 (very unattractive) and 10 (very attractive). Repeated measures ANOVA was used for intra-group comparison whereas one-way ANOVA and Z-test were used for inter-group comparisons.

RESULTS

The Class I profile was the most preferred in both male and female profile photos by orthodontists of both the two populations, whereas the Class III profile (prognathic mandible) was considered the least attractive (P<0.05). North-eastern layperson and dentists preferred profiles with a slightly retrusive maxilla, while mainland layperson and dentists were tolerant to a protrusive profile (P<0.05).

CONCLUSION

The participants' perception regarding the Class I profile aesthetics were found to be similar. However, differences were observed in the profile preferences in people of different ethnicities and regions. Also, professional training was found to influence the perception of profile aesthetics.

Clinical features and visual outcomes of pediatric optic neuritis in the Indian population: A prospective study

Purpose

Optic neuritis, defined as inflammation of the optic nerve, is the most common optic neuropathy affecting adults. Various studies in Southeast Asia have shown that the clinical profile of optic neuritis might differ in these regions from that reported in the western literature. Through this study, we evaluate the clinical profile of pediatric optic neuritis (PON) in the Indian population.

Methods

This was a hospital-based prospective observational study. Patients with optic neuritis younger than 16 years who attended the neuro-ophthalmology clinic from May 2016 to April 2017 were included in the study.

Results

This study included 54 eyes of 38 patients. The mean age of presentation was 10.6 years. Unilateral disease (58%) was found to be more common, and a slight female preponderance (58%) was noted. The most common feature was visual loss (96.3%). Pupillary light reflex abnormality was seen in most patients. Fundus examination revealed disk edema (77.7%) to be the most common feature. Neuroimaging was performed in 34 patients, and multiple sclerosis was diagnosed in four patients. At 3 months follow-up after treatment, 89% of eyes had best correct visual acuity of 6/9 or better (P < 0.001).

Conclusion

In our study, we found the clinical profile of PON to be similar to that seen in western studies as well as those done previously in the Indian population, although with a few differences.

A Computed Tomography-Based Assessment of the Anatomical Parameters Concerning S2-Alar Iliac Screw Insertion Using "Safe Trajectory Method" in Indian Population

STUDY DESIGN

A retrospective computed tomography (CT)-based radiological analysis.

PURPOSE

To obtain CT-based morphometric data for the S2 alar iliac (S2AI) screw in the Indian population presenting to School of Medical Sciences and Research, Greater Noida, we used the concept of "safe trajectory" by Pontes and his colleagues in a recent study.

OVERVIEW OF LITERATURE

Although previous CT-based morphometric studies on the S2AI screw have been published for a variety of ethnic groups, morphometric data specifically for the Indian population are scarce.

METHODS

We used the three-dimensional multiplanar reformatting software to conduct a retrospective CT analysis of 112 consecutive patients who met our exclusion criteria for various abdominal and pelvic pathologies. CT imaging planes were rotated between the S1 and S2 foramen until they matched the ideal S2AI screw trajectory, which was represented by the longest and widest iliac osseous channel observed in the axial CT section. Following the concept of a safe trajectory, S2AI screw morphometric parameters were measured on both sides of the pelvis using corresponding axial and sagittal CT images.

RESULTS

In the sagittal and transverse planes on both sides of the pelvis, females had significantly higher screw trajectory angulation than males (p<0.001). On both sides of the pelvis, males had significantly greater iliac width, maximum screw trajectory length, and intrascrotal length than females (p<0.001). On both sides of the pelvis, the S2AI screw entry point in females was significantly deeper than in males from the skin margin (p<0.001).

CONCLUSIONS

Based on our methodology, we discovered that the S2AI screw trajectory is significantly more caudal and lateral in females, the maximum screw length is sufficient for use in clinical practice regardless of gender, and that 8.5 mm or even larger screw diameters are feasible in the majority of the Indian population.

Association of serum vitamin D levels with clinical spectrum of central serous chorioretinopathy patients of Indian origin

BACKGROUND

Vitamin D, a fat-soluble prohormone has been implicated in various ophthalmological diseases such as ocular inflammation, glaucoma, diabetic retinopathy and ocular angiogenesis. Many studies have shown effect of vitamin D on oxidative stress, angiogenesis and retinal circulation. However, there is definitive lack in published literature on effect of vitamin D on central serous chorioretinopathy especially in view of various epidemiological studies reporting risk of vitamin deficiency in up to 40% adult population.

OBJECTIVE

To determine serum vitamin D levels in various clinical profiles of central serous chorioretinopathy and their effect on its pathophysiology in Indian population.

DESIGN

Case control observational study METHODS: Study included 42 patients (group P) of central serous chorioretinopathy (CSCR) diagnosed with optic coherence tomography (OCT), fundus fluorescein angiography (FFA) which were further sub-grouped into acute(P1), chronic (P2) and recurrent (P3). A total of 44 age & sex-matched healthy control subjects (group C) were also included. The vitamin D levels of both groups were examined and analyzed.

RESULTS

No significant difference between the groups P and C in respect of age, gender or baseline best corrected visual acuity (P = 0.153, P = 0.123 and P = 0.08, respectively) was noted. Vitamin D levels were determined as 16.473 ± 7.307 ng/mL in group P and 34.940 ± 8.348 ng/mL in group C and difference was statistically significant(P = 0.001). There were statistically significantly more no of patient in group P (78.57%) with deficient vitamin D levels as compared to normal serum levels (4.76%) (P = 0.04). Patients in group P1(acute CSCR) and P2(Chronic CSCR) also had significant more no of subjects with deficient vitamin D levels as compared to normal serum levels (P = 0.01 and P = 0.03).

CONCLUSIONS

The low serum vitamin D levels were determined in all clinical sub-types of central serous chorioretinopathy patients which point to its possible role in the pathophysiology of the disease. There is a need for further studies to determine the changes that could occur with vitamin replacement therapy in CSCR.

Whole transcriptome sequencing reveals HOXD11-AGAP3, a novel fusion transcript in the Indian acute leukemia cohort

Introduction: Acute leukemia is a heterogeneous disease with distinct genotypes and complex karyotypes leading to abnormal proliferation of hematopoietic cells. According to GLOBOCAN reports, Asia accounts for 48.6% of leukemia cases, and India reports ~10.2% of all leukemia cases worldwide. Previous studies have shown that the genetic landscape of AML in India is significantly different from that in the western population by WES. Methods: We have sequenced and analyzed 9 acute myeloid leukemia (AML) transcriptome samples in the present study. We performed fusion detection in all the samples and categorized the patients based on cytogenetic abnormalities, followed by a differential expression analysis and WGCNA analysis. Finally, Immune profiles were obtained using CIBERSORTx. Results: We found a novel fusion HOXD11-AGAP3 in 3 patients, BCR-ABL1 in 4, and KMT2A-MLLT3 in one patient. Categorizing the patients based on their cytogenetic abnormalities and performing a differential expression analysis, followed by WGCNA analysis, we observed that in the HOXD11-AGAP3 group, correlated co-expression modules were enriched with genes from pathways like Neutrophil degranulation, Innate Immune system, ECM degradation, and GTP hydrolysis. Additionally, we obtained HOXD11-AGAP3-specific overexpression of chemokines CCL28 and DOCK2. Immune profiling using CIBRSORTx revealed differences in the immune profiles across all the samples. We also observed HOXD11-AGAP3-specific elevated expression of lincRNA HOTAIRM1 and its interacting partner HOXA2. Discussion: The findings highlight population-specific HOXD11-AGAP3, a novel cytogenetic abnormality in AML. The fusion led to alterations in immune system represented by CCL28 and DOCK2 over-expression. Interestingly, in AML, CCL28 is known prognostic marker. Additionally, non-coding signatures (HOTAIRM1) were observed specific to the HOXD11-AGAP3 fusion transcript which are known to be implicated in AML.

Assessment of prevalence and morphology of plantaris tendon in Indian population by ultrasound

Background

There is wide racial difference in the prevalence of the absence of the plantaris tendon. This study was conducted to determine the prevalence of plantaris tendon in Indian population.

Materials and methods

The presence of the plantaris tendon was determined by ultrasound in 250 healthy volunteers using the standard technique.

Results

Out of 250 individuals 28 (11.2%) had absence of plantaris tendon either unilaterally or bilaterally. Unilateral absence of plantaris tendon was in 3.2%, bilateral absence in 4.8% and overall absence was in 8%. According to the hand and foot dominance the probability of finding right plantaris tendon in right dominant person was 92.3% and in left dominant is 89.7%. Height of the person also correlated significantly with tendon length.

Conclusions

Plantaris tendon was absent in ∼11%, either unilaterally or bilaterally, in this cohort of Indian population.

Safety and Efficacy of Bendamustine and Rituximab (BR) Regimen in Indian Chronic Lymphocytic Leukaemia Patients

We investigated the safety and efficacy of bendamustine-rituximab (BR) in previously untreated symptomatic and advanced CLL patients, as there is no data available on BR from the Indian subcontinent.This retrospective study included 120 consecutive treatment naïve patients with CLL without del (17p), who were registered at the Department of Medical Oncology, AIIMS between January 2010 and July 2018. Bendamustine was given at a dose of 90 mg/m2 on days 1 and 2, combined with rituximab 375 mg/m2 rituximab on day 1, every 28 days for up to 6 courses. Event-free survival (EFS) was defined as the date of treatment to date of relapse, disease progression, or death due to any cause.The median age was 57 years (range: 30-75 years). As per the clinical Rai stage, 30 (25%) patients were in stage II, 42 (35%) were in stage III and 48 (40%) were in stage IV. ZAP70 was positive (> 20%) in 50%, CD 38 was positive (> 30%) in 33%, and CD49d was positive (> 30%) in 49% of cases. Beta-2 microglobulin (B2M) was elevated (≥ 3.5 mg/L) in 80% of cases. Fifty-five cases (50%, n = 110) were IGHV mutated. The mean number of cycles was 5 (1-6). The overall response rate (ORR) seen with BR was 90% and complete response was 45%. Median progression-free survival was 24 months with a median follow-up period of 29 months. Haemoglobin (< 10 g/dL), elevated B2 M, unmutated IGHV had a statistically significant adverse impact on EFS on univariate analysis but on multivariate analysis, only IGHV mutation status was found to had significance on EFS. The median EFS was 27 months in IGHV mutated versus 18 months in IGHV unmutated-CLL patients (p = 0.001). Grade 3/4 neutropenia, thrombocytopenia, anemia, and infections were observed in 30.6%, 8%, and 12% respectively. The most common non-hematological toxicity was skin rash which was grade 1/2 in 24 (20%) cases and grade 3/4 in 12 (10%) cases. This is the largest study from India to demonstrate the safety and efficacy of BR in symptomatic CLL patients. BR is an effective and safe regimen in the first-line treatment of CLL. Unmutated-CLL patients have inferior EFS than mutated-CLL patients. Skin toxicity was the most common adverse effect seen in our population which was observed in around one-third of cases.

Vitamin D and Interleukins in Chronic Rhinosinusitis with Polyposis

Vitamin D is thought to play an inflammatory modulatory role in the pathogenesis of chronic rhinosinusitis with nasal polyposis (CRSwNP) & it also affects the severity of inflammation so the study was focused on the evaluation of serum vitamin D & interleukins in CRSwNP. The prospective study was conducted on clinic-radiological confirmed cases. The patients were not operated prior, clubbed under primary nasal polyposis (PNP) group and the patients were operated prior, clubbed under recurrent nasal polyposis (RNP) group. The subjective and objective severity of the disease was assessed by sino-nasal outcome score (SNOT 22) & NCCT PNS & orbit. Serum levels of cytokines (IL4, IL 5, and IL 13) were quantified using the ELISA method using the Human Interleukin antibody coated ELISA kit. Measurement of vitamin D was done by using recombinant ruthenium-labelled VDBP. There was a significant difference in Vitamin D, AEC, IL 4, IL 5, IL 13 levels in the disease groups compared to control group. Low vitamin D, high SNOT & high absolute eosinophil count (AEC) count was noticed in both disease groups. Vitamin D may play a significant role in nasal polyposis formation. For the establishment of interaction, a community based larger study is required as the prevalence of low vitamin D level is high in Indian population.

Forensic evaluation of mitochondrial DNA heteroplasmy in Gujarat population, India

BACKGROUND

Owing to its high copy number and its small size, mtDNA analysis is the most reliable choice when biological materials from crime scenes are degraded or have mixed STR profiles.

AIM

To examine the occurrence of heteroplasmy along with its frequency and pattern in both HV1 and HV2 regions of the mtDNA among unrelated individuals from India.

SUBJECTS AND METHODS

Mitochondrial DNA control region [hypervariable region one (HV1) and hypervariable region two (HV2)] were analysed in blood and buccal tissues of 104 unrelated individuals from the Indian state of Gujarat.

RESULTS

A high frequency of point heteroplasmy (PH) and length heteroplasmy (LH) was revealed. PH was detected in 7.69% of the population, with a higher frequency observed in blood than in buccal samples. However, there were no statistically significant differences in PH between the two tissues (Chi-square = 0.552, p ≥ 0.05). A total of six PH positions were detected: three at HV1, and another three at HV2. The studied population showed 46.15% LH in the HV1 and HV2 regions of both tissues. The LH positions observed in the Gujarat population were the same as those previously reported at HV1 np16184-16193 and HV2 np303-315.

CONCLUSIONS

Our findings suggest that differences in the pattern of heteroplasmy found in different tissues can complicate the forensic analysis, on the other hand, the probability of a match between the questioned and reference samples increases when the heteroplasmy is identical in both tissues. Variability of PH among persons and even within tissues recommends analysing multiple tissue samples before drawing a conclusion in forensic mtDNA analyses.

Reference values of myocardial native T1 and T2 mapping values in normal Indian population at 1.5 Tesla scanner

T1 and T2 mapping techniques on cardiovascular magnetic resonance (CMR) provide insights into the myocardial tissue characterisation. We sought to establish the normal reference values of native T1 and T2 mapping in Indian population which can be used subsequently in clinical practice for addressing various cardiac pathologies. This prospective study included consecutive healthy volunteers (18-60 years) who underwent CMR on a 1.5 Tesla scanner using standard protocol. T1 mapping sequence was performed using MOLLI sequence with two different flip angles (FA) (35° and 50°). T2 mapping was performed using a hybrid gradient and spin-echo sequence sequence with two different FA (70° and 12°). Images were analysed with ROIs drawn in all the 16 AHA myocardial segments. 50 volunteers (average age-34 years, males-72%) were included. All the scans were normal. The mean T1 value at 35-degree FA was 946.86 + 14.16 ms and at 50-degree FA was 941.60 + 11.89 ms. The mean T2 mapping value at 70-degree FA was 45.67 + 1.39 ms and at 12-degree FA was 45.61 + 1.47 ms. The mapping values were not statistically different between males and females (all p > 0.2). The T1 and T2 mapping values did not show any significant correlation with LVEF, age, BMI or heart rate (all r < 0.33). The T1 mapping values significantly differ at 35- and 50-degree FAs (p = 0.002). The results establish the normal reference T1 and T2 mapping value for Indian population in institutes using the same protocol and parameters at 1.5 Tesla and may guide future research.

Morphometric Analysis of Ulnar Variance and Its Demographic Dynamics Using High Resolution MRI: A Retrospective Study in Indian Population and Review of Literature

Background

Ulnar variance (UV) is the variation of the level of the distal articulating surface of the radius with respect to the distal articulating surface of the ulna. These variations either positive or negative can predispose to pathologies involving the wrist joint. The aim of this study was to measure the ulnar variance in a subset of Indian population using high-resolution MRI and compare our results with the existing literature.

Materials and Methods

Retrospective analysis of 100 normal wrist MRIs were done performed during November 2020 to November 2021 and the ulnar variance was calculated using the Method of Perpendiculars. All the MRI sequences were performed by an experienced radiologist with prior fixed protocol for the study. The measurements were done on the mid-coronal section based on the Method of Perpendiculars using Meddiff Rispacs software.

Results

The average age of the participants was 42 years, with Male to female ratio of 0.9:1. 47 MRIs were of the left wrist, while 53 MRIs were of the right wrist. The mean UV was - 0.7 mm (SD-0.175), ranging from - 4.5 mm to 3.5 mm. There was a significant relationship between ulnar-variance and age, as ulnar-variance increases with the age (p value = 0.039). There was no statistically significant correlation of ulnar-variance with gender distribution and handedness.

Conclusions

This study utilized high-resolution MRI for measuring ulnar-variance in a subset of Indian population and disclosed that the ulnar-variance affirms a positive correlation with age, while no specific pattern between the ulnar-variance and gender or handedness could be established.

Graphical abstract

Early Results of Bone-Conserving High Flexion Posterior-Stabilized Total Knee System in Indian Population

Background

A number of total knee arthroplasty (TKA) systems are used across a variety of markets in which outcome will be influenced by patient factors, surgical technique and implant characteristics. The aim of the current study was to report the early functional results of a primary TKA system in support of the component design characteristics adapted for achieving increased functional expectations of the patients.

Materials and Methods

A prospective, continuous series of 304 primary posterior-stabilized (PS) TKAs were performed in 208 patients by a single surgeon. Inclusion criterion was patients undergoing primary TKA with Freedom Total Knee system and willing to participate in the study. Exclusion criteria were patients undergoing revision TKA, patients not willing to participate and patients who were lost to follow-up. Patients were clinically and radiologically assessed for a minimum of 5 years post-operatively. Oxford Knee score (OKS) and range of motion (ROM) were assessed for the entire study population and by gender.

Results

There were no patients who were lost to follow-up. Two patients (Two knees) required incision and secondary suturing for superficial skin wound complication. At minimum 5-year follow-up, there was no radiographic evidence of component loosening/failure. Clinical evaluation at 5 years post-operatively showed statistically significant increase in the OKS and ROM as compared to pre-operative values (OKS pre-operative 19.27 ± 1.86, post-operative 38.76 ± 1.5, p value < 0.001, ROM pre-operative 94.57 ± 3.49, post-operative 127.69 ± 3.65, p value < 0.001). There was no statistically significant difference in the clinical outcome between male and female genders as well as between unilateral and bilateral TKA.

Conclusion

The study showed encouraging early results for the bone-conserving high flexion TKA system in 208 patients at minimum 5-year follow-up. The adapted design characteristics for improved functional expectations are confirmed in this reported Indian population study group cohort. Further continued evaluation is warranted for this primary TKA system across Indian and other ethnic population.

A normative study of the Color Trails Test in the adult Indian population

The Color Trails Test (CTT) is a neuropsychological measure assessing for frontal and executive functioning, while also minimizing the cultural and language barriers inherent in similar measures such as the Trail Making Test (TMT). This study establishes convergent validity for the CTT in the Indian population by comparing participant performance on the CTT and TMT. It also generates culturally appropriate normative data for CTT-Form A among the Indian adult population. Six-hundred and sixty-nine cognitively healthy, community-dwelling individuals between ages 18 and 69 participated in the study and were stratified based on age, gender, and educational attainment. Participant performance on the CTT and TMT were correlated to establish convergent validity. Strong correlation was found between TMT-A and CTT-1 (r = 0.61) and between TMT-B and CTT-2 (r = 0.66). An analysis of variance test was used to determine the mean and standard deviation for each stratified participant group. Further analysis found that age and educational attainment significantly impact participant performance on CTT-1 [F(4, 649) = 4.395, p = 0.002], whereas gender, age, and educational attainment significantly impact participant performance on CTT-2 [F(4,649) = 2.446, p = 0.045]. Normative data generated from this study has important clinical implications and contributes to the growing body of culturally appropriate normative data available for the Indian population.

1029 genomes of self-declared healthy individuals from India reveal prevalent and clinically relevant cardiac ion channelopathy variants

BACKGROUND

The prevalence and genetic spectrum of cardiac channelopathies exhibit population-specific differences. We aimed to understand the spectrum of cardiac channelopathy-associated variations in India, which is characterised by a genetically diverse population and is largely understudied in the context of these disorders.

RESULTS

We utilised the IndiGenomes dataset comprising 1029 whole genomes from self-declared healthy individuals as a template to filter variants in 36 genes known to cause cardiac channelopathies. Our analysis revealed 186,782 variants, of which we filtered 470 variants that were identified as possibly pathogenic (440 nonsynonymous, 30 high-confidence predicted loss of function ). About 26% (124 out of 470) of these variants were unique to the Indian population as they were not reported in the global population datasets and published literature. Classification of 470 variants by ACMG/AMP guidelines unveiled 13 pathogenic/likely pathogenic (P/LP) variants mapping to 19 out of the 1029 individuals. Further query of 53 probands in an independent cohort of cardiac channelopathy, using exome sequencing, revealed the presence of 3 out of the 13 P/LP variants. The identification of p.G179Sfs*62, p.R823W and c.420 + 2 T > C variants in KCNQ1, KCNH2 and CASQ2 genes, respectively, validate the significance of the P/LP variants in the context of clinical applicability as well as for large-scale population analysis.

CONCLUSION

A compendium of ACMG/AMP classified cardiac channelopathy variants in 1029 self-declared healthy Indian population was created. A conservative genotypic prevalence was estimated to be 0.9-1.8% which poses a huge public health burden for a country with large population size like India. In the majority of cases, these disorders are manageable and the risk of sudden cardiac death can be alleviated by appropriate lifestyle modifications as well as treatment regimens/clinical interventions. Clinical utility of the obtained variants was demonstrated using a cardiac channelopathy patient cohort. Our study emphasises the need for large-scale population screening to identify at-risk individuals and take preventive measures. However, we suggest cautious clinical interpretation to be exercised by taking other cardiac channelopathy risk factors into account.

Transcatheter Aortic Valve Implantation for Severe Bicuspid Aortic Stenosis - 2 Years Follow up Experience From India

Background

Transcatheter aortic valve implantation (TAVI) is challenging in bicuspid aortic valve (BAV) anatomy. The patients are young, morphological phenotypes are many, calcium burden is high and there are technical challenges for best outcomes. Observational studies and registries are available with favorable data and experiences from around the world sharing methodologies and algorithms for sizing and implantation. We, therefore, analysed our data of procedural and in-hospital outcomes of TAVI in Bicuspid Aortic Valve cases performed at two high volume centres in India and their follow up for two years.

Methods and Results

The data were collated and analysed from two centres (Fortis Escorts Heart Institute, New Delhi and Apollo Hospitals, Chennai) in India for patients who underwent TAVI in a BAV anatomy. It included a total of 70 cases from 2 centres. All symptomatic severe AS patients more than and equal to 65 years having bicuspid anatomy were included in the study irrespective of their STS score. Patients under 65 years of age were advised TAVI only if they were at high risk for open heart surgery. These patients were followed for a period of 2 years and the data were analysed. Pre TAVI imaging tools utilised were 2D echo, transthoracic echocardiography (TTE), trans oesophageal echocardiography (TEE), and ECG gated multi slice CT (MSCT) scan imaging. MSCT was utilised for confirmation of the anatomy and classifying the morphological type of valve, measuring, and evaluating all anatomic determinants of aortic root complex for planning the procedure and choice of the valve and its size. Sizing in balloon expanding valve (BEV) and self-expanding valve sizing (SEV) were based primarily on annulus area and perimeter, respectively. The SEV used in our study were the Core Valve and Evolut R (Medtronic, United States) and the BEVs included Sapien3 (Edwards Lifesciences, United States) and Myval (Meril Lifesciences, India). The BAV cohort constituted 24.4% of the total 287 TAVI cases, followed up for 2 years. The mean age of these patients was 72 years. The incidence of male patients was 68.57% and female patients was 31.4%. The Sievers type 1 included 78.5%, type 0 were 21.4% of the cases and there was no case of type 2 in the study. The procedural success was to the tune of 98%. Patients with normal left ventricular ejection fraction (LVEF) improved their symptoms class after TAVI and remained so at 2 years follow up. The poor LVEF subset of patients did not have heart failure admissions and also had improvement in their symptom status. The peak-to-peak aortic valve gradient decreased to 0 mmHg at the end of the procedure in most of the cases. The mean pressure gradient (PG) across the new valve ranged between 0 and 15 mmHg and the aortic valve area (AVA) was close to 2 cm². These numbers were consistent at 2 years follow up. Significant paravalvular leak (PVL) 24.28% was seen immediately after deployment of the valve in heavily calcified anatomy but it reduced to mild or trivial PVL after post-dilation and one patient needed a second valve to treat PVL. No patient had more than mild PVL with either type of valve at the end of the procedure. Permanent pacemaker implantation (PPI) was required in 11.4% of the patients within 24 h to 7 days of the procedure. No one needed a PPI in the 2 year follow up. Coronary occlusion did not happen to any patient. No patient had a disabling stroke. Non-disabling stroke was seen in 10% of cases and mostly in the first week or 30 days of the procedure and the incidence was more with BEV (14%) as compared to SEV (8%). There was one case of valve embolisation after 24 h of the procedure, which needed a surgical valve replacement. There was no case of annular injury or injury to other parts of the aortic root complex. Two cases had access vessel (femoral artery) thrombosis at end of the procedure and a third patient had proglide related residual stenosis. Two cases had acute kidney injury and needed dialysis. There was no major bleeding complication in any patient. Peri procedural mortality occurred in two patients. Valve thrombosis was seen in one patient after 3 months, which was treated with oral anticoagulation. Valve degeneration and failure or infective endocarditis were not seen in any patient.

Conclusion

The patients with BAV stenosis who underwent TAVI in this study had good procedural success rates and clinical outcomes. The haemodynamics achieved with both SEV and BEV were good at 2 years. The rates of PVL, PPI, and stroke are similar to that of many other studies and registries. PPI rate and non-disabling stroke incidence appear to be higher similar to many studies done. There was no case of coronary occlusion in the study. Meticulous CT analysis of the aortic root complex, selection of appropriate type and size of the valve, and best implantation practices along with cerebral protection will probably be the key to safer and more successful TAVI in this population.

Preliminary genome wide screening identifies new variants associated with coronary artery disease in Indian population

AIM

Coronary artery disease (CAD) is a major health problem in developed and developing nations. Development of CAD involves a complex interaction between genetics and lifestyle factors. Individuals with high-risk genetic predisposition along with poor lifestyle are more inclined to the development of CAD. Advancement in genotyping technologies and increase in genome wide studies has provided a platform to identify new risk factors associated with CAD and associated complexities.

METHODOLOGY

In this study we performed genome wide screening in 76 well-defined CAD cases and 77 control samples in Indian population. Interestingly, new variants are identified in three genes viz, VLDLR, IFITM2 and C2CD4C.

RESULTS

The odds ratios observed for variant rs1869592 (VLDLR), rs1059091 (IFITMI) and rs7247159 (C2CD4C) were 2.6 (1.4-4.8 95% CI), 1.9 (95% CI 1.2-3.1) and 2.1 (1.2-3.7 95% CI), respectively with significant P value <0.01. These variants that are associated with pathogenesis of CAD were not previously reported in literature. Moreover, we anticipate that these variants will be further validated using a larger sample size.

Factors Determining Risk Categories in Differentiated Thyroid Carcinoma: Study of an Indian Cohort

INTRODUCTION

Differentiated thyroid carcinoma/cancer (DTC) burden in developing countries could be different from that of the developed nations.

AIMS AND OBJECTIVES

To describe the clinicopathological characteristics in a cohort of DTC patients in a south Indian state of Kerala and to compare with the data from other centres.

MATERIALS AND METHODS

A retrospective analysis of the data collected on DTC patients, from January 2010 to August 2018, attending thyroid cancer clinic at a tertiary care centre.

RESULTS

mong the 944 patients (male 262; female 682; mean age 43.8 years; standard deviation, SD 13.8), types of tumour were as follows: classical papillary thyroid carcinoma (cPTC) 48.3%, follicular variants of PTC (FVPTC) 28.8%, follicular and hurthle cell carcinoma (FTC&HCC) 10.1%. Mean size of the tumour was 2.7 cm (SD 1.8) papillary thyroid micro carcinomas (PTMC) were seen in 113 patients (12%), which were detected incidentally. Metastases were present at diagnosis in 40.2% cases, most common site being cervical lymph nodes. Distant metastases were seen in 113 patients (14.5%) and commonest site was bone. The American Thyroid Association (ATA) risk stratification was possible only in 684 subjects and showed 31.3% low risk, 41.8% intermediate risk and 26.9% at high-risk category. Lymph node metastasis and distant metastasis were the commonest determining factors for intermediate and high-risk category, respectively. High-risk category was significantly higher in patients >55 years, tumour size >4 cm, FTC/HCC tumour type and extranodal extension (ENE) of lymph node metastasis. Radio active iodine ablation was given to 85.2% subjects.

CONCLUSION

In our DTC population, FVPTC formed the second most common type and PTMC were all incidentalomas. Metastasis at diagnosis was higher suggesting delayed presentation. Old age, FTC/HCC, large size of the tumour, ENE were significantly higher in high-risk patients. Rest of the features of these cohort was comparable with the United States cohort of DTC patients.

Analysis of 61 SNPs from the CAD specific genomic loci reveals unique set of SNPs as significant markers in the Southern Indian population of Hyderabad

Background

The present study is a part of the major project on coronary artery disease (CAD) carried out at Indian Statistical Institute, Hyderabad to investigate the pattern of association of SNPs selected from the CAD specific genomic loci. The study is expected to portray the genetic susceptibility profile of CAD specifically in the Southern Indian population of Hyderabad.

Methods

The study was conducted in a cohort of 830 subjects comprising 350 CAD cases and 480 controls from Hyderabad. A prioritized set of 61 SNPs selected from the NHGRI GWAS catalogue were genotyped using FluidigmNanofluidic SNP Genotyping System and appropriate statistical analyses were used in interpreting the results.

Results

After data pruning, out of 45 SNPs qualified for the association analysis, four SNPs were found to be highly significantly associated with increased risk for CAD even after Bonferroni correction for multiple testing (p < 0.001). These results were also replicated in the random subsets of the pooled cohort (70, 50 and 30%) suggesting internal consistency. The ROC analysis of the risk scores of the significant SNPs suggested highly significant area under curve (AUC = 0.749; p < 0.0001) implying predictive utility of these risk variants.

Conclusions

The rs10455872 of LP(A) gene in particular showed profound risk for CAD (OR 35.9; CI 16.7–77.2) in this regional Indian population. The other significant SNP associations observed with respect to the pooled CAD cohort and in different anatomical and phenotypic severity categories reflected on the role of genetic heterogeneity in the clinical heterogeneity of CAD. The SNP rs7582720 of WDR12 gene, albeit not individually associated with CAD, was found to be conferring significant risk through epistatic interaction with two SNPs (rs6589566, rs1263163 in ZPR1, APOA5-APOA4 genes) of the 11q23.3 region.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02562-4.

Implications of COVID-19 on Thrombotic Profile of Severely Affected Patients

INTRODUCTION

Coronavirus disease 2019 (COVID-19) is a novel viral disease that spread as a global pandemic in 2020 by infecting millions of people across the world. Its clinical prognosis is dependent on various coagulatory parameters since thrombotic events are frequently associated with infection severity.

METHODS

A total of 383 COVID-19 patients enrolled in Rajiv Gandhi Super Specialty Hospital, Delhi, India, were included in the present retrospective study. Patients were divided into three categories, severe (n = 141), moderate (n = 138), and mild (n = 104) based on infection severity. Various thrombotic parameters and anticoagulant levels were measured in 70 patients and further analyzed.

RESULTS

Coagulopathy is seen in COVID-19 patients (n = 70) with a significant increase in fibrinogen, D-dimer levels, and prothrombin time in patients with severe and moderate disease compared to patients with a mild infection. Approximately, 70% of patients with severe and moderate disease demonstrated fibrinogen levels higher than the standard reference range. 60.41% of patients with severe disease showed significantly higher D-dimer levels. Thrombotic parameters were notably elevated in the nonsurvivors group compared to COVID-19 survivors. Nearly, 91% of patients with severe infection had anticoagulant protein S levels below the reference range.

CONCLUSION

COVID-19 infection severely impacts the blood coagulation cascade, which might lead to the manifestation of severe symptoms and increased mortality in patients.

Bifidobacterium Is Enriched in Gut Microbiome of Kashmiri Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a very common endocrine condition in women in India. Gut microbiome alterations were shown to be involved in PCOS, yet it is remarkably understudied in Indian women who have a higher incidence of PCOS as compared to other ethnic populations. During the regional PCOS screening program among young women, we recruited 19 drug naive women with PCOS and 20 control women at the Sher-i-Kashmir Institute of Medical Sciences, Kashmir, North India. We profiled the gut microbiome in faecal samples by 16S rRNA sequencing and included 40/58 operational taxonomic units (OTUs) detected in at least 1/3 of the subjects with relative abundance (RA) ≥ 0.1%. We compared the RAs at a family/genus level in PCOS/non-PCOS groups and their correlation with 33 metabolic and hormonal factors, and corrected for multiple testing, while taking the variation in day of menstrual cycle at sample collection, age and BMI into account. Five genera were significantly enriched in PCOS cases: Sarcina, Megasphaera, and previously reported for PCOS Bifidobacterium, Collinsella and Paraprevotella confirmed by different statistical models. At the family level, the relative abundance of Bifidobacteriaceae was enriched, whereas Peptococcaceae was decreased among cases. We observed increased relative abundance of Collinsella and Paraprevotella with higher fasting blood glucose levels, and Paraprevotella and Alkalibacterium with larger hip, waist circumference, weight, and Peptococcaceae with lower prolactin levels. We also detected a novel association between Eubacterium and follicle-stimulating hormone levels and between Bifidobacterium and alkaline phosphatase, independently of the BMI of the participants. Our report supports that there is a relationship between gut microbiome composition and PCOS with links to specific reproductive health metabolic and hormonal predictors in Indian women.

Vitamin K Insufficiency in the Indian Population: Pilot Observational Epidemiology Study

Background

The fat-soluble K vitamins K1 and K2 play an essential role in the blood coagulation cascade and are made available predominantly through selective dietary intakes. They are less known for their nonessential roles in a family of vitamin K–dependent proteins that promote various functions of organs and systems in the body. A lack of vitamin K can characterize vitamin and nutritional element insufficiency, which is different from a clinically apparent vitamin deficiency.

Objective

This epidemiological study evaluated the nutritional status of vitamin K in a sample of the Indian population and vitamin K content in staple Indian foods.

Methods

Serum levels of vitamin K1 and vitamin K2 in the form of menaquinone-7 (MK-7) were assessed via high-performance liquid chromatography coupled with fluorescence detection in 209 patients with type 2 diabetes, 50 healthy volunteers, and common staple foods in India.

Results

After comparing populations with high and low serum vitamin K levels from various geographical regions, our results indicated that the sample of healthy Indian individuals and the sample of Indian patients with type 2 diabetes had low (insufficient) levels of vitamin K2 (MK-7; range 0.3-0.4 ng/mL). No significant differences existed in vitamin K1–related and MK-7–related values between healthy male and female subjects, between male and female subjects with diabetes, and between the healthy sample and the sample of patients with diabetes. The staple, commonly consumed Indian foods that were tested in this study had undetectable levels of vitamin K2, while levels of vitamin K1 varied widely (range 0-37 µg/100 g).

Conclusions

Based on our sample’s low serum levels of vitamin K2 (MK-7) as well as the low levels of vitamin K2 in their typical diet, we propose that the general Indian population could benefit from the consumption of vitamin K2 in the form of MK-7 supplements.

Trial Registration

Clinical Trials Registry - India CTRI/2019/05/014246; http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=21660&EncHid=&userName=014246; Clinical Trials Registry - India CTRI/2019/03/018278; http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=32349&EncHid=&userName=018278

Normative values of skeletal muscle indices for nutritional assessment and implications on definition of sarcopenia in Indian adult population

INTRODUCTION

Sarcopenia is defined as both low muscle function (performance or strength) and low muscle mass. Although aging is the main cause of sarcopenia, it can also occur due to poor nutrition and chronic diseases like liver cirrhosis, chronic kidney disease, and diabetes.

OBJECTIVE

To do the quantitative analysis of various normative skeletal muscle indices (to define sarcopenia) in the Indian population.

METHODS

Sex-specific means, standard deviations (SD), and sarcopenia cutoffs (mean-2SD) of psoas muscle thickness (PMTH), psoas muscle area (PMA), psoas muscle index (PMI), erector spinae muscle area (ESMA), skeletal muscle radiation attenuation (SMRA), total skeletal muscle area (SMA), and total skeletal muscle index (SMI) were computed.

RESULTS

A total of 2002 individuals (1308 males and 694 females) underwent CT evaluation. PMTH (mm/m) was observed to be 15.87±2.67 in males vs. 12.61±2.46 in females (p=0.0001); PMA (cm2) was 18.55±3.45 in males vs.13.52±2.80 in females (p=0.0001); PMI (cm2/m2) was 6.69±1.40 in males vs. 5.57±1.18 in females (p=0.0001); ESMA (cm2) was 45.74±6.01 in males vs. 35.37±5.63 in females (p=0.0001); ESMI (cm2/m2) was 16.5±2.55 in males vs. 14.62±2.6 in females (p=0.0001); SMRA was 55.80±3.91 Hounsfield unit (HU) in males vs. 52.36±3.67 HU in females (p=0.0001); SMA (cm2) was 147.73±11.77 in males vs. 106.33±12.00 in females (p=0.0001); and SMI (cm2/m2) was estimated to be 51.00±5.70 in males vs. 43.93±6.05 in females (p=0.0001). PMTH, PMI, ESMI, SMI, and SMRA cutoffs for sarcopenia at L3 were observed to be 10.53 mm/m, 3.89 cm2/m2, 11.40 cm2/m2, 39.59 cm2/m2, and 47.98 HU among males and 7.69, 3.20, 9.42, 31.83, and 45.01 among females, respectively; these values were consistent with previously reported cutoffs in Indian studies but not consistent with the cutoffs reported in other countries.

CONCLUSION

Normative values of skeletal muscle indices for either sex among the Indian adult population would enable future studies on sarcopenia in various medical conditions.

What do patients want out of their Total Knee Arthroplasty?: An Indian perspective

INTRODUCTION AND AIM

Total Knee Arthroplasty surgery is one of the most successful operations in orthopaedics. Still a sizable percentage of patients remain dissatisfied. Various studies have been conducted to analyse the red flags associated with poor outcome. In this study we tried to have insight on actual requirements of Indian patients from TKA operation.

MATERIAL & METHODS

300 patients undergoing TKA were studied by way of patient expectation feedback form. The form had various patient related capture points. It had a leading question: What are your expectations from TKA? They were asked to rank the 5 most important options in the order of importance. The patient expectation form was distributed and collected by an independent observer.

RESULTS

70% of patients ranked relief of pain as the most important expectation. 20% reported improvement in walking as the number one expectation. Nearly equal number listed improvement in walking and ease of doing day-to-day activities as the second most important expectation. This was followed by improvement in climbing the stairs and improvement in quality of life. Correction of deformity and no pain while squatting and getting up from sitting position ranked at the bottom.

CONCLUSION

Our study shows that the primary expectations of Indian population from their TKA are relief from pain and improvement in walking. Secondary expectations include ease of doing day-to-day activities and improvement in quality of life.

Burden of Type 2 Diabetes and Associated Cardiometabolic Traits and Their Heritability Estimates in Endogamous Ethnic Groups of India: Findings From the INDIGENIUS Consortium

To assess the burden of type 2 diabetes (T2D) and its genetic profile in endogamous populations of India given the paucity of data, we aimed to determine the prevalence of T2D and estimate its heritability using family-based cohorts from three distinct Endogamous Ethnic Groups (EEGs) representing Northern (Rajasthan [Agarwals: AG]) and Southern (Tamil Nadu [Chettiars: CH] and Andhra Pradesh [Reddys: RE]) states of India. For comparison, family-based data collected previously from another North Indian Punjabi Sikh (SI) EEG was used. In addition, we examined various T2D-related cardiometabolic traits and determined their heritabilities. These studies were conducted as part of the Indian Diabetes Genetic Studies in collaboration with US (INDIGENIUS) Consortium. The pedigree, demographic, phenotypic, covariate data and samples were collected from the CH, AG, and RE EEGs. The status of T2D was defined by ADA guidelines (fasting glucose ≥ 126 mg/dl or HbA1c ≥ 6.5% and/or use of diabetes medication/history). The prevalence of T2D in CH (N = 517, families = 21, mean age = 47y, mean BMI = 27), AG (N = 530, Families = 25, mean age = 43y, mean BMI = 27), and RE (N = 500, Families = 22, mean age = 46y, mean BMI = 27) was found to be 33%, 37%, and 36%, respectively, Also, the study participants from these EEGs were found to be at increased cardiometabolic risk (e.g., obesity and prediabetes). Similar characteristics for the SI EEG (N = 1,260, Families = 324, Age = 51y, BMI = 27, T2D = 75%) were obtained previously. We used the variance components approach to carry out genetic analyses after adjusting for covariate effects. The heritability (h²) estimates of T2D in the CH, RE, SI, and AG were found to be 30%, 46%, 54%, and 82% respectively, and statistically significant (P ≤ 0.05). Other T2D related traits (e.g., BMI, lipids, blood pressure) in AG, CH, and RE EEGs exhibited strong additive genetic influences (h² range: 17% [triglycerides/AG and hs-CRP/RE] - 86% [glucose/non-T2D/AG]). Our findings highlight the high burden of T2D in Indian EEGs with significant and differential additive genetic influences on T2D and related traits.

Prevalence and factors contributing to primary sarcopenia in relatively healthy older Indians attending the outpatient department in a tertiary care hospital: A cross-sectional study

BACKGROUND

Literature is scarce on primary sarcopenia among Indian older adults. This study was aimed to estimate the prevalence of primary sarcopenia among older persons in India using the European Working Group on Sarcopenia in the Older People 2010 (EWGSOP) diagnostic criteria and to elucidate the factors leading to its development.

METHODOLOGY

Two hundred twenty-seven subjects over 60 years of age attending the geriatric outpatient clinic were recruited for the study. Sarcopenia was diagnosed based on set criteria for gait speed, handgrip, and skeletal muscle mass assessment by dual-energy x-ray absorptiometry.

RESULT

The prevalence of primary sarcopenia in the study population was 39.2% (n = 89). Male patients were more sarcopenic than women, 47% (n = 72) vs 23% (n = 17). Obese subjects (body mass index > 25 kg/m2) had a lower prevalence of sarcopenia (odds ratio = 0.10; 95% confidence interval = 0.05-0.19). There was no association between sarcopenia and other postulated risk factors like low vitamin D levels, dietary protein or carbohydrate intake, or sedentary lifestyle.

CONCLUSION

Contrary to published data, primary sarcopenia appears to be higher among older Indians using presently available guidelines. Community studies with validated cutoffs suited for the Indian subcontinent may yield a lower prevalence of primary sarcopenia.

Genetic Risk Prediction of COVID-19 Susceptibility and Severity in the Indian Population

Host genetic variants can determine their susceptibility to COVID-19 infection and severity as noted in a recent Genome-wide Association Study (GWAS). Given the prominent genetic differences in Indian sub-populations as well as differential prevalence of COVID-19, here, we compute genetic risk scores in diverse Indian sub-populations that may predict differences in the severity of COVID-19 outcomes. We utilized the top 100 most significantly associated single-nucleotide polymorphisms (SNPs) from a GWAS by Pairo-Castineira et al. determining the genetic susceptibility to severe COVID-19 infection, to compute population-wise polygenic risk scores (PRS) for populations represented in the Indian Genome Variation Consortium (IGVC) database. Using a generalized linear model accounting for confounding variables, we found that median PRS was significantly associated (p < 2 x 10⁻¹⁶) with COVID-19 mortality in each district corresponding to the population studied and had the largest effect on mortality (regression coefficient = 10.25). As a control we repeated our analysis on randomly selected 100 non-associated SNPs several times and did not find significant association. Therefore, we conclude that genetic susceptibility may play a major role in determining the differences in COVID-19 outcomes and mortality across the Indian sub-continent. We suggest that combining PRS with other observed risk-factors in a Bayesian framework may provide a better prediction model for ascertaining high COVID-19 risk groups and to design more effective public health resource allocation and vaccine distribution schemes.

Evaluating the accuracy of two different age estimation methods in growing children in Navi Mumbai using Orthopantomograph: A radiographic study

BACKGROUND

Age estimation through dental maturity indicators is relatively more accurate, reliable, and valid for living as well as dead individuals. It acts as an important tool in diagnosis and treatment planning in clinical as well as in forensic dentistry. There are various methods to estimate the dental age. Out of which, Demirjian's method has been widely used in various populations. However, there is a dearth of literature on Indian population comparing Demirjian's method to Cameriere's method.

AIM

The purpose of this study was to evaluate the accuracy of Demirjian's and Cameriere's age estimation methods to chronological age in growing children using orthopantomograph (OPG).

SETTING AND DESIGN

The sample consisted of digital OPGs of 280 children in Navi Mumbai aged 5-16 years.

MATERIALS AND METHODS

Digital OPGs were used to assess the dental maturity of seven mandibular left teeth using Demirjian and Cameriere's method and were compared to the chronological age.

STATISTICAL ANALYSIS USED

Data were analyzed using Student's t tests.

RESULT

Irrespective of gender, dental age estimated by Cameriere's method (mean 10.23 ± 2.79 years), underestimated the chronological age (mean 11.74 ± 2.86 years) for overall population which showed statistically significant difference. Demirjian's method overestimated (mean 12.24 ± 3.06 years) the chronological age for the overall population but was statistically insignificant.

CONCLUSION

Demirjian's method is more closely in correlation with the chronological age of growing children as compared to the Cameriere method when applied to children of age 5-16 years in Navi Mumbai.

COVID-19 Associated Coagulopathy in an Indian Scenario: A Correlation with Disease Severity and Survival Status

Covid-19 pandemic reveals that the virus causes Covid-19 associated coagulopathy and it is well known that thrombotic risk is associated with ethnicity. To describe the Covid-19 associated coagulopathy in Indian population and to correlate it with the disease severity and survivor status. A cross sectional descriptive study of 391 confirmed Covid-19 cases was carried out over a period of 1.5 months. Patients were categorised as mild to moderate, severe and very severe and also labelled as survivors and non survivors. Prothrombin time (PT), International normalised ratio (INR), activated partial thromboplastin time, D dimer, Fibrin degradation products (FDP), fibrinogen and thrombin time and platelet counts were investigated among the subgroups. Mean age was higher in patients with severe disease (57.62 ± 13.08) and among the non survivors (56.54 ± 12.78). Statistically significant differences in D dimer, FDP, PT, INR and age were seen among the 3 subgroups and survivors. Strong significant positive correlation was noted between D dimer and FDP (r = 0.838, p < .001), PT and INR (r = 0.986, p < 0.001). D dimer was the best single coagulation parameter as per the area under curve (AUC: 0.762, p < 0.001) and D dimer + FDP was the best combination parameter (AUC: 0.764, p = 0) to differentiate mild moderate from severe disease. Raised levels of D dimer, FDP, PT, PT INR and higher age correlated positively with disease severity and mortality in Indian Population.

Adaptation and psychometric validation of Hindi version of the Behavioural Emotion Regulation Questionnaire

BACKGROUND

The Behavioural Emotion Regulation Questionnaire (BERQ; Kraaij and Garnefski, 2019) is a recently developed tool which assesses behavioural strategies for emotion regulation.

AIM

The present study aimed at validating the factor structure and psychometric properties of the Hindi version of the BERQ (BERQ-H) in a sample of Indian population.

METHOD

A community sample of n = 358 individuals completed the Hindi version of the Behavioural Emotion Regulation Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, and the Kessler Psychological Distress Scale (K-10).

RESULTS

Exploratory factor analysis revealed that the original five factor structure of the BERQ was replicable. Confirmatory factor analysis favoured a modified five factor structure of the BERQ-H. The unidimensional and the second order factor models of the BERQ-H were not supported. The internal consistency reliability of the BERQ-H subscales was acceptable. Withdrawal, Actively approaching and Ignoring subscales showed inverse associations with depression, anxiety and psychological distress. Seeking distraction did not correlate significantly, whereas Seeking social support showed atypical associations with depression and psychological distress.

CONCLUSION

The BERQ-H is a reliable and valid measure of behavioural emotion regulation strategies. It is advisable to mainly interpret subscale scores on the BERQ-H instead of the overall score.

C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR) Trends following Total Hip and Knee Arthroplasties in an Indian Population - A Prospective Study

INTRODUCTION

To evaluate the trends of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) in the first three weeks after uncomplicated total hip (THR) and total knee (TKR) arthroplasty/replacement in the Indian population and to compare it with available literature.

MATERIALS AND METHODS

A total of 90 patients were enrolled for this prospective study, of which 30 were unilateral THR, 30 were unilateral TKR (U/L TKR) and 30 were simultaneous bilateral TKR (B/L TKR). Serum CRP and ESR were measured on the day before surgery and post-operatively on day 1st, 2nd, 3rd, 7th, 12th, and at the end of 3rd week.

RESULTS

CRP showed a peak at day 2nd with normalisation to pre-operative value by the end of 3rd week. While ESR showed a peak on day 3rd and continued to remain elevated even at end of 3rd week post-operatively. Both mean CRP and ESR values were higher in THR patients followed by in B/L TKR and then in U/L TKR patients.

CONCLUSION

CRP persists to be the best acute phase reactant in the early post-operative phase with a relatively typical pattern as compared to ESR. CRP values peak at post-operative day 2nd and then show a gradual decline. However, its normalisation to pre-operative baseline values may vary among different groups of population.