Association of NOTCH4 and ACHE gene polymorphism in Alzheimer's disease of Gujarat cohort.

BACKGROUND: Alzheimer's Disease (AD) is the most common form of dementia, affecting cognitive and behavioral functions. AD is a complex disease resulting from the modest effect of gene interaction and environmental factors, as a result of which the exact pathogenesis is still unknown. AIM: The aim of the present study was to investigate the association between variants of 98 targeted genes with Alzheimer's disease phenotype. METHOD: A total of 98 genes from 32 AD cases and 11 controls were genotyped using the Haloplex target enrichment method and the PCR-RFLP approach.Association analysis was performed using the PLINK tool to identify the variant significantly associated with AD. Functional enrichment analysis and network analysis was performed using ClueGo and String database respectively. The Expression Quantitative Trait Loci (eQTL) analysis using the Genotype Tissue Expression (GTEx) dataset to explore the possible implication of the variant on the expression of one or more genes in different brain regions and whole blood. RESULT: Association analysis showed significant association of 19 variant assigned to 16 genes with Alzheimer's with p-value < 0.05 with rs367398/NOTCH4 only variant that passed multiple test corrections. Functional enrichment analysis showed association of these genes with AD. ClueGo and network analysis utilizing the String database suggested that genes are directly and indirectly linked to the AD pathogenesis. eQTL analysis revealed that the rs367398/NOTCH4 and rs1799806/ACHE variant showed significant eQTL for the neighbouring genes. CONCLUSION: The present study showed the possible role of 16 genes in AD pathogenesis, especially highlighting the role of rs367398/NOTCH4 and rs1799806/ACHE. However further investigation with large cohort is required to study and validate the implication of these variants in the AD pathogenesis.

Cost of implementing the QualityRights programme in public hospitals in Gujarat providing mental healthcare.

Background & objectives: Investment in mental health is quite meagre worldwide, including in India. The costs of new interventions must be clarified to ensure the appropriate utilization of available resources. The government of Gujarat implemented QualityRights intervention at six public mental health hospitals. This study was aimed to project the costs of scaling up of the Gujarat QualityRights intervention to understand the additional resources needed for a broader implementation. Methods: Economic costs of the QualityRights intervention were calculated using an ingredients-based approach from the health systems' perspective. Major activities within the QualityRights intervention included assessment visits, meetings, training of trainers, provision of peer support and onsite training. Results: Total costs of implementing the QualityRights intervention varied from Indian Rupees (₹) 0.59 million to ₹ 2.59 million [1United States Dollars (US $) = ₹ 74.132] across six intervention sites at 2020 prices with 69-79 per cent of the cost being time cost. Scaling up the intervention to the entire State of Gujarat would require about two per cent increase in financial investment, or about 7.5 per cent increase in total cost including time costs over and above the costs of usual care for people with mental health conditions in public health facilities across the State. Interpretation & conclusions: The findings of this study suggest that human resources were the major cost contributor of the programme. Given the shortage of trained human resources in the mental health sector, appropriate planning during the scale-up phase of the QualityRights intervention is required to ensure all staff members receive the required training, and the treatment is not compromised during this training phase. As only about two per cent increase in financial cost can improve the quality of mental healthcare significantly, the State government can plan for its scale-up across the State.

Atmiyata, a community champion led psychosocial intervention for common mental disorders: A stepped wedge cluster randomized controlled trial in rural Gujarat, India.

BACKGROUND: While effective lay-health worker models for mental health care have been demonstrated through efficacy trials, there is limited evidence of the effectiveness of these models implemented in rural LMIC settings. AIM: To evaluate the impact of a volunteer community-led intervention on reduction in depression and anxiety symptoms and improvement in functioning, and social participation among people living in rural Gujarat, India. METHODS: Stepped-wedge cluster randomized controlled trial was used to assess the effectiveness of delivery of psychosocial intervention across 645 villages in Mehsana district of Gujarat, India between April 2017 and August 2019. The primary outcome was an improvement in depression and/or anxiety symptoms assessed using GHQ-12 at 3-month follow-up. Secondary outcomes were improvement in (a) depression and anxiety (Patient Health Questionnaire, (PHQ-9), Generalized Anxiety Disorder (GAD-7) & Self-Reporting Questionnaire-20 (SRQ-20); b) quality of life (EQ- 5D); c) functioning (WHO-DAS-12), and social participation (Social Participation Scale SPS). Generalized linear mixed-effects models were used to assess the independent effect of the intervention. RESULTS: Out of a total of 1191 trial participants (608- intervention & 583-control), 1014 (85%) completed 3-month follow-up. In an adjusted analysis, participants in the intervention condition showed significant recovery from symptoms of depression or anxiety (OR 2.2; 95% CI 1.2 to 4.6; p<0.05) at the end of 3-months, with effects sustained at 8-month follow-up (OR 3.0; 95% CI 1.6 to 5.9). Intervention participants had improved scores on the PHQ-9 (Adjusted mean difference (AMD) -1.8; 95%CI -3.0 to -0.6), and SRQ-20 (AMD -1.7; 95%CI -2.7 to -0.6), at 3-months and PHQ-9, GAD-7, SRQ-20, EQ-5D and WHO-DAS at 8 months follow-up. CONCLUSION: Findings suggest that Atmiyata had a significant effect on recovery from symptoms of depression and anxiety with sustained effects at 8-month follow-up. TRIAL REGISTRATION: Trial registration details. The trial was registered prospectively with the "Clinical Trial Registry in India" (registry number: CTRI/2017/03/008139).

The efficacy of oral ketamine in severely depressed patients at high risk of suicide.

BACKGROUND: Ketamine is most easily and inexpensively administered by the oral route and in racemic form. Oral racemic ketamine may be an important approach to the emergency management of suicide risk in clinical settings, especially in third world countries, that have a limited range of available healthcare resources. METHODS: In a prospective, uncontrolled, open-label investigation, we studied 30 severely depressed inpatients who consented to participate in a pilot hospital service offering ketamine for management of high suicide risk. Patients sipped a solution of racemic ketamine (150 mg) across 10-15 min in 3 alternate day sessions. Patients were assessed using the Modified Scale for Suicidal Ideation (MSSI), Montgomery-Asberg Depression Rating Scale (MADRS), and Clinical Global Improvement-Severity (CGI-S) scale at baseline and 1 day after the last ketamine session. RESULTS: There was statistically and clinically significant improvement on all outcomes. Mean (standard deviation) MSSI scores dropped from 25.1(1.8) to 17.3(5.6), MADRS scores from 28.8(3.4) to 21.9(3.6), and CGI-S scores from 6.0(0.2) to 3.6(0.9). At endpoint, MSSI scores had dropped from severe to low or mild-to-moderate in 67% of patients. The 90 ketamine sessions were uneventful; the treatment was well tolerated and no patient dropped out. CONCLUSION: Oral racemic ketamine may be a useful and potentially life-saving approach to the emergency management of severely depressed patients at high risk of suicide.

Serum Levels of Activin A: Predictor of Insulin Resistance and Atherosclerosis in Prediabetics.

BACKGROUND: Pathological effects of dysglycemia and insulin resistance on atherosclerosis and cardiac remodeling starts as early as in the prediabetic state before the onset of overt diabetes. Activin A is a molecule with multiple functions, including an important part in glucose homeostatic mechanisms as well as inflammatory processes and is therefore being researched as a useful novel biomarker for prompt recognition of the risk of cardiovascular disease (CVD) in prediabetic individuals, thereby helping in disease prognostication and early institution of therapeutic measuresObjective: The study aimed to measure serum levels of activin A in prediabetic patients and evaluate them in comparison to normoglycemic controls. The association of activin A with carotid intima media thickness (CIMT), left ventricular diastolic dysfunction (LVDD), and homeostatic assessment of insulin resistance (HOMA-IR) was also studiedMaterials and methods: A total of 60 prediabetic cases and 60 normoglycemic control subjects [matched as per age, gender, and body mass index (BMI)] were recruited. Measurement of serum glucose levels (fasting and postprandial) and fasting insulin levels and glycated hemoglobin (HbA1c) levels were done in all the subjects. The values of HOMA-IR were computed using established formulae. Enzyme-linked immunosorbent assay (ELISA) kits were used for the evaluation of serum levels of activin A in both groups. Parameters for the two groups were compared. In the cases, CIMT (using B-mode ultrasound) and LVDD (using two-dimensional (2D) echocardiography) were measured and correlated with activin A levelsResults: Serum fasting insulin (mIU/L) was considerably higher in cases than in the controls (p < 0.001). HOMA-IR median [interquartile range (IQR)] was 4 (3.25-4.93) in some cases, and that in the control group was 1.2 (0.88-1.5) (p < 0.001). Serum activin A levels in the cases group had a median (IQR) of 263.55 (227.1-279.5) ng/mL, which was substantially greater as compared to the control group 159.9 (150.7-178.7) ng/mL (p < 0.001). A significant positive association of serum activin A levels with HOMA-IR (ρ = 0.75, p < 0.001) and CIMT (ρ = 0.50, p < 0.001) was found. In LVDD grade I and II groups, the serum levels of activin A were 257.86 (219.3-271.2) ng/mL and 269 (244.19-291.5) ng/mL, respectively (p = 0.12)Conclusion: A substantial proportion of morbidity and mortality related to dysglycemic states can be attributed to cardiovascular complications. Elevated levels of activin A in prediabetes can act as an indicator of subclinical CVD leading to early diagnosis and intervention.

Prediction of Enhancers in DNA Sequence Data using a Hybrid CNN-DLSTM Model.

Enhancer, a distal cis-regulatory element controls gene expression. Experimental prediction of enhancer elements is time-consuming and expensive. Consequently, various inexpensive deep learning-based fast methods have been developed for predicting the enhancers and determining their strength. In this paper, we have proposed a two-stage deep learning-based framework leveraging DNA structural features, natural language processing, convolutional neural network, and long short-term memory to predict the enhancer elements accurately in the genomics data. In the first stage, we extracted the features from DNA sequence data by using three feature representation techniques viz., k-mer based feature extraction along with word2vector based interpretation of underlined patterns, one-hot encoding, and the DNAshape technique. In the second stage, strength of enhancers is predicted from the extracted features using a hybrid deep learning model. The method is capable of adapting itself to varying sizes of datasets. Also, as proposed model can capture long-range sequencing patterns, the robustness of the method remains unaffected against minor variations in the genomics sequence. The method outperforms the other state-of-the-art methods at both stages in terms of performance metrics of prediction accuracy, specificity, Mathew's correlation coefficient, and area under the ROC curve. In summary, the proposed method is a reliable method for enhancer prediction.

Serum levels of sclerostin in prediabetes and its correlation with bone mineral density.

Background: Diabetes is a major burden globally, more commonly so in developing countries, as its complications are detected relatively late due to underdeveloped healthcare systems. These complications, when detected, are more or less irreversible, thereby leading to increased morbidity and mortality. Among these, complications related to bones (mainly osteoporosis) start fairly early (even in the prediabetes stage) but are less emphasized, nonetheless are major contributors to morbidity in diabetics due to increased fracture risk. One of the novel bone markers recently discovered is sclerostin, which helps in the assessment of the effect of hyperglycemia on bone homeostasis. Bone mineral density (BMD) by DXA scan is a good tool to assess the status of bone health but requires modern expensive radiological equipment. In this study, we wanted to see the correlation of serum levels of sclerostin to BMD so that by a simple serum investigation, early detection of poor bone quality in treatment-naive prediabetics can be done. Objective: The aim of the study was to measure serum levels of sclerostin in prediabetics, compare them with normoglycemic controls, and find the correlation of serum levels of sclerostin with BMD. Methods: 50 prediabetic patients and 50 age, sex, blood pressure, and BMI-matched controls were recruited in the study. In both the groups, serum levels of fasting blood glucose and postprandial glucose, glycated hemoglobin (HbA1c), Vitamin D, fasting insulin, and serum sclerostin levels were measured in both groups using ELISA. The obtained values were compared between the two groups. Bone mineral density is measured by DXA scan in cases and a correlation between BMD and serum levels of sclerostin was observed. Results: Serum sclerostin was significantly higher in the cases [18.22 (19.42) ng/ml] compared to the control group [11.08 (4.73) ng/ml] with a P value of 0.013. The mean of BMD in prediabetes is 1.06 g/cm2, T score is - 1.02, and Z score is - 0.59. There was a significant negative correlation between serum sclerostin levels and BMD in prediabetes (r = -0.404, P < 0.001). Conclusion: Serum levels of sclerostin are increased in prediabetes and correlate well with low BMD in prediabetes, and can therefore be used for early recognition of osteoporosis and fractures in diabetes.

Study of neuregulin-4 levels in newly diagnosed type 2 diabetes mellitus.

Background: Neuregulin-4 is a recently recognized adipokine acting as ligands to tyrosine kinases receptor of the Erb B family. This adipose tissue augmented endocrine factor participates in the modulation of lipid and glucose metabolism and energy homeostasis. This novel adipokine is associated with insulin resistance, dyslipidemia, obesity, oxidative stress, and inflammation. Objective: The study aimed to compare plasma levels of neuregulin-4 in newly diagnosed type 2 diabetes mellitus as compared to matched controls and to correlate with glycemic and lipid parameters. Materials and Methods: 100 newly diagnosed T2DM patients and 100 age, sex, and BMI-matched controls after fulfilling all exclusion and inclusion criteria were included in the study. Fasting and postprandial blood glucose levels, glycated hemoglobin (HbA1c), and fasting plasma insulin levels were measured in both cases and controls. HOMA-IR values in both groups were calculated using fasting glucose and insulin levels. Results: Mean levels of plasma neuregulin-4(pg/mL) in newly diagnosed T2DM were 7949.76 ± 949.76) pg/ml, which was significantly lower as compared to 9143 ±949.76) pg/ml in the control group (P-value <.0001). In the present study, a significant negative correlation was seen between plasma neuregulin-4 (pg/mL) with fasting blood sugar, postprandial blood sugar, HbA1C, and HOMA-IR with a correlation coefficient of -0.303, -0.416, -0.433, and -0.514, respectively. Moreover, a significant positive correlation was seen between plasma neuregulin-4 (pg/mL) with HDL with a correlation coefficient of 0.216. A significant negative correlation was seen between plasma neuregulin-4 (pg/mL) and LDL, with a correlation coefficient -0.208. Conclusion: Neuregulin levels are significantly lower in diabetics as compared to controls. There levels correlated inversely with HbA1C and HOMA IR.

Serum levels of Activin A: Marker of insulin resistance and cardiovascular risk in prediabetics.

Background: A substantial proportion of health burden in diabetic individuals can be attributed to cardiovascular complications. The increasing risk of cardiovascular complications along the spectrum of dysglycemia warrants the need to devise novel markers for early assessment and management. Activin A is a multifunctional cytokine with an important role in glucose homeostasis and vascular diseases. It can thus serve as a guide for early identification of cardiovascular disease (CVD) risk in prediabetes. Objective: The aim of the study was to measure serum levels of activin A in prediabetics, compare them with normoglycemic controls and find the correlation of activin A with markers of insulin resistance such as the homeostatic model assessment of insulin resistance (HOMA-IR). Methods: Sixty prediabetic patients and similar age-, sex-, blood pressure-, and BMI-matched controls were recruited in the study. In both groups, serum levels of fasting blood glucose and post prandial glucose, glycated hemoglobin (HbA1c) and fasting insulin were measured. HOMA-IR values were calculated. Serum activin A levels were measured in both groups using ELISA. The obtained values were compared between the two groups. Results: The median (IQR) of s. fasting insulin (mIU/L) in the case group was 15.3 (12.2-18.62) which was significantly higher than that in the control group, which was 6 (4.2-7.3). The median (IQR) of s. activin A (ng/mL) in the case group was 263.55 (227.18-279.56) which was significantly higher than that in the control group, which was 159.9 (150.73-178.75) (P < 0.001). There was a very strong positive correlation of s. activin A (ng/mL) with s. fasting insulin (mIU/L) and HOMA-IR (rho = 0.67 and 0.75, respectively, P < 0.001). Conclusion: Activin A, if combined with other atherosclerotic markers, might improve the assessment of insulin resistance and cardiovascular risk in prediabetics and lead to focus on lifestyle modifications and preventive medical therapy, thereby contributing to the prevention of CVD-related mortality and morbidity in these patients.

TG/HDL Ratio: A marker for insulin resistance and atherosclerosis in prediabetics or not?

BACKGROUND: The spectrum of Diabetes Mellitus and various complications associated with it have been regarded as major global health challenges. Raised TG/HDL has been regarded as one of the valid markers for Insulin resistance. It leads to increased risk of CVD by causing Insulin resistance and also by its own effect on the vessel wall. Detection of raised TG/HDL ratio and early intervention before the patients develop clinical disease can help in mitigation of future consequences of CVD. AIMS: The aim of our study was to compare TG/HDL ratio between prediabetics and controls and further to look for any correlation between the TG/HDL ratio value with HOMA-IR and Carotid Intima Media Thickness (CIMT) in prediabetics. SETTINGS AND DESIGNS: A cross sectional study. METHODS AND MATERIAL: Study was done at ABVIMS and Dr RML Hospital, New Delhi. 60 prediabetics and 60 age, sex, BMI matched controls were employed. In both cases and controls fasting and postprandial blood glucose, glycated Hemoglobin (HbA1C) and fasting Insulin levels were measured. HOMA-IR values in both the groups were calculated using fasting glucose and Insulin levels. Serum lipid profile was obtained and TG/HDL ratio was analysed in two groups. Values obtained were compared between the two groups. CIMT was only measured in cases using B mode ultrasonography. STATISTICAL ANALYSIS AND RESULTS: Median (IQR) of fasting plasma Insulin (µIU/ml) in cases was 11.3 (10.175-13.505) versus that in controls being 5.73 (4.3-7.1). HOMA-IR (IQR) values in cases and controls were 3.12 (2.73 - 3.595) and 1.21 (0.918 - 1.505) respectively. Median (IQR) for TG/HDL ratio was 3.26 (2.712 - 4) for cases and 2.05 (1.755- 2.502) for controls. However no correlation was observed between either the mean CIMT (mm) or HOMA-IR with TG/HDL ratio. CONCLUSIONS: Diabetes Mellitus and its various complications are of a great burden to society. Diagnosing the risk factors early before the onset of these manifestations can help us in combating these major issues. One of the risk factors among them is raised TG/HDL ratio. Early detection of elevated TG/HDL in prediabetics may serve in early detection of atherosclerotic complications and help physicians in framing primary preventive strategies for tackling ASCVD in patients with prediabetes and full-blown Diabetes.

A rare case of nephrotic syndrome with chylothorax.

Chylothorax is an infrequent cause of pleural effusion that is most commonly caused by the obstruction or disruption of the thoracic duct. Chylothorax is rare in nephrotic syndrome. Unilateral chylothorax of the right side is due to the transdiaphragmatic shunting of chylous ascites. It is usually transient and self-limiting but a massive chylothorax requiring therapeutic thoracentesis can also be encountered. Here, we present a rare cause of chylous ascites-nephrotic syndrome resulting in chylothorax, where initially therapeutic thoracentesis is done followed by the management of nephrotic syndrome with modified Ponticelli regimen. This case highlights the need to consider chylous ascites as a cause of chylothorax via transdiaphragmatic shunting in patients with nephrotic syndrome to institute the appropriate treatment.

Transthyretin - A Novel Biomarker for Insulin Resistance and Atherosclerosis Risk in Prediabetics.

OBJECTIVE: The aim of the study was to compare serum levels of Transthyretin in prediabetics and controls and to correlate levels of same with HOMA-IR and mean CIMT Method: It was a case control study in which 60 prediabetic patients and 60 controls (age, sex, BMI matched) were employed. Plasma levels of glucose (fasting and postprandial), glycated hemoglobin (HbA1c), and serum levels of insulin (fasting) were measured in both cases and controls. HOMA-IR values in both the groups were calculated using fasting plasma glucose and serum insulin levels. Serum Transthyretin levels were measured using ELISA. The values obtained were compared between cases and controls. In cases, obtained serum levels of Transthyretin were correlated with HOMA-IR values and mean CIMT (measured in cases only using B-mode ultrasonography). RESULTS: Median (IQR) of serum levels of insulin (fasting in µIU/ml) in cases {11.3 (10.175-13.505)} was significantly higher than that of controls {5.73 (4.3-7.1)}. HOMA-IR median (IQR) in cases and controls was 3.12 (2.73-3.595) and 1.21(0.918- 1.505) respectively. Median (IQR) for serum levels of Transthyretin was also significantly higher in cases as compared to controls [46.74 (30.43-81.225) and 22.38 (16.628-27.89) respectively]. Significant positive correlations were observed between serum levels of Transthyretin with both HOMA-IR and mean CIMT (with correlation coefficients being 0.288 and 0.536 respectively). Univariate linear regression analysis showed that with increase in serum Transthyretin by 1 mg/ dl, mean CIMT increases by 0.001 mm. CONCLUSION: Individuals with impaired glucose tolerance have been found to have increased risk of atherosclerosis as compared to normoglycemics after excluding other risk factors. Assessment for the risk of same with the help of novel markers can help in diagnosis and intervention at an early stage and thereby preventing risk of further complications.

Serum Retinol Binding Protein-4 Levels in Prediabetics - Novel Biomarker of Insulin Resistance and Atherosclerosis.

BACKGROUND: Atherosclerotic cardiovascular diseases are the leading cause of morbidity and mortality in both diabetics and prediabetics. In insulin resistant states, increased levels of various adipose derived cytokine (adipokine) have been found to have an important role in the process of atherosclerosis. One such novel adipokine is RBP4, (belonging to lipokalin family) which also by exerting an inflammatory process has a role in the pathogenesis of insulin resistance and CVD.. Early detection of all these inflammatory cytokines may immensely help us in prognosticating the pace of disease besides instituting early interventional manuevers. OBJECTIVE: The aim of the study was to compare serum levels of RBP4 in prediabetics and controls and to correlate levels of RBP4 with HOMA-IR and CIMT. METHODS: 60 prediabetic patients and 60 age, sex, BMI matched controls were employed in the case control study. In both cases and controls serum levels of fasting and postprandial blood glucose, glycated hemoglobin (HbA1c) and fasting insulin levels were measured. HOMA-IR values in both the groups were calculated using fasting glucose and insulin levels. Serum RBP4 levels were measured using ELISA. The values obtained were compared between cases and controls. CIMT was only measured in cases using B-mode ultrasonography. RESULTS: Median (IQR) of fasting plasma insulin levels (uIU/ml)in cases was 11.3 (10.175-13.505) versus that of controls which was 5.73 (4.3-7.1). HOMA-IR median (IQR) in cases and controls was 3.12 (2.73-3.595) and 1.21(0.918-1.505) respectively. Median (IQR) for RBP4 in cases was 67.4 (46.166-111.088) which was significantly higher as compared to controls 33.92 (23.902-52.45). Significant positive correlation was seen between RBP4 with both, HOMA-IR and mean CIMT with correlation coefficients of 0.3693 and 0.621 respectively. On performing univariate linear regression analysis it was found that with increase in serum RBP4 levels by 1 mg/L, HOMA-IR and mean CIMT significantly increased by 0.007 units and 0.001 mm respectively. METHODS: 60 prediabetic patients and 60 age, sex, BMI matched controls were employed in the case control study. In both cases and controls serum levels of fasting and postprandial blood glucose, glycated hemoglobin (HbA1c) and fasting insulin levels were measured. HOMA-IR values in both the groups were calculated using fasting glucose and insulin levels. Serum RBP4 levels were measured using ELISA. The values obtained were compared between cases and controls. CIMT was only measured in cases using B-mode ultrasonography. CONCLUSION: Prediabetics have been found to have more risk of cardiovascular events as compared to normoglycemics. Early assessment of the same with the use of novel biomarkers like RBP4 can be considered for early detection of atherosclerosis in prediabetic individuals. It may further help in early intervention and thus prevention from future complications.

Scrub typhus and lateral rectus palsy: an uncommon presentation of a common illness.

Scrub typhus is a zoonosis, which usually manifests as an acute febrile illness. It is caused by a rickettsia, Orientia tsutsugamushi, which is endemic in the Asian region. It can present with varied clinical manifestations, ranging from acute febrile illness to life-threatening multiorgan dysfunction syndrome. Central nervous system involvement in the form of altered sensorium and/or meningitis is frequently observed in scrub typhus. However, isolated cranial nerve involvement is uncommon and so far only a few such cases have been reported in the literature. We present a rare case of scrub typhus with fever and diplopia at presentation, which completely improved with doxycycline-based treatment.

Acute arthritis, skin rash and Lofgren's syndrome.

Sarcoidosis is an autoimmune multisystem granulomatous disorder of unknown aetiology, which mainly affects the adults in the age group of 20-39 years. The disease can affect any organ in the body but mainly presents as bilateral hilar lymphadenopathy, pulmonary infiltrates, cutaneous lesions, ocular manifestations and arthropathy. Lofgren's syndrome is an uncommon initial presentation of sarcoidosis which is recognised by the classical triad of acute arthritis, erythema nodosum and bilateral hilar lymphadenopathy. We describe a newly diagnosed case of sarcoidosis who presented as Lofgren's syndrome. Acute sarcoid arthritis should be kept as one of the differential diagnoses for patients presenting with acute arthritis and skin lesions; and chest X-ray should be considered to rule out bilateral hilar lymphadenopathy in these patients. Early suspicion and identification of classical clinical features are essential to establish early diagnosis.

Unique collaboration of modern medicine and traditional faith-healing for the treatment of mental illness: Best practice from Gujarat.

BACKGROUND AND AIMS: Modern psychiatry brings tremendous value to the treatment of mental illness, however, at times is inadequate in providing holistic care within a patient's broader cultural framework. Traditional healing and modern psychiatry together offer a comprehensive, patient-centred approach to treatment, which encompass a patient's spiritual and religious beliefs. In this context, "Dava-Dua" intervention-combination of psychiatric medicine and faith healing-is implemented by the Government of Gujarat at Mira Data Dargah in Mehsana District. The study assesses intervention outcomes, understand implementation challenges and patients' perspectives on the treatment. METHODS: Using a multi-method research approach, case records from July 2008 to March 2018 were retrieved for secondary analysis of patients' profile and outcomes; 26 patients from three groups: Dava, Dua and Dava-Dua; and 6 mental health service providers were interviewed to assess perspectives of patients and service providers on mental health, implementation barriers and facilitators. RESULTS: Despite some implementation challenges, the findings indicate that collaboration of modern psychiatry medicine and faith-based treatment practices certainly benefit patients with otherwise limited access to mental health care thereby protects human rights of patients. CONCLUSION: Dava-Dua model compliments existing primary healthcare services. It provides an access to modern medicine without compromising patients' religious and spiritual practices. It has the potential to scale-up and replicate where faith-healing is the prime treatment modality to cure mental illness provided implementation challenges are proactively addressed.

Synthetic dyes degradation using lignolytic enzymes produced from Halopiger aswanensis strain ABC_IITR by Solid State Fermentation.

The present work focuses on studying the degradation of industrial synthetic dyes, which poses serious health hazards and a drastic impact on the environment. Currently available enzymatic processes have higher production and operational costs. However, most enzymes are active at acidic pH, which limits its application in textile dye degradation. This problem can be overcome by lignolytic enzymes obtained from halo-alkaliphile through Solid State Fermentation (SSF) using wheat bran (agro-byproduct) as a substrate. The major lignolytic enzymes studied were Lignin Peroxidase (LiP), Manganese Peroxidase (MnP), and laccase. The results demonstrated the highest activity of 215.4 ± 1.57 of LiP, 36.8 ± 2.38 of MnP, and 8.34 ± 0.21 IU/gds of laccase. Crude enzymes were used to treat synthetic dyes (mainly azo dyes), and their potential for its degradation was confirmed by spectrophotometric, GC-MS, and HPLC analysis. The highest decolorization of 82-93% of Malachite Green (MG) was achieved in LiP and MnP mediated reaction system within 2 hours. The laccase reaction system showed degradation of 53.87% of methyl orange without adding any redox mediator. After obtaining these results, the crude LiP and MnP in the reaction system were further subjected to decolorization at a higher MG concentration of 100-600 mg/L without a redox mediator. As a result, both LiP and MnP decolorized MG by 72-89%. Further, GC-MS analysis of MG biodegradation products confirmed the formation of less toxic low molecular weight products such as benzaldehyde and methanone.

Systematic evaluation of the QualityRights programme in public mental health facilities in Gujarat, India.

BACKGROUND: Recognising the significant extent of poor-quality care and human rights issues in mental health, the World Health Organization launched the QualityRights initiative in 2013 as a practical tool for implementing human rights standards including the United Nations Convention on Rights of Persons with Disabilities (CRPD) at the ground level. AIMS: To describe the first large-scale implementation and evaluation of QualityRights as a scalable human rights-based approach in public mental health services in Gujarat, India. METHOD: This is a pragmatic trial involving implementation of QualityRights at six public mental health services chosen by the Government of Gujarat. For comparison, we identified three other public mental health services in Gujarat that did not receive the QualityRights intervention. RESULTS: Over a 12-month period, the quality of services provided by those services receiving the QualityRights intervention improved significantly. Staff in these services showed substantially improved attitudes towards service users (effect sizes 0.50-0.17), and service users reported feeling significantly more empowered (effect size 0.07) and satisfied with the services offered (effect size 0.09). Caregivers at the intervention services also reported a moderately reduced burden of care (effect size 0.15). CONCLUSIONS: To date, some countries are hesitant to reforming mental health services in line with the CRPD, which is partially attributable to a lack of knowledge and understanding about how this can be achieved. This evaluation shows that QualityRights can be effectively implemented even in resource-constrained settings and has a significant impact on the quality of mental health services.

H-FABP: A beacon of hope for prediabetic heart disease.

BACKGROUND: Prediabetes is increasingly being studied in the context of its association with cardiovascular disease (CVD). Besides raised HbA1c and sugar levels, the major underlying defect seems to be insulin resistance (IR). Subclinical atherosclerosis, measured by high sensitivity C reactive protein (hsCRP) and carotid artery intima media thickness (CIMT) underlies the pathogenesis of CVD in prediabetes. Heart-type fatty acid binding protein (H-FABP), a novel cardiac biomarker also might have a role in predictin prediabetic heart disease. AIMS: The aim of the study is to compare serum levels of H-FABP in prediabetics and controls and correlate them with the atherosclerotic markers, hsCRP and CIMT. SETTING AND DESIGN: 50 prediabetic patients and 50 age, sex and BMI matched controls were employed in the case control study. Serum F & PPBS, (HbA1c), fasting insulin levels were measured in cases and controls. Serum H-FABP was measured in both cases and controls. All cases and controls were subjected to bilateral CIMT measurements and Serum hsCRP levels. The values were compared between both the groups and subjected to appropriate statistical analysis. STATISTICAL ANALYSIS USED: Categorical variables were presented in number and percentage (%) and continuous variables were presented as mean ± SD and median. Normality of data was tested by Kolmogorov-Smirnov test. If the normality was rejected then non parametric test was used. Quantitative variables were compared using Independent t test/Mann-Whitney Test (when the data sets were not normally distributed) between the two groups. Qualitative variables were correlated using Chi-Square test/Fisher's Exact test. Spearman rank correlation coefficient was used to find out the correlation of various parameters with each other. Univariate linear regression was used to find out the cause and effect relationship between various parameters. A p <0.05 was considered statistically significant. The data analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. RESULTS: The mean serum levels of H-FABP among cases and controls were 6.38± 2.76ng/ml and 3.24 ± 2.47 ng/ml respectively (p <0.0001). Mean CIMT was found to be higher in prediabetics (0.59 ± 0.11 mm ) compared to controls (0.45 ± 0.07mm) (p<0.0001). Serum hsCRP levels were also statistically higher in prediabetics (5.75± 4.16 mg/l) then that of controls (1.86± 1.67 mg/l) (p <0.0001). The correlations of the two variables, hsCRP and CIMT with H-FABP were both strongly positive (r = 0.687) & (r = 0.779) respectively [both cases (p < 0.0001)]. CONCLUSION: The novel cardiac biomarker H-FAPB might be a good predictor of cardiovascular risks in prediabetics.