Systematic review and meta­analysis of observational studies to check the protective role of non­steroidal anti­inflammatory drugs in Alzheimer's disease.

Alzheimer's disease (AD) is a major neurodegenerative disease, affecting more than two third cases of dementia in the world. Non­steroidal anti­inflammatory drugs (NSAIDs) are widely used anti­inflammatory analgesic agents representing 7.7% of worldwide prescriptions of which 90% are in patients over 65 years old. Based on mixed findings a systematic review and meta­analysis were conducted to develop a better understanding of the protective role of NSAIDs in AD. We used three database PubMed, Web of Science, and Embase to identify the literatures. The studies following cohort and case­control design were investigated separately to check the effect of NSAIDs on AD, by the using their fundamental indicators (relative risk and odds ratio). The fixed effect or random effects model were used to estimate the pooled relative risk and pooled odds ratio separately for both the study design, based on magnitude of heterogeneity. A total of 14 studies were selected for meta­analysis. Eight studies were following cohort study design, whereas, six studies were following case­control study design. In meta­analysis of cohort studies, the pooled relative risk was 0.67 with 95% C.I 0.39 to 1.15, which was statistically insignificant. In meta­analysis of case­control studies, the pooled odds ratio was 0.71 with 95% C.I 0.46 to 1.10, which was statistically insignificant. NSAIDs do not act as a protective factor for Alzheimer's disease. Additionally, methodologically sound randomized controlled trials are required to produce a robust result.

Post-stroke Visual Gait Measure for Developing Countries: A Reliability and Validity Study.

BACKGROUND: Visual gait assessment is a cost-effective clinical method to assess post-stroke gait deviations. The Rivermead Visual Gait Assessment (RVGA) is a one such measure that assesses the kinematic aspect of the gait deviations in stroke. However, the available information on psycho-clinocometric properties of the measure is not adequate. OBJECTIVE: To establish reliability and validity of RVGA using walking-videos of the post-stroke subjects. METHODS: Design: Observational study. SETTING: A rehabilitation institute Participants: A convenience sample of 40 chronic stroke patients. OUTCOME MEASURES: RVGA, Fugl-Meyer assessment (lower extremity), 10-m walk test, Time up and go test, and Berg balance scale (BBS). PROCEDURE: Walking was video-taped from the anterior aspect, posterior aspect, affected side, and less-affected side. After coding the tapes, a research staff member provided them to four different raters in a random order. Each rater scored the coded video on the RVGA data collection sheet twice: one at the baseline and another after 1 month to eliminate any recollection of the initial assessment. RESULTS: The findings exhibit that there was good-to-excellent agreement between the scores of the raters and also between the assessments (correlation coefficient = 0.94 to 0.95; P < 0.001). The measure also exhibits acceptable validity when correlated with scores of BBS (r = 0.4; P < 0.001). CONCLUSION: Video-based RVGA is a reliable and valid tool to assess gait-related impairment in post-stroke hemiparesis. This cost-effective measure may be incorporated in the clinical and research practice to discern and quantify complex phenomenon of the gait deviation. RVGA may be considered as a useful tool, especially in developing countries where expensive gait analyzer is usually not available.

Does long term colchicine prevent degradation of collagen fiber network in osteoarthritis?

AIM: Several studies have shown that colchicine exhibits an improvement in the symptoms of knee osteoarthritis (OA) but its effect on disease progression is unknown. To clarify the mechanism of action this study was done to see if colchicine prevents degradation of collagen fiber network in OA by studying serum cartilage oligomeric matrix protein (COMP) levels, a marker of cartilage turnover, over a period of 1 year. METHODS: Seventy-five patients received colchicine plus paracetamol and 75 received placebo alone for the same time period. Serum COMP assays were done at baseline, 2 months and 1 year by enzyme-linked immunosorbent assay. These markers were compared between visits using repeated measures analysis of variance. RESULTS: Serum COMP levels in the paracetamol-alone group did not show significant change between baseline and 2 months; however, there was a significant increase in serum COMP levels from 2 months to 1 year, suggesting increased uncoupling of proteoglycans from collagen and disease progression. No such change was seen in the colchicine group, signifying lack of progression of disease in this group. CONCLUSION: Colchicine may act as a disease-modifying agent in OA.

Oral Methotrexate in split dose weekly versus oral or parenteral Methotrexate once weekly in Rheumatoid Arthritis: a short-term study.

OBJECTIVE: To investigate whether methotrexate (MTX) administered orally to rheumatoid arthritis (RA) patients in split doses at 2-3 days' interval, would result in equal or better efficacy, tolerability and compliance, without increasing toxicity compared to single weekly dose given orally or parenterally. MATERIALS AND METHODS: One hundred and thirty-five patients fulfilling the American College of Rheumatology (ACR) 2010 criteria for RA, on 7.5 mg of MTX weekly orally, with the Simplified Disease Activity Index (SDAI) > 11 were enrolled for a 24-week period. Patients were randomly divided into three groups and were given MTX: Group 1 7.5 mg twice or thrice weekly orally, Group 2 15 mg or 22.5 mg in a single dose weekly orally and Group 3 15 mg or 22.5 mg in a single dose weekly as an intramuscular injection. The primary outcomes were low disease activity (LDA) and mean change in SDAI at week 24, whereas secondary outcomes included remission, adverse events and compliance. RESULTS: At week 24, adherence to treatment was maximum in Group 1, 69% (P = 0.09). In intention-to-treat analysis at 24 weeks, Group 1, 49%, Group 2, 36% and Group 3, 47% achieved LDA (P = 0.4). There was significant difference in mean change in SDAI at week 24 from baseline (P = 0.008) among the groups. Group 3 patients were more uncomfortable with the mode of administration of MTX (P = 0.003). There was no significant difference in adverse events. CONCLUSION: Oral split doses of MTX are better than an oral single dose and similar to parenteral MTX in terms of efficacy.

Serum level of orexin-A, leptin, adiponectin and insulin in north Indian obese women.

BACKGROUND AND AIMS: Obesity is regulated by different metabolic factors like leptin, adiponectin insulin and neuropeptide orexin-A. The aim of this study is to assess the role of these hormones and their interrelationship with obesity in north Indian women. METHOD: A total of 168 obese women with Body Mass Index (BMI)>30kg/m2 and 150 lean women (BMI<25kg/m2) as control were recruited in this study. Women with obesity were further subdivided into two groups according to their BMI, 71 overweight women with the BMI 25-29.9kg/m2 (mean±S.D: 27.87±0.71) and the 97 obese women with BMI>30kg/m2 (34.68±1.90). Orexin -A, leptin and adiponectin were estimated using quantitative sandwich enzyme linked immunoassay and insulin was estimated by using an immuno-radiometric assay. RESULT: Orexin -A and adiponectin level were significantly lower however, leptin and inulin level were significantly higher in obese women as compared with control group. Further, the one- way group analysis showed that the orexin -A and adiponectin level were significantly lower but leptin and insulin level was significantly higher in obese women as compared to overweight and control group respectively. CONCLUSION: Result showed that the level of adiponectin, leptin, orexin-A and insulin play an important role in the regulation of energy expenditure. In obesity, the activity of these peptides is disturbed.

Osteoporosis in Postmenopausal Females with Primary Knee Osteoarthritis in a Vitamin D Deficient Population.

AIM AND OBJECTIVE: To find prevalence of osteoporosis (OP) in postmenopausal females with primary knee osteoarthritis (OA) in India, where there is widespread Vitamin D deficiency (VDD). MATERIAL AND METHODS: 75 postmenopausal women (PMW) fulfilling ACR criteria for Knee OA between 40 - 60 years of age, having OA grade 2 or more as per Kellgren Lawrence grade on anterior- posterior radiograph of the right knee were enrolled. 34 PMW of the same age with normal right knee radiograph were taken as controls. Bone mineral density (BMD) of lumber spine (L1- L4), total hip and left forearm was performed using DXA in all patients and controls. The results were expressed in absolute values (g/cm2) and as per WHO criteria - Osteoporosis: T score < -2.5, Osteopenia: T score between -1 and -2.5. Vitamin D Level was done by ELISA. RESULTS: Body mass index (BMI) of patients was significantly higher than controls (p 0.006). There was no difference in BMD between patients and controls at any site. Forty percent patients and 53% controls had osteopenia (p ns), while 34.6% patients and 41.1% controls had osteoporosis at any site (p ns). When this comparison was made at each site there was no difference between patients and controls. CONCLUSION: Prevalence of osteoporosis in PMW with primary knee OA is similar to that in general population.

An epidemiological survey in hospital setup in Lucknow district: A cross-sectional study.

INTRODUCTION: Oral cancer is the sixth most common form of cancer reported globally which includes lip, tongue, mouth, and throat. Developing countries face several challenges to identify and remove potential risk factors. Chewing tobacco/pan masala is considered to be the most potential risk factor for oral precancerous lesions and oral cancer. OBJECTIVE: To study the clinical-epidemiological profile of oral cancer cases and potential risk factor associated with it. MATERIALS AND METHODS: This is cross-sectional study which includes all major tertiary hospital in Lucknow district. Five hundred and eight cases of oral cancer reported in all major tertiary hospitals in Lucknow district during 2013-2016. STUDY VARIABLE: Clinicoepidemiological characteristics of oral cancer cases. STATISTICAL ANALYSIS: percentages, proportions. RESULTS: Out of 508 cases, majority of the subjects included in the study belonged to 18-75 years age group. Reported cases of oral cancer in males were higher as compared to females. Most of the subjects belonged to lower middle and upper lower socioeconomic group. It was found that 199 (39.2%) subjects consumed smokeless tobacco. Buccal mucosa was the common site of oral cancer being present in 50.4% of the subjects. Histopathologically, 256 cases of buccal mucosa, 17 cases of lip, 33 cases of alveolar region, 16 cases of mandible region, 156 cases of tongue region, 7 cases of gingival buccal sulcus region, and 23 cases of palate were diagnosed as oral squamous cell carcinoma. CONCLUSION: In the present study, the most affected site was buccal mucosa (50.4%), tongue (30.7%), and other diagnosis was <10%.

Development and validation of a questionnaire to evaluate association of tobacco abuse with oral submucous fibrosis.

OBJECTIVE: Development of a reliable questionnaire to quantify habit of substance abuse with development of oral submucous fibrosis. MATERIALS AND METHODS: The questionnaire, substance abuse and precancer evaluation (SAPE) tool, was designed to assess the association of the habit of substance abuse with development of oral submucous fibrosis, a precancerous condition and various physical, social, psychological factors. Health professionals confirmed the content validity. Face validity was established by a participant focus group. The questionnaire was applied to 1100 participants with or without habit of substance abuse. RESULTS: A total of 52 validated items were applied to the participants. Principal component analysis yielded 8 components having eigenvalues ≥2.0. Reliability was obtained by Cronbach's α. The validity was measured by computing product-moment correlation coefficient between the diagnosis and the scores on the selected components. CONCLUSIONS: Preliminary reliability and validity of the SAPE tool has been demonstrated although more extensive testing is suggested.

Classification of hard core and petty criminals using anthropometric measurements.

The purpose of the present study was to compare the somatometric measurements among hard core criminals, petty criminals and community people. Using standard anthropometric procedures, somatometric dimensions were studied on 250 subjects each from the three groups: (i) experimental (hard core criminal) group, (ii) control-I (petty criminal) group, and (iii) control-II (community people) group. Univariate analysis of variance was used for making comparisons of somatometric measurements between these groups in the univariate case. Quadratic discriminant analysis (QDA) was used to develop a model based on measurements that classifies the cases into groups. The study revealed that the somatometric measurements such as morphological total facial height (p < 0.01), physiognomic total facial height (p = 0.015), nasal length (p = 0.001), height of lower face (p = 0.001), nasal depth (p = 0.002), sitting height vertex (p = 0.011), bigonial breadth (p < 0.001), maximum head breadth (p = 0.001), morphological upper facial height (p < 0.001), and physiognomic ear breadth (p = 0.039) were significantly different between the three groups. Morphological upper facial height, physiognomic total facial height, nasal length and height of lower face could be used as identifying factors for hard core criminals. Morphological total facial height, physiognomic upper facial height, physiognomic ear breadth, and sitting height were found different significantly in the experimental group as compared to the control-II group. The QDA provided an overall 72.4% correct classification of cases and 74.5%, 69.6%, and 72.9% correct classification for the experimental, control-I and control-II groups, respectively. The blurred distinction of the three groups could be explained by using the QDA model.