Demographic, socioconomic, and health correlates of sleep quality and sleep duration among community-dwelling older adults in India.

BACKGROUND: Recent research has revealed that today's older adults report more sleep problems than their predecessors, a trend compounded by expanding social stratification. As such, this study examined the demographic, socioeconomic, and health correlates of sleep quality and sleep duration among community-dwelling older adults in India. METHODS: The current study sample draws on data from 7118 respondents aged 50 years and over participating in the World Health Organization's Study on global AGEing and adult health (WHO-SAGE) wave-2 dataset. Sleep quality (good, moderate, and poor) and sleep duration (in hours and minutes) were self-reported. Adjusted multivariable logistic regression models were employed to examine the associations between sleep quality and sleep duration and several demographic, socioeconomic, and health indicators. RESULTS: A total of 12.84% and 36.1% of older adults reported long (> 8 h) and short (< 7 h) sleep, respectively. Older adults with primary education had lower odds of poor sleep [aOR: 0.85, CI: 0.73-0.99] than peers with no formal education. The odds of poor sleep were lower among those in higher wealth quintiles than those in the poorest quintile. Older adults with higher education had higher odds of short sleep [aOR: 1.36, CI: 1.06-1.74], and those with primary education had lower odds of long sleep [aOR: 0.70, CI: 0.54-0.91] than those without formal education (base category: age-appropriate sleep, i.e., 7-8 h). Older adults who were widowed had lower odds of both short [aOR: 0.82, CI: 0.68-0.98] and long sleep [aOR:0.74, CI: 0.58-0.95] compared to those who were currently married. Older individuals with adequate nutritional intake reported lower odds of short [aOR:0.59, CI: 0.49-0.72] and higher odds of long sleep [aOR:1.52, CI: 1.20-1.93] relative to their counterparts. Older adults who reported chronic conditions and body pain had higher odds of poor sleep and short sleep than their counterparts. CONCLUSIONS: We identified significant associations between several unmodifiable factors, including age, education, and marital status, and modifiable factors such as dietary intake, body pain, and pre-existing chronic ailments, and sleep quality and sleep duration. Our findings can assist health care providers and practitioners in developing a more holistic and empathic approach to care. Moreover, that several demographic, socioeconomic, and health-related factors are consequential for older adults' sleep health suggests that early detection through screening programs and community-based interventions is vital to improving sleep among older Indians who are most susceptible to sleep problems.

Combined left atrial appendage occlusion and catheter ablation procedure for left atrial arrhythmias: A real-world, propensity-matched analysis.

INTRODUCTION: Real-world studies comparing safety and efficacy of combined percutaneous left atrial appendage occlusion (LAAO) and catheter ablation (CA) to LAAO alone are limited. METHODS: Patients from a large US hospital system undergoing combined LAAO and left-atrial CA from 8/2020 to 2/2024 were retrospectively analyzed and compared to a control group undergoing LAAO alone. Controls were identified using a 1:2 propensity score match based on LAAO device type (Watchman FLX vs. Amulet), CHA2D2-VASc and Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio [INR], Elderly, Drugs/alcohol (HAS-BLED) scores and compared for safety, sealing performance and clinical outcomes at 6 months. RESULTS: Patients were younger in the combined (n = 72) than in the control group (n = 144, 70.2 ± 7.3 vs. 76.7 ± 6.9 years, p < 0.001) but otherwise comparable with a mean CHA2D2-VASc score of 4.2 ± 1.1 and 4.4 ± 1.2 (p = 0.26) and HAS-BLED score of 2.2 ± 0.8 and 2.3 ± 0.7 (p = 0.34). Successful LAAO implantation rates were the same (95.8% vs. 95.8%, p = 0.99) with longer procedure times seen in the combined group (156.5 ± 53 vs. 56 ± 26 min, p < 0.001). Both major (1.4% vs. 2.1%, p = 0.72) and minor (27.8% vs. 19.4%, p = 0.17) in-hospital complications were similar between the combined and control group, respectively. At 45 days, presence of peri-device leak (18.3% vs. 30.4%, p = 0.07) and device related thrombosis (4.5% vs. 4.5%, p = 0.96) on transesophageal echocardiogram did not differ. Finally, all-cause mortality (0% vs. 1.4%, p = 0.99), thromboembolic (0% vs. 0%, p = 0.99) and bleeding (6.1% vs. 4.4%, p = 0.73) events during follow-up were comparable. CONCLUSION: This large, real-world analysis indicates comparable safety and efficiency of combined LAAO and CA when compared with LAAO alone.

Something old, something new: the origins of an unusual renal cell underpinning a beetle water-conserving mechanism.

Tenebrionid beetles have been highly successful in colonising environments where water is scarce, underpinned by their unique osmoregulatory adaptations. These include a cryptonephridial arrangement of their organs, in which part of their renal/Malpighian tubules are bound to the surface of the rectum. Within the cryptonephridial tubules, an unusual cell type, the leptophragmata, plays a key physiological role underpinning water conservation. Nothing was known about the developmental mechanisms or evolution of these unusual renal cells. Here, we investigate mechanisms underpinning leptophragmata development in Tribolium castaneum. We find that leptophragmata express and require the Tiptop transcription factor, similar to secondary renal cells in Drosophila melanogaster, which express Teashirt and Tiptop, despite Drosophila lacking a crypronephridial arrangement. An additional transcription factor, Dachshund, is required to establish leptophragmata identity and to distinguish them from the secondary cells in the non-cryptonephridial region of renal tubule of Tribolium. Dachshund is also expressed in a sub-population of secondary cells in Drosophila. Leptophragmata, which are unique to the beetle lineage, appear to have originated from a specific renal cell type present ancestrally and to be specified by a conserved repertoire of transcription factors.

Dowry demand, perception of wife-beating, decision making power and associated partner violence among married adolescent girls: A cross-sectional analytical study in India.

BACKGROUND: Violence against women is considered a fundamental violation of their human rights. According to the world health organization (WHO), one-third of women worldwide experience some form of intimate partner violence (IPV). This study aimed to investigate the relationship between dowry demand, perception of wife-beating, decision-making on work and household purchases and physical, sexual, and emotional violence against married adolescent girls in India by using a large dataset. METHODS: Data from the Understanding the lives of adolescents and young adults (UDAYA) project survey were used in this study. The final sample size included 4893 married adolescent girls. Descriptive statistics and bivariate analyses were performed to examine preliminary results. Multivariate logistic regression analysis was used to analyze the associations between dowry demand, perception of wife-beating, decision-making and types of IPV. RESULTS: The prevalence of emotional, physical, and sexual violence among married adolescent girls were 28.6%, 22.9%, and 26.1%, respectively. Approximately 44% of married adolescent girls have experienced some form of violence (emotional, physical, or sexual). The likelihood of experiencing violence was 3.64 times more likely among adolescent girls who reported that dowry was demanded by their in-laws than their counterparts [aOR: 3.64; CI: 3.05-4.35]. Moreover, married girls who justified wife-beating were more likely to face any violence than their counterparts [aOR: 1.56; CI: 1.28-1.90]. Similarly, adolescent girls whose work decisions were made by others had higher odds of experiencing any violence than those who decided their work themselves/jointly with others [aOR: 1.34; CI: 1.07-1.68]. The odds of any violence were higher among adolescent girls whose decisions on household purchases were made by others compared to those who decided to make purchases themselves or jointly with others [aOR: 1.37; CI: 1.09-1.71]. CONCLUSIONS: The findings revealed significant associations between dowry-demand, justification of wife-beating, decision making power and IPV among married adolescent girls, and suggest policies that help reduce violence related to the predominantly practiced dowry system in the country, and programs aimed at educating adolescent married girls about their rights against violence and empowering them to retain equal decision-making power within their families and reduce their vulnerability to domestic violence.

Increased expression of proton pump and allergic inflammation genes predicts PPI failure in pediatric eosinophilic esophagitis.

Proton pump inhibitors (PPIs) are one of the standards of care of eosinophilic esophagitis (EoE) treatment, though PPI response rates are variable ranging from 23 to 63% in pediatric studies. We sought to determine if expression of select genes in esophageal mucosa can predict PPI responsiveness in EoE. Children with a new diagnosis of EoE (15 or more eosinophils/hpf on esophageal biopsy) were prospectively treated with 8 weeks of PPI therapy before follow-up esophagogastroduodenoscopy (EGD). Children with <15 eosinophils/hpf on follow-up were classified as having PPI-Responsive EoE (PPI-R) and ≥ 15 eosinophils/hpf as PPI-Nonresponsive EoE (PPI-NR). Using the Nanostring nCounter Analysis System, mRNA expression of a custom panel of genes was measured in esophageal biopsies. Immunohistochemical staining of biopsies was performed. Among children with EoE, 32% (8/25) had PPI-R EoE. ATP12A, ATP4A, tryptase-beta 2 (TPSB2), CLC and IL13 had higher expression in PPI-NR EoE compared to PPI-R EoE or controls. Immunohistochemical staining of ATP12A was higher among PPI-R EoE and PPI-NR EoE, compared to non-EoE controls. In this study, PPI-NR EoE had significantly higher baseline gene expression of mast cell, cytokine, proton pump, and eosinophil genes compared to PPI-R EoE. PPIs may be involved in an inflammatory cascade of mast cell activation that stimulates IL-13 release, which upregulates ATP12A and ATP4A that leads to eosinophil recruitment. Histologic PPI failure may occur when increased gene expression of these components is high and cannot be overcome pharmacologically, especially in the case of proton pump genes.

BeetleAtlas: An Ontogenetic and Tissue-specific Transcriptomic Atlas of the Red Flour Beetle Tribolium castaneum.

The red flour beetle Tribolium castaneum has emerged as a powerful model in insect functional genomics. However, a major limitation in the field is the lack of a detailed spatio-temporal view of the genetic signatures underpinning the function of distinct tissues and life stages. Here, we present an ontogenetic and tissue-specific web-based resource for Tribolium transcriptomics: BeetleAtlas (https://www.beetleatlas.org). This web application provides access to a database populated with quantitative expression data for nine adult and seven larval tissues, as well as for four embryonic stages of Tribolium. BeetleAtlas allows one to search for individual Tribolium genes to obtain values of both total gene expression and enrichment in different tissues, together with data for individual isoforms. To facilitate cross-species studies, one can also use Drosophila melanogaster gene identifiers to search for related Tribolium genes. For retrieved genes there are options to identify and display the tissue expression of related Tribolium genes or homologous Drosophila genes. Five additional search modes are available to find genes conforming to any of the following criteria: exhibiting high expression in a particular tissue; showing significant differences in expression between larva and adult; having a peak of expression at a specific stage of embryonic development; belonging to a particular functional category; and displaying a pattern of tissue expression similar to that of a query gene. We illustrate how the different feaures of BeetleAtlas can be used to illuminate our understanding of the genetic mechanisms underpinning the biology of what is the largest animal group on earth.

Fluorescence in-situ hybridization assessment of spindle cell-rich testicular sex cord stromal tumors demonstrates multiple chromosomal gains across histologic subtypes.

Spindle cell-rich testicular sex cord-stromal tumors (TSCSTs) comprise a group that includes mostly (but not exclusively): myoid gonadal stromal tumor (MGST), adult granulosa cell tumor (AGCT), and unclassified TSCST. These entities demonstrate histopathologic overlap, and prior genomic studies have failed to identify specific oncogenic drivers. Results of DNA sequencing suggest that different types of spindle cell-rich TSCSTs harbor a recurrent pattern of chromosomal gains. However, these results have not been validated by alternative methods and the extent of these changes within individual tumors remains unknown. We used a combination of commercially available fluorescence in-situ hybridization (FISH) probes (3q11.2, 6p24.3, 6q11.1, 6q23, 7q11.21-q11.22, 9p21.3, 11q13.3, 17p11.2) to enumerate a subset of chromosomes identified as altered (gained) in prior studies. We analyzed 10 cases (3 MGST, 4 unclassified TSCST, 3 AGCT), including 7 that had been previously sequenced. FISH demonstrated gains of chromosomes 3, 6, 7, 9, and 11 above the pre-established threshold (25%) in 50%, 80%, 70%, 20%, and 40% of cases, respectively, with gains of chromosome 17 being present in only 1 unclassified TSCST. The proportion of cells with chromosomal gains ranged from 26% to 60%. Tumors with available copy number data from prior genomic analyses showed a partial discordance between FISH and sequencing results. This study demonstrates that spindle-cell rich TSCSTs harbor a recurrent pattern of chromosomal gains, which are present in variable subsets of neoplastic cells. Further studies are needed to determine if these chromosomal changes represent a mechanism relevant for oncogenesis or a secondary event.

Sex Differences in the Associations Between Chronic Diseases and Insomnia Symptoms Among Older Adults in India.

Background: Sleep problems are a critical issue in the aging population, affecting quality of life, cognitive efficiency, and contributing to adverse health outcomes. The coexistence of multiple diseases is common among older adults, particularly women. This study examines the associations between specific chronic diseases, multimorbidity, and insomnia symptoms among older Indian men and women, with a focus on the interaction of sex in these associations. Methods: Data were drawn from 31,464 individuals aged 60 and older in the Longitudinal Ageing Study in India, Wave-1 (2017-18). Insomnia symptoms were assessed using four questions adapted from the Jenkins Sleep Scale (JSS-4), covering difficulty falling asleep, waking up, waking too early, and feeling unrested during the day. Multivariable logistic regression models, stratified by sex, were used to analyze the associations between chronic diseases and insomnia symptoms. Results: Older women had a higher prevalence of insomnia symptoms than men (44.73% vs 37.15%). Hypertension was associated with higher odds of insomnia in both men (AOR: 1.20) and women (AOR: 1.36). Women with diabetes had lower odds of insomnia (AOR: 0.80), while this association was not significant in men. Neurological or psychiatric disorders, stroke, and bone and joint diseases were linked to higher odds of insomnia in both sexes. Chronic lung disease was associated with insomnia in men (AOR: 1.65), but not in women. Additionally, having three or more chronic diseases significantly increased the odds of insomnia in both men (AOR: 2.43) and women (AOR: 2.01). Conclusion: Hypertension, bone and joint diseases, lung diseases, stroke, neurological or psychiatric disorders, and multimorbidity are linked to insomnia symptoms in older Indian adults. Disease-specific management and routine insomnia screening are crucial for promoting healthy aging in this vulnerable population.

Nano-protected form of rosemary essential oil has a positive influence on blood biochemistry parameters, haematological indices, immune-antioxidant status, intestinal microbiota and histomorphology of meat-type chickens.

This study aimed to investigate the potential of free and nanoprotected rosemary essential oil (REO) as an antibiotic alternative in blood biochemistry, hematology, immune-antioxidant status, intestinal microbiology, and histomorphology of broilers. A total of 420 1-wk-old broiler chicks (Cobb) were randomly allotted into 7 treatments, each having 4 replicates of 15 chicks. The first group served as control received basal diet, while the second group was fed a basal diet plus 100 mg/kg enramycin and third group basal diet plus 150 mg/kg chitosan nanoparticles (CNPs). The fourth and fifth groups received diets supplemented with 100 mg and 200 mg free REO (F-REO)/kg diet. The sixth and seventh groups were supplemented with 100 mg and 200 mg nanoprotected REO (N-REO)/kg diet. Results revealed that supplementing nanoprotected REO significantly (P < 0.05) decreased the levels of blood cholesterol and low-density lipoproteins (LDL) compared to control and enramycin groups. The kidney and liver function parameters were not altered by adding free or nanoprotected REO to the diet. Both levels of nanoprotected REO significantly (P < 0.05) reduced heterophil: lymphocyte (H: L) ratio compared to all other groups. Birds receiving nanoprotected REO at 200 mg/kg diet had significantly (P ˂ 0.05) raised serum levels of immunoglobulin G (IgG) and immunoglobulin M (IgM) compared to control and other birds. Anti-SRBC titre and cell-mediated immunity improved significantly (P < 0.05) in nanoprotected REO groups. Supplementation of nanoprotected REO resulted in significantly (P < 0.05) higher values for superoxide dismutase (SOD), glutathione (GSH) and total antioxidant status (TAS). The caecal microbiota was improved in broiler birds fed diets supplemented with nanoprotected REO. The 200 mg nanoprotected REO/kg diet supplementation resulted in significantly (P < 0.05) better villus height (VH) and villus height: crypt depth (VH: CD) ratio in all the segments of the small intestine. In conclusion, feeding REO in nanoprotected form in a 200 mg/kg diet could be used as an antibiotic substitute to improve broiler chicken's lipid profile, immune-antioxidant status, and intestinal health.

Cardiac Electrical and Structural Changes after Iodinated Contrast Media Administration: A Longitudinal Cohort Analysis.

Background: Iodinated contrast is commonly used for radiological procedures, with one dose delivering several hundred-fold the daily requirements needed for normal thyroid hormone production. Risks of excess iodine include incident thyroid dysfunction, which is associated with adverse cardiac outcomes, yet there are no prospective studies investigating the changes in cardiac physiology following iodine contrast administration. This study was conducted to investigate the longitudinal relationships between the amount of iodinated contrast administration and changes in cardiac electrophysiology and structure. Methods: A longitudinal cohort study was conducted with prospectively enrolled participants who received iodine contrast for elective computed tomography or coronary angiography. Serum thyroid function tests, electrocardiograms (EKG), and transthoracic echocardiograms were obtained serially until 36 months. Trends of electrical and structural cardiac changes following iodine contrast administration were assessed using mixed effect models. Results: The cohort was composed of 129 patients (median age, 70 [interquartile range: 63, 75] years; 98% male). Larger amounts of iodine exposure were associated with increases in QRS and QTc durations and decreased ejection fraction (EF), and these associations were still observed for follow-up EF after additionally adjusting for baseline values (the high-iodine contrast group vs. the low-iodine contrast group, -4.23% [confidence interval, -7.66% to -0.79%]). Dose-response analyses also showed lower EF with larger amounts of iodine received; these trends were not significant for the EKG parameters studied. Conclusions: Over a period of up to 36 months, a larger amount of administered iodine contrast was associated with lower EF among participants. Further investigation is needed to elucidate the long-term trends of electrical and structural cardiac function after iodine contrast administration.

Polymer-assisted synthesis of ternary magnetic graphene oxide nanocomposite for the adsorptive removal of Cr(VI) and Pb(II) ions.

The presence of chromium [Cr(VI)] and lead [Pb(II)] ions in the water bodies have adverse effects on humans and aquatic life. Graphene oxide-based magnetic nanocomposites synthesized in the presence of chitosan (mGO/CS) or polyaniline (mGO/PA) as potential adsorbents for the removal of Cr(VI) and Pb(II) ions. The FTIR (Fourier transform infrared spectroscopy), EDX (Energy dispersive X-ray), XRD (X-ray diffraction) and SEM (Scanning electron microscopy) were employed to investigate the chemical composition, structural, elemental analysis, crystalline size and morphology of the nanocomposites. The FTIR results confirmed the synthesis of the nanocomposites by detecting peaks of specific functional groups. The average crystallite sizes of the mGO, mGO/CS, and mGO/PA nanocomposites were 17, 25, and 23 (nm), respectively, as determined by the Debye-Scherrer equation from the XRD data. Batch adsorption experiments were conducted for Pb(II) and Cr(VI) removal by varying the variables like pH, concentration of metal ions and contact time. The Box Behnken design (BBD) was used to optimize the adsorption parameters. Under the optimum conditions, mGO/CS and mGO/PA showed maximum removal percentages (%R) of 92.36 and 98.7 for Pb(II), and 85.25 and 93.08 for Cr(VI), respectively. The adsorption capacities were 110.84 and 118.44 mg/g for Pb(II), and 87.74 and 111.7 mg/g for Cr(VI) were obtained for mGO/CS and mGO/PA, respectively. The pseudo-second-order kinetic model and Langmuir isotherm fitted well to the experimental data and explain the adsorption mechanism of the nanocomposite materials for both metal ions.

Association Between Multimorbidity and Presence of Diagnosed Vision Problems Among the Middle-Aged and Older Population in India.

PURPOSE: The aim of the study was to estimate the prevalence of diagnosed vision problems and to examine the association of single and multiple chronic conditions with vision problems among middle-aged and older adults in India. METHODS: The study utilized data from the Longitudinal Ageing Study in India (LASI) Wave 1, (2017-18). Descriptive statistics along with bivariate and multivariable analyses were conducted to achieve the study objectives. RESULTS: The prevalence of diagnosed vision problems in the sampled population was 48.2%. The older adults (60+ years) (55.3%) had shown a greater prevalence of vision problems than the middle-aged individuals (41%). Among chronic conditions, hypertension, diabetes, chronic lung diseases, chronic heart diseases, bone related diseases, psychiatric disorders, and high cholesterol were significantly associated with vision problems in the case of both middle-aged and older adults. Furthermore, odds of experiencing vision problems according to the presence of multimorbidity were higher in the middle-aged population [adjusted odds ratio (AOR) = 1.986; confidence interval (CI):1.855-2.126] than in the older population [AOR = 1.746; CI:1.644-1.854]. CONCLUSIONS: Middle-aged and older adults with chronic illnesses and multimorbidity were at greater risk of vision problems. Due to the high prevalence of vision problem, interventions aimed at prevention or early detection are warranted.

Separate and combined associations of cognitive impairment and body pain with functional and mobility disabilities among older women and men in India.

This study examined the separate and combined associations of cognitive impairment and body pain with functional and mobility disabilities (FMDs) among older women and men in India. Multivariable linear regression models were applied using data from the Longitudinal Aging Study in India (2017-18) comprising 31,464 adults aged 60+. Older adults with cognitive impairment and pain reported higher levels of FMDs than peers without any pain and cognitive impairment. The likelihood of FMDs was significantly greater among older Indians enduring both cognitive impairment and pain (p < 0.05). Moreover, the association between cognitive impairment and functional disability was noticeably stronger in older women, particularly those with frequent pain, while the link between cognitive impairment and mobility disability was more pronounced in men with pain. Integrated cognitive rehabilitation and pain management programs, along with guided physical therapy, gender-specific support groups, and community-based health promotion activities, should be considered to reduce FMDs in older Indians.

Comparison of Efficacy of Autologous Platelet Rich Plasma Therapy With 5% Topical Minoxidil Spray in Treating Alopecia Areata: A Head-to-Head Assessment of Novel Approaches.

BACKGROUND: Alopecia areata (AA) remains one of the most challenging afflictions encountered in dermatology clinics. It is characterized by an autoimmune-mediated inflammatory process of and around hair follicles, causing reversible, non-scarring hair loss. With the ongoing search for optimal treatment strategies, the potentially positive role of autologous platelet-rich plasma (PRP) therapy as well as minoxidil has been reported in various studies; however, the comparison of the two treatment modalities is largely underexplored. This research aims to compare and assess the effectiveness of intralesional PRP with topical minoxidil therapy in AA to identify efficacious management options amongst the newly described treatment modalities. METHODOLOGY: The research work was conducted over four months and included 40 (31 males and 9 females) patients suffering from alopecia areata. They were divided into Group A, which was administered monthly autologous PRP injections, while Group B was given daily topical 5% minoxidil therapy. In group A, four treatments of PRP were given, each one month apart. While in group B, daily topical minoxidil spray was administered for the same duration. The alopecia areata severity grade was recorded by employing the "Severity of Alopecia Tool" (SALT) scoring system. The pre- and post-treatment SALT scores were noted and compared at each monthly visit. RESULTS: The study comprised nine (22.5%) female and 31 (77.5%) male patients. At the beginning of the study and after one month of treatment, the difference in the SALT score was not statistically significant between the two groups, suggesting that both interventions had similar effects during the early stages of the treatment. At two months, a statistically significant difference emerged (p-value 0.037), indicating that a more significant fall in the SALT score was observed with autologous PRP treatment compared to topical minoxidil. After four months, a highly significant difference was noted between the two groups (p-value <0.0001), implying that intralesional PRP therapy led to a far more significant decrease in the SALT score compared to topical minoxidil therapy. CONCLUSION: Monthly intralesional autologous PRP therapy for four months manifests better outcomes in alopecia areata than daily 5% topical minoxidil therapy.

Efficacy and Safety of Bempedoic Acid in Patients With Hyperlipidemia and Non-alcoholic Fatty Liver Disease.

Hyperlipidemia and its association with cardiovascular diseases have been significant public health concerns for many decades. Statins have long been the primary therapeutic option for lowering cholesterol levels and reducing cardiovascular mortality. However, a substantial number of patients either do not achieve optimal lipid goals with maximally tolerated statin doses or experience statin intolerance. In recent years, there have been remarkable developments in the field of hyperlipidemia management, leading to the approval of novel hypolipidemic drugs in North America and Europe. This article reviews the clinical development of bempedoic acid, a promising new drug, alone and in combination with ezetimibe, as an alternative approach to managing hyperlipidemia. The Phase I trials established the safety and tolerability of bempedoic acid, paving the way for further investigation in Phase II and Phase III trials. Multiple phase II studies evaluated the lipid-lowering efficacy of bempedoic acid as monotherapy or in combination with other hypolipidemic agents, showing significant improvements in lipid levels and inflammatory markers. The recently approved fixed drug combination of bempedoic acid and ezetimibe presents a viable option for patients who need additional LDL-C lowering alongside dietary modifications and maximally tolerated statin therapy.

Subjective social status and socio-demographic correlates of perceived discrimination among older adults in India.

BACKGROUND: Considering India's diversity, marked by differences in caste, class, ethnicity, religion, region, and language, discrimination can take on varying forms across social-structural locations. We examined the association between subjective social status (SSS) and perceived discrimination, and assessed the sociodemographic correlates of perceived discrimination among older persons in India. METHODS: Data come from the 2017-18 wave 1 of the Longitudinal Aging Study in India (LASI) with a sample of 30,253 adults 60 years or older. SSS was examined using the Macarthur scale with a ladder technique. Perceived discrimination was evaluated with the Everyday Discrimination Scale. Multivariable logistic regression models examined the odds of reporting discrimination by its types and attributions. RESULTS: 39% of older adults reported low SSS, whereas 7.3% reported high SSS. Older adults with low SSS had significantly higher odds of experiencing some discrimination than those with high SSS. Compared to high-SSS peers, low-SSS individuals attributed age, gender, caste, financial, and health status as reasons for discrimination. Older women attributed gender as a reason for discrimination. Caste was reported as a reason for discrimination by rural but not urban dwellers. Relative to northerners, those from southern India reported age, financial, and health statuses as reasons for discrimination. CONCLUSIONS: That low-SSS older adults reported age, gender, caste, financial status, and health status as reasons for discrimination and that this association persisted after considering objective indicators of socioeconomic status (SES) is suggestive of SSS as independently consequential for perceived discrimination. These findings are useful for care providers and practitioners as they encourage older patients -- especially those with low SSS who may feel stigmatized -- to seek care, comply with care regimen, and engage in behaviors that protect and promote health.

Efficacy of Pegylated Interferon-alpha-2a in Chronic Hepatitis Delta: Experience from a Tertiary Care Hospital in Karachi.

Background: Chronic hepatitis D (CHD) along with chronic hepatitis B (CHB) is an important cause of morbidity and mortality in patients with cirrhosis. It is a potentially curable infection that has long awaited a good treatment option. Objective: To ascertain the efficacy of pegylated interferon (PEG-IFN)-alpha-2a in patients suffering from CHD. A tertiary care hospital experience from Pakistan. Materials and methods: The study included 207 CHD polymerase chain reaction (PCR)-positive patients treated with PEG-IFN-alpha-2a between July 2020 and October 2022. Virological response rate (PCR negative) at weeks 24 and 48 was the primary endpoint. Secondary outcomes included partial response (>2 log reduction in PCR) and treatment failure rate (<2 log reduction in PCR). Results: A total of 187 patients started PEG-IFN therapy, and 148 patients completed the assigned 48 weeks of therapy. Patients' mean age was 25.7 years with 65% being males. The virological response rate was 40.5% at week 24 and 32.4% at week 48. The partial response rate was 24% at both weeks 24 and 48. The treatment failure rate was 36% at week 24 and 44% at week 48. Hemoglobin, white blood cell (WBC) count, and total bilirubin were found to be predictive of treatment response. Side effects led to treatment discontinuation among eighteen patients and one patient died due to hepatic failure. Conclusion: Therapy with PEG-IFN-alpha-2a shows suboptimal outcomes in patients with CHD. There is a strong need for more effective alternate therapies for CHD patients. How to cite this article: Butt N, Usmani MT, Hussain R, et al. Efficacy of Pegylated Interferon-alpha-2a in Chronic Hepatitis Delta: Experience from a Tertiary Care Hospital in Karachi. Euroasian J Hepato-Gastroenterol 2024;14(1):51-55.

Natural and human-made disaster and associated health outcomes among community-dwelling older adults in India: Findings from LASI, 2017-18.

BACKGROUND: Droughts, flash floods, rail accidents, and riots are relatively regular occurrences for those living in many low- and middle-income countries like India. While such natural and human-made disasters put everyone in harm's way, their toll on specific segments of society-like older adults-is the heaviest. Therefore, in this study, we examine (1) the prevalence of natural and human-made disasters in India and (2) the association between natural and human-made disasters and several physical and mental health outcomes among older Indians. METHODS: A cross-sectional study was conducted utilizing data come from the 2017-18 wave 1 of the nationally representative Longitudinal Ageing Study in India, comprising a sample of 29,333 older adults (14,120 males and 15,213 females) aged 60 years and above. Multivariate random intercept multilevel logistic regression analysis is used to examine the association between natural and human-made disasters and poor self-rated health, difficulty in activities of daily living, difficulty in instrumental activities of daily living, communicable diseases, non-communicable diseases, depressive symptoms, and psychiatric disorder. RESULTS: Overall, 3.58% of older adults reported that they have encountered any type of natural or human-made disaster in the past five years. Compared to those who did not experience any (natural or human-made) disaster, older adults who experienced any disaster had a higher prevalence of poor self-rated health (33.4% vs 23.31%), difficulty in activities of daily living (33.94% vs 23.00%), difficulty in instrumental activities of daily living (60.09% vs 47.70%), communicable diseases (49.57% vs 25.86%), depressive symptoms (17.30% vs 8.06%) and psychiatric disorders (3.42% vs 2.78%). After adjusting for the selected variables and the contextual effect, the odds of poor self-rated health (1.64 [1.40, 1.92]), difficulty in activities of daily living and instrumental activities of daily living (1.89 [1.61, 2.21] and 1.63 [1.40, 1.89]), communicable and non-communicable diseases (2.12 [1.83, 2.46] and 1.38 [1.20, 1.60]), depressive symptoms and psychiatric disorder (1.67 [1.55, 2.05] and 1.52 [1.33, 2.18]) were significantly higher among older adults who experienced a natural or human-made disaster than their counterparts without such an experience. CONCLUSIONS: Relative to their non-exposed counterparts, older Indians who survived natural or human-made disasters endured an inflated risk of poor self-rated health, functional difficulties, communicable and non-communicable diseases, depressive symptoms, and psychiatric disorders. As such, post-disaster efforts should be grounded in policies and programs that address disaster-related trauma and diseases and improve the functional, physical, and psychological facets of health among older disaster survivors.