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Background: Psoriasis begins in childhood in around one-third of the cases. There has been conflicting evidence regarding the association of paediatric psoriasis with comorbidities. Aims and Objectives: The objective of this study was to find out various comorbidities (abnormal body mass index, metabolic syndrome, lipid abnormalities, diabetes mellitus, and raised blood glucose) associated with paediatric psoriasis. Materials and Methods: All patients of psoriasis (age <18 years) who visited the Paediatric Psoriasis clinic from January 2017 to September 2021 were recruited in this record-based study. Results: Records of 100 patients were analysed, with female to male ratio of 1:1. The age group ranged from 11 months to 18 years. The average body surface area involved was 5.43%. The average psoriasis area and severity index was 2.47. Joint involvement was seen in 7% of patients in our study. A total of 52 (52%) patients had abnormal body mass index, out of which 21 patients were overweight and 31 were obese. At least one lipid abnormality was found in 66 (66%) patients. The most common lipid abnormality was decreased high-density lipoprotein, followed by raised total cholesterol, raised total triglycerides and raised low-density lipoprotein. 8 (8%) patients were found to have raised blood glucose levels. Out of which, six had impaired fasting glucose and two were diagnosed with diabetes mellitus. 5 (5%) patients were diagnosed with metabolic syndrome. Conclusion: Paediatric psoriasis is a chronic disfiguring disease and may have profound emotional and psychological effects. There is a lack of studies from India on the prevalence of these comorbidities in paediatric psoriasis. More studies are required from different parts of the world for a better understanding of paediatric psoriasis.
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Background: Psoriasis is a chronic, immune mediated inflammatory condition of the skin and imbalance in inflammatory mediators could result in insulin resistance, metabolic syndrome and facilitate the occurrence and progression of Non-alcoholic fatty liver disease (NAFLD). Objectives: Primary objectives: To study the frequency of NAFLD in cases of chronic plaque psoriasis and controlsTo study the interleukin levels in cases of chronic plaque psoriasis and controls. Secondary objectives: To study the BMI, lipid profile, waist circumference, FBS (fasting blood sugar), PPBS (post prandial blood sugar) and serum insulin in cases and controlsTo study the association of age, duration of psoriasis, PASI (psoriasis area severity index), BSA (body surface area) involved, BMI (body mass index), lipid profile, obesity, waist circumference, FBS (fasting blood sugar), PPBS (post prandial blood sugar) and serum insulin levels with NAFLD in patients of chronic plaque psoriasisTo correlate serum levels of IL1-ß, IL6 and TNF-α with NAFLD in patients of chronic plaque psoriasis. Methods: 50 clinically diagnosed cases of chronic plaque psoriasis with age ≥ 18years, diseases duration ≥ 6 months and 30 age and sex matched controls were recruited. PASI, BSA of cases was calculated and BMI, BP, WC of all subjects was measured. Serum lipid profile, FBS, PPBS, insulin level, IL1- ß , IL6, TNF- α , high frequency B-mode ultrasound, LFT and fibroscan were done in all subjects. Results: 28(56.0%) cases and 2(6.6%) controls had NAFLD with statistically significant difference. Significantly elevated WC, serum insulin, deranged lipid profile, fatty liver, transaminitis, fibroscan score, liver fibrosis, NAFLD and interleukins were found in cases vs controls. There was a significant association of NAFLD in psoriatic patients with increasing duration of psoriasis, BMI ≥23 Kg/m2, high WC, increasing BSA involved, deranged lipid profile, raised total cholesterol levels and increasing number of risk factors. Nonsignificant but positive association of NAFLD in cases was found with high levels of IL1 - ß, IL - 6, TNF-α, FBS and increasing PASI. Conclusion: Significantly increased interleukin levels and their weak positive correlation with the severity of psoriasis (PASI, BSA) in patients of chronic plaque psoriasis explains the possible role of inflammation in the causation of psoriasis. Screening may be considered in psoriatic patients with increasing duration of psoriasis, high WC, high BSA involved, high BMI, obesity, dyslipidemia and insulin resistance. Limitations: Small sample size. Conflict of Intrest: NONE.
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BACKGROUND: Depression is a highly prevalent condition and includes clusters of symptoms, namely, depressive cognition, anxiety, and visceral symptoms. Depressive symptoms often respond sub-optimally to pharmacotherapy. Adjunctive transcranial direct current stimulation (tDCS), a noninvasive brain stimulation modality, may improve depressive symptomatology. AIM: The aim of this study was to study the effect of tDCS as an augmentation strategy in depression and its various symptom domains. MATERIALS AND METHODS: It is a prospective interventional study. Patients diagnosed with depressive disorder (based on International Classification of Disease- 10 criteria, diagnosed by treating psychiatrist), aged 18-70 years, who showed inadequate improvement on antidepressant selective serotonin reuptake inhibitors, were recruited after informed consent. Each participant was administered 20 sessions of tDCS over 2 weeks, each session of 20 min, with anode placement at left dorsolateral prefrontal cortex and cathode at right supraorbital region. Hamilton Rating Scale for Depression (HAM-D) was administered pre- and post-intervention to assess the change in symptoms. RESULTS: Of a total of 35 participants, the mean score on HAM-D prior to and postintervention was 19.97 (standard deviation [SD] = 3.519) and 13.17 (SD = 3.365), respectively. The difference was statistically highly significant (P = 0.000) on paired t-test. All symptom domains of HAM-D, identified using the Cole and Motivala model (Cole et al., 2004), also showed significant reduction from pre-tDCS to post-tDCS scores (P = 0.000). CONCLUSION: Positive effect of tDCS on depressive symptoms, its tolerability and safety profile, and affordability makes it an effective therapeutic strategy in augmenting antidepressants in patients with depression. However, longer period studies with larger sample size may yield more generalizable results.