Prevalence and Risk Factors of Urinary Incontinence among Elderly Women Residing in Kochi Corporation: A Community-based Cross-sectional Study.

Background: A study was done on the prevalence, risk factors, and treatment-seeking behavior of elderly women with urinary incontinence (UI) residing in Kochi Corporation, Kerala, India. The community-based cross-sectional study was done in Kochi on 525 elderly women aged 60 years and above, selected by cluster random sampling, after getting consent, using a questionnaire. The overall prevalence of UI was found to be 64% (95% confidence interval (CI) 59.5-67.6). The most common type of UI was found to be the urge type of incontinence (38.3%, 95% CI, 34.14-42.45). Chronic cough (odds ratio [OR] 1.754, 95% 1.170-2.631), chronic constipation (OR: 1.563, 95% CI: 1.030-2.373), obesity (OR: 1.591, 95% CI: 1.110-2.280), diabetes (OR: 1.517, 95% CI: 1.036-2.222), and taking medications for diabetes and hypertension (OR: 1.476, 95% 1.008-2.163) were found to be risk factors of UI. Multiparity (OR: 1.757, 95% CI: 1.073-2.876), delivery at home (OR: 1.761, 95% CI: 1.205-2.575), undergoing any pelvic surgery (OR: 1.504, 95% CI: 1.052-2.150) were the gynecological and obstetric factors associated with UI. Context: Very few community-based studies are available on UI among elderly women. Aim: The primary objective of the study was to estimate the prevalence of UI among elderly women residing in the Kochi corporation. The secondary objective was to determine the risk factors of UI. Settings and Design: A community-based cross-sectional study was done in the Kochi Corporation of Ernakulam district. Subjects and Methods: A pilot study was conducted and based on this, the sample size was computed to be 72.41. Data from 525 individuals were collected using cluster random sampling. A questionnaire for urinary incontinence diagnosis questionnaire was used for assessing the type of UI. Statistical Analysis Used: Percentage prevalence, Chi-square test. Results: The overall prevalence of UI was found to be 64%. The most common type of UI was found to be the urge type of incontinence. Chronic cough, chronic constipation, obesity, diabetes, taking medications for diabetes, and hypertension were found to be risk factors of UI. Multiparity, delivery at home, and undergoing any pelvic surgery were the gynecological and obstetric factors associated with UI. Conclusions: The prevalence of UI among elderly women in this study was found to be 63.9%. The most common type of UI was found to be urge type of incontinence 38.3%, followed by mixed incontinence 32.3%, and stress incontinence 29.3%. Chronic cough (OR: 1.754), chronic constipation (OR: 1.563), obesity (OR: 1.591), diabetes (OR: 1.517), and taking medications for diabetes and hypertension (OR: 1.476) were found to be risk factors for UI. Multiparity (OR: 1.757), delivery at home (OR: 1.761) and undergoing any pelvic surgery (OR: 1.504) were the gynecological and obstetric factors associated with UI among elderly women in this study. Chronic cough (adjusted odds ratio [aOR] 1.64, 95% CI: 1.08-2.50), obesity (aOR: 1.64, 95% CI: 1.13-2.39), pelvic surgery (aOR: 1.64, 95% CI: 1.13-2.39), and delivery at home (aOR: 1.89, 95% CI: 1.27-2.82) were found to be independent risk factors for UI among elderly women.

Homozygous variant, p.(Arg643Trp) in VAC14 causes striatonigral degeneration: report of a novel variant and review of VAC14-related disorders.

VAC14-related disorders include two distinct phenotypes, striatonigral degeneration [MIM# 617054] and Yunis-Varon syndrome. Striatonigral degeneration is a recently described childhood onset dystonia caused by pathogenic variants in VAC14. It is characterized by a period of apparent normalcy followed by abrupt onset neuroregression, dystonia, involuntary movements and degenerative brain lesions involving caudate nucleus, putamen and substantia nigra. Yunis-Varon syndrome is a well described severe condition characterised by skeletal findings and dysmorphism along with neuronal degeneration. Pathogenic variants in FIG4 have been previously reported to cause Yunis-Varon syndrome. Recently, loss of function variants in VAC14 were also reported in an individual affected with Yunis-Varon syndrome. Total seven individuals from four families are reported to have VAC14-related disorders till date. Here, we report another individual with clinical and radiological features suggestive of striatonigral degeneration with homozygous missense variant in VAC14. The patient fibroblasts showed extensive vacuolization, characteristic of VAC14-related disorders. We also review the phenotype and genotype associated with these disorders.

Anti-inflammatory Effect of Picrorhiza kurroa in Experimental Models of Inflammation.

Picrorhiza kurroa is an important medicinal plant in the Ayurvedic system of medicine. The root and rhizome of this plant are used for the treatment of various liver and inflammatory conditions. In the present study, we sought to investigate the anti-inflammatory activity of P. kurroa rhizome extract against carrageenan-induced paw edema and cotton pellet implantation-induced granuloma formation in rats. In addition, its immunomodulatory activity was evaluated in Complete Freund's Adjuvant-induced stimulation of a peritoneal macrophage model and lipopolysaccharide-stimulated RAW 264.7 murine macrophages. Pretreatment with P. kurroa rhizome extract inhibited carrageenan-induced paw edema and cotton pellet-induced granuloma formation in a dose-dependent manner. This was associated with reduced levels of inflammatory cytokines (TNF-α, IL-1ß, IL-6) accompanied with increased anti-inflammatory cytokine (IL-10) in the serum and peritoneal macrophages. Additionally, P. kurroa rhizome extract inhibited inflammatory TNF-receptor 1 and cyclooxygenase-2 in Complete Freund's Adjuvant-induced activated peritoneal macrophages. Furthermore, P. kurroa rhizome extract treatment significantly inhibited iNOS and suppressed the activation of NF-κB through inhibition of its phosphorylation and by blocking the activation of IκB kinase alpha in lipopolysaccharide-stimulated RAW264.7 macrophages. Taken together, these results suggest that P. kurroa has anti-inflammatory activity that is mediated through the suppression of macrophage-derived cytokine and mediators via suppression of NF-κB signaling.