Prevalence of dementia in India: National and state estimates from a nationwide study.

INTRODUCTION: Prior estimates of dementia prevalence in India were based on samples from selected communities, inadequately representing the national and state populations. METHODS: From the Longitudinal Aging Study in India (LASI) we recruited a sample of adults ages 60+ and administered a rich battery of neuropsychological tests and an informant interview in 2018 through 2020. We obtained a clinical consensus rating of dementia status for a subsample (N = 2528), fitted a logistic model for dementia status on this subsample, and then imputed dementia status for all other LASI respondents aged 60+ (N = 28,949). RESULTS: The estimated dementia prevalence for adults ages 60+ in India is 7.4%, with significant age and education gradients, sex and urban/rural differences, and cross-state variation. DISCUSSION: An estimated 8.8 million Indians older than 60 years have dementia. The burden of dementia cases is unevenly distributed across states and subpopulations and may therefore require different levels of local planning and support. HIGHLIGHTS: The estimated dementia prevalence for adults ages 60+ in India is 7.4%. About 8.8 million Indians older than 60 years live with dementia. Dementia is more prevalent among females than males and in rural than urban areas. Significant cross-state variation exists in dementia prevalence.

Nordic walking training and nutritional supplementation in pre-frail older Indians: an open-labelled experimental pre-test and post-test pilot study to develop intervention model.

BACKGROUND: Identifying and treating people in a pre-frail state may be an effective way to prevent or delay frailty and preserve their functional capacity. This study aimed to assess the efficacy of, and compliance with, a 12 week individualized nutritional supplementation (INS) and Nordic walking (NW) program in pre-frail older Indians. The primary measure is physical performance, as indicated by Fried's Frailty scale. Other measures include: cognition, as indicated by the Hindi Mental Status Examination; mood, by the Geriatric Depression Scale; and nutritional status, by the Mini Nutritional Assessment. METHODS: This is an open-labeled experimental pre-test and post-test study, which took place from October 2012 to December 2014. The study was approved by Institute Ethics committee (IEC/NP-350/2012/RP-26/2012) at the All India Institute of Medical Sciences (AIIMS), New Delhi. Participants were sixty-six pre-frail elderly, who were randomly allocated into three subgroups, namely: A (NW only), B (INS only), and C (NW and INS). One-way ANOVA was used to statistically assess differences in baseline characteristics for quantitative variables, with the Chi-Square/Fischer exact test utilized for qualitative variables. Paired t-tests were used to assess pre and post intervention difference within the group for quantitative variables, with McNemar's Chi-Square test used for qualitative variables. Kruskal Wallis test was used to assess significant intervention effects among the groups. A p-value < 0.05 was considered as statistically significant. RESULTS: There was significant effect of intervention in gait speed in group A (p = 0.001) and C (p = 0.002), but not in group B (p = 0.926). While there was no significant change in grip strength in Group A (p = 0.488) and B (p = 0.852), a statistically significant increase was observed in group C (p = 0.013). Mood significantly improved in group B (p = 0.025) and C (p = 0.021). No significant difference was noted in cognitive status across groups. Following the interventions, a total of 18.18% of pre-frail participants were classified as non-frail. CONCLUSIONS: Combining NW and INS provides a simple, pragmatic intervention with efficacy in the management of functionally vulnerable older adults, and allows their maintained independence. Future studies should replicate this readily applicable intervention in a larger cohort with a longer follow-up period. TRIAL REGISTRATION: Clinical Trial Registry-India CTRI/2016/05/006937 [Registered on: 16/05/2016]; Trial was Registered Retrospectively.

Performance of iterative reconstruction and automated tube voltage selection on the image quality and radiation dose in abdominal CT scans.

OBJECTIVE: To study the impact of sinogram-affirmed iterative reconstruction (SAFIRE) and concurrent application of automated tube voltage selection (ATVS) on image quality (IQ) and radiation dose. METHODS: A phantom was scanned using various computed tomography (CT) parameters (kV, 80-120; mAs, 50-200). Abdomen contrast-enhanced CT (CECTs) in 170 adults were performed using dose-modified protocols: in 145 patients (group I), ATVS was applied (mAs, 111-649); in 25 (group II), the kV was fixed at 120 (reference mAs, 150). In 95 patients, standard-dose (SD) scan was available. Two readers evaluated the IQ of filtered back projection (FBP) and SAFIRE (levels 1, 3, and 5) images. RESULTS: In phantom, nonlinear drop in noise with increasing strengths of IR (levels S1-S5) was noted. The dose-modified IR scan was rated diagnostic in all 170 patients, with IQ score comparable to that of SD-FBP (P = 0.3). Lower kV (100/80) was prescribed by ATVS in 70% examinations in group I. In comparison with SD-FBP, the mean dose in CT dose index in group I (IR, 3.2 mGy; SD-FBP, 13.02 mGy; P < 0.0001) and in group II (IR, 4.8 mGy; SD-FBP, 11.8 mGy; P < 0.001) was 75.4% and 59.3% lower. CONCLUSIONS: Use of SAFIRE and ATVS provides diagnostic quality images at 59.3% to 75.4% reduced dose compared with SD-FBP scan.

Deep phenotyping and genomic data from a nationally representative study on dementia in India.

The Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) is a nationally representative in-depth study of cognitive aging and dementia. We present a publicly available dataset of harmonized cognitive measures of 4,096 adults 60 years of age and older in India, collected across 18 states and union territories. Blood samples were obtained to carry out whole blood and serum-based assays. Results are included in a venous blood specimen datafile that can be linked to the Harmonized LASI-DAD dataset. A global screening array of 960 LASI-DAD respondents is also publicly available for download, in addition to neuroimaging data on 137 LASI-DAD participants. Altogether, these datasets provide comprehensive information on older adults in India that allow researchers to further understand risk factors associated with cognitive impairment and dementia.

Impact of iterative reconstruction on image quality and radiation dose in multidetector CT of large body size adults.

OBJECTIVE: To compare image quality and radiation dose using Adaptive Statistical Iterative Reconstruction (ASiR) and Filtered Back Projection (FBP) in patients weighing ≥ 91 kg. METHODS: In this Institution Review Board-approved retrospective study, single-phase contrast-enhanced abdominopelvic CT examinations of 100 adults weighing ≥ 91 kg (mean body weight: 107.6 ± 17.4 kg range: 91-181.9 kg) with (1) ASiR and (2) FBP were reviewed by two readers in a blinded fashion for subjective measures of image quality (using a subjective standardized numerical scale and objective noise) and for radiation exposure. Imaging parameters and radiation dose results of the two techniques were compared within weight and BMI sub-categories. RESULTS: All examinations were found to be of adequate quality. Both subjective (mean = 1.4 ± 0.5 vs. 1.6 ± 0.6, P < 0.05) and objective noise (13.0 ± 3.2 vs.19.5 ± 5.7, P < 0.0001) were lower with ASiR. Average radiation dose reduction of 31.5 % was achieved using ASiR (mean CTDIvol. ASiR: 13.5 ± 7.3 mGy; FBP: 19.7 ± 9.0 mGy, P < 0.0001). Other measures of image quality were comparable between the two techniques. Trends for all parameters were similar in patients across weight and BMI sub-categories. CONCLUSION: In obese individuals, abdominal CT images reconstructed using ASiR provide diagnostic images with reduced image noise at lower radiation dose. KEY POINTS: • CT images in obese adults are noisy, even with high radiation dose. • Newer iterative reconstruction techniques have theoretical advantages in obese patients. • Adaptive statistical iterative reconstruction should reduce image noise and radiation dose. • This has been proven in abdominopelvic CT images of obese patients.

Indirect computed tomography venography of the lower extremities using single-source dual-energy computed tomography: advantage of low-kiloelectron volt monochromatic images.

PURPOSE: To study the performance of dual-energy indirect computed tomography (CT) venography from single-source dual-energy CT in the assessment of lower extremity deep venous thrombosis (DVT). MATERIALS AND METHODS: In a retrospective study, 110 patients suspected to have pulmonary embolism (PE) underwent dual-energy CT venography on a single-source dual-energy CT scanner as a part of CT pulmonary angiography protocol at 3 minutes after injection of contrast material. Two radiologists evaluated 50-kiloelectron volt (keV) and 70-keV monochromatic images reconstructed from a dual-energy CT scan for image quality, image noise, venous contrast, and confidence level in interpretation for DVT using a scale of 1-5. In addition, a combined 50-keV and 70-keV data set was assessed for confidence level in image interpretation. Attenuation, contrast-to-noise ratio (CNR), and objective noise were measured in bilateral common femoral and popliteal veins. Data were analyzed using Student t test and Wilcoxon rank sum test. Radiation dose was measured for dual-energy CT venography protocol. RESULTS: A diagnosis of DVT was made in 8 of 110 patients (7.27%). The subjective image quality was comparable between 50-keV and 70-keV images (4.3 vs 4.5; P > .05). The subjective venous contrast opacification (4.7 vs 3.5; P = .0036) and confidence (4.8 vs 3.9; P = .0028) in image interpretation were superior at 50 keV. Confidence level for interpretation on combined 50-keV and 70-keV series (score 4.7) was similar to that for 50-keV series (score 4.8). Compared with 70-keV data, 50-keV data yielded 90% increase in intravascular CT attenuation (207.4 Hounsfield units [HU] ± 39.0 vs 106.8 HU ± 7.6; P <.0001) and higher CNR (10.7 ± 4.07 vs 7.2 ± 4.1; P = .0001) of the deep veins. However, objective noise at 50 keV was higher (14.8 HU vs 6.5 HU; P = .0031). Because of inadequate contrast opacification, 6% of CT venography studies were deemed suboptimal for rendering a diagnostic interpretation on 70-keV images, but these images were considered acceptable at 50 keV. The mean effective radiation dose for the dual-energy CT venography examination was 4.2 mSv. CONCLUSIONS: Optimal image quality with substantially higher venous attenuation is provided by 50-keV monochromatic images from dual-energy CT venography acquisition compared with 70-keV images. The 50-keV monochromatic images increase the confidence in the image interpretation of DVT and decrease the number of indeterminate studies.

Use of Ellavi Balloon Tamponade Device for Management of Atonic PPH.

In this manuscript the authors describe the Ellavi balloon tamponade device and its use in the management of atonic postpartum hemorrhage. Additionally the manuscript discusses a case in which this device was used.

Carcinosarcoma of Uterus: a Case Report.

Carcinosarcoma is a malignant mixed Müllerian tumor with a highly malignant, biphasic tumor consisting of both epithelial and mesenchymal components. A 59-year-old nulligravida came with postmenopausal bleeding. Hysteroscopy revealed highly vascular polypoidal mass with prominent vasculature. Gross examination of specimen showed a polypoid mass, occupying whole uterine cavity and invading more than half of myometrium. Immunohistochemical analysis showed epithelial component AE1/AE3 and stromal component desi and p16. Tumor cells were negative for ER. As carcinosarcoma is a highly aggressive less common variant of endometrial cancer, early diagnosis and aggressive treatment are important to minimize morbidity and overall survival.

Low-dose MDCT and CT enterography of patients with Crohn disease: feasibility of adaptive statistical iterative reconstruction.

OBJECTIVE: The purpose of this study was to evaluate the image quality and diagnostic performance of low-dose MDCT and CT enterography with adaptive statistical iterative reconstruction (ASIR) in the evaluation of Crohn disease. SUBJECTS AND METHODS: Forty-eight patients (20 men, 28 women; mean age, 33.3 years; range, 17-83 years) with known or suspected Crohn disease who underwent low-dose MDCT and CT enterography with ASIR between December 2008 and December 2009 were included in the study. Twenty-seven patients had previously undergone standard-dose 64-MDCT and CT enterography with filtered back projection (FBP), and those images were used for comparison. The weight-based i.v. contrast protocol and scan parameters (120 kVp, 5-mm section thickness, 0.5-second rotation, pitch of 1.375, 64 × 0.625 mm detector configuration) were constant for the two techniques except for a higher noise index (×1.3) in the ASIR group. Two blinded readers reviewed 75 randomized MDCT-CT enterographic scans of 48 patients to assess image quality and diagnostic performance in the evaluation of Crohn disease, and the radiation dose for the studies was estimated. RESULTS: All 75 MDCT and CT enterographic scans had acceptable quality for diagnostic interpretation. Findings of Crohn disease were seen on 63 of 75 scans (84%). Low-dose scans in the ASIR group had optimal image quality and were rated comparable to or better than standard-dose FBP images (mean score, 4.2 vs 3.87; p = 0.007). The subjective image noise score (mean, 1.43 vs 1.58; p = 0.2) and objective image noise measurements were lower for ASIR images (p < 0.001). Low-dose studies with ASIR allowed average dose reduction of 34.5% compared with standard-dose scans with FBP (volume CT dose index for ASIR, 7.7 ± 2.1 mGy; for FBP, 12 ± 5.5 mGy; p < 0.01). CONCLUSION: Low-dose MDCT and CT enterographic studies reconstructed with ASIR were of appropriate quality for confident evaluation of the manifestations of Crohn disease while allowing approximately 34% dose reduction in comparison with FBP technique.

Early postoperative acetabular discontinuity after total hip arthroplasty.

Periprosthetic acetabular fracture is a rare complication after total hip arthroplasty (THA). However, we have treated 2 patients with acute postoperative acetabular discontinuity that occurred 2 and 3 weeks after primary THA. Both fractures were in elderly osteoporotic female patients with minimal trauma and may have developed from unrecognized intraoperative fractures. Pelvic stability was restored with acetabular revision using medial morselized bone grafting and a cemented reconstruction cage. This report demonstrates that early postoperative periprosthetic acetabular discontinuity after THA is a risk in elderly patients with severe osteoporosis and that salvage of acetabular fixation can be achieved with cemented cage reconstruction and medial morselized bone grafting.

Hemosiderin Pigmentation on Hysteroscopy.

Pigmentation on hysteroscopy is a rare finding. The authors describe a case where hysteroscopy revealed hemosiderin pigmentation on fundal endometrium. Hemosiderin pigmentation is a marker of a number of uterine afflictions including Adenomyosis and endometritis among others.

Computed tomography findings in pseudothrombosis of the iliofemoral vein.

Computed tomography findings in 3 patients with apparent thrombosis of an iliofemoral vein due to mixing artifact related to venous collateral formation are presented, 1 with portosystemic collaterals and 2 with collaterals secondary to subclavian vein thrombosis. Mixing artifact or asymmetric enhancement related to collateral formation should be considered for an apparent thrombus in the iliofemoral vein. Examination of axial and reformatted images may facilitate recognition and help avoid an erroneous diagnosis of deep venous thrombosis.

Sonographic anatomy of the gastrohepatic ligament.

OBJECTIVE: The purpose of this presentation is to illustrate anatomic and pathologic features of the gastrohepatic ligament (GHL) and to show its usefulness for precise localization of abnormalities, particularly in relation to the lesser peritoneal cavity and diseases occurring within the confines of the ligament itself. METHODS: Cases were selected that illustrate the objectives above. RESULTS: Illustrations show various anatomic and pathologic features meant to enhance interpretation of left upper quadrant sonograms. CONCLUSIONS: Illustrations seen in the sonographic literature vaguely interpret the relationships of the GHL. Misunderstanding has led not only to improper nomenclature but also to the use of inappropriate indicators of lesser omental diseases. With a clear understanding of the anatomy of the GHL and its use as a pivotal marker for structures around and within it, one can avoid these pitfalls and better evaluate adult and pediatric lesser omental anatomy.

Artificial Intelligence: The Future of Obstetrics and Gynecology.

BACKGROUND: Artificial intelligence or 'big data' comprises of algorithms which aid in decision making. It has made an impact on a number of professions including obstetrics and gynecology. OBJECTIVE: To make readers aware of where artificial intelligence has a role in obstetrics and gynecology. MATERIAL AND METHODS: A comprehensive review of the literature was undertaken to compile a list of instances where artificial intelligence was applied to obstetrics and gynecology. CONCLUSION: Artificial intelligence should be utilized to benefit patient care and assist the physician in providing data for decision making.

Neuroprotection by ethanolic extract of Syzygium aromaticum in Alzheimer's disease like pathology via maintaining oxidative balance through SIRT1 pathway.

The oxidative stress plays a key role in Alzheimer's disease (AD) and Sirtuin (SIRT1) is potential mediator of oxidative pathway. This study explored the role of Syzygium aromaticum on SIRT1 and oxidative balance in amyloid beta induced toxicity. Anti-oxidative capacity of Syzygium aromaticum was performed in Aß25-35 induced neurotoxicity in neuronal cells. Superoxide dismutase, Catalase and Glutathione enzyme activity were determined by the treatment of Syzygium aromaticum. Both recombinant and endogenous SIRT1 activity were performed in its presence. The expression of γ-secretase and SIRT1 were evaluated by western blot. Syzygium aromaticum was capable to scavenge ROS and elevate the percentage of anti-oxidant enzymes. It also activated and elevated the level of SIRT1 and downregulated γ-secretase level. These findings show a holistic approach towards the neurodegenerative disease management by Syzygium aromaticum which could lead to the formulation of new drug for AD. This Ayurvedic product can give a healthy aging with no side effects and also be cost effectives. It may meet unmet medical needs of current relevance.

Pancreaticoduodenectomy in the Setting of Pre-operative Post Endoscopic Retrograde Cholangiopancreatography Acute Pancreatitis: Intraoperative Challenges and Post-operative Outcome

Background: Pancreaticoduodenectomy (PD) in the setting of preoperative post-ERCP acute pancreatitis (PAP) might pose significant challenges and leads to higher morbidity as compared to those without acute pancreatitis. The aim of the study was to study patients undergoing PD and compare intraoperative variables and postoperative outcomes in patients with and without preoperative PAP. Methods: We retrospectively analysed 20 patients who underwent PD from January 2015 to July 2017. Out of these, 2 patients had preoperative PAP following endoscopic biliary drainage for cholangitis.This group was compared with the rest 18 patients (control group) in terms of patient characteristics, operative variables and postoperative outcomes. Postoperative outcomes and overall complication rate, specifically hemorrhage, delayed gastric emptying and pancreatic fistula were noted. The postoperative complications in stented (n=9) and non-stented (n=11) patients were studied. Risk factors for pancreatic fistula were analysed in entire study population. (n=20). Results: PAP was found in 2 out of 20 patients (10%). The number of complications were higher in the PAP group (8/2) compared to control group (20/18). The ICU stay, delayed gastric emptying (DGE)and postoperative stay was higher in PAP group. There was one perioperative mortality due to grade C pancreatic fistula in the control group. Overall as well as infectious complications, were not statistically different in stented versus non-stented group. Soft pancreas(p=0.001) and non-dialted pancreatic duct (p=0.004) were significantly associated with pancreatic fistula. Conclusion: PD in the setting of PAP is feasible, albeit associated with more frequent complications, prolonged ICU and hospital stay.

Second Trimester Medical Termination of Pregnancy with Combined Intracervical and Intravaginal Misoprostol: Comparative Analysis with Intravaginal Misoprostol-A Pilot Study.

CONTEXT: Intravaginal placement of misoprostol has been used extensively to terminate second trimester pregnancies. Intracervical misoprostol is an alternative method of termination of pregnancy for women in this period of gestation. OBJECTIVE: To assess the efficacy and safety of combined intracervical and intravaginal misoprostol in the management of mid-trimester medical termination of pregnancy and to compare it with intravaginal misoprostol. MATERIALS AND METHODS: In this IRB approved prospective study, twenty-two women (mean age 25.4 ± 3.2 years, range 23-32 years; mean BMI 22.3 ± 3.4 kg/m(2); mean parity 2.1 ± 1.4, average gestational age 17.9 ± 2.4 weeks) underwent second trimester termination of pregnancy at our institution. Patient cohort was randomized into two treatment protocols depending on the drug used and route of administration. Induction-abortion interval, need for surgical evacuation, completeness of abortion and side effects if any were documented. RESULTS: Mean induction-abortion interval for intravaginal group and combination group was comparable (t = 7.9 ± 1.8 and 6.5 ± 3.5 h, respectively). Three patients required surgical evacuation for incomplete abortion (n = 2 after vaginal misoprostol and one after intracervical-intravaginal misoprostol). Number of patients aborting within 6 h was more in the intracervical-intravaginal group (36.3 %). Patients with intracervical misoprostol complained of abdominal pain more often than those in other groups. Excessive bleeding and uterine rupture was not seen in any patient. CONCLUSION: Intracervical misoprostol is an effective method of medical treatment of second trimester pregnancy failure. Its short induction to abortion interval and acceptable safety profile makes induction via the cervical route acceptable for second trimester abortion.

Relative Alterations in Blood-Based Levels of Sestrin in Alzheimer's Disease and Mild Cognitive Impairment Patients.

Sestrins (sesn) are highly conserved proteins that play an important neuroprotective role, in part as a consequence of their antioxidative capacity, which prevents reactive oxygen species formation. In this study, we evaluated the concentrations of sesn1 and sesn2 in the serum of 41 Alzheimer's disease (AD) patients, 27 mild cognitive impairment (MCI), and 60 elderly controls, by surface plasmon resonance, which was validated by using western blot. Moreover, the mRNA level of sestrins in all the study groups was determined by real time polymerase chain reaction. The results showed significant overexpression of serum sesn2 protein and mRNA levels in the AD group compared to MCI and elderly control groups. A difference in serum sesn2 concentration between MCI and the control group was also evident. ROC analysis showed highly sensitive, selective cutoff values for sens2 in the differentiation of AD, MCI, and controls. No significant difference in sesn1 level was observed among the study groups. This study highlights the important role of sesn2 in the progression of the AD, indicating its potential utility as a protein marker in this devastating disease.

Can perineal tear be predicted by severity of striae gravidarum score?

Background: The objective of this study was to wether perineal tear predicted by scoring of severity of striae gravidarum. The objective of this study was to predict perineal tear by simple non-invasive method and help to prevent maternal morbidity.Methods: Three hundred ninety four patients delivered normally were included in this study. Striae gravidarum score was assessed using the Atwal numerical scoring system. The association was examined between striae and perineal tear as the outcome measure, defined by tears or laceration, and the total striae scores (TSS) was obtained.Results: In present study population mean age was 25.16 years ranging from 16-40 , mean gravidity was 2.16 ranging from 1 -8 ,average baby birth weight was 2.713 kg ranging from  1.62-4.58 The only predictors of perineal tears that were found to be statistically significant in our study were severity of striae gravidarum and episiotomy given or not. In patients with moderate to severe striae there was tear in 90 patients as compared to 29 patients with no or mild striae. 224 patients belonging to no or mild striae group delivered without any perineal tear whereas 51 patients in moderate to severe striae group delivered without tear. Out of these 51 patients 5 were given episiotomy. 2 patients who were given episiotomy had perineal tear as compared to 117 patients who were not given episiotomy. This shows that patients who had an episiotomy were less likely to have perineal tear in most cases.Conclusions: This study demonstrates a significant relation between severity of striae gravidarum and perineal tear. The findings suggest that striae gravidarum assessment may be used in the clinical setting even by paramedical staff as a simple and noninvasive tool to better define women at risk for perineal tear.