Burden of Anxiety, Depression and Perceived Stress in Patients with Inflammatory Bowel Disease: A Cohort Study from North India.

BACKGROUND: Patients with Inflammatory bowel disease (IBD) are susceptible to psychiatric co-morbidities. We aimed to ascertain the burden of anxiety, depression, and perceived stress in patients with IBD from north India. METHODS: Consenting adult patients with an established diagnosis of IBD were enrolled. The enrolled patients filled the Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS) questionnaires. The patient and disease characteristics were analyzed to determine the correlations and predictors of psychiatric comorbidities. RESULTS: A total of 318 patients (255 UC, 63 CD; mean age 40.13 ± 12.06 years, 168 [52.8%] males; mean partial Mayo score 2.10 ± 2.35; and mean HBI 2.77 ± 2.13) were enrolled. The prevalence of anxiety, depression and moderate to high perceived stress was 14%, 12%, and 41%, respectively. Females had higher mean perceived stress, anxiety and depression scores compared to males. The partial Mayo score (PMS) correlated poorly with anxiety (ρ = 0.083, p = 0.187), depression (ρ = 0.123, p = 0.49) and perceived stress (ρ = 0.169; p = 0.007). The Harvey Bradshaw index (HBI) correlated fairly with anxiety (ρ = 0.336, p = 0.007) and poorly with depression (ρ = 0.287, p = 0.022) and perceived stress (ρ = 0.20; p = 0.117). Younger age (OR 0.93, 95% CI 0.90-0.97; p = 0.001) and hand-grip strength (OR 4.63, 95% CI 1.88-11.42; p = 0.001) predicted anxiety in patients with UC while rural area of residence (OR 4.75, 95% CI 1.03-21.98; p = 0.046) and HBI (OR 1.60, 95% CI 1.12-2.29; p = 0.009) were significant predictors of anxiety in patients with CD. CONCLUSION: Psychiatric comorbidities are common in patients with IBD, with higher prevalence in females. Young adults with UC and sarcopenia; and individuals with active CD living in rural areas are at an increased risk of anxiety.

Dynamics of nanoscale triangular features on Ge surfaces.

Ion beam sputtering, known as potential technique for producing nanoripple on various surfaces having wide range of applications. Along with nanoripple, triangular features are also superimposed, limiting their use for some potential applications. Here we are reporting evolution of triangular features on Ge (100) surfaces under low energy (300-1000 eV) Xe ion irradiation at room temperature for angles of incidence (61°-80°) and ion fluences of (5.34 × 1017-8.01 × 1018ions cm-2). Triangular features appear with the onset of ripple formation and disappear when the ripple periodicity is lost. These features formation depend not only on material but also depend on the ratio of the ion/target mass. In comparison with numerical simulations based on modified anisotropic Kuramoto-Sivanshinsky equation, we find good agreement for the evolution of base angle and lateral length for the triangular features with ion incidence angle. The dynamics of triangular feature with ion incidence angle and ion fluence have been reported. Ion-incidence angle dependency is adequately replicated in numerical simulations. Experimentally the base angle and lateral length increases with increase in ion incidence angle, similar trend is observed in numerical simulation.

Relapse rates after withdrawal of thiopurines in patients with inflammatory bowel disease.

PURPOSE: Withdrawal of thiopurines after remission is associated with an increased risk of relapse in patients with inflammatory bowel disease (IBD). However, long-term data on thiopurine withdrawal is limited, especially from developing countries where the cost of long-term therapy poses a significant burden on patients. METHODS: Patients with IBD on thiopurine monotherapy for ≥ 4 months, who stopped thiopurines while in clinical remission and were not on any other immunomodulator or biologics at the time of withdrawal, were included in this retrospective analysis. RESULTS: Among 1093 patients with IBD on thiopurine monotherapy, 461 patients stopped thiopurine due to various reasons. Among these, 218 (ulcerative colitis (UC) = 179; Crohn's disease (CD) = 39) patients were in clinical remission and were continued on mesalamine. Overall, 36.7% (n = 80) relapsed after a median duration of 20 months (IQR: 9-49). Relapse rate was higher in UC than CD (39.7% vs 23%, p = 0.055). Cumulative probabilities of relapse were 17%, 34%, and 44% at the end of 1, 3, and 5 years, respectively. The relapse rate at 5 years was significantly lower in patients who had stopped azathioprine after 4 years of therapy (31% vs 54%, p = 0.007). On multi-variate cox regression analysis, male sex [HR: 1.6(1.0-2.6), p = 0.02] and short duration of therapy with thiopurines [HR: 1.02 (1.01-1.02), p = 0.004] before withdrawal were associated with increased risk of relapse. CONCLUSION: Approximately 50% patients with IBD in remission would relapse after 5 years of thiopurine withdrawal. Male sex and shorter treatment duration predict relapse. Treatment should be continued in patients who tolerate and maintain remission on long-term thiopurine.

Minimal risk of lymphoma and non-melanoma skin cancer despite long-term use of thiopurines in patients with inflammatory bowel disease: A longitudinal cohort analysis from northern India.

BACKGROUND AND AIM: Thiopurines are widely used to maintain remission in both ulcerative colitis (UC) and Crohn's disease (CD). Reported effectiveness and tolerability rates have been variable across studies. There are only sparse data in Asian population regarding the long-term efficacy and safety of thiopurines. METHODS: Records of 5351 patients followed up at inflammatory bowel disease (IBD) clinic, All India Institute of Medical Sciences, New Delhi from 2004 to 2020 were evaluated retrospectively. Safety was evaluated in terms of long-term adverse events and development of malignancy. RESULTS: Of 5351 patients with IBD, 1093 who received thiopurine for > 3 months (UC = 788 [proctitis-1.9%, left-sided colitis-44.9%, & pancolitis-53.1%] & CD = 305 [inflammatory-42.6%, stricturing-46.9%, & fistulizing-10.5%]) were included (60.8%-male patients). Follow up and treatment duration on thiopurine were 7 (4-12) years and 39.4 ± 40.3 months, respectively, with 254 (23.2%) patients receiving thiopurines for more than 5 and 68 (6.2%) receiving for more than 10 years. Three hundred and fifty-nine (UC: 249 [31.6%]; CD: 110 [36.1%]; P = 0.1) patients developed adverse events; commonest was myelosuppression (23.4%) followed by gastrointestinal intolerance (3%), flu-like illness (1.7%), and arthralgia/myalgia (1.4%). Myelosuppression was the commonest cause of thiopurine withdrawal. No patient (including 254 patients on thiopurine for ≥ 5 years) developed lymphoma or non-melanoma skin cancer. The cumulative probability of staying free from adverse events in overall IBD cohort at 1, 2, and 5 years was 78.6%, 71.9%, and 68.4%, respectively, and this was comparable between UC and CD (P = 0.09). CONCLUSION: Long-term follow up of patients with IBD from northern India on thiopurine monotherapy demonstrated minimal risk of development of lymphoma as well as non-melanoma skin cancer.

CASTE DIFFERENTIALS IN DEATH CLUSTERING IN CENTRAL AND EASTERN INDIAN STATES.

This study assessed caste differentials in family-level death clustering, linked survival prospects of siblings (scarring) and mother-level unobserved heterogeneity affecting infant mortality risk in the central and eastern Indian states of Jharkhand, Madhya Pradesh, Odisha and Chhattisgarh. Family-level infant death clustering was examined using bivariate analysis, and the linkages between the survival prospects of siblings and mother-specific unobserved heterogeneity were captured by applying a random effects logit model in the selected Indian states using micro-data from the National Family Health Survey-III (2005-06). The raw data clustering analysis showed the existence of clustering in all four states and among all caste groups with the highest clustering found in the Scheduled Castes of Jharkhand. The important factor from the model that increased the risk of infant deaths in all four states was the causal effect of a previous infant death on the risk of infant death of the subsequent sibling, after controlling for mother-level heterogeneity and unobserved factors. The results show that among the Scheduled Castes and Scheduled Tribes, infant death clustering is mainly affected by the scarring factor in Jharkhand and Madhya Pradesh, while mother-level unobserved factors were important in Odisha and both (scarring and mother-level unobserved factors) were key factors in Chhattisgarh. Similarly, the Other Caste Group was mainly influenced by the scarring factor only in Odisha, mother-level unobserved factors in Jharkhand and Chhattisgarh and both (scarring and mother-level unobserved factors) in Madhya Pradesh. From a government policy perspective, these results would help in identifying high-risk clusters of women among all caste groups in the four central and eastern Indian states that should be targeted to address maternal and child health related indicators.

Role of atom redeposition during rising ion flux in ion-induced nanodot self-assembly on GaSb surfaces.

In this study, a bottom-up approach of ion irradiation from hot cathode DC discharge plasma was used to investigate the role of energetic ion flux on the self-assembly of GaSb nanodots (NDs) at normal incidence. It was observed that, when increasing the flux in the range of 1014-1015 ions cm-2 s-1, the lateral dimension and root mean square (RMS) roughness of NDs is reduced even at constant temperature conditions in the ion energy range from 400-800 eV. The evolution of the surface morphology for different flux regimes is observed in a numerical integration simulation using the nonlinear isotropic damped Kuramoto-Sivashinsky (DKS) equation. By introducing a redeposition term, the DKS equation is found to be in good qualitative agreement with the experimental results. We have demonstrated the linear dependency of the redeposition coefficient on the ion flux and also reported the nonlinear dependency on the thermal diffusion coefficient, transition time, and characteristic length with the flux. In accordance with the nonlinearity, we have also discussed the effect of the variation of the ion flux on the RMS roughness and lateral dimension of NDs.

Optical characterisation of plasmonic nanostructures on planar substrates using second-harmonic generation.

Off-normal, polarization dependent second-harmonic generation (SHG) measurements were performed ex situ on plasmonic nanostructures grown by self-assembly on nanopatterned templates. These exploratory studies of Ag nanoparticle (NP) arrays show that the sensitivity of SHG to the local fields, which are modified by the NP size, shape and distribution, makes it a promising fixed wavelength characterization technique that avoids the complexity of spectroscopic SHG. The off-normal geometry provides access to the out-of-plane SH response, which is typically an order-of-magnitude larger than the in-surface-plane response measured using normal incidence, for example in SHG microscopy. By choosing the plane of incidence orthogonal to the NP array direction, it was shown that the p-polarized SH response, as a function of input polarization, is very sensitive to NP morphology, with a change of 20% in the aspect ratio of the NPs producing a variation of a factor of 30 in the easily measureable ratio of the p-polarized SH field strength for s- and p-polarized input. The results show that such a fixed geometry could be used for the in situ characterization of anisotropic nanostructure morphology during growth by self-assembly, which could be particularly useful in situations where rotating the sample may be neither desirable nor easily accomplished.

Unveiling the hidden culprit: Parathyroid adenoma induced recurrent renal calculus and pancreatitis-A case report.

This case report describes a 52-year-old patient presenting with recurrent episodes of pancreatitis and renal stones. Further investigation revealed hypocalcemia and elevated parathyroid hormone (PTH) levels, leading to diagnosis of a parathyroid adenoma. This case highlights the importance of considering primary hyperparathyroidism in patients with recurrent pancreatitis and renal stones, as early diagnosis and surgical intervention can prevent recurrence and reduce morbidity. Abstract: Primary Hyperparathyroidism secondary to Parathyroid adenoma, rarely presents as acute pancreatitis. A 38-year-young male with a history of recurrent renal stones referred from a local center, presented to the emergency services, with a diagnosis of acute pancreatitis and bilateral renal stones. Laboratory evaluation showed an elevated calcium level, elevated PTH levels, low vitamin D, and low phosphorus levels. CT scan done outside was suggestive of acute pancreatitis along with bilateral renal calculi. USG neck and MIBI scan done as a part of hypercalcemia evaluation showed presence of a right parathyroid adenoma. Parathyroid adenoma was later removed, and calcium and parathyroid levels were normal on subsequent follow ups.

Thiopurines Have Sustained Long-term Effectiveness in Patients with Inflammatory Bowel Disease, Which is Independent of Disease Duration at Initiation: A Propensity Score Matched Analysis.

BACKGROUND AND AIMS: Thiopurines are viable option for the treatment of inflammatory bowel disease [IBD] in resource-limited countries. However, data on the effect of disease duration at thiopurines initiation on long-term effectiveness are limited. METHOD: We performed a propensity matched analysis of a retrospective cohort of patients with ulcerative colitis [UC] and Crohn's disease [CD]. Patients initiated on thiopurines early in the disease course [≤2 years] were compared with those started late [>2 years]. Effectiveness was defined as no requirement for hospitalisation, anti-tumour necrosis factor [TNF] agents, or surgery, and minimum steroid requirement [≤1 steroid course in 2 years] during follow-up. RESULTS: A total of 988 [UC: 720, CD: 268] patients were included (male: 665 [60.8%], median age: 40 [32-51] years, median follow-up: 40 [19-81] months). Overall effectiveness at 5 and 10 years was 79% and 72% in UC, and 69% and 63% in CD, respectively. After propensity score matching, there was no difference in 5- and 10-year effectiveness between early and late thiopurine initiation groups either for UC [81% and 80% vs 82% and 74%; p = 0.92] or CD [76% and 66% vs 72% and 51%, p = 0.32]. Male sex for UC (negative: hazard ratio [HR]: 0.67, 95% confidence interval [CI): 0.45-0.97; p = 0.03), and ileal involvement [positive: HR: 3.03, 95% CI: 1.32-6.71; p = 0.008], steroid-dependent disease [positive: HR: 2.70, 95% CI: 1.26-5.68; p = 0.01] and adverse events [negative: HR: 0.47, 95% CI:0.27-0.80; p = 0.005] for CD were predictors of thiopurine effectiveness. CONCLUSION: Thiopurines have sustained long-term effectiveness in both UC and CD. However, early thiopurine initiation had no better effect on long-term disease outcome compared with late initiation.

"Prevalence, Predictors, and Impact of Hepatic Steatosis in Patients With Ulcerative Colitis: A Prospective Observational Cohort Study".

Background and Aims: There are no prospective studies evaluating effect of non-alcoholic fatty liver disease (NAFLD) in patients with ulcerative colitis (UC). This prospective observational study assessed the prevalence of NAFLD, its predictors, and its effect on long-term outcomes in UC. Methods: Consecutive UC patients underwent transient elastography, body composition analysis, bone densitometry, anthropometry, and baseline demographic and subjective global assessment. NAFLD was diagnosed by controlled attenuation parameter of >260 dB/m. To evaluate predictors and outcomes, patients of UC with NAFLD (n = 29) were compared with age- and sex-matched patients of UC without NAFLD (n = 27). Results: Among 107 patients of UC (mean age-29 ± 10.6 years; males = 56%, median disease duration-48 [interquartile range: 24-84] months, left sided/pancolitis = 84%), 27% (n = 29) had NAFLD. Patients with body mass index (BMI) > 23 kg/m2 had higher proportion of NAFLD than with normal or low BMI (54.7% [23/42] vs 10% [5/50] vs 6.7% [1/15]). Patients with NAFLD had high BMI (P < 0.001), waist circumference, and fat mass (P < 0.001) but similar fat-free mass (P = 0.798) compared to patients without NAFLD. There was no difference in immunosuppressant and cumulative steroid exposure between two groups. Dietary parameters including daily energy, protein, fat, and carbohydrate intake were similar between the two groups. On multivariate analysis, high BMI was found to be predictive and low socioeconomic status as a protective factor of NAFLD. On long-term follow-up of three years, there was no difference in steroid, or biologic requirement, disease-related hospitalization, or composite of all three outcomes between two groups. Conclusion: The prevalence of NAFLD was found in nearly a quarter of patients of UC and was affected by metabolic parameters rather than disease activity.