Assessment of nicotine dependence in subjects with vascular dementia

Background: Nicotine dependence is an important public health issue. Nicotine dependence is a risk factor for vascular diseases like myocardial infarction and vascular dementia. The rate of nicotine dependence in Indian subjects with vascular dementia is not known. Hence we decided to assess nicotine dependence in subjects with vascular dementia.Methods: Nicotine dependence in subjects with vascular dementia was assessed among subjects presenting to memory clinic of a tertiary care hospital over a period of 16 months. Data regarding sociodemographic profile and severity of nicotine dependence as per Fagerstrom nicotine dependence scale for smoking and smokeless tobacco was analysed using SPSS version 17.Results: Our study shows that in 159 subjects with vascular dementia continuing nicotine dependence was seen in nearly 12% of the subjects. Though the rates are less than the population prevalence for India, it is still relevant as nicotine is not just a risk factor for development of vascular dementia but severe nicotine dependence and longer duration of nicotine use were found to be poor prognostic factors associated with severe dementia. Further as all subjects continued to be nicotine dependent despite having been advised to quit tobacco, suggesting the need for a more comprehensive tobacco cessation intervention be offered to subjects with vascular dementia to improve outcomes.Conclusion: In subjects with vascular dementia continuing nicotine dependence is an important risk factor which must be addressed.  

ETS-related gene (ERG) expression as a predictor of oncological outcomes in patients with high-grade prostate cancer treated with primary androgen deprivation therapy: a cohort study.

Objectives To determine whether ETS-related gene (ERG) expression can be used as a biomarker to predict biochemical recurrence and prostate cancer-specific death in patients with high Gleason grade prostate cancer treated with androgen deprivation therapy (ADT) as monotherapy. Methods A multicentre retrospective cohort study identifying 149 patients treated with primary ADT for metastatic or non-metastatic prostate cancer with Gleason score 8–10 between 1999 and 2006. Patients planned for adjuvant radiotherapy at diagnosis were excluded. Age at diagnosis, ethnicity, prostate-specific antigen and Charlson-comorbidity score were recorded. Prostatic tissue acquired at biopsy or transurethral resection surgery was assessed for immunohistochemical expression of ERG. Failure of ADT defined as prostate specific antigen nadir +2. Vital status and death certification data determined using the UK National Cancer Registry. Primary outcome measures were overall survival (OS) and prostate cancer specific survival (CSS). Secondary outcome was biochemical recurrence-free survival (BRFS). Results The median OS of our cohort was 60.2 months (CI 52.0 to 68.3). ERG expression observed in 51/149 cases (34%). Multivariate Cox proportional hazards analysis showed no significant association between ERG expression and OS (p=0.41), CSS (p=0.92) and BRFS (p=0.31). Cox regression analysis showed Gleason score (p=0.003) and metastatic status (p<1×10-5) to be the only significant predictors of prostate CSS. Conclusions No significant association was found between ERG status and any of our outcome measures. Despite a limited sample size, our results suggest that ERG does not appear to be a useful biomarker in predicting response to ADT in patients with high risk prostate cancer

Clinico-epidemiological profile and risk factors associated with failure of conservative therapy in pediatric empyema patients

Objective: The objective is to study the clinico-epidemiological profile and risk factors associated with failure of conservative therapy in pediatric empyema patients and to correlate the Light’s criteria in the same. Materials and Methods: A hospital-based prospective observational study was performed in the pediatric department of a tertiary care hospital, New Delhi. A total of 74 children of ≤12 years of age having either macroscopic frank pus in pleural tap or a positive Gram-stain or positive culture in pleural fluid were enrolled in the study. Those empyema patients who fail to improve with antibiotics and chest tube drainage after 7–14 days (4 weeks for Staphylococcus aureus and 6–12 weeks for anaerobic organisms, respectively) or develop some complications in the mean time were considered as a failure of therapy. Results: Head nodding, lethargy and inability to feed/drink, prior antibiotic therapy, duration of illness (&gt;7 days) before presenting to the hospital, and growth on the cultures were the main factors associated with the failure of conservative therapy. S. aureus is the most common organism causing empyema. Considering Light’s criteria, significant results were obtained and almost all the enrolled empyema patients found to have exudative pleural fluid. In the study, failure of conservative therapy occurred in 27.03%, prolonged hospitalization was seen among 48.65 % children, 28.38% needed change in antibiotics, and 1.35% children expired. Conclusion: History of prior antibiotic therapy, long duration of illness, and clinical features at admission along with the microorganism involved affect the conservative therapy response and may predispose to complications. Light’s criteria were very well validated in the study for its use in pediatric population

Biomolecular interaction simulation of supramolecular topologies of organometallic assemblies of Bi(V) with antibiotic Tetracycline Amoxicillin drugs and their experimental activities evaluation

This is an accepted manuscript of an article published by IS Publications in Journal of Biomedical & Therapeutic Sciences on 30/09/2020, available online: http://www.pubs.iscience.in/journal/index.php/jbts/article/view/926/594 The accepted version of the publication may differ from the final published version.Antibiotic drugs i.e. tetracycline and amoxicillin, were used mixed ligands (ML), for designing, architecturing, tailoring and synthesis for synthesis of supramolecular topologies of organometallic assemblies of Bi(V), represented as OMCs‐Bi(V), having O5 set for bonding. Molecular models were proposed as a standard to judge specific interactions in topologies of molecules of ML and derived organometallic assemblies. In OMCs‐Bi(V), on chelation, polarity of Bi(V) get reduced to great extent due to overlap of ML orbital. As a result, delocalization of π‐electrons density clouds get spread over the surface of chelating ring and enhances penetration power of OMCs‐Bi(V) into lipid membranes. This influenced binding with enzyme sites in microorganisms. Some electron set for bonding groups present in ligands moieties display extensive biological activity that may be responsible for increase in hydrophobic character and liposolubility of supramolecular topologies of organometallic of assemblies; ultimately enhanced biological activity of OMCs‐Bi(V)

Designing age-friendly communities: Exploring qualitative perspectives on urban green spaces and ageing in two Indian megacities

The World Health Organization and the United Nations have increasingly acknowledged the importance of urban green space (UGS) for healthy ageing. However, low- and middle-income countries (LMICs) like India with exponential ageing populations have inadequate UGS. This qualitative study examined the relationships between UGS and healthy ageing in two megacities in India. Participants were recruited using snowball sampling in New Delhi and Chennai and semi-structured interviews were conducted with consenting participants (N = 60, female = 51%; age > 60 years; fluent in English, Hindi, or Tamil). Interviews were recorded, transcribed, translated, and analysed using inductive and thematic analysis. Benefits of UGS included community building and social capital, improved health and social resilience, physical activity promotion, reduced exposure to noise, air pollution, and heat. Poorly maintained UGS and lack of safe, age-friendly pedestrian infrastructure were identified as barriers to health promotion in later life. Neighbourhood disorder and crime constrained older adults’ use of UGS in low-income neighbourhoods. This study underscores the role of UGS in the design of age-friendly communities in India. The findings highlight the benefits of UGS for older adults, particularly those living in socially disadvantaged or underserved communities, which often have least access to high-quality parks and green areas

Older adults’ experience of neuropsychological assessments for dementia screening in South India: a qualitative study

Background: In community settings, neuropsychological assessment is the most commonly employed method for early recognition of dementia. However, little is known about the experience and perspectives of older adults when they undertake neuro psychological assessments in low-and middle-income countries (LMICs), including India. Methods: We conducted semi-structured interviews for 11 individuals (aged between 64 and 88 years) who had undergone cognitive assessment in the CST International (Cognitive Stimulation Therapy International) study and were free from dementia. The transcripts were analysed manually utilising Interpretative Phenomenological Analysis to develop key themes. Results: When data were analysed three super-ordinate themes (experiences related to the process, content and outcomes) each with a set of subordinate themes emerged. Conclusions: This study highlights the need for a thorough planning of pre-assessment briefing for equipping participants with adequate information related to the neuro psychological assessment: its indication, length of procedure, contents of the test, possible outcomes, medical implications of those outcomes, possible therapeutic options if diagnosed with lower cognitive function.We discuss our findings in relation to extant knowledge and explore issues clinicians should consider when conducting neuro psychological assessments in LMIC settings

Psychometric properties of outcome measures in non‐pharmacological interventions of persons with dementia in low‐and middle‐income countries: A systematic review

Despite high burden of dementia in low-and middle-income countries (LMICs), only a small number of clinical trials of psychosocial interventions for persons with dementia (PwD) have been conducted in these settings. It is essential that such trials use appropriate outcome measures that are methodologically robust and culturally appropriate to evaluate the effectiveness of interventions. We carried out a systematic review to examine the evidence base and psychometric properties of measures employed in these studies in LMICs. A systematic search of published literature on randomised controlled trials (RCT) of psychosocial interventions for PwD in LMICs between 2008 and April 2020 was carried out. Measures employed in each of the eligible studies were identified and through a focused search, we further explored the evidence base and psychometric properties employing Terwee criteria. Data extraction and quality appraisal were conducted by two independent reviewers. The review identified 41 measures from 17 RCTS which fulfilled eligibility criteria and they examined effectiveness across the domains of cognition (n = 16), behaviour and psychological symptoms (n = 11) and quality of life (n = 8). Of these 41, we were able to access relevant literature only for 18 and they were subject to psychometric analysis. Psychometric properties of these 18 instruments were at best modest, with Terwee scores ranging from 3 (low) to 15 (moderate). A majority of the studies were from China (n = 5) and Brazil (n = 6). The evidence base for the routinely employed measures in RCTs of non-pharmacological interventions for PwD in LMICs is limited. The quality of adaptation and validation of these instruments is variable and studies are largely uninformative about their psychometric properties and cultural appropriateness to the study setting. There is an urgent need to develop scientifically robust instruments in LMIC settings that can be confidently employed to measure outcomes in trials of psychosocial interventions for PwD

A new approach for developing “implementation plans” for cognitive stimulation therapy (CST) in low and middle-income countries: Results from the CST-International study

Background: Even with a strong evidence base, many healthcare interventions fail to be translated to clinical practice due to the absence of robust implementation strategies. For disorders such as Alzheimer's disease and other dementias, access to evidence-based interventions beyond research settings is of great importance. Cognitive Stimulation Therapy (CST) is a brief, group-based intervention, with consistent evidence of effectiveness. Methods: An implementation focused, three-phase methodology was developed using extensive stakeholder engagement. The methods resulted in a standardized Implementation Plan for the successful translation of CST from research to practice. The methodology was developed using the Consolidated Framework for Implementation Research (CFIR) and refined in three countries that vary in levels of economic development and healthcare systems (Brazil, India and Tanzania. Results: Five Implemention Plans for CST were produced. Each plan contained implementation strategies and action plans devised in conjunction with policy professionals, healthcare professionals, people with dementia and family carers, and an international team of researchers and clinicians. Conclusion: This novel methodology can act as a template for implementation studies in diverse healthcare systems across the world. It is an effective means of devising socio-culturally informed Implementation Plans that account for economic realities, health equity and healthcare access