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Introduction. There is a scarcity of information available on clinical and laboratory features of adult-onset idiopathic autoimmune uveitis. Therefore, we conducted a single centre descriptive cross-sectional study. Patients and Methods. A chart review of all patients with idiopathic autoimmune uveitis with onset after 18 years of age who were referred to the rheumatology department between January 2017 and December 2018 was performed. Their clinical features, demographic features, and HLA-B genotypes were documented and described. Results. Out of 210 patients referred to rheumatology, 66 were found to have uveitis, and 16 of these had an adult-onset idiopathic autoimmune uveitis. Apart from a slight female preponderance (62.5%), our patients were characterized by a high proportion of panuveitis (4 out of 16, i.e., 25%). There was an increased frequency of occurrence of synechiae (5 out of 16, i.e., 31.3%), retinal vasculitis (4 out of 16, i.e., 25%), optic disc edema (3 out of 16, i.e., 18.8%), and cystoid macular edema (seen in 2 patients, i.e., 12.5%). These features correlated with the anatomical subtypes. Retinal vasculitis and optic disc edema present in three fourth of all panuveitis cases were the most prominent features. The odds of finding HLA-B∗35 in retinal vasculitis were 33 times higher than odds of finding it in idiopathic autoimmune uveitis patients not having retinal vasculitis (OR 33; 95% CI 1.6–698). Conclusion. Idiopathic autoimmune uveitis in our patients is characterized by a high frequency of panuveitis and retinal vasculitis, and complications with a probable association between HLA-B∗35 and retinal vasculitis.

Advances in bioinformatics, information technology, advanced computing, imaging techniques are changing fundamentally the way physicians define, diagnose, treat, and prevent disease. New disciplines - Artificial Intelligence, Machine Learning, Computational Biology - are improving healthcare. Digital health solutions have immense scope. Education and practice need to keep pace. We aimed at assessment of \"Technology proficiency\" required by medical graduates and its implementation, if found useful. All this in a conceptual framework of \"TP\" model, having categories (a) proper assessment (b) pertinent treatment (c) progress monitoring (d) prevention applications (e) professional standards. A search of the literature was performed using MedLine & Cochrane Central Register of Controlled Trials databases, for systematic reviews and meta-analysis articles published in the last five years using keyword \"technology\". Analysis of those relevant to the role all medical graduates should play. An analysis of worldwide statutory medical institutions guidelines. Twenty-three systematic studies and meta-analysis were studied. Eighteen show clear evidence for 'Technology proficiency\", while 5 recommend further studies. The findings are discussed suiting the roles of doctors in the \"TP\" model. Medical institutions guidelines worldwide diligence suggests need of including \"Technology proficiency\" as a definite and distinct strategic plan. Medical Council of India mandates \"use information technology for appropriate patient care and continued learning\". General Medical Council, UK and Medical Council India have been proactive in technology training. GMC recommends technology use for learning, prescribing, communication, and interpersonal skills. It should be expanding technology proficiency in practice as an essential professional capability. \"Technology proficiency\" is found pertinently fruitful. It should be included as a definitive requirement and a distinct strategic plan worldwide. Modern curriculum development is proposed (i) Educational goals and objectives as the proposed Conceptual framework \"Technology proficiency\" model (ii) Instructional strategies 'Five Bs' (iii) Implementation 'Five Ms'.

Fibromyalgia is characterized by chronic widespread pain, which has been linked to neuroinflammation. Hematological indices, i.e., neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) have been shown to be effective markers in neurological diseases like depression. To study the association between fibromyalgia severity and the hematological indices (NLR, PLR, and MPV). This was a hospital-based cross-sectional study of fibromyalgia patients satisfying the 2016 modification of the 2010/11 ACR criteria. Demographic and clinical characteristics were recorded along with fibromyalgia outcomes and hematological indices. Statistical analysis was done using descriptive statistics, ROC analysis using the Youden index, and Pearson and Spearman correlations. A total of 266 patients were recruited. The (mean ± S.D) NLR, MPV, and PLR were 1.92 ± 1.26, 8.94 ± 1.25, and 119.48 ± 76.91, respectively. Patients with severe visual analog scale (VAS) pain scores had lower MPV (8.8 ± 1.3) than those with mild/moderate pain (9.2 ± 1.1, p = 0.016). MPV showed a mild negative correlation with the Fibromyalgia Impact Questionnaire-Revised (FIQR) score (R2 -0.31 p 0.004). MPV threshold of 8.95 was discriminated severely from mild/moderate VAS-pain score with a sensitivity of 52.3 % and specificity of 66.7%. MPV can possibly be considered as a biomarker for predicting pain severity in fibromyalgia. Given its inexpensive nature, MPV can be used as a cost-effective method to assess fibromyalgia severity in rural India.

Introduction One of the most prevalent disorders treated by general surgeons is inguinal hernias. Many of the etiological factors that lead to hernia development are unknown. This study looked at the role of pelvic bone anatomy in the development of inguinal hernia. The pubic tubercle's location (as measured by the Radoievitch angle) and its relationship to the formation of inguinal hernia, as well as its function in the pathophysiology of various forms of inguinal hernia, were investigated. Materials and methods From October 2019 to June 2021, a prospective case-control study with 70 individuals over the age of 18 years in each arm was conducted in the Department of General Surgery at our tertiary care institution. Plain digital X-ray radiography of the pelvis, including bilateral hips, was taken in the anteroposterior (AP) view with the patient in the supine position, and the Radoievitch angle and Ami line were measured using suitable measuring instruments. The required information for patients in both groups was tallied and examined in a data sheet. Results Between the case and control groups, there was a statistically significant difference in the mean Radoievitch angles and the mean length of the Ami line (42.46 +/-2.442 degrees vs 40.91 +/-2.547 degrees; p<0.05); (8.54+/-1.059 cm vs 7.27+/-1.034 cm; p<0.05). There was a statistically significant increase in the Radoievitch angle of patients with bilateral hernias compared to unilateral hernias (p-value <0.01), as well as indirect hernias compared to other forms of hernias (p-value <0.05). Conclusion The probability of having an inguinal hernia was higher when the Fruchaud region was increased, as indicated by a larger Radoievitch angle or a longer Ami line. A low-lying pubic tubercle increased the likelihood of bilateral and indirect inguinal hernias. Pelvimetry is an easy test that should be considered on a routine basis and can be applied accurately in all patients. Surgeons can employ pelvimetry to identify patients who are more likely to benefit from non-mesh repairs.

Objectives: Sulfasalazine has been widely used in treatment of rheumatoid arthritis and spondyloarthritis. This study aims to assess persistence with sulfasalazine and also frequency and severity of adverse drug reactions (ADRs) encountered with this very well-established disease-modifying anti-rheumatoid drug.Materials and methods: This retrospective study was done in 1,114 patients from medicine and rheumatology outpatient departments of six centers across India. The inclusion criteria was patients taking sulfasalazine. Patients receiving sulfasalazine for rheumatoid arthritis or spondyloarthritis were selected and details on drugs used, duration of taking sulfasalazine, ADRs to sulfasalazine and whether sulfasalazine had to be stopped due to ADRs were analyzed.Results: Of the total of patients included in the study, 10.1% had ADRs with sulfasalazine, and stopped the drug. Gastritis, deranged liver enzymes, hepatitis, skin rashes were the most commonly encountered ADRs. Of the total number of patients recruited for the study, 11% were lost to follow-up, as most of the centers were army hospitals and the officers and staff were posted to other places. Sulfasalazine was taken for less than 1 month by 3.8% patients while 12.5% had taken the drug for less than 6 months. Of the study patients, 28.6% had taken the drug for 24 – 60 months and 4.6% (51 patients) had taken it for more than 5 years. It was found that ADRs were most commonly encountered within the first year of using the drug, and persistence was seen in patients on long-term therapy.Conclusion: Sulfasalazine is a safe option in chronic therapy of rheumatoid arthritis and spondyloarthritis. Although frequency of ADRs with patients taking sulfasalazine is minimal, it did necessitate the stoppage of drug. If not well tolerated, sulfasalazine would not have been continued for more than 12 months as evidenced from this study.

Background: Radiation plays a major role in the management of localized prostate cancer (CaP). There are limited studies reporting the quality of life (QOL) and toxicity with CaP tomotherapy. Materials and Methods: This is a single-institutional prospective observational study evaluating the acute toxicity and QOL of patients with CaP receiving tomotherapy from May 2018 to October 2019. Toxicity assessed using radiation therapy oncology group toxicity grading. QOL assessed using International Prostate Symptom Score (IPSS) and QOL score. Results: A total number of 74 patients received radiation therapy (RT), of which 25 had postoperative RT and 49 had radical RT. The median age was 71 years. During RT, 8 (10.8%) had Grade 2 gastrointestinal (GI) and 4 (5.4%) had Grade 2 genito urinary (GU) toxicities. At 3 months, 1 (1.4%) had Grade 2 GI, 1 (1.4%) had Grade 2 GU, and 1 (1.4%) had Grade 3 GU toxicities. At 6 months, 1 patient had Grade 2 GU and no Grade 2 GI toxicity noted. In postoperative RT Group, 2 (8%) Grade 2 GI and 1 (1.4%) Grade 2 genitourinary toxicity reported during radiation. At 3 months, 1 (1.4%) Grade 2 GI, 1 (1.4%) G2 GU, and 1 (1.4%) G3 GU toxicities noted. At 6 months, no ≥ Grade 2 noted. In radical RT group, during radiation 6 (12.2%) Grade 2 GI and 3 (6.1%) Grade 2 GU recorded. At 3 and 6 months, no ≥ Grade 2 GI/GU toxicity was recorded. No Grade 3/Grade 4 observed in radical RT group. One patient in radical RT and one in postoperative RT had severe IPSS symptom score. Results are comparable to reported studies. Conclusion: Our initial clinical experience with helical tomotherapy in CaP confirms lower rate of toxicities and no significant worsening of QOL with RT.

Background: Rheumatoid arthritis (RA) patients are more prone to develop neurological dysfunction; thus, it is important to recognize peripheral neuropathy in them. Since there are very few studies to exhibit the prevalence of peripheral neuropathy in newly diagnosed RA in Eastern part of India, our study will help to find out the proportion of peripheral neuropathy among newly diagnosed RA patients. Material & Methods: Sixty patients who were newly diagnosed with RA classified by ACR/EULAR criteria for RA 2010 and who had a Nerve Conduction Study done within 3 months of diagnosis were randomly selected and a retrospective observational study was done to look for presence of peripheral neuropathy. Results: 30% of study population had electrophysiologically detected peripheral neuropathy. Entrapment neuropathy was the most common type of neuropathy seen. Presence of neuropathy in RA patients is found to significantly increase with increase in DAS28 ESR score (Odd's ratio - 2.092). Disease duration and RF positivity also have association with neuropathic involvement. Conclusion: It's observed that even in early RA a significant number of patients were found to have peripheral neuropathy. Early detection of high disease activity and its treatment accordingly, or prevention of escalation of disease activity can be helpful in preventing morbidity arising from neuropathy.

Osteoporosis (OP) is being increasingly recognized in inflammatory rheumatic diseases like rheumatoid arthritis (RA). Ethnicity influences bone mineral density (BMD) and fracture risk. Due to paucity of data on this aspect of RA from Asian countries including India, we prospectively studied 84 premenopausal women with RA of at least 2 years duration and 247 healthy, age (within 5 years) and sex-matched controls. A significant difference in BMD between patients and controls was observed only at the femoral neck. As many as 22% patients with RA exhibited osteoporosis at least one site in contrast to 9% controls. Nearly 40% of patients exhibited osteopenia at all the three sites. Modified Sharp score, disease duration and DMARD naive period were found to correlate with low BMD. However, on multivariate analysis, only modified Sharp score was shown to be significantly associated with low BMD. Our study draws attention to the poor bone health in Asian Indian women with RA.

The reduced level of complement receptor 1 (CR1) on erythrocytes is speculated as a key mechanism contributing to immune complex (IC) overload and exaggerated complement (C) activation in systemic lupus erythematosus (SLE). Comparatively, fewer studies documented lower levels of CR1 on leukocytes and glomerular podocytes in this disease. The decline in E-CR1 is largely believed as an acquired phenomenon caused due to the proteolytic cleavage of CR1 from erythrocyte membrane. The mechanism underlying reduced CR1 expression on nucleated cells is under constant investigation. Recently, reduced leukocytes CR1 gene transcription had been demonstrated in SLE and was suggested as the main cause of decline in leukocyte CR1 (L-CR1). The relationship of L-CR1 gene transcription with severity and pathophysiology of disease needs to be elucidated. We determined the levels of L-CR1 in 30 active SLE patients and compared with normal healthy controls (n = 30). Patients were categorized into two groups i.e., with nephritis (n = 14) or without nephritis (n = 16). The expression of L-CR1 at transcriptional level was correlated with the levels of serum CIC, C3 and anti dsDNA antibodies. The levels of L-CR1 transcription were significantly reduced in all SLE patients as compared to controls (P, 0.001). This decline in L-CR1 however, was more marked in patients with nephritis than those without nephritis. In addition, the serum levels of CIC, anti dsDNA antibodies were higher and the levels of serum C3 were lower than the normal range in the patients. The difference was much more marked in SLE patients with nephritis than those without nephritis. The levels of L-CR1 transcription correlated negatively with the levels of CIC and anti dsDNA antibodies and positively with serum C3 levels. Thus, between SLE patients with and without nephritis, we found significant difference in the levels of L-CR1 transcription (P, 0.01), CIC (P, 0.05), anti dsDNA antibodies (P, 0.01) and C3 (P, 0.01). Our findings suggest that L-CR1 is drastically reduced in patients with severe form of SLE, i.e., lupus nephritis. Determination of L-CR1 expression at transcriptional level in addition to disease hallmarks like C3, CIC and anti-dsDNA antibodies may facilitate the assessment of severity of SLE and discrimination between patients with or without renal involvement.