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Background: The profile of thyroid disorder has been reported with limited evidence in Nepal. The aim of this study was to examine the profile and incidence of different types of thyroid disorder in patients attending a hospital appointment in Western Nepal and identify factors associated with it. Method: This was a hospital-based study. A total of 1000 patients attending the department of medicine at Gandaki Medical College, Teaching Hospital and Diabetes, Thyroid and Endocrinology Care Centre, Pokhara for thyroid examination were recruited. Thyroid disorders were classified as hypothyroidism, Hyperthyroidism, T4-thyrotoxicosis including their sub types where applicable. Results: Nearly 33% of the participants were found to have some form of thyroid disorders. Majority of the patients with thyroid disorder were females (87%). Hypothyroidism was found to be the most common type of thyroid disorder (57.5%) followed by hyperthyroidism (37.5%) and secondary hyperthyroidism (5.0%). BMI was found to be independently associated with hyperthyroidism on regression model. Conclusion: Hypothyroidism was found to be the most common thyroid disorder followed by hyperthyroidism. The findings highlight that thyroid disorder is a significant clinical burden and a major public health concern in Western Nepal. The findings also emphasise a need to roll out thyroid screening programmes in the general population so that this condition can be identified and treated early.

Background/Aim People with diabetes are at a greater risk of serious complications from Coronavirus disease (COVID-19). Self-management of diabetes is therefore of paramount importance. The purpose of this study is to compare self-management of diabetes pre-COVID-19 and during the COVID-19 pandemic. Methods 679 participants with diabetes completed an online structured questionnaire survey. Various exposure variables (demographics, duration, treatment and complications of diabetes, self-isolation, etc.) were analysed to examine associations with the following outcome variables: (i) fluctuation of blood glucose levels, (ii) access to diabetes medicine, (iii) access to healthy diet, (iv) physical activity. Adjusted multiple regression analysis ascertained significant associations for each outcome variable against exposure variables. Results Multiple regression analysis showed that self-isolation was significantly associated with greater fluctuation in blood glucose levels (OR = 1.8, 95% CI = 1.2–2.6, p = 0.005), reduced access to diabetes medicine (OR = 1.9, 95% CI = 1.1–3.1, p = 0.02) and reduced access to healthy diet (OR = 3.0, 95% CI = 2.0–4.6, p OR = 2.2, 95% CI = 1.2–3.9, p = 0.008) and reduced access to diabetes medicine was significantly higher in people who were on insulin (OR = 2.1, 95% CI = 1.3–3.3, p = 0.001). Conclusions Self-isolation was shown to impact almost all factors that influence self-management of diabetes. A targeted approach to improved access to diabetes medicine, healthy diet for people who needed to self-isolate is vital in order to ensure that they are able to self-manage their diabetes effectively.

Background People of Black and Asian ethnicities have a higher infection rate and mortality as a result of COVID‐19. It has also been reported that vitamin D deficiency may play a role in this, possibly because of the multi‐gene regulatory function of the vitamin D receptor. As a result, increased dietary intake and/or supplementation to attain adequate 25‐hydroxyvitamin D (25(OH)D) levels could benefit people in these ethnicities. The present study aimed to review the literature examining the changes in 25(OH)D in different types of vitamin D supplementation from randomised controlled trials in this population. Methods This systematic review was conducted using the PRISMA guidelines. Electronic databases were systematically searched using keywords related to vitamin D supplementation in Black and Asian ethnicities. Results Eight studies were included in the review. All the included studies found that supplementation of vitamin D (D2 and D3), regardless of dosage, increased 25(OH)D levels compared to a placebo. All trials in which participants were vitamin D deficient at baseline showed increased 25(OH)D levels to a level considered adequate. Two studies that used food fortification yielded smaller 25(OH)D increases compared to similar studies that used oral supplementation (10.2 vs. 25.5 nmol L−1, respectively). Furthermore, vitamin D2 supplementation yielded significantly lower 25(OH)D increases than vitamin D3 supplementation. Conclusions Oral vitamin D supplementation may be more efficacious in increasing 25(OH)D levels than food fortification of Black and Asian ethnicities, with vitamin D3 supplementation possibly being more efficacious than vitamin D2. It is recommended that people with darker skin supplement their diet with vitamin D3 through oral tablet modes where possible, with recent literature suggesting a daily intake of 7000–10,000 IU to be potentially protective from unfavourable COVID‐19 outcomes. As a result of the paucity of studies, these findings should be treated as exploratory., Highlights Oral vitamin D supplementation could be more efficacious than food fortification in Black and Asian populations.Vitamin D3 is more efficacious than vitamin D2.It is recommended that people with darker skin supplement their diet with vitamin D3.

ObjectiveGeographic atrophy (GA), a type of dry age-related macular degeneration, affects vision as central vision loss (CVL). The challenges faced due to bilateral CVL in activities of daily living and strategies taken to overcome those challenges are not very well understood in the Indian population. This qualitative study aims to understand the impact on everyday life activities and related adaptive and coping strategies in people with long-standing bilateral CVL due to GA in India.Design, participants, setting and methodsA qualitative study using a semistructured face-to-face interview was conducted on 10 people with bilateral CVL after obtaining written informed consent. The interviews were audio-recorded, and were transcribed verbatim. Thematic analysis was carried out to understand the challenges faced and adaptive methods due to the impact of CVL.ResultsTen participants (50% male) with a median age (IQR) of 72 (70, 74) years were interviewed. All the participants had best-corrected visual acuity of ≤6/60 in the better eye and reported an absolute central scotoma with the home Amsler chart. Qualitative thematic analysis identified four main themes: challenges in everyday living (difficulty in face identification, reading), challenges with lifestyle and socialisation (driving, cooking, reading for a longer duration, watching TV, socially inactive), psychological implications (depression, poor self-esteem, fear due to poor vision) and strategies to overcome the challenges (voice identification, technology support).ConclusionGA has a severe negative impact on the quality of life in people with CVL. Inability to recognise faces was the main reason for dependency on others and being socially disconnected. The findings will help clinicians in providing improved rehabilitative care.

Objective: Age-related impairments in human visual short-term memory (VSTM) may reflect a reduced ability to retain bound object representations, viz., object form, name, spatial, and temporal location (so called ‘memory sources’). Our objective is to examine how healthy aging affects VSTM in a battery of memory recognition tasks in which sequentially presented objects, locations, and names (as auditory stimuli) were learned, with one component cued at test. Methods: Thirty-six young healthy adults (18-30 years) and 36 normally aging older adults (>60 years with no underlying health and vision issues) completed five VSTM tasks: 1. Object recognition for two or four objects; 2. Spatial location recognition for two or four objects; 3. Bound object-location recognition for two or four objects; 4. Object recognition with location priming for two or four objects; 5. Bound name (auditory)-location (cross-modal) recognition for four objects. Results: Significantly lower performance for older adults was found in spatial location recognition [task 2, p=0.03, 2 (memory loads) × 2 (age groups) ANOVA], bound object-location recognition [task 3, p˂0.001, 2 (memory loads) × 2 (age groups) ANOVA], object recognition with location priming [task 4, p=0.02, 2 (memory loads) × 2 (age groups) ANOVA], and bound name-location recognition [task 5, p=0.001, independent samples t-test] tasks. A significant age group-task interaction was found (p =0.02) Conclusion: Performance for all tests except test 1 was impaired in older adults. Lower performance for older adults was most significant in VSTM tasks requiring object-location (visual only) or name-location (auditory and visual) binding. The findings are compatible with the ‘memory source’ model, demonstrating that age-related binding performance is influenced by spatial coding and location priming deficits.

Aim: To determine whether barriers to diabetes awareness and self-help differ in South Asian participants of different demographic characteristics (age, gender, and literacy) with type 2 diabetes living in the United Kingdom.\ud \ud Methods: Six focus group discussions (FGDs) were carried out in patients who were categorized according to age (30-60 years, ≥60 years), gender (male, female) and literacy status (literate, illiterate). Data were analysed following the iterative process of thematic analysis techniques.\ud \ud Results: Barriers were demographic-specific. The illiterate groups reported language as the major barrier to improved diabetes awareness and self-help. The literate groups reported that information provided by healthcare providers was general, and not specific to their diet/culture. Major barriers to adherence to the recommended diet for diabetes included: insufficient knowledge/awareness about nutritional content of food (all groups); lack of self-will to resist eating sweets, especially during weddings/festivals (literate older groups/literate younger females/illiterate older males); difficulty cooking separate meals for diabetic and non-diabetic family members (illiterate/literate older females). Other barriers to seeking advice/help ranged from not wanting to disclose their diabetes as it may affect employment/work (literate groups) to fear of being singled out at social gatherings (illiterate groups). General lack of motivation to exercise was reported by all groups. Time constraints and not knowing what/how to exercise was reported by literate younger groups whilst the illiterate older groups reported to not having suitable exercising facilities at local communities. Different barriers were also reported when accessing healthcare; language barriers (illiterate groups), restricted access to doctors’ appointments/difficulty attending specific appointment slots offered by General Practitioners (literate females).\ud \ud Conclusion: Different barriers exist to improved awareness about diabetes and self-help in different patient demographics. Lack of culturally appropriate diabetes educational/awareness programs in the community appeared to be a major barrier in most older and illiterate participants while younger participants reported time constraint.

Background: Early cognitive changes in people at risk of developing dementia may be detected using behavioral tests that examine the performance of typically affected brain areas, such as the hippocampi. An important cognitive function supported by the hippocampi is memory binding, in which object features are associated to create a unified percept. Aim: To compare visual short-term memory (VSTM) binding performance for object names, locations, and identities between a participant group known to be at higher risk of developing dementia (mild cognitive impairment [MCI]) and healthily aging controls. Methods: Ten MCI and 10 control participants completed five VSTM tests that differed in their requirement of remembering bound or unbound object names, locations, and identities, along with a standard neuropsychological test (Addenbrooke’s Cognitive Examination [ACE]-III). Results: The performance of the MCI participants was selectively and significantly lower than that of the healthily aging controls for memory tasks that required object-location or name-location binding. Conclusion: Tasks that measure unimodal (object-location) and crossmodal (name-location) binding performance appear to be particularly effective for the detection of early cognitive changes in those at higher risk of developing dementia due to Alzheimer’s disease.

Abstract. Numerous kinds of visual event challenge our ability to keep track of the objects that populate our visual environment from moment to moment. These include blinks, occlusion, shifting visual attention, and changes to object’s visual and spatial properties over time. These visual events may lead to objects falling out of our visual awareness, but can also lead to unnoticed changes, such as undetected object replacements and positional exchanges. Current visual memory models do not predict which visual changes are likely to be the most difficult to detect. We examine the accuracy with which switches (where two objects exchange locations) and substitutions (where one or two objects are replaced) are detected. Inferior performance for one-object substitutions versus two-objects switches, along with superior performance for two-object substitutions versus two-object switches was found. Our results are interpreted in terms of object file theory, trade-offs between diffused and localized attention, and net visual change.

Background/aimsTo examine the profile of diabetic retinopathy, awareness and self-help in patients attending a specialist eye clinic in Hangzhou, China.MethodsA total of 199 consecutive patients with diabetes (mean age = 57 years, SD = 11) attending eye clinic at the School of Medicine, Zhejiang University, Hangzhou were examined in a cross-sectional study. Clinical/demographic data were obtained from patients’ records. Fundus photographs obtained from each patient were graded using Early Treatment of Diabetic Retinopathy Study (ETDRS) criteria; severe non-proliferative, proliferative retinopathy and/or macular oedema (hard exudates/thickening around fovea) were classified as sight-threatening diabetic retinopathy (STDR). Optical coherence tomography was used to confirm the diagnosis of macular oedema. Data on knowledge/awareness about diabetes and self-help/lifestyle were collected using a structured questionnaire.ResultsSTDR was found in 80% patients of whom 18% had visual acuity of ≤counting fingers in at least one eye. Male gender, longer diabetic duration and use of insulin were significantly associated with STDR (p ≤ 0.05). Of the total, 41% patients reported that they were attending for the first time. Of all the first-time attendees, 67% had STDR. Also of all the first-time attendees, 14% were unclear whether diabetes affected their eyes. Fifty-one per cent of patients who thought their diabetes was well controlled had fasting blood sugar ≥6.5 mmol/L (p < 0.001). Of the total, 65% patients reported not doing ≥4 hours/week of physical exercise.ConclusionsThe majority of patients with diabetes presented to this eye clinic suffered with late-stage retinopathy. Our results advocate the need to improve diabetic diagnosis, management and awareness and to set up eye screening for diabetics in Hangzhou, China.

Harmful effects of ultraviolet (UV) and blue-violet light manifest differently in the human eye. Cumulative exposure to blue-violet light has been linked with the development of age-related macular degeneration (AMD). This article highlights the potential hazards of exposure to UV and blue-violet light, and summarizes some of the commonly prescribed protective/preventative measures.

Visual short-term memory (VSTM) is a limited-capacity system that holds a small number of objects online simultaneously, implying that competition for limited storage resources occurs (Phillips, 1974). How the spatial and temporal proximity of stimuli affects this competition is unclear. In this 2-experiment study, we examined the effect of the spatial and temporal separation of real-world memory targets and erroneously selected nontarget items examined during location-recognition and object-recall tasks. In Experiment 1 (the location-recognition task), our test display comprised either the picture or name of 1 previously examined memory stimulus (rendered above as the stimulus-display area), together with numbered square boxes at each of the memory-stimulus locations used in that trial. Participants were asked to report the number inside the square box corresponding to the location at which the cued object was originally presented. In Experiment 2 (the object-recall task), the test display comprised a single empty square box presented at 1 memory-stimulus location. Participants were asked to report the name of the object presented at that location. In both experiments, nontarget objects that were spatially and temporally proximal to the memory target were confused more often than nontarget objects that were spatially and temporally distant (i.e., a spatiotemporal proximity effect); this effect generalized across memory tasks, and the object feature (picture or name) that cued the test-display memory target. Our findings are discussed in terms of spatial and temporal confusion "fields" in VSTM, wherein objects occupy diffuse loci in a spatiotemporal coordinate system, wherein neighboring locations are more susceptible to confusion. (PsycINFO Database Record

Visuo-manual interaction in visual short-term memory (VSTM) has been investigated little, despite its importance in everyday tasks requiring the coordination of visual perception and manual action. This study examines the influence of a manual action performed during stimulus learning on a subsequent VSTM test for object appearance. The memory display comprised a sequence of briefly presented 1/f noise discs (i.e., possessing spectral properties akin to natural images), wherein each new stimulus was presented at a unique screen location. Participants either did (or did not) perform a concurrent manual action (spatial tapping) task requiring that a hand-held stylus be moved to a position on a touch tablet that corresponded (or did not correspond) to the screen position of each new stimulus as it appeared. At test, a single stimulus was presented, either at one of the original screen positions, or at a new position. Two factors were examined: the execution (or otherwise) of spatial tapping at a corresponding or non-corresponding position, and the presentation of test stimuli either at their original spatial positions, or at new positions. We find that spatial tapping at corresponding positions elevates VSTM performance by more than 15%, but this occurs only when stimulus positions are matched from memory to test display. Our findings suggest that multimodal attentional focus during stimulus encoding (incorporating visual, spatial, and manual components) leads to stronger, more robust memory representations. We posit several possible explanations for this effect.

The role of extrafoveal information in visual short-term memory has been investigated relatively little, and, in most existing studies, using verbalisable stimuli susceptible to the recruitment of long-term memory (LTM). In addition, little is known about the impact of extrafoveal information available pre- and posttarget foveation, as it is typical to provide extrafoveal information prior to the foveation of memory targets. In this study, two object-position recognition experiments were conducted (each with two conditions) to establish the impact of extrafoveal information provided before and after the foveation of memory targets. Stimuli comprised 1/f noise discs that minimised the recruitment of LTM by eliminating verbal and semantic cues. Overall, a greater hit rate was found where extrafoveal information was available; however, performance analyses in which extrafoveal information was considered relative to the temporal lag at which target stimuli were foveated reveals both costs and benefits. A bene...

Objective/introductionIt is known that knowledge, awareness, and practice influence diabetic control. We compared factors pertaining to healthy lifestyle (exercising, avoiding smoking), self-help (attending appointments, following treatment regimens), and diabetic awareness in high-risk patients for diabetic complications, specifically, those on insulin versus non-insulin treatment, and also those with a longer diabetic duration (≥5 years) versus a shorter duration.Methods200 consecutive patients with type 2 diabetes (52.0±11.6 years) attending diabetic clinic at a referral hospital in Nepal were recruited. A structured questionnaire explored non-clinical parameters including age, gender, diabetic duration, awareness about diabetes control, self-help, and lifestyle. Clinical data were also measured: HbA1c, fasting blood sugar (FBS), blood pressure, and treatment type (insulin, diet/tablet).ResultsA significantly higher proportion of patients on insulin (vs non-insulin) or with diabetic duration ≥5 years (vs ConclusionPoor self-help/lifestyle and reduced knowledge/awareness about diabetic control was found in patients on insulin or with longer diabetic duration. This is a worrying finding as these patients are already at high risk for developing diabetic complications. The findings highlight need for targeting this more vulnerable group and provide more support/diabetic educational tools.

This study examines how normal aging affects the occurrence of different types of incorrect responses in a visual short-term memory (VSTM) object-recall task. Seventeen young (Mean = 23.3 years, SD = 3.76), and 17 normally aging older (Mean = 66.5 years, SD = 6.30) adults participated. Memory stimuli comprised two or four real world objects (the memory load) presented sequentially, each for 650 ms, at random locations on a computer screen. After a 1000 ms retention interval, a test display was presented, comprising an empty box at one of the previously presented two or four memory stimulus locations. Participants were asked to report the name of the object presented at the cued location. Errors rates wherein participants reported the names of objects that had been presented in the memory display but not at the cued location (non-target errors) vs. objects that had not been presented at all in the memory display (non-memory errors) were compared. Significant effects of aging, memory load and target recency on error type and absolute error rates were found. Non-target error rate was higher than non-memory error rate in both age groups, indicating that VSTM may have been more often than not populated with partial traces of previously presented items. At high memory load, non-memory error rate was higher in young participants (compared to older participants) when the memory target had been presented at the earliest temporal position. However, non-target error rates exhibited a reversed trend, i.e., greater error rates were found in older participants when the memory target had been presented at the two most recent temporal positions. Data are interpreted in terms of proactive interference (earlier examined non-target items interfering with more recent items), false memories (non-memory items which have a categorical relationship to presented items, interfering with memory targets), slot and flexible resource models, and spatial coding deficits.

Visuo-manual interaction in visual short-term memory (VSTM) has been investigated little, despite its importance in everyday tasks requiring the coordination of visual perception and manual action. This study examines the influence of a manual action performed during stimulus learning on a subsequent VSTM test for object appearance. The memory display comprised a sequence of briefly presented 1/f noise discs (i.e., possessing spectral properties akin to natural images), wherein each new stimulus was presented at a unique screen location. Participants either did (or did not) perform a concurrent manual action (spatial tapping) task requiring that a hand-held stylus be moved to a position on a touch tablet that corresponded (or did not correspond) to the screen position of each new stimulus as it appeared. At test, a single stimulus was presented, either at one of the original screen positions, or at a new position. Two factors were examined: the execution (or otherwise) of spatial tapping at a corresponding or non-corresponding position, and the presentation of test stimuli either at their original spatial positions, or at new positions. We find that spatial tapping at corresponding positions elevates VSTM performance by more than 15%, but this occurs only when stimulus positions are matched from memory to test display. Our findings suggest that multimodal attentional focus during stimulus encoding (incorporating visual, spatial, and manual components) leads to stronger, more robust memory representations. We posit several possible explanations for this effect.

The effect of spatial position on visual short-term memory (VSTM) for sequentially presented objects has been investigated relatively little, despite the fact that vision in natural environments is characterised by frequent changes in object position and gaze location. We investigated the effect of reusing previously examined spatial positions on VSTM for object appearance. Observers performed a yes – no recognition task following a memory display comprising briefly presented 1/ f noise discs (ie possessing spectral properties akin to natural images) shown sequentially at random coordinates. At test, single stimuli were presented either at original spatial positions, new positions, or at a fixed central position. Results, interpreted in terms of appearance and position preview effects, indicate that, where original spatial positions were reused at test, memory performance was elevated by more than 25%, despite that spatial position was task-irrelevant (in the sense that it could not be used to facilitate a correct response per se). This study generalises object – spatial-position binding theory to a sequential display scenario in which the influences of extrafoveal processing, spatial context cues, and long-term memory support were minimised, thereby eliminating the hypothesis that object priming is the principal cause of the ‘same-position advantage’ in VSTM.

Purpose: Visual short-term memory (VSTM) for briefly presented visual stimuli has been estimated at 4–6 items for real-world objects (Luck and Vogel, 1997). To measure the fundamental capacity of VSTM the use of real-world objects is undesirable, since estimates are confounded by verbal descriptors and/or long-term memory support (Olsson and Poom, 2005). The purpose of this study is to measure the accuracy and capacity of VSTM for unfamiliar, non-categorical visual stimuli. Method: Stimuli were random grayscale noise patterns subtending 2°× 2, displayed at a distance of 57 cm. A series of reference stimuli were presented sequentially at the centre of a computer display for 500 ms each. Following this, a blank interval of 500 ms, and then a test stimulus were displayed. Signal present test stimuli originated from a random index in the study series. The probability of a signal present trial was 50%. Observers were instructed to indicate, via a numeric keypad, if the test stimulus was present in the study series (yes/no). Series length was increased from 1 to 5 across blocks of trials. The number of blocks completed for each series length, S, was 2S, where each block comprised 100 trials (i.e. 3000 trials per observer were completed). Four normal/corrected-to-normal observers participated in the study. The number of objects encoded in VSTM was calculated using Cowan's formula (Cowan, 2001). Results: Across series lengths 1–5, average performance rate (pooled across observers) decreased exponentially from 95% for series length 1, to 60% for series length 5. The number of stimuli encoded in VSTM, determined using Cowan's formula, was found to be 1.52, achieved for series length 3. Beyond series length 3, the number of items encoded was found to decrease, at 0.92, 1.30, 1.52, 1.35 and 1.40 for series lengths 1–5, respectively. For series lengths > 1, large recency effects were found by analysis of the reference indices of correctly identified signal present test stimuli. Conclusions: We find that the capacity of VSTM for serially presented non-categorical visual stimuli is limited to 1.5 items, in line with VSTM capacity estimates of Olsson and Poom (2005), rather than the more commonly cited 4–6 items (Cowan, 2001; Luck and Vogel, 1997), and is seen to decrease exponentially with increases in series length or decreases in recency. A suite of related experiments are underway to construct a memory performance model under varying stimulus presentation scenarios, including parallel display and variable location.