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Background: The economic burden of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) in India is significant. Aim: To estimate the cost of illness (COI) and out-of-pocket expenditure of AS and RA among patients on conventional disease-modifying antirheumatic drugs. Methodology: A retrospective, cross-sectional study on 87 participants using a prevalence-based, bottom-up approach and the human capital method was adopted to calculate the direct and indirect costs of RA and AS. Results: The average COI for patients with RA was estimated to be ₹51,741 person per year, whereas the COI for patients with AS was ₹41,379 per person per year (Consumer Price Index 2021: 134.44). Direct cost was the major contributor to COI constituting 65.21% [₹33,743] and 58.84% [₹24,348] of the total COI of RA and AS, respectively. Increasing disease severity, longer duration of illness and increasing impairment of daily activities were significantly associated with increasing COI of both RA and AS. The main expense towards annual direct costs per year in patients with RA was medication expenses, whereas for patients with AS, it was investigation expenses. Out-of-pocket spending was significant as nearly half (54.95%) of the direct expenditure on health for both RA [₹18,544] and AS (39.2%) [₹9,544] was borne by patients themselves. RA and AS caused catastrophic health expenditure in 14.92% and 6.67% of households, respectively. Indirect costs of RA and AS were ₹17,998 and ₹17,030, respectively. Indirect costs of RA and AS increased as productivity at work decreased. Average overall work productivity impairment and overall activity impairment reached close to 50% and was comparable for RA and AS. Conclusion: The economic burden of RA and AS is significant. There is an urgent need to prioritise policies and interventions for management of rheumatological conditions. [ABSTRACT FROM AUTHOR]

Objectives: Post-coronavirus disease 2019 (COVID-19) symptoms were widely reported. However, data on post-COVID-19 conditions following infection with the Omicron variant remained scarce. This prospective study was conducted to understand the prevalence, patterns, and duration of symptoms in patients who had recovered from COVID-19. Methods: A prospective study was conducted across 11 districts of Delhi, India, among individuals who had recovered from COVID-19. Study participants were enrolled, and then returned for post-recovery follow-up at 3 months and 6 months interval. Results: The mean age of study participants was 42.07 years, with a standard deviation of 14.89 years. The majority of the participants (79.7%) reported experiencing post-COVID-19 symptoms. The most common symptoms included joint pain (36.0%), persistent dry cough (35.7%), anxiety (28.4%), and shortness of breath (27.1%). Other symptoms were persistent fatigue (21.6%), persistent headache (20.0%), forgetfulness (19.7%), and limb weakness (18.6%). The longest duration of symptom was observed to be anxiety (138.75±54.14 days), followed by fatigue (137.57±48.33 days), shortness of breath (131.89±60.21 days), and joint pain/swelling (131.59±58.76 days). At the first follow-up visit, 2.2% of participants presented with abnormal electrocardiogram readings, but no abnormalities were noticed during the second follow-up. Additionally, 4.06% of participants exhibited abnormal chest X-ray findings at the first followup, which decreased to 2.16% by the second visit. Conclusion: The most frequently reported post-COVID-19 symptoms were joint pain, dry cough, anxiety and shortness of breath. These clinical symptoms persisted for up to 6 months, with evidence of multi-system involvement. Consequently, findings highlighted the need for long-term follow-up during the post-COVID-19 period. [ABSTRACT FROM AUTHOR]

Both Takayasu arteritis (TAK) and ulcerative colitis (UC) are uncommon diseases with diverse pathophysiological and clinical features. Their occurrence in the same patient is highly unusual and interesting. We describe the case of a 32-year-old female with UC who developed TAK, 4 years after the initial diagnosis. She was also found to have the HLA subtype B52 which has been commonly reported in these two conditions. We discuss the similarities and differences in clinico-epidemiological, pathophysiological, and genetic features of TAK and UC. We also performed a literature search and reviewed similar case reports and case series of co-occurrence of TAK and UC, between 2010 and 2021. [ABSTRACT FROM AUTHOR]

Background: Nail fold capillaroscopy (NFC) is mainly used in connective tissue diseases (scleroderma, mixed connective tissue disease, and inflammatory myositis). It is not used routinely in the evaluation of diabetic patients and no specific patterns of nail fold capillary changes have been established in diabetes. We studied morphological patterns of nail fold capillaries by video capillaroscope in diabetic patients and their association with diabetic retinopathy (DR). Methods and Material: Fifty diabetics were recruited after informed consent. The mean age of patients was 49.5 ± 10.6 years. Seventeen patients had DR. Capillary length, capillary density, and various morphological parameters were assessed and these parameters were compared between patients with DR and without DR. Results: The most frequent NFC morphological alterations, among diabetics as a group, were tortuous capillaries (56%), giant capillaries (46%), and cross-linked capillaries (44%). Overall, mean nail fold capillary length was reduced in diabetic patients. When individual morphological alterations were compared in patients with DR versus without DR, statistically significant differences were seen for presence of giant capillaries, tortuous capillaries, and avascular areas. On further analysis, mean nail fold capillary length and mean nail fold capillary density were also significantly lesser in patients with DR versus without DR. Conclusions: The presence of nail fold capillary morphological abnormalities among diabetics and a significant association with microangiopathic changes in the retina suggest that microvascular changes can be detected early using a simple, non-invasive office-based method of NFC. More large-scale studies in the future can establish a characteristic pattern for diabetes as seen in systemic sclerosis so that microvascular changes in diabetics can be detected at the earliest with the simple noninvasive method by using NFC. [ABSTRACT FROM AUTHOR]

The venereal disease research laboratory (VDRL) test, a nontreponemal test for syphilis, may under a certain set of conditions give false positive results in patients who are not infected with Treponema pallidum. A false positive reaction is defined as a positive reaction to nontreponemal tests, and a negative reaction to treponemal tests, in the serum of a patient who has no history or clinical evidence of syphilis or other treponematosis. A prozone phenomenon in nontreponemal tests is seen largely with secondary syphilis due to high-titer samples that show nonreactive results unless the specimens are diluted. We report here perhaps the first case of lepromatous leprosy, which had a false positive reaction to the VDRL test with the prozone phenomenon. The case initially presented to the outpatient clinic with complaints of epistaxis with nasal stuffiness. The finding of septal perforation on nasal endoscopy is what led to the initial suspicion of syphilis and the subsequent syphilis workup. It was only when the false positive reaction to VDRL test with the prozone phenomenon was noted that the search for other causes was made, which eventually lead to the diagnosis of lepromatous leprosy. [ABSTRACT FROM AUTHOR]

Introduction: Nature of disease, poor working conditions, prolonged work duration, stigma, and discrimination in the community have worsened the well-being of health care professionals in COVID-19. This survey is conducted to understand the quality of life and its key determinants among health care workers (HCWs) during the COVID-19 pandemic in a low middle-income country like India. Methodology: A cross-sectional study using a Google form-based online questionnaire survey was planned at two COVID dedicated centers of New Delhi. A convenience sample of 300 HCWs involved in patient care at the study sites was studied using an SF-36 questionnaire for quality of life assessment and a self-made questionnaire (risk exposure assessment). Results: In the study, 61.0% were males and 40.72% were females across all specialties. The majority (77%) were single and 81.4% were from the age group of 20 to 30 years. 84% of the study subjects belonged to clinical specialties. Nearly 56% of study subjects reported being not satisfactory or uncomfortable in the personal protective equipment (PPE). Shortage of PPE was reported by 10% of study subjects. The majority (82.35%) of study subjects were satisfied with the quality of PPE. Satisfaction of the study subjects was less than satisfactory among food provided, accommodation, and transport facilities. Social isolation (70.5%) and lockdown restraints (57.6%) were reported by the majority of study subjects. The median score for the domain of general vitality was 55, for the emotional domain was 33, and for social was 62. The domains of quality of life were not significantly affected by place of work, discipline, age, sex, and type of work. Conclusion: The overall well-being of HCWs was affected during the pandemic mostly across mental, social, and general vitality domains. Social isolation was a key concern reported by the majority of HCWs. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a multisystem disease with dominant pulmonary involvement (90%). Isolated extrapulmonary involvement is less common. Skeletal muscle (1-2%) involvement is even rare. We report a 40 year old lady presented with easy fatigability, low grade fever for 5-6 months and generalized myalgias. Examination revealed pallor, a receding hair line, hepatomegaly and proximal muscle weakness. Investigations revealed anemia, hypercalcemia and raised serum ACE level. During hospital stay patient developed right sided hemiparesis (acute vasculitic infarct in left parietal cortex). A FDG-PET scan was done which revealed that the muscles of upper and lower limbs showed diffuse, heterogenous areas of increased FDG avidity suggestive of myositis. Final diagnosis of extrapulmonary sarcoidosis (presenting as myositis along with CNS vasculitis and hypercalcemia) was made. Patient showed marked improvement in her symptoms with immunosuppressive therapy. This case is a rare manifestation of extrapulmonary sarcoidosis and emphasizes the role of FDG-PET in diagnosing these cases. [ABSTRACT FROM AUTHOR]

Introduction: Autonomic Neuropathy (AN), found to be a strong predictor of sudden cardiac death, has been reported variably in patients with Rheumatoid Arthritis (RA). Manifesting as sweating disturbances, gastrointestinal irregularities, bladder or erectile dysfunction, AN can significantly affect a patient's quality of life and alter the course of the disease. Aim: This study was undertaken to find out the prevalence and severity of AN in RA patients attending the Rheumatology Clinic at a Tertiary Care Hospital in New Delhi, India and also to investigate its correlation with patient and disease factors such as age, gender, disease severity, duration and serological status. Materials and Methods: In this cross-sectional study, AN was assessed subjectively by a survey of autonomic symptoms. Cardiac autonomic involvement was assessed by five cardiovascular reflex tests as described by Ewing: Heart Rate (HR) response to deep breathing, standing, and Valsalva and Blood Pressure (BP) response to standing and sustained handgrip. Results: A total of 31 RA patients and 31 age and sex matched healthy volunteers were recruited. Upon analysis it was found that the prevalence of cardiac AN was significantly higher in patients (80.65%) as compared to controls (51.61%) (p=0.016). Positive correlation with disease severity was observed with the patient reported questionnaire but not with the objective cardiovascular reflex tests. No significant correlation between grade of AN and patient's age, gender, disease duration or serological status was established. Conclusion: At the end of the study, it was concluded that the pathological mechanisms responsible for autonomic dysfunction are more active in RA as compared to others. [ABSTRACT FROM AUTHOR]

We report the case of a 25-year-old woman with tetralogy of Fallot who presented with chest pain and hypertension, and on further investigation, was diagnosed with a pheochromocytoma in the right adrenal gland. She underwent surgical excision of the tumor. While the simultaneous occurrence of these two diseases is extremely rare, the suspicion of a possible relationship has been raised in the past. [ABSTRACT FROM AUTHOR]

Combined arterial and venous thrombosis in patients with ulcerative colitis is a rare extra vascular manifestation, which motivated the current report. Increased coagulability is a recognised feature of ulcerative colitis with frequency increasing during flares. We report the case of a 42-year-old lady who was a diagnosed case of ulcerative colitis, currently in remission. She presented with swelling followed by discolouration of left lower limb which later was diagnosed as deep venous thrombosis combined with femoral and popliteal artery thrombosis. This led to wet gangrene of the limb, sepsis, septic shock and death despite aggressive management with heparin infusion, ionotropes, and parenteral antibiotics therapy. [ABSTRACT FROM AUTHOR]

Transdermal drug-delivery systems (TDDS) offer an attractive alternative to the oral route for delivery of biotherapeutics. Technological advancements in the past few decades have revolutionized the fabrication of micro-structured devices including creation of microneedles (MC). These devices are used for delivering peptides, macromolecules such as proteins and DNA, and other therapeutics through the skin. Here, we review the current use of MCs as a cost effective method for the self-administration of therapeutics. We will then review the current and common use of MCs as an effective treatment strategy for a broad range of diseases and their utility in the generation of effective vaccination delivery platforms. Finally, we will summarize the currently FDA approved MCs and their applications, along with the ongoing clinical trials that use such devices.

Objectives: To estimate the prevalence of non-alcoholic fatty liver disease (NAFLD) by ultrasonography, and to correlate NAFLD with coronary artery disease (CAD) and coronary risk factors in a group of Indian type 2 diabetics., Methods: Consecutive patients of type 2 diabetes were recruited. History and physical examination were recorded. Laboratory investigations included fasting and 2-hour post-prandial blood glucose, blood urea, serum creatinine, liver function tests, lipid profile, glycated haemoglobin, microalbuminuria, and ultrasonographic measurement of carotid intimal-medial thickness (CIMT). NAFLD was diagnosed on the basis of ultrasound assessment of the liver., Results: The study group (n=124) was divided into a NAFLD group (n=71) and a non-NAFLD group (n=53). The prevalence of NAFLD was 57.2%. CAD was more prevalent in the NAFLD subgroup (60.5%) compared to the non-NAFLD subgroup (45.2%). The NAFLD subgroup had higher prevalence of hypertension, smoking, obesity (measured by BMI), central obesity (measured by waist circumference and waist hip ratio), higher HbAlc, higher triglyceride levels and lower HDL levels, and higher mean CIMT. Using binary logistic regression analysis, it was found that hypertension (p=0.013), LDL cholesterol (p=0.049), microalbuminuria (p=0.034) and NAFLD (p=0.016) were significantly correlated with CAD., Conclusion: Among type 2 diabetics, NAFLD clusters with traditional coronary risk factors. It is a surrogate and fairly reliable marker of risk for CAD amongst type 2 diabetic patients. Ultrasonographically detected NAFLD is a simple, cheap, and safely assessable parameter for coronary risk stratification in type 2 diabetics.