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ObjectiveExpression of glial fibrillary acidic protein (GFAP), a marker of reactive astrocytosis, colocalizes with neuropathology in the brain. Blood levels of GFAP have been associated with cognitive decline and dementia status. However, further examinations at a population-based level are necessary to broaden generalizability to community settings.MethodsCirculating GFAP levels were assayed using a Simoa HD-1 analyzer in 4338 adults without prevalent dementia from four longitudinal community-based cohort studies. The associations between GFAP levels with general cognition, total brain volume, and hippocampal volume were evaluated with separate linear regression models in each cohort with adjustment for age, sex, education, race, diabetes, systolic blood pressure, antihypertensive medication, body mass index, apolipoprotein E ε4 status, site, and time between GFAP blood draw and the outcome. Associations with incident all-cause and Alzheimer's disease dementia were evaluated with adjusted Cox proportional hazard models. Meta-analysis was performed on the estimates derived from each cohort using random-effects models.ResultsMeta-analyses indicated that higher circulating GFAP associated with lower general cognition (ß = -0.09, [95% confidence interval [CI]: -0.15 to -0.03], p = 0.005), but not with total brain or hippocampal volume (p > 0.05). However, each standard deviation unit increase in log-transformed GFAP levels was significantly associated with a 2.5-fold higher risk of incident all-cause dementia (Hazard Ratio [HR]: 2.47 (95% CI: 1.52-4.01)) and Alzheimer's disease dementia (HR: 2.54 [95% CI: 1.42-4.53]) over up to 15-years of follow-up.InterpretationResults support the potential role of circulating GFAP levels for aiding dementia risk prediction and improving clinical trial stratification in community settings.

BackgroundWhether high blood pressure has a causal effect on cognitive function as early as middle age is unclear. We investigated whether high blood pressure (BP) causally impairs cognitive function at midlife using Mendelian Randomization (MR).MethodsWe applied a two-sample MR approach to investigate the causal relationship between BP and midlife cognitive performance measured by the Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), and Stroop Interference test. We used a total of 109 genetic polymorphisms with established associations with BP as instrumental variables and estimated gene-cognitive function association in 1369 middle-aged adults (Mean age (SD): 50.8 (3.3), 54.0% women) from the CARDIA study.ResultsA 10 mmHg increment in genetically-predicted systolic, diastolic, or pulse pressure was associated with a 4.9 to 7.7-point lower DSST score (P = 0.002, SBP; P = 0.005, DBP and P = 0.008, PP), while a 10 mmHg increment in genetically-predicted SBP was associated with a 0.7 point lower RAVLT and a 2.3 point higher Stroop (P = 0.046 and 0.011, respectively).ConclusionsThis MR analysis shows that high BP, especially SBP, is causally associated with poorer processing speed, verbal memory, and executive function during midlife. These findings emphasize the need for further investigation of the role and mechanisms of BP dysregulation on cognitive health in middle age and perhaps, more broadly, across the lifespan.

Dengue viral infection is a cause of considerable morbidity and mortality and may be associated with a variety of mucocutaneous manifestations that may provide important early clues to the diagnosis of this condition. Cutaneous and mucosal findings like confluent erythema, morbilliform eruptions, and hemorrhagic lesions may figure prominently in the clinical features of dengue. The differential diagnoses include a large number of bacterial and viral exanthems as well as drug rash.

Alopecia areata (AA) frequently occur in association with other autoimmune diseases such as thyroid disorders, anemias and other skin disorders with autoimmune etiology. Despite numerous studies related to individual disease associations in alopecia areata, there is paucity of literature regarding comprehensive studies on concomitant cutaneous and systemic diseases. The present study has been designed to determine if there is a significant association between alopecia areata and other autoimmune diseases. This study covers 71 patients with the diagnosis of alopecia areata as the case group and 71 patients with no evidence of alopecia areata as the control group. Among the cutaneous diseases associated with AA, atopic dermatitis (AD) showed maximum frequency with an O/E ratio of 2.5, which indicates that it is two to three times more common in patients with alopecia areata. In our study, thyroid disorders showed the highest frequency with on O/E ratio of 3.2 and a P value of 0.01, which is statistically highly significant. Among the thyroid disorders, hypothyroidism was the most frequent association (14.1%) in our study. Since systemic involvement is not infrequent in patients with alopecia areata, it is imperative to screen these patients for associated disorders, particularly atopy, thyroid diseases, anemias and other autoimmune disorders, especially if alopecia areata is chronic, recurrent and extensive.

Background: Adopting interactive teaching in dermatology will encourage the students to acquire a deeper understanding of the subject, increase attention span and retention of knowledge, and enhance self-directed learning. Aim and Objectives: To introduce Quiz as an Interactive teaching tool in dermatology and assess the perception of the undergraduate students and faculty about using quizzes in dermatology. Methodology: This prospective study was conducted in the department of dermatology. Participants are the 2nd year MBBS students. After sensitizing the students and taking informed consent, quizzes were conducted on four topics, at appropriate time intervals using the "POLL EVERYWHERE" software. During the lecture, a quiz was conducted as follows: At the beginning of the lecture (a), after 20 min (b) and at the end of the lecture (c). At the end of the 4 interactive lectures, questionnaires were provided to the students and faculty to get feedback on their perception regarding the interactive teaching sessions. The responses of the feedback forms were graded using a 5-point Likert's scale. Statistical Analysis: The data were entered in Microsoft Excel and analyzed using SPSS (Statistical Packages for the Social Sciences, software version 21.o. Armonk, NY: IBM corp). Open-ended questions were analyzed by thematic qualitative analysis and expressed as percentages. Results: About 44.6% agreed that quizzes do make dermatology more interactive. Around 53% students agreed that interactive learning helps in better retention of knowledge. All faculty perceived that interactive learning is an appropriate motivator for the undergraduate students to do self-directed learning and that quiz is an effective tool. Conclusions: Interactive teaching learning methods such as quizzes will encourage the students in the better understanding of dermatology. [ABSTRACT FROM AUTHOR]

Background: Neonatal life, as defined by the World Health Organization, constitutes the first 28 days of extrauterine life. The transition of neonatal skin from an aqueous to an air-dominant environment results in various changes, both physiological and pathological. Aims: This study was designed to find the prevalence and pattern of various physiological and pathological dermatoses as well as its relation to maternal and neonatal factors in the early neonatal period. Materials and Methods: This prospective study was done on 505 live born neonates at Christian Medical College and Hospital, Ludhiana. All consecutive live born babies and those presenting for follow-up within 7 days of birth were considered. Results: Out of 505 neonates that were examined, 284 (56.24%) were males and 221 (43.76%) were females. Physiological skin changes were seen in 460 (91.09%), the most common being physiological desquamation in 211 (41.78%) neonates followed by Milia in 199 (39.41%). Pathological changes were seen in 102 (20.20%) neonates of whom one had aplasia cutis congenita. The most common developmental abnormality was accessory nipple in 6 (1.19%) neonates. Icterus was most often seen in neonates delivered by normal vaginal delivery 134 (56.54%). Milia was more often seen in babies of multiparous mothers, 135 (67.84%) as compared to primiparous mothers. Conclusion: A good knowledge of neonatal dermatoses helps allay concerns in parents and treating physicians thereby avoiding diagnostic and therapeutic procedures, which may not be required, especially as most of the early neonatal dermatoses are transient in nature. [ABSTRACT FROM AUTHOR]

Lymphangioma circumscriptum is a microcystic lymphatic malformation localized to an area of the skin, subcutaneous tissue, and muscle which presents with vesiculo-papules or warty lesions, resembling a "frog spawn." Keloids develop due to the proliferation of dermal tissue following skin injury. We present a case of lymphangioma circumscriptum with secondary infection and keloid formation treated with intralesional bleomycin. [ABSTRACT FROM AUTHOR]

A letter to the editor and a reply are presented in response to the article "Scleromyxedema: An atypical case," by Emy Thomas and colleagues in the 2015 issue.

Background: Brain arterial diameters (BADs) are novel imaging biomarkers of cerebrovascular disease, cognitive decline, and dementia. Traditional vascular risk factors have been associated with BADs, but whether there may be genetic determinants of BADs is unknown., Methods and Results: The authors studied 4150 participants from 6 geographically diverse population-based cohorts (40% European, 14% African, 22% Hispanic, 24% Asian ancestries). Brain arterial diameters for 13 segments were measured and averaged to obtain a global measure of BADs as well as the posterior and anterior circulations. A genome-wide association study revealed 14 variants at one locus associated with global BAD at genome-wide significance ( P <5×10 -8 ) (top single-nucleotide polymorphism, rs7921574; β=0.06 [ P =1.54×10 -8 ]). This locus mapped to an intron of CNNM2 . A trans-ancestry genome-wide association study meta-analysis identified 2 more loci at NT5C2 (rs10748839; P =2.54×10 -8 ) and AS3MT (rs10786721; P =4.97×10 -8 ), associated with global BAD. In addition, 2 single-nucleotide polymorphisms colocalized with expression of CNNM2 (rs7897654; β=0.12 [ P =6.17×10 -7 ]) and AL356608.1 (rs10786719; β=-0.17 [ P =6.60×10 -6 ]) in brain tissue. For the posterior BAD, 2 variants at one locus mapped to an intron of TCF25 were identified (top single-nucleotide polymorphism, rs35994878; β=0.11 [ P =2.94×10 -8 ]). For the anterior BAD, one locus at ADAP1 was identified in trans-ancestry genome-wide association analysis (rs34217249; P =3.11×10 -8 )., Conclusions: The current study reveals 3 novel risk loci ( CNNM2 , NT5C2 , and AS3MT ) associated with BADs. These findings may help elucidate the mechanism by which BADs may influence cerebrovascular health.