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Darier disease (DD), also known as keratosis follicularis or dyskeratosis follicularis, is a rare autosomal dominant genodermatosis with high penetrance and variable expressivity. It is caused by mutations of ATP2A2 gene which encodes the sarco/endoplasmic reticulum Ca2+ ATPase isoform 2. It is clinically manifested by hyperkeratotic papules primarily affecting seborrheic areas on the head, neck and thorax, with less frequent involvement of the oral mucosa. When oral manifestations are present, they primarily affect the palatal and alveolar mucosa, are usually asymptomatic and are discovered in routine dental examination. Histologically, the lesions show suprabasal clefts with acantholytic and dyskeratotic cells. We present a case of 35-year-old female patient with typical clinical and histological features of DD.

Aims and methodDispensing of methadone to individuals with opioid dependence is a discretionary service and many independent pharmacies remain unwilling to do this. We aimed to determine whether there was any correlation between negative stigmatised attitude towards these individuals and the likelihood of methadone dispensing. The 20-point Attitude to Mental Illness Questionnaire (AMIQ) was used to assess stigmatised attitudes in a cluster randomised sample of managers of community pharmacies in England.ResultsThe response rate was 66%. The AMIQ stigma scores had a median difference of 1 and effect size of 0.42 in favour of those pharmacies which dispensed methadone (mean = 0.53; n = 138) compared with those who did not (mean = 0.93; n = 69; P <0.001).Clinical implicationsThe results show a clear behavioural distinction (discrimination) based on stigmatised attitudes towards individuals with opioid dependence. This may arise because managers with stigmatised attitudes refuse to dispense methadone to this group. Conversely, familiarity with these individuals may have a de-stigmatising effect.

Background:The global prevalence of type 2 diabetes continues to rise. Interest has been increasing recently in noninvasive diagnostic procedure. Hence, an attempt has been made by the present study to analyze the changes in cytomorphometry in exfoliated buccal and gingival mucosa cells in type 2 diabetic patients.Aim:The aim of this study was to analyze the cytomorphometric changes in exfoliated cells of gingiva and buccal mucosa as an adjunct to diagnosis of diabetes.Materials and Methods:In the present study, fifty known type 2 diabetic patients were taken as study group, and the control group was comprised of fifty healthy individuals. Smear was prepared from buccal mucosa and gingival epithelium of both study and control groups and was stained by rapid Papanicolaou (Pap) stain. Stained smears were subjected to cytomorphometric analysis using Lynx Biolux (Lawrence and Mayo) image analysis software. In each Pap smear, 100 cells were evaluated for nuclear area (NA), cytoplasmic area (CA) and cytoplasm to nuclear ratio (CNR).Results:Mean NA was significantly higher (P < 0.05) in study group whereas mean CA did not exhibit any statistically significant difference (P > 0.05). The mean CNR was significantly lower in the study group (P < 0.05).Conclusion:This study contributes to the general understanding of the alterations in the cellular pattern of buccal and gingival mucosa cells in diabetic patients and can be used as an additional tool to aid in the evaluation of oral mucosal alterations in diabetes mellitus.

Objective: Social distancing to limit COVID-19 transmission has led to extensive lifestyle changes, including for people with dementia (PWD). The aim of this study, therefore, was to assess the impact of lockdown on the mental health of PWD and their carers. Methods: Forty-five carers of PWD completed a telephone interview during the baseline assessment of the SOLITUDE study to gather information on life conditions and changes in symptoms of PWD during lockdown. Associations between changes in symptoms of PWD and carers’ concerns and mental health were investigated. Results: About 44% of carers experienced anxiety and irritability and reported changes in behavioural and cognitive symptoms in PWD. These changes were associated with worse carers’ mental health and concerns about faster disease progression (χ2 = 13.542, p < 0.001). Conclusion: COVID-19-related social isolation has had a negative impact on patients’ and carers’ mental health. Potential long-term neurocognitive consequences require further investigation.

Background:Lipids are major cell membrane components essential for various biological functions including cell growth and division of normal and malignant tissue. They are also required for maintenance of structural and functional integrity of all biological membranes. Alteration in the plasma lipid profile has been associated with a variety of cancers and precancerous conditions including those of the head and neck region.Aim:The present study aimed to evaluate the alteration in plasma lipid profile in oral submucous fibrosis (OSF) patients.Materials and Methods:A total of 30 patients were included in the study, 20 with oral submucous fibrosis and 10 healthy controls. Fasting plasma lipid profile including Total Cholesterol (TC), Very Low Density Lipoproteins (VLDL), Low Density Lipoproteins (LDL), High Density Lipoproteins (HDL) and Tri-Glycerides (TG) were measured using semiautomatic analyser. The data obtained were analysed using independent sample ‘t’ test.Results:A statistically significant decrease in plasma total cholesterol, LDL and HDL was observed in patients with OSMF as compared to the controls, but it was not statistically significant for VLDL and TG values.Conclusion:The results of the present study show that there is an inverse relationship between lipid profile and the presence of oral submucous fibrosis. Hence, alteration in plasma lipid profile may have a diagnostic role in the future and can be used as a biochemical indicator to detect the initial changes seen in the neoplastic process.

Objective: Chronic kidney disease (CKD) is increasingly recognized as a global public health problem. There is now convincing evidence that CKD can be detected using simple laboratory tests, and that treatment can prevent or delay complications of decreased kidney function, slow the progression of kidney disease and reduce the risk of cardiovascular disease (CVD). Currently, screening for CKD is accepted practice only in patients with hypertension or diabetes, but more widespread screening is increasingly proposed. We screened a sample of population on World Kidney Day on three consecutive years for detecting patients with CKD and to describe the natural course of the disease. Materials and Methods: Everyone aged ≥18 was invited to participate. The study population was general population from Varanasi were screened in OPAL hospital. The survey comprised an extensive questionnaire and a brief clinical examination, including analysis of serum creatinine concentration in all participants. We screened all the participants who had at least one risk factor for CKD (including hypertension, diabetes mellitus, or a family history of CKD). Urine dipstick tests were done and blood sample was obtained to detect proteinuria and measure serum creatinine concentration, respectively. Results: A total of 547 participants were enrolled of which all 547 subjects were included in the analyses. The mean serum creatinine was 0.9525 mg/dL (0.900 to 1.0050). A high serum creatinine level was demonstrated in 16 participants (2.92 %), and 191 (34.91 %) were demonstrated to have proteinuria. There was a signifi cant correlation between CKD and age, DM, urine protein and serum creatinine. There was no signifi cant correlation between serum creatinine level and urinary protein excretion (P = .001). There were no signifi cant differences between CKD and gender. Conclusion: The study demonstrates that increasing age, diabetes mellitus, Serum creatinine and urinary protein were found signifi cantly related to kidney disease with P value of 0.02, 0.0006, <0.0001, 0.0002, respectively, which means that there is a chance for the aged, diabetes patients and patients with elevated serum creatinine and urine protein to suffer with kidney disease with respect to the younger subject. Abstract Access this article onlineWebsite: www.ijmedph.org

BackgroundPeople with dementia (PWD) are vulnerable to abrupt changes to daily routines. The lockdown enforced on the 23rd of March 2020 in the UK to contain the expansion of the COVID-19 pandemic limited opportunities for PWD to access healthcare services and socialise. The SOLITUDE study explored the potential long-term effects of lockdown on PWD’s symptoms and carers’ burden.MethodsForty-five carers and 36 PWD completed a telephone-based assessment at recruitment (T0) and after 3 (T1) and 6 months (T2). PWD completed measures validated for telephonic evaluations of cognition and depression. Carers completed questionnaires on their burden and on PWD’s health and answered a customised interview on symptom changes observed in the initial months of lockdown. Longitudinal changes were investigated for all outcome variables with repeated-measures models. Additional post hoc multiple regression analyses were carried out to investigate whether several objective factors (i.e., demographics and time under social restrictions) and carer-reported symptom changes observed following lockdown before T0 were associated with all outcomes at T0.ResultsNo significant changes were observed in any outcomes over the 6 months of observations. However, post hoc analyses showed that the length of social isolation before T0 was negatively correlated with episodic and semantic memory performance at T0. Carers reporting worsening of neuropsychiatric symptoms and faster disease progression in PWD also reported higher burden. Moreover, carer-reported worsening of cognitive symptoms was associated with poorer semantic memory at T0.ConclusionPWD’s symptoms and carers’ burden remained stable over 6 months of observation. However, the amount of time spent under social restrictions before T0 appears to have had a significant detrimental impact on cognitive performance of patients. In fact, carer-reported cognitive decline during social isolation was consistent with the finding of poorer semantic memory, a domain sensitive to progression in Alzheimer’s disease. Therefore, the initial stricter period of social isolation had greater detrimental impact on patients and their carers, followed then by a plateau. Future interventions may be designed to maintain an optimal level of social and cognitive engagement for PWD in challenging times, to prevent abrupt worsening of symptoms and associated detrimental consequences on patients’ carers.