Rajendra Memorial Research Institute of Medical Sciences,Indian Council of Medical Research

This study examined the association between multimorbidity, lifestyle factors, and cognitive performance among older adults in India using data from the Longitudinal Ageing Study in India (LASI) Wave 1. The analysis included 65,562 individuals aged 45 years and above. Cognitive performance was assessed across multiple domains, including orientation, word recall, arithmetic ability, and executive function. Descriptive statistics, bivariate analyses, and multivariable logistic regression were used to evaluate the relationships between socioeconomic characteristics, multimorbidity, lifestyle behaviours, and cognitive performance and to calculate adjusted odds ratios (aORs). Overall, 30.2% of participants had multimorbidity, with the highest prevalence among individuals aged 61–70 years (35.0%) and those aged ≥ 71 years (39.1%). With advancing age, the odds of poor cognitive performance increased substantially; individuals aged ≥ 71 years had more than fourfold higher odds compared with those aged 45–50 years (aOR = 4.19; 95% CI: 4.18–4.20). Females had significantly higher odds of poor cognitive performance than males (aOR = 1.81; 95% CI: 1.81–1.81). Unhealthy lifestyle behaviours, including smokeless tobacco use and alcohol consumption, were also associated with poorer cognitive outcomes, while physical inactivity, frequent sleep problems, and social isolation further increased risk. In contrast, higher education, greater wealth, engagement in physical activity and yoga, and adherence to prescribed medications were protective. These findings indicate that multimorbidity in combination with adverse socioeconomic and lifestyle factors substantially influences cognitive performance in later life. Targeted, integrated interventions focusing on high-risk groups and the promotion of healthy lifestyles are essential to support cognitive health in India’s ageing population.

IntroductionThe majority of presumptive TB cases report late. Early detection of tuberculosis (TB) cases is crucial for its control. We developed a logic model program involving members of a governmental and community-driven youth club of Nehru Yuva Kendra Sangathan (NYKS) volunteers and explored its feasibility.MethodologyThe study defined the purpose, scope, and program domains. The domains were input, process, output, and outcome. These domains were drafted, refined, and finalized using standard techniques. A qualitative study, including in-depth interviews and focus group discussions, was undertaken with community members, healthcare staff, and NYKS volunteers across diverse settings. Acceptability, feasibility, effectiveness, barriers, and improvement strategies of the developed model were synthesized through thematic analysis.ResultsThe developed “Logic Model” aims to actively screen and motivate individuals with TB-suggestive symptoms for early detection of active TB, using various domains and corresponding activities. Information, education, communication (IEC), screening, referral, and case detection activities have been monitored using 36 indicators. Most participants expressed acceptance of the model, owing to its alignment with community values, trust among volunteers, and perceived benefits. Key motivators included the proximity of services, improved awareness, and civic responsibility. Barriers included a lack of financial incentives, logistical challenges, and overlapping stakeholder roles. Suggestions for improvement included enhancing gender diversity, confidentiality, volunteer training, and intersectoral coordination.DiscussionThe developed logic model provides a visual display of the input, process, output, and outcome domains, their activities, and relationships. The model links resources, activities, and outcomes for the screening and referral of diagnosed cases. It was broadly accepted, despite some reported challenges. Addressing barriers is essential for program sustainability. Tailored strategies to improve volunteer support, training, and trust-building can enhance the model’s effectiveness and contribute to India’s TB elimination program.

INTRODUCTION:Lamotrigine is prescribed for neurological and psychiatric conditions, including epilepsy and bipolar disorder. Although generally safe, it may cause rare but severe cutaneous adverse reactions, such as Stevens-Johnson syndrome. This review synthesized case reports and case series on lamotrigine-induced Stevens-Johnson syndrome to improve clinical awareness and promote safer prescribing. METHODS:PubMed was searched from inception to December 2024 using terms related to lamotrigine and Stevens-Johnson syndrome. Eligible studies were case reports or case series demonstrating Stevens-Johnson syndrome after lamotrigine use. Studies not reporting Stevens-Johnson syndrome, lacking clinical details, or not implicating lamotrigine were excluded. A total of 264 records were identified, and 36 studies met the inclusion criteria. Screening, quality assessment, and data extraction were done independently by two reviewers. Data on demographics, indications for use, lamotrigine dosage, co-administered drugs, clinical features, management, and patient outcomes were extracted and synthesized. RESULTS:Thirty-six studies comprising 38 individual cases were included. Lamotrigine was used either alone or in combination, most frequently with valproic acid (n = 19). Lamotrigine doses ranged from 12.5 to 750 mg/day, with most cases developing Stevens-Johnson syndrome within the first month of therapy. Clinical features included mucocutaneous lesions, epidermal detachment, and systemic symptoms such as fever and conjunctivitis. Management typically involved immediate lamotrigine discontinuation, corticosteroids, immunoglobulins, and supportive care. Most patients recovered within 2-3 weeks, although two deaths were reported. DISCUSSION:The findings show that the risk of lamotrigine-induced Stevens-Johnson syndrome is highest in the initial weeks of therapy, especially when lamotrigine is combined with valproic acid or titrated rapidly. Early warning signs such as fever and mucosal symptoms should be closely monitored to ensure timely intervention. Although corticosteroids and immunoglobulins are commonly used, their effectiveness remains uncertain, and supportive care continues to be the cornerstone of management. CONCLUSION:Lamotrigine-induced Stevens-Johnson syndrome is a rare but serious reaction. Careful dose titration, early recognition of symptoms, and patient education are imperative. Standardized reporting and causality assessment are needed to strengthen the evidence base and support safer prescribing.

Background and objectives A considerable proportion of the older populations have been suffering from stroke multimorbidity. Post-stroke complications often affect the overall well-being of individuals. This study assesses the trends, patterns, and determinants of stroke multimorbidity. Methods We used data from three waves of the World Health Organization study on global ageing and adult health (WHO-SAGE) and analysed individuals aged 50 and above years (Wave I, 7,150 individuals, Wave II, 6,823 individuals, and Wave III, 6,719 individuals) who reported a physician diagnosis of stroke. We analysed trends and patterns of stroke multimorbidity across three waves of WHO-SAGE. Stroke multimorbidity was also analysed with respect to the socioeconomic characteristics of study participants. Results We found a significant increase in the prevalence of stroke multimorbidity over one and a half decade (1,050 per 100,000 to 2,410 per 100,000). The burden of stroke multimorbidity increased steadily, mainly among individuals suffering from two or more long-term conditions. Prevalence of stroke multimorbidity was much higher among older people aged 80 yr and above in wave 3 as compared with wave 1, a relative increase of around 200%. An older individual with no formal education showed an increased prevalence of stroke multimorbidity, a relative change of 102% in last one and a half decade. Interpretation and conclusions This study demonstrated a significant increase in the prevalence of stroke multimorbidity over the last one and a half decade (2007-2020), which considerably varied by age group, sex, place of residence, education, and wealth quintile.

Visceral leishmaniasis is a vector-mediated parasitic disease caused by Leishmania donovani. Its treatment relies on chemotherapy with limited options. Existing drugs face significant challenges, including low efficacy, high relapse rates, toxicity, and cost. Therefore, exploring novel chemotherapeutic strategies identified as newer drugs targeting L. donovani CYP51 either alone or in combination with Miltefosine, which presents a promising alternative to current therapy. Here, we have evaluated the antileishmanial potential of an azole drug, luliconazole, which was previously demonstrated to target the sterol biosynthesis pathway in Leishmania major, in combination with conventional antileishmanial agents. Luliconazole exhibited significant inhibitory activity against both extracellular and intracellular L. donovani, with half-maximal inhibitory concentrations of 4.67 and 6.24 µM, respectively. Notably, the addition of miltefosine and luliconazole combinations resulted in a synergistic effect, reducing the effective doses by 3.26- and 5.62-fold compared to monotherapy with miltefosine and luliconazole, respectively. Conversely, the combination of luliconazole with Amphotericin B yielded antagonistic effects. A significant increase in nitric oxide by the parasite-infected macrophages after luliconazole treatment underscores its leishmanicidal potential. Evaluation of host cell cytotoxicity, hemolytic assays, and oxidative burst affirmed the safety of luliconazole. This study is limited to in vitro intracellular amastigote. These findings highlight the efficacy of luliconazole, particularly in combination with miltefosine. Further investigations including formulation development and in vivo validation, are needed to assess the translational potential. This is the first study to demonstrate that luliconazole enhances miltefosine efficacy against L. donovani.