Objective: To determine the frequency of intolerance to Methotrexate (MTX) in patients with inflammatory arthritis by using MTX intolerance severity score, and evaluate the effects of Ondansetron in reducing MTX intolerance.

Background: Methotrexate (MTX) is a cornerstone in the treatment of patients with inflammatory arthritis but is not tolerated well by patients. This intolerance can be identified using the Methotrexate Intolerance Severity Score (MISS). Objective: The objective of this study was to translate and validate the MISS in the Urdu language. Materials and Methods: It was a cross-sectional study done at the Department of Rheumatology, Combined Military Hospital, Lahore, from December 1, 2021, to March 31, 2022. A total of 181 patients with inflammatory arthritis taking MTX for >3 months participated in the study. The translated Urdu version was tested in these patients who attempted the questionnaire twice with a gap of 2 weeks. Cronbach’s alpha, item correlations, and kappa coefficients were used to evaluate internal consistency, acceptability, and reproducibility. A culturally admissible Urdu version of MISS was developed. Results: The results show a 90% response rate, <1% missing data with very good acceptability, and understanding of patients. There were satisfactory inter-item, dimension-item, and inter-dimension correlations. The kappa coefficient was more than 0.90 for most items except associative stomachache (0.79). Cronbach’s alpha coefficient was 0.78, much higher than 0.6, and in the validation cohort, it was 0.74. The internal and external consistency results for validation were satisfactory. There was a good understanding between the test and retest for every patient. The MISS showed a sensitivity of 72% and a specificity of 100% at a discriminative cutoff value of 6.5. Of the 181 patients receiving MTX, 48 (26.5%) experienced MTX intolerance. Conclusion: This validated Urdu version MISS is a sensitive and specific tool that can better detect this MTX intolerance. It discriminates well between MTX-tolerant and intolerant patients.

Background: Diabetes is a clinical condition predisposing individuals to a higher risk of infection. Vaccination can reduce susceptibility to infections. Unfortunately, robust data on the vaccination status of our population with diabetes is lacking though we stand as a country with the third highest cases of diabetes worldwide. Therefore, we intend to identify the vaccination status of our diabetic population and assess people’s awareness and attitude toward vaccination against influenza and Pneumonia. Methods: This was a cross-sectional survey in which patients with diabetes were asked for relevant information as per a pre-defined questionnaire. The statistical analysis was done using SPSS 22.0 version. Results: We enrolled 526 patients; the mean age was 58 years (SD±10.9). The majority of participants were females 68 % (362/526), and 52% (274/526) were aware of being increasingly susceptible to influenza and pneumonia. Only 12 % (64/526) were vaccinated against influenza over the last 5 years and 7% (36/526) against pneumococcus. More males were vaccinated against influenza than females and this result was statistically significant (p-value < 0.001). Influenza and pneumococcal vaccination were more common among the more affluent and more educated individuals this comparison was statistically significant (p-value < 0.001). A significant proportion of unvaccinated (374/460, 81%) showed a willingness to get vaccinated. Conclusion: The uptake of annual influenza every autumn, and one-off pneumococcal vaccines among diabetics in our region is very low. The importance of vaccination needs to be generated through effective awareness campaigns as people with diabetes showed keen interest in receiving relevant vaccination.