Rumpel-Leede phenomenon is a rare clinical sign involving the appearance of purpura after application of a tourniquet or in noninvasive arterial blood pressure monitoring. This sign has been most commonly associated with hypertensive and diabetic microvascular fragility and thrombocytopenia. We describe a case of Rumpel-Leede phenomenon in an otherwise healthy patient with positive laboratory markers for Sjögren disease, a previously undescribed relationship. We aim to inform physicians of this potential complication in patients with Sjögren disease and suggest special consideration be given to patients with autoimmune diseases with secondary vascular or dermal manifestations.

Background: National Mental Health Program (NMHP) was launched by the government with an aim to improve mental health of the society through precise and focused interventions and policies. In order to provide reliable data and evidence for NMHP, there is a strong requirement of a comprehensive system for integrative collection, storage, and analysis of data generated by this program. Methods: Data collection tools, questionnaires, instruments, and scales provided by the National Coordinating Unit were digitized using the District Health Information Software 2 (DHIS2) framework (version 2.30). The rules for data validation and automated scoring were implemented as per the scales. The developed system ( i-MANN, ICMR-Mental Health Assessment National Network) is based on modular architecture with role-based access to data input forms and dashboards. Results: The data are stored on a centralized server at ICMR. i-MANN captures data on basic and advanced demographic details followed by category specific forms from 15 multicentric ICMR-funded projects. Data collection module is divided into 12 categories containing 93 scales/instruments with built-in validation rules, scoring patterns, and indicators. As of August 2020, the system contains 17,690 records. Conclusions: i-MANN is the first web-based, modular, robust, and extendable system for collection, integration, management, and analysis of data on mental health in India.

Despite the high burden of mental disorders in low- and middle-income countries (LMICs), less than 25% of those in need have access to appropriate services, in part due to a scarcity of locally relevant, evidence-based interventions and models of care. To address this gap, researchers from India and the United States and the Indian Council of Medical Research (ICMR) collaboratively developed a “Grantathon” model to provide mentored research training to 24 new principal investigators (PIs). This included a week-long didactic training, a customized web-based data entry/analysis system and a National Coordination Unit (NCU) to support PIs and track process objectives. Outcome objectives were assessed via scholarly output including publications, awards received and subsequent grants that were leveraged. Multiple mentorship strategies including collaborative problem-solving approaches were used to foster single-centre and multicentre research. Flexible, approachable and engaged support from mentors helped PIs overcome research barriers, and the NCU addressed local policy and day-to-day challenges through informal monthly review meetings. Bi-annual formal review presentations by all PIs continued through the COVID-19 pandemic, enabling interim results reporting and scientific review, also serving to reinforce accountability. To date, more than 33 publications, 47 scientific presentations, 12 awards, two measurement tools, five intervention manuals and eight research grants have been generated in an open-access environment. The Grantathon is a successful model for building research capacity and improving mental health research in India that could be adopted for use in other LMICs.

Objective: A link between gut microbiota and Ulcerative Colitis (UC) has been established in several studies. However, a few studies have examined specific changes in microbiota associated with different phases of disease activity in UC. In this study, we investigated phenotypic variability underlying genetically distinct north Indian (NI) UC patients by identifying differentially abundant taxa between (i) UC patients and healthy controls and (ii) different disease phases of disease activity. Design: 16S rRNA (V3,V4) sequencing of 105 patients with UC [newly diagnosed (n=14); patients in remission (n=36) and active disease (relapse, n=55)]; and 36 healthy controls was performed. The faecal microbiota composition in different phases of UC disease activity and healthy controls was analysed. Results: Lower gut microbial diversity; enrichment of lactate-producing bacteria namely Streptococcus, Bifidobacterium and Lactobacillus; and depletion of butyrate-producing bacteria (e.g., Lachnospiraceae and Ruminococcaceae), was observed among UC patients. Subgroup analysis revealed differential abundance of Escherichia-Shigella, Streptococcus, Enterococcus and Faecalibacterium in newly diagnosed UC patients. No discrete microbial features were observed between patients in remission and those with active disease. Co-occurrence network analysis revealed a mutualistic association between opportunistic pathogens and Bifidobacterium and Lactobacillus and antagonistic relationship with butyrate-producers. Conclusion: This first faecal microbiome study elucidated dysanaerobiosis; loss of short chain fatty acid producers and enrichment of inflammation associated microbes; population specific differential microbial genera; and microbial signature for early dysbiosis, among NI UC cohort.