Depression often shows suboptimal outcomes with antidepressants, with ~66% response and ~37% remission after 6 weeks of treatment (MDD-1 India study). Renin–angiotensin–aldosterone system (RAAS) has been implicated in mood regulation through its effects on neuroplasticity, inflammation, and stress. While ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely prescribed for cardiovascular disease, their influence on antidepressant response and RAAS-related mechanisms remains underexplored.

To evaluate influence of ACEI/ARBs on antidepressant treatment response and correlate them with RAAS and depression related biomarkers.

This prospective observational study included patients with depression who were going to receive antidepressants for 6 weeks. They were divided into two groups: a. AD group: only antidepressants, b. AD+ACEI/ARBs group: antidepressants with ongoing ACEI/ARBs treatment for ≥ 3 months. Depression severity was assessed using Hamilton Depression Rating Scale (HDRS-17) at baseline and 6 weeks. Serum biomarkers (ACE, Ang II, Ang 1–7, renin, BDNF, cortisol) were quantified by ELISA, and gene expression (ACE, AT1R, AT2R, MasR) was analysed in peripheral blood by qRT-PCR. Safety of medications was evaluated through routine laboratory tests.

This study included 186 patients with depression (AD group: n=102; AD+ACEI/ARB group: n=64) and 20 healthy controls. Reduction in HDRS-17 score was greater within the AD+ACEI/ARB group (22.19 ± 7.15 to 10.61 ± 4.00) compared with AD group (21.97 ± 7.54 to 13.24 ± 6.50; p=0.001). Responder rate (≥ 50% reduction in HDRS score from baseline) was higher in AD+ACEI/ARBs (p=0.001) compared to AD group. At baseline AD+ACEI/ARB group had significantly lower serum ACE (p=0.022) compared to AD group. At 6 weeks of follow-up there was significant reduction in Ang II level (p = 0.002) in AD+ACEI/ARBs group compared to AD group. At baseline gene expression analysis showed upregulation of MasR (p = 0.022) and downregulation of ACE (p = 0.049) in the AD+ACEI/ARB group (with ≥ 3 months ACEI/ARB treatment) vs AD group. However, at follow-up there was no significant change among AD vs AD+ACEI/ARBs group in serum Ang 1–7, renin, BDNF, cortisol levels, and gene expression of AT1 and AT2 receptors.

Adjunctive ACEI/ARB therapy improves antidepressant treatment response, which may be ascribed to the modification of RAAS-related biomarkers. This was reflected through reduction in serum ACE and Ang II levels, downregulation of ACE and upregulation of MasR expression.

None Declared

This study aimed to evaluate the surgical success of a modified inlay tympanoplasty technique, known as circumferential subannular tympanoplasty, for anterior and subtotal perforations.

This prospective study was performed in a tertiary care teaching hospital between October 2013 and April 2016. A total of 58 adult patients of both sexes with anterior or subtotal perforations underwent circumferential subannular tympanoplasty under local anaesthesia. In this technique, after tympanomeatal flap elevation, the temporalis fascia graft is placed directly onto the annulus instead of being tucked underneath the tympanic membrane remnant. Outcome data were graft uptake and hearing improvement.

This technique had a surgical success rate of 97 per cent and led to significant hearing improvement.

Circumferential subannular tympanoplasty has a definitive role in managing anterior and subtotal perforations.

To evaluate the success rate of dry and wet temporalis fascia grafts in type I underlay tympanoplasty.

A prospective, randomised study was conducted. One hundred adult patients (males and females) with chronic suppurative otitis media (mucosal type) were divided into 2 groups of 50 each: one group underwent dry graft tympanoplasty and the other underwent wet graft tympanoplasty. Fibroblast count was calculated in dry and wet grafts.

The dry graft and wet graft groups had overall surgical success rates of 82 and 90 per cent, respectively; this finding was not statistically significant. A statistically significant high fibroblast count was observed in wet grafts, but it did not correlate with surgical success.

A dry or wet temporalis fascia graft does not influence the outcome of tympanoplasty type I.

To evaluate and analyse the success rate of tympanoplasty type I in paediatric patients aged 5 to 8 years compared to a control group (patients aged over 14 years).

In this prospective study, 60 patients (of either sex) with chronic suppurative otitis media inactive mucosal disease were divided into 2 groups (30 in each): group A comprised paediatric patients aged 5–8 years and group B consisted of older individuals aged over 14 years. All patients underwent tympanoplasty type I with an underlay technique using a temporalis fascia graft.

Impressive surgical success rates of 87 and 90 per cent were recorded in groups A and B, respectively. Furthermore, audiological success rates of 69 and 78 per cent were achieved in groups A and B respectively. Statistical analysis of the data revealed that eustachian tube function had no impact on the outcome of tympanoplasty.

Tympanoplasty type I performed in children aged five to eight years gives comparable results to those of older individuals.