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The catastrophic declines of three species of ‘Critically Endangered’ Gyps vultures in South Asia were caused by unintentional poisoning by the non-steroidal anti-inflammatory drug (NSAID) diclofenac. Despite a ban on its veterinary use in 2006 (India, Nepal, Pakistan) and 2010 (Bangladesh), residues of diclofenac have continued to be found in cattle carcasses and in dead wild vultures. Another NSAID, meloxicam, has been shown to be safe to vultures. From 2012 to 2018, we undertook covert surveys of pharmacies in India, Nepal and Bangladesh to investigate the availability and prevalence of NSAIDs for the treatment of livestock. The purpose of the study was to establish whether diclofenac continued to be sold for veterinary use, whether the availability of meloxicam had increased and to determine which other veterinary NSAIDs were available. The availability of diclofenac declined in all three countries, virtually disappearing from pharmacies in Nepal and Bangladesh, highlighting the advances made in these two countries to reduce this threat to vultures. In India, diclofenac still accounted for 10–46% of all NSAIDs offered for sale for livestock treatment in 2017, suggesting weak enforcement of existing regulations and a continued high risk to vultures. Availability of meloxicam increased in all countries and was the most common veterinary NSAID in Nepal (89.9% in 2017). Although the most widely available NSAID in India in 2017, meloxicam accounted for only 32% of products offered for sale. In Bangladesh, meloxicam was less commonly available than the vulture-toxic NSAID ketoprofen (28% and 66%, respectively, in 2018), despite the partial government ban on ketoprofen in 2016. Eleven different NSAIDs were recorded, several of which are known or suspected to be toxic to vultures. Conservation priorities should include awareness raising, stricter implementation of current bans, bans on other vulture-toxic veterinary NSAIDs, especially aceclofenac and nimesulide, and safety-testing of other NSAIDs on Gyps vultures to identify safe and toxic drugs.
The optimal management of symptomatic tetralogy of Fallot in neonates and younger infants with unfavourable anatomy is unclear and is further constrained by resource limitations in low and middle income countries.
Retrospective medical record review of infants with tetralogy of Fallot undergoing corrective or palliative procedures between January 2016 and June 2019.
The study included 120 infants; of whom 83 underwent primary complete repair, four underwent surgical palliation, and 33 underwent catheter-based palliation, including balloon pulmonary valvuloplasty (n = 18), right ventricular outflow tract stenting (n = 14), and stenting of the patent arterial duct (n = 1). Infants undergoing catheter-based procedures were younger in age (median 32 days; inter-quartile range (IQR) 7–144 versus 210 days; IQR 158–250), with lower baseline saturation (65 ± 12% versus 87 ± 7%) and had smaller pulmonary artery z-scores compared to the complete repair cohort. Follow-up was available for 31/33 (94%) infants (median 7 months [IQR 4–11]) who underwent trans-catheter palliation; 12 underwent complete repair, 10 are well, awaiting repair, eight required further palliation (catheter: 6; surgical: 2), and one died post-discharge from non-cardiac causes.
Catheter-based palliation is a safe and effective alternative in infants with tetralogy of Fallot who are at high risk for primary surgical repair.
We study the effects of food safety awareness on consumers’ milk purchasing behavior in Nepal. We conducted consumer survey and employed an instrumental variable regression. We find education, income, and social network to influence food safety consciousness (FSC). Our results indicate the positive impact of FSC on weekly milk expenditure and probability of purchasing milk from milk cooperatives. Any policy that helps to improve the FSC levels will likely increase the purchase of safe milk from the modern market outlet, and lack of such awareness raising policies has prevented the market for safe food from evolving and expanding.
Conventional planar manipulators have their links in a single plane. Increasing payload at the end effector/mobile platform can induce high stress in the links due to the cantilever nature of links. Thus, it limits the total vertical load that can be applied on the mobile platform. In contrast to the links in conventional planar parallel mechanisms, non-planar links are proposed in this paper, that is, links are made inclined to the horizontal plane and non-planar legs are constructed. Though the links are made non-planar, the end effectors’ planar motion is retained. For studying the application of such non-planar links in planar manipulators, new models of inertia, stiffness and leg dynamics have to be developed. In this article, these models are developed by the static analysis of the planar manipulators with non-planar links, and the performance is compared with the corresponding conventional planar manipulators.
In this study, AA5083-reinforced multiwalled carbon nanotubes (MWCNT) nanocomposites were selected as the alternate material for a redundant articulated robot (RAR) design by varying the composition of MWCNT wt%. By assigning AA5083-reinforced MWCNT as a custom material to the parts of RAR developed by Solid Works and exported to MATLAB/SimMechanics platform to convert the model into multi-body system blocks. The dynamic parameter torque was observed utilising simulation capability in a SimMechanics second-generation environment. The simulation results inferred that AA5083 reinforced with increased wt% of MWCNT has better properties suitable for RAR design.
Nipah virus (NiV) outbreak occurred in Kozhikode district, Kerala, India in 2018 with a case fatality rate of 91% (21/23). In 2019, a single case with full recovery occurred in Ernakulam district. We described the response and control measures by the Indian Council of Medical Research and Kerala State Government for the 2019 NiV outbreak. The establishment of Point of Care assays and monoclonal antibodies administration facility for early diagnosis, response and treatment, intensified contact tracing activities, bio-risk management and hospital infection control training of healthcare workers contributed to effective control and containment of NiV outbreak in Ernakulam.
To establish the adherence of Assertive Outreach Service to the local protocol for the use of high dose antipsychotic (HDAT) medication. This audit cycle was started with an intention to minimise metabolic syndrome due to antipsychotic medication.
’Guidelines for the use of high dose antipsychotic (HDAT) medication’-February 2008. The following standards from the guidelines were measured from the sample:
1. HDAT monitoring sheet should be completed for all HDAT patients
2. ECG should be done for all HDAT patients
3. Blood tests (LFTs and U&Es) should be done for all HDAT patients
4. Physical examination should be done for all HDAT patients
5. Consent should be obtained from all HDAT patients and filled on the monitoring sheet.
6. Physical health risk factors should be filled for all HDAT patients
Data sample and collection
Out of 179 patients under the team, 17 patients were prescribed HDAT. All the data were collected from the case notes of all HDAT patients and entered into the HDAT monitoring sheets in January 2009 as a baseline assessment by Dr. Praveen Kumar and re-audited in June 2009 by Dr. Gaurav Mehta.
As evidenced by the results of audit in January 2009 and re-audit in June 2009, all the parameters were up to the standards in June 2009 except the physical examination not performed on all 17 HDAT patients as revealed inthe re-audit.
India, with its rich and distinct socio-cultural heritage, bestow diverse impact over individual symptom complexes, coloring the picture and causing wide variation in presentation and prognosis of psychiatric illnesses. With the widespread use of atheoretical categorical diagnostic systems such as DSM-IV, ICD-10, etc. and success of psychopharmacological treatment approach, psychiatrists in developing and underdeveloped countries have tended to overlook the role of psycho-social and cultural factors and their interplay with neurobiological factors in governing illness patterns, and are reluctant initiators of non-pharmacological treatment measures.
The study aims to descriptively analyze and compare the use of pharmacological to non-pharmacological intervention initiation in outpatients in a general hospital setting.
The study sample will comprise of consecutive patients referred to psychiatry outpatient department from February to July 2009. The socio-demographic and clinical profile will be analyzed using a semi-structured proforma and diagnosis will be made as per ICD-10-DCR. An analysis of pharmacological and non-pharmacological intervention initiation will be made and compared. Descriptive statistical analysis for continuous and categorical variables will be done as needed.
The study is currently been undertaken and the results and conclusion will be presented at the conference.
A cross sectional study was conducted to examine the nature of insight in schizophrenia and bipolar disorder as well as compare it between the two disorders. Forty patients with schizophrenia and forty patients with bipolar disorder matched on age, age of onset of illness and duration of illness, were recruited consecutively from the outpatient clinic of a psychiatric hospital. The patients had to be clinically stable on follow-up treatment for at least three months. Insight was measured using Schedule for Assessment of Insight- Extended Version (SAI-E) and Scale of Unawareness of Mental Disorders (SUMD). Both schizophrenia and bipolar disorder had modest level of insight as measured on both the instruments. There was no qualitative difference in insight between the two disorders. However, patients with bipolar disorder had significantly better awareness of illness than patients with schizophrenia. This was evident on both the instruments that showed significant concordance on the items of insight for both the disorders.
To assess psychiatric comorbidity in patients of alcohol dependence.
All the patients of alcohol dependence attending alcohol and drug de-addiction OPD and adult psychiatry OPD on specific days were screened. Those fulfilling the selection criteria were included in the study. A detailed evaluation was done for socio-demographic variables and history of drug using semi-structured proforma especially prepared for the study. Diagnosis of alcohol dependence was made according to DSM-IV-TR criteria. The patients were seen for co-morbid psychiatric illness by applying Structured Clinical Interview for DSM-IV-TR I & II (SCID I & II).
Out of 37 patients 24 (64.8%) were found to have comorbid psychiatric illness. Axis I and Axis II comorbidity was found in 64.8% and 5.4% of the samples, respectively. Patients of cluster A & B personality were equally distributed in the sample. Patients with more than one comorbidity accounted for 37.8% of the sample.
Psychiatric comorbidity in alcohol dependence is very high, other substance in particular. Number of comorbid diagnoses in a person may as high as three.
There are major health care implications of quality of life (QOL) in longstanding disorders such as Bipolar affective disorder (BD) for the patients and their caregivers.
The aim of the present study is to compare quality of life among bipolar disorder patients, their caregivers and to assess whether the level of depression correlates with the scores of quality of life in Bipolar Disorder patients.
We compared bipolar disorder (N = 40), their caregivers (N = 40) and no psychiatric illnesses (N = 150) on health related quality of life (HRQOL) which was assessed using the 26-item World Health Organization QOL instrument (WHOQOL-BREF Hindi version). All patients were diagnosed using the Structured Clinical Interview for DSM IV. Within the group with bipolar disorder, we examined the relationship between HRQOL using WHOQOL BREF Hindi version and depression assessed using the 17-item Hamilton Depression Rating Scale (HDRS).
Patients in bipolar disorder group had lower QOL on all the four domains compared to healthy controls, caregivers. The four domains of the WHOQOL scale correlated negatively with the HDRS.
Our findings suggest that bipolar depression and residual symptoms of depression are negatively correlated with QOL in BD patients.
Sociocultural factors profoundly influence and determine every aspect of psychiatric disorder. The term culture bound syndrome refers to psychopathological entities that are not mere variants of well recognized psychiatric disorder, have a geographically defined prevalence, and are largely determined, at least in their symptoms by the beliefs and assumptions prevalent in the native culture. Dhat syndrome, possession syndrome, Koro, Ascetic syndrome, Gilhari syndrome are some of the frequently reported culture bound syndromes from Indian subcontinent.
To assess the prevalence rates and psychiatric co morbidities in patients affected by Dhat syndrome, possession syndrome, Koro, Ascetic syndrome, Gilhari syndrome.
50 subjects of either sex affected by at least one of the following culture bound syndromes - Dhat syndrome, possession syndrome, Koro, Ascetic syndrome, Gilhari syndrome were recruited on consecutive basis from the patients attending psychiatry outpatients department of a tertiary care hospital in Delhi, India. The selected subjects were assessed for respective prevalence rates and co morbidity profile in patients affected with above listed culture bound syndromes.
Of 50 cases of culture bound syndromes seen in psychiatry OPD, Dhat syndrome was most common (80%), followed by Possession syndrome (14%), Ascetic syndrome (2%), Gilhari syndrome (2%), Koro (2%). Depression was the most common associated psychiatric disorder.
Culture bound syndromes exhibit significant psychiatric co morbidity, this study calls for careful evaluation of these patients psychologically to detect and treat the associated psychiatric co morbidity appropriately.
Dhat syndrome is a commonly recognized clinical entity in Indian culture. It consists of vague somatic symptoms (fatigue, weakness, anxiety, loss of appetite, guilt, etc.) and at times sexual dysfunction (impotence or premature ejaculation), which the patient attributes to the passing of semen (Dhat) in urine as a direct consequence of his excessive indulgence in masturbation or sexual intercourse.
To assess medical and psychiatric co-morbidities and prevalent knowledge and attitudes among patients of Dhat syndrome.
A cross-sectional study of 50 consecutive male patients with Dhat syndrome attending psychosexual clinic of a tertiary care hospital in Delhi was performed to ascertain co-morbid psychiatric and medical disorders and the prevalent knowledge and attitudes of subjects towards Dhat syndrome and its management.
The commonest associated psychiatric illness was neurotic depression followed by anxiety neurosis. The commonest associated medical illness was urinary tract infections (UTI) followed by sexually transmitted diseases (STDs). Majority of subjects believed Dhat to be semen; that Dhat syndrome causes both physical and mental weakness and; that health tonics are required for successful management of Dhat syndrome. More than half of the subjects believed that masturbation causes Dhat syndrome. The study reveals a change in knowledge and attitudes of patients affected with Dhat syndrome in the last decade.
Dhat syndrome exhibits significant medical and psychiatric co-morbidity. The findings of this study need to be further evaluated in the immigrant population.
Previously, we reported the clinical efficacy of MPH-LA in adult ADHD evaluated in a 40-week, randomised, double-blind, placebo-controlled, multicentre core study [comprising of dose confirmation (9-week), real-life dose optimisation (5-week) and maintenance of effect phases (6- month)] (Atten Defic Hyperact Disord. 2013;(5):219–220). Here, we report the long-term efficacy from the 26-week extension phase of the same study.
During the extension phase, patients initiated treatment with MPH-LA 20 mg/day (oral, once daily capsules); uptitrated to optimal dose of 40, 60 or 80 mg/day in increments of 20 mg/week. Change in DSM-IV ADHD rating scale (RS) and SDS total scores at the end of study, were evaluated from the baseline of maintenance of effect phase of the core study and the baseline of extension phase.
At the end of the extension phase, the mean change in DSM-IV ADHD RS and SDS total scores from baseline of the maintenance of effect phase was −0.9 and −1.4 points respectively; and from baseline of extension phase was −7.2 and −4.8 respectively (Table). No new or unexpected safety concerns were observed during the extension phase.
MPH-LA continued to maintain clinical efficacy in adult ADHD patients over long-term.
Table DSM-IV ADHD RS, SDS total scores and change from baseline at the end of extension phase
Schizophrenia is a mental disorder characterized by social problems and disorders of thought, behaviour and cognitive functions. These impaired cognitive functions may be associated with alterations in resting state functional connectivity in schizophrenia. Therefore, the present study has been carried out to determine the resting state functional brain connectivity changes associated with schizophrenia in all the resting state networks (RSNs) using independent component analysis approach (ICA) and dual-regression based approach.
The objective of this study was to investigate the aberrant resting-state functional connectivity patterns in schizophrenia patients as compared to healthy controls.
35 schizophrenia patients and 31 healthy controls were recruited for the study and scanned by using resting state functional magnetic resonance (rsfMRI). Pre-processing and post-processing of the resting state functional data were performed using the FMRI Expert Analysis Tool (FEAT), which is a part of FSL (FMRIB's Software Library, www.fmrib. ox.ac.uk/fsl).
Our results showed significantly decreased functional connectivity in the regions of left fronto-parietal network, lateral visual network, medial visual network, motor network and default mode network (DMN) in schizophrenia patients as compared with healthy controls.
The overall findings suggest that the alterations in these resting state network connectivity may, in part, contribute to the impairments in cognitive functions associated with schizophrenia. These findings also suggest that aberrant resting state network connectivity contributes to regional functional pathology in schizophrenia and bears significance for core symptoms.
Schizophrenia often presents in adolescence (13–18 years), is more likely to have a poor prognosis and young people are also more prone to adverse effects. Clearer guidance is needed in order to plan treatment for early onset cases more effectively.
We aimed to evaluate effects of atypical antipsychotic medications for psychosis in adolescents.
We searched the Cochrane Schizophrenia Group's Register. References of all identified studies were inspected for further trials.
All relevant RCTs that compared atypical antipsychotic medication with pharmacological or non-pharmacological interventions in adolescents with psychosis were included. We reliably selected, quality assessed and extracted data from trials.
There were 13 RCTs with a total of 1112 participants. Adolescents improved more on standard dose of risperidone (1.5 – 6.0 mg) against low dose of risperidone (0.15 – 0.6 mg) (1 RCT, n = 255, RR 0.54 CI 0.38 to 0.75). Participants on clozapine were three times more likely to have drowsiness as compared to haloperidol (1 RCT, n = 21, RR 3.30 CI 1.23 to 8.85, NNH 2 CI 2 to 17). Lesser number of adolescents on atypical antipsychotics left the study due to adverse effects (3 RCTs, n = 187, RR 0.65 CI 0.36 to 1.15) than on typical antipsychotics.
There is no convincing evidence that atypical-antipsychotic medications are superior over typical antipsychotic medications. There is some evidence to show that adolescents respond better to standard-dose as opposed to lower dose of medications. Larger, more robust, trials are required.
The objective of this study was to investigate protective potential of 17β estradiol (E2) treatment on the activity of monoamine oxidase, calcium homeostasis, membrane polarization, genomic DNA degradation, 4- hydroxynonenal and protein oxidation levels occurring in brains of female rats of 3 months (young), 12 months (adult) and 24 months (old) age groups, and to see whether these changes are restored to normal levels after exogenous administration of estradiol.
The aged rats (12 and 24 months old) (n= 8 for each group) were given subcutaneous injection of 17b-estradiol (0.1 μg/g body weight) daily for one month. After 30 days of hormone treatment, experimental animals of all the groups were sacrificed and brains were isolated for further study.
The results obtained in the present work revealed that normal aging was associated with significant increases in the activity of monoamine oxidase, calcium homeostasis, genomic DNA degradation, 4- hydroxynonenal and protein oxidation levels in the brains of aging female rats, and a decrease in membrane polarization. Our data showed that exogenous administration of E2 brought these changes to near normalcy in aging female rats.
It can therefore be concluded that E2's beneficial effects seemed to arise from its, antioxidant and antilipidperoxidative effects, implying a therapeutic potential drug for age related changes. Based on our studies and others, we conclude that E2 have therapeutic potential for adjunctive therapy along with dopamine replacement in Parkinson's disease.
The term endophenotype was first used by Gottesman to describe a trait that may be intermediate on the chain of causality from genes to diseases. An endophenotype may be neuropathological, neurocognitive, emotional, neuro-physiological or neurobiological in nature. There is dearth of studies about the use of neurocognive dysfunction as endophenotype marker of BPAD, particularly from developing countries.
Aim and Hypothesis-
We aimed to evaluate neurocognitive dysfunctions as endophenotype markers of bipolar affective disorder (BPAD) in first degree relative of BPAD patients. We hypothesized that first degree relative of BPAD patients differ significantly in regard to neurocognitive dysfunction from matched controls.
A cross sectional study was carried out. Sample was drawn from first degree relatives (FDR) of patients of BPAD and controls. After assessment of neurocognitive function first degree relatives of BPAD were compared with controls on measures of attention, verbal working memory, auditory verbal memory, Visuo spatial working memory, visual attention and executive functions.
Results indicated that, first degree relatives of BPAD scored poorly on measures of neurocognition then controls. On conducting comparison over composite neurocognitive score 'we found that cognitive index in combination better discriminate the first degree relatives of BPAD from controls.
Neurocognitive dysfunction on measures of attention, verbal episodic memory, auditory verbal working memory, visuospatial working memory and executive functions significantly differentiated first degree relatives of BPAD patients from controls.