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The therapeutic use of lithium in bipolar disorder is often restricted due to its narrow therapeutic window and adverse drug reactions. Lithium-induced early renal dysfunction is clinically important as it may lead to sodium depletion due to natriuresis leading to lithium retention and lithium toxicity. This is most often seen in the initial phases of therapy, and psychiatrists struggle titrating the dose of lithium and stabilizing the serum lithium level.
The present study was conducted to evaluate the effect of add-on sodium chloride on serum lithium levels in bipolar disorder.
The present randomized controlled trial (NCT04222816) was conducted in 60 patients with type I bipolar disorder who were randomized into the control group who received lithium carbonate with the advice not to take additional salt (at the table) and the test group who received sachets of sodium chloride (1 g/d) as an add-on to lithium carbonate and were advised to restrict their additional salt intake (at the table) to 1 g/d. After baseline assessments, all patients were followed up at 4 weeks, 8 weeks, and 12 weeks when serum lithium, sodium and potassium were estimated. Serum creatinine and aldosterone were repeated at 12 weeks.
In the test group, the fluctuation rate in serum lithium (26.7%) was significantly (p=0.01) lower than in the control group (63.3%). There was a significant difference in serum lithium in the control group at different time points; however, the changes were not significant in the test group. There was a significant difference in serum lithium between the groups at 8 and 12 weeks of follow-up. There were no significant differences in the change in serum sodium, potassium, creatinine, aldosterone, creatinine clearance, and blood pressure within the group and between the groups. A significant positive correlation was found between serum lithium and aldosterone at baseline.
Intake of add-on sodium chloride (1 gm/day) may reduce the fluctuations in serum lithium during the maintenance phase of lithium therapy in type I bipolar disorder.
Himalayan glaciers have been shrinking and losing mass rapidly since 1970s with an enhanced rate after 2000. The shrinkage is, however, quite heterogeneous and it is important to document individual glacier characteristics and their changes at the basin scale. We present an updated glacier inventory of the Upper Alaknanda Basin (UAB), Central Himalaya for the year 2020 and report area, debris cover and length changes for the periods 1994–2006 and 2006–2020 based on remote-sensing data. We identified 198 glaciers, comprising an area of 354.6 ± 8.5 km2, and classified them according to their size and morphology. The glaciers of the basin lost 4.2 ± 2.9% (0.16 ± 0.11% a−1) of their frontal area (from 368.6 ± 9.2 to 353.0 ± 5.3 km2) from 1994 to 2020. The average retreat rate was higher in the period 2006–2020 (13.3 ± 1.8 m a−1) in comparison to 1994–2006 (9.3 ± 1.9 m a−1). However, the area change rate was similar for the two periods (0.14 ± 0.27% a−1 for 1994–2006 and 0.16 ± 0.19% a−1 for 2006–2020). The debris-covered area has increased by 13.4 ± 4.4% from 1994 to 2020. A comparison with previous studies in UAB indicates consistent area loss of ~0.15% a−1 since the 1960s.
Protection of biodiversity requires inclusive and gender-responsive programming. Evidence of success in engaging women in large carnivore conservation remains scarce, however, although women play an important role in caring for livestock at risk of predation and could contribute to large-carnivore conservation. We aimed to assess the performance of an income-generation and skills-building programme for women in Spiti Valley (India) that sought to engage women in local conservation action. Annual programme monitoring together with a one-time survey of attitudes, perceptions and social norms in eight communities exposed to the conservation programme and seven ‘control’ communities revealed: a keen interest and increasing levels of women’s participation over 7 years of programme operation; participant reports of multiple programme benefits including additional personal income, social networking and travel opportunities; and more positive attitudes towards snow leopards among programme participants than among non-participants in the control communities. Women from programme communities recorded in their diaries 33 self-directed conservation actions including improving livestock protection and preventing wildlife poaching. These results show a way forward to purposively engage women in conservation programming towards achieving sustainable and equitable outcomes in efforts to promote carnivore–human coexistence.
Rhino-orbito-cerebral mucormycosis is a rapidly progressive disease with high mortality rates of about 60 per cent. The increasing incidence of rhino-orbito-cerebral mucormycosis in coronavirus disease 2019 patients in India and worldwide has become a matter of concern owing to the case fatality rate. This study explored the use of low dose aspirin in decreasing the mortality rate of coronavirus disease 2019 associated mucormycosis.
This was a retrospective observational study. Patients suffering from post-coronavirus disease 2019 mucormycosis were included in the study. Each patient was treated with surgical debridement and systemic amphotericin B. Low dose aspirin was added, and mortality rates were compared with the patients who did not receive aspirin.
The demographic data and rhino-orbito-cerebral mucormycosis staging between the two groups were not significantly different. There was a statistically significant difference in mortality outcomes between the two groups (p = 0.029) and a 1.77 times higher risk of dying for patients not receiving aspirin. Kaplan–Meier survival indicated that patients receiving aspirin had better survival rates (p = 0.04).
A novel application of Best Worst Method (BWM) enables one to incorporate the complexity of specific sub-criteria of technological development to assess its maturity with the pre-established Technology Readiness Level (TRL) framework. It utilizes the concept of Multi-Criteria Decision Making (MCDM) methods to determine the cardinality of endpoint quantitative processes. The model is used to determine the maturity of Class II Ventilators and to detect the consistency aspects for their selection.
To compare the efficacy of bone pâté versus bioactive glass in mastoid obliteration.
This randomised parallel groups study was conducted at a tertiary care centre between September 2017 and August 2019. Sixty-eight patients, 33 males and 35 females, aged 12–56 years, randomly underwent single-stage canal wall down mastoidectomy with mastoid obliteration using either bone pâté (n = 35) or bioactive glass (n = 33), and were evaluated 12 months after the operation.
A dry epithelised cavity (Merchant's grade 0 or 1) was achieved in 65 patients (95.59 per cent). Three patients (4.41 per cent) showed recidivism. The mean air–bone gap decreased to 16.80 ± 4.23 dB from 35.10 ± 5.21 dB pre-operatively. The mean Glasgow Benefit Inventory score was 30.02 ± 8.23. There was no significant difference between the two groups in these outcomes. However, the duration of surgery was shorter in the bioactive glass group (156.87 ± 7.83 vs 162.28 ± 8.74 minutes; p = 0.01).
Improved plasticity models require simultaneous experimental local strain and microstructural evolution data. Microscopy tools, such as electron backscatter diffraction (EBSD), that can monitor transformation at the relevant length-scale, are often incompatible with digital image correlation (DIC) techniques required to determine local deformation. In this paper, the viability of forescatter detector (FSD) images as the basis for the DIC study is investigated. Standard FSD and an integrated EBSD/FSD approach (Pattern Region of Interest Analysis System: PRIAS™) are analyzed. Simultaneous strain and microstructure maps are obtained for tensile deformation of Q&P 1180 steel up to ~14% strain. Tests on an undeformed sample that is simply shifted indicate a standard deviation of error in strain of around 0.4% without additional complications from a deformed surface. The method resolves strain bands at ~2 μm spacing but does not provide significant sub-grain strain resolution. Similar resolution was obtained for mechanically polished and electropolished samples, despite electropolished surfaces presenting a smoother, simpler topography. While the resolution of the PRIAS approach depends upon the EBSD step size, the 80 nm step size used provides seemingly similar resolution as 8,000× (22.7 nm) FSD images. Surface feature evolution prevents DIC analysis across large strain steps (>6% strain), but restarting DIC, using an FSD reference image from an interim strain step, allows reasonable DIC across the stress–strain curve. Furthermore, the data are obtained easily and provide complementary information for EBSD analysis.
Patients with chronic schizophrenia require long term treatment. Attitude towards antipsychotic medications is a crucial determinant of medication adherence and is influenced by multiple factors.
The present study was conducted to investigate clinical and socio-demographic correlates of attitude of patients with schizophrenia to the antipsychotic medications and its correlation with psychopathology and insight.
A cross-sectional sample of 361 patients (194 males, 167 females) with schizophrenia diagnosed as per DSM IV, aged 16-55, having illness for ≤ 6 years and not having co morbid psychiatric, physical and substance use disorders, were assessed on Positive and Negative Syndrome Scale (PANSS) . The subjects were also assessed on drug attitude inventory -30 (DAI-30) and schedule for assessment of insight (SAI) to evaluate insight.
Mean age (±SD) of sample was 32.9 (SD 9.25) years and mean duration of illness was 286.39 (± 293.63) weeks. The subjects got a mean (±SD) score on PANSS, SAI and DAI 56.38 (± 17.04), 8.27 (±2.76) and 18.95 (±6.83) respectively. Most (92.8%) of patients had a positive attitude towards antipsychotic medications. A negative correlation (r= – 3.78, p=0.00) was observed between scores on DAI and PANSS and a positive correlation (0.06, p=0.00) was seen between scores on DAI and SAI. No correlation was observed between scores on DAI and other clinical and socio-demographic variables.
Majority of patients with chronic schizophrenia, who are on treatment, have positive attitude towards antipsychotic medications. There is a need for community based studies on the subject.
The aim of this study was to evaluate contact endoscopy in detecting local treatment failures post-radiotherapy in squamous cell carcinoma of the upper aerodigestive tract.
A total of 135 consecutive patients with suspected residual or recurrent cancer after definitive radiotherapy underwent contact endoscopy before biopsy. Contact endoscopy findings were compared with histopathological examination findings. Contact endoscopy could not be completed in 7 patients (5.9 per cent) and histopathological examination was inconclusive in 5 patients (3.7 per cent). The findings of the remaining 123 patients were compared.
The sensitivity, specificity and accuracy of contact endoscopy were 88.75, 88.72 and 86.99 per cent, respectively, with similar results across various sites of upper aerodigestive tract. Inter-observer kappa value was 0.86 (95 per cent confidence interval: 0.79–0.93). The intra-observer kappa value was 0.93 (95 per cent confidence interval: 0.87–1.00) for the first observer and 0.95 (95 per cent confidence interval: 0.90–1.00) for second and third observers.
Contact endoscopy showed the same high sensitivity and specificity with low inter- and intra-observer variability in detecting post-radiotherapy failures in cancer of the upper aerodigestive tract as has been shown in non-irradiated tissues in earlier studies.
Late-onset depression has been associated with history of vascular disease and atherosclerosis. As immune dysregulation is critically involved in vascular disease. We hypothesized that responsiveness of late onset depression can be associated with level of inflammatory markers in these subjects.
Role of inflammatory mediator in antidepressant responses in late onset depression.
To study C-reactive protein as predictor of antidepressant response in late onset depression.
Depressed patient (as per ICD 10 DCR) age > 60 years recruited from department of psychiatry and complete clinical assessment done and base line depression severity measure on Hamilton Depression Rating Scale (HDRS). C reactive protein level was assessed at base line. Patient prescribed antidepressant medication and at 8 week follow up re assed for depression severity in HDRS. Data analyzed with spss.21 and spearman correlation was used.
Mean age of responder (n = 6) 63.5 ± 4.9 year and HDRS at base line 16 ± 1.9. Mean age of partial responder or non-responder (n = 19) 65.1 ± 6.1 year and HDRS at base line 18.5 ± 3.9. Continuous decrease in depression severity during study period and antidepressant response rate was 24%. Base line CRP level had negative correlation with antidepressant responsiveness (r = –0.6, P < 0.05).
Late onset depression was less responsive to antidepressant medication and poor antidepressant response rate was associated with higher level of CRP in late onset depression.
Document not received.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Bell pepper or sweet pepper (Capsicum annuum L. var. grossum) is highly susceptible to high-temperature stress (HT). Hence, search for donor across C. annuum for HT tolerance was undertaken by following Temperature Induction Response (TIR) technique. The induction and challenging temperature requirement for TIR screening were standardized in 1 d-old Capsicum seedlings. Forty Capsicum genotypes were evaluated based on the recovery growth (RG) and per cent reduction in recovery growth (%RRG) of the seedlings. The genotypes Punjab Guchhedar and Ajeet 1 were found to have maximum cellular level tolerance (CLT) to HT with higher RG and lower %RRG compared to the non-induced seedlings and HDC 75 was found to have minimum CLT. In order to confirm the findings, another experiment was conducted under managed stress and control conditions. Absolute yield obtained from both the environments were used to calculate stress tolerance indices such as heat susceptibility index, tolerance index, stress tolerance index, mean productivity, geometric mean productivity and yield stability index. Based on these tolerance indices, Punjab Guchhedar and Ajeet 1 were found to be highly tolerant and HDC 75 as highly susceptible. Further, the combined result of TIR and tolerance indices also gave the same result confirming Punjab Guchhedar and Ajeet 1 can be used as a donor for the future breeding programme aimed at evolving high-temperature-tolerant bell pepper cultivars. The result also confirms the fitness of TIR technique to screen Capsicum genotypes for tolerance to HT based on variability in acquired thermotolerance.
The binary metal oxides are increasingly used as supercapacitor electrode materials in energy storing devices. Particularly NiCo2O4 has shown promising electrocapacitive performance with high specific capacitance and energy density. The electrocapacitive performance of these oxides largely depends on their morphology and electrical properties governed by their energy band-gaps and defects. The morphological structure of NiCo2O4 can be altered via the synthesis route, while the energy band-gap could be altered by doping. Also, doping can enhance crystal stability and bring in grain refinement, which can further improve the much-needed surface area for high specific capacitance. Given the above, this study evaluates the electrochemical performance of Ca-doped Ni1-xCaxCo2O4 (0 ≤ x ≤ 0.8) compounds. This stipulates promising applications for electrodes in future supercapacitors.
Hydrilla is an invasive aquatic plant that has rapidly spread through many inland water bodies across the globe by outcompeting native aquatic plants. The negative impacts of hydrilla invasion have become a concern for water resource management authorities, power companies, and environmental scientists. The early detection of hydrilla infestation is very important to reduce the costs associated with control and removal efforts of this invasive species. Therefore, in this study, we aimed to develop a tool for rapid, frequent, and large-scale monitoring and predicting spatial extent of hydrilla habitat. This was achieved by integrating in situ and Landsat 8 Operational Land Imager satellite data for Lake J. Strom Thurmond, the largest US Army Corps of Engineers lake east of the Mississippi River, located on the border of Georgia and South Carolina border. The predictive model for presence of hydrilla incorporated radiometric and physical measurements, including remote-sensing reflectance, Secchi disk depth (SDD), light-attenuation coefficient (Kd), maximum depth of colonization (Zc), and percentage of light available through the water column (PLW). The model-predicted ideal habitat for hydrilla featured high SDD, Zc, and PLW values, low values of Kd. Monthly analyses based on satellite images showed that hydrilla starts growing in April, reaches peak coverage around October, begins retreating in the following months, and disappears in February. Analysis of physical and meteorological factors (i.e., water temperature, surface runoff, net inflow, precipitation) revealed that these parameters are closely associated with hydrilla extent. Management agencies can use these results not only to plan removal efforts but also to evaluate and adapt their current mitigation efforts.
Suicide is a major global health concern. Bhutanese refugees resettled in the USA are disproportionately affected by suicide, yet little research has been conducted to identify factors contributing to this vulnerability. This study aims to investigate the issue of suicide of Bhutanese refugee communities via an in-depth qualitative, social-ecological approach.
Focus groups were conducted with 83 Bhutanese refugees (adults and children), to explore the perceived causes, and risk and protective factors for suicide, at individual, family, community, and societal levels. Audio recordings were translated and transcribed, and inductive thematic analysis conducted.
Themes identified can be situated across all levels of the social-ecological model. Individual thoughts, feelings, and behaviors are only fully understood when considering past experiences, and stressors at other levels of an individual's social ecology. Shifting dynamics and conflict within the family are pervasive and challenging. Within the community, there is a high prevalence of suicide, yet major barriers to communicating with others about distress and suicidality. At the societal level, difficulties relating to acculturation, citizenship, employment and finances, language, and literacy are influential. Two themes cut across several levels of the ecosystem: loss; and isolation, exclusion, and loneliness.
This study extends on existing research and highlights the necessity for future intervention models of suicide to move beyond an individual focus, and consider factors at all levels of refugees’ social-ecology. Simply focusing treatment at the individual level is not sufficient. Researchers and practitioners should strive for community-driven, culturally relevant, socio-ecological approaches for prevention and treatment.
While birthweight of offspring is associated with pre-pregnancy body mass index (BMI) and later risk of obesity, its mediating effect between the association of maternal pre-pregnancy BMI and offspring’s childhood anthropometrics has rarely been investigated. This study aimed to examine whether offspring birthweight is a mediator in the association between pre-pregnancy BMI and offspring’s childhood anthropometrics. The study included 1,618 mother–child pairs from the Australian Longitudinal Study on Women’s Health and Mothers and their Children’s Health Study. Children’s anthropometrics [mean age 8.6 (s.d. =3.0) years] were calculated from the mothers’ self-reported child weight and height measures. G-computation was used to estimate the natural direct and indirect (via birthweight) effects of pre-pregnancy BMI. In the fully adjusted model for maternal sociodemographic and lifestyle factors, the natural direct effects of pre-pregnancy obesity on child BMI-for-age, height-for-age, weight-for-age and weight-for-height outcomes were, β (95% confidence interval, CI), 0.75 (0.55, 0.95), 0.13 (−0.07, 0.32), 0.62 (0.44, 0.80) and 0.57 (0.24, 0.90), respectively. The corresponding natural indirect effects were 0.04 (−0.04, 0.12), −0.01 (−0.09, 0.07), −0.01 (−0.08, 0.07) and 0.09 (−0.05, 0.23). Similar results were observed for pre-pregnancy overweight and pre-pregnancy BMI as a continuous scale. Most of the effect of pre-pregnancy obesity on childhood weight-related anthropometric outcomes appears to be via a direct effect, not mediated through offspring’s birthweight.
There is limited evidence on the association between maternal preconception body mass index (BMI) trajectories and pregnancy complications and child development. This study examined the relationships of maternal BMI trajectories, diabetes and hypertensive disorders during pregnancy and offspring’s childhood physical and cognitive development. Data were from the Australian Longitudinal Study on Women’s Health and the Mothers and their Children’s Health study (n=771). Women’s preconception BMI trajectories were identified using group-based trajectory modelling. Children’s physical and cognitive development (up to the average age of 5 years) were obtained from the Ages and Stages Questionnaire (suspected gross motor delay) and the Australian Early Development Census (AEDC). Generalized estimating equation models, adjusted for maternal sociodemographic and lifestyle factors, were used for analyses. Three distinct BMI trajectories were identified (normative, chronically overweight and chronically obese). Children born to chronically obese women were more likely to be classified as developmentally vulnerable/at-risk on AEDC domains; gross and fine motor skills [risk ratio (RR)=1.64, 95% confidence interval (CI): 1.04, 2.61] and communication skills and general knowledge (RR=1.71, 95% CI: 1.09, 2.68). They also had an elevated risk of suspected gross motor delay (RR=2.62, 95% CI: 1.26, 5.44) compared with children born to women with a normative BMI trajectory. Maternal diabetes or hypertensive disorders during pregnancy were not associated with child outcomes. Maternal preconception BMI trajectories were associated with poorer childhood development. This study finding underscores the importance of excessive weight gain prevention throughout the reproductive stage of life.
To evaluate the survival outcomes and toxicities experienced by non-metastatic head and neck cancer (HNC) patients receiving modulated radiotherapy (RT).
Materials and methods
A total of 608 HNC patients treated consecutively from March 2010 to December 2014 with common subsites (oral cavity, oropharynx, hypopharynx, larynx and nasopharynx) of HNCs formed the study group. Eligible patients included those treated with radical or postoperative RT between March 2010 and December 2014. More than 90% patients received modulated RT [intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT)] with concurrent chemotherapy as per stage guidelines. Demographic parameters and disease-related factors were analysed. Disease-free survival (DFS) was calculated from end date of RT till last follow-up or last date of disease control. Overall survival (OS) was calculated from date of registration to last follow-up date if alive. The primary endpoint was survival. The statistical analyses were performed using SPSS version 20.0 and Kaplan–Meier method was used for calculation survival.
Among the evaluable patients, the median age was 60 years (range: 16–93) with male preponderance (male:female – 513:95). Majority were squamous cell carcinoma 93·4% (568/608). The subsites treated were oral cavity 36·8% (224). oropharynx 26·4% (161), larynx 19·7% (120), hypopharynx 10% (62) and nasopharynx 6·4% (41). RT intent was radical in 63·5% (386) and postoperative in 36·5% (222), with 59·5% (362) receiving concurrent chemotherapy. At last follow-up, 348 (57·2%) patients were alive, 169 (27·7%) patients had succumbed to disease and 120 (24·6%) patients had recurrent disease. Out of 120 recurrent cases loco-regional recurrence, nodal recurrence and distant metastases were seen in 62 (51·7%), 25 (20·8%), 33 (27·5%), respectively. In the entire study cohort at 2 year OS and DFS was 80 and 79% whereas 3 years OS and DFS was 70 and 75%, respectively.
In our study, 2 years and 3 years OS and DFS rates are found comparable to the international data with acceptable toxicity profile with the use of modulated RT. It seems to be possible because of stringent departmental protocols and good medical physics support. Our data re-validates need and benefit of advanced RT techniques like IG-IMRT and VMAT for both postoperative and radical HNC treatment at the cost of minimal long-term side effects. Future stringent follow-up and quality of life issues are being considered in a prospective manner.
It has been established that Coronal Mass Ejections (CMEs) may have significant impact on terrestrial magnetic field and lead to space weather events. In the present study, we selected several CMEs which are associated with filament eruptions on the Sun. We attempt to identify the presence of filament material within ICME at 1AU. We discuss how different ICMEs associated with filaments lead to moderate or major geomagnetic activity on their arrival at the Earth. Our study also highlights the difficulties in identifying the filament material at 1AU within isolated and in interacting CMEs.
Understanding species distributions, patterns of change and threats can form the basis for assessing the conservation status of elusive species that are difficult to survey. The snow leopard Panthera uncia is the top predator of the Central and South Asian mountains. Knowledge of the distribution and status of this elusive felid and its wild prey is limited. Using recall-based key-informant interviews we estimated site use by snow leopards and their primary wild prey, blue sheep Pseudois nayaur and Asiatic ibex Capra sibirica, across two time periods (past: 1985–1992; recent: 2008–2012) in the state of Himachal Pradesh, India. We also conducted a threat assessment for the recent period. Probability of site use was similar across the two time periods for snow leopards, blue sheep and ibex, whereas for wild prey (blue sheep and ibex combined) overall there was an 8% contraction. Although our surveys were conducted in areas within the presumed distribution range of the snow leopard, we found snow leopards were using only 75% of the area (14,616 km2). Blue sheep and ibex had distinct distribution ranges. Snow leopards and their wild prey were not restricted to protected areas, which encompassed only 17% of their distribution within the study area. Migratory livestock grazing was pervasive across ibex distribution range and was the most widespread and serious conservation threat. Depredation by free-ranging dogs, and illegal hunting and wildlife trade were the other severe threats. Our results underscore the importance of community-based, landscape-scale conservation approaches and caution against reliance on geophysical and opinion-based distribution maps that have been used to estimate national and global snow leopard ranges.