Clinical utility of a short resting-state MRI scan in differentiating bipolar from unipolar depression

OBJECTIVE

Depression in bipolar disorder (BipD) requires a therapeutic approach that is from treating unipolar major depressive disorder (UniD), but to date, no reliable methods could separate these two disorders. The aim of this study was to establish the clinical validity and utility of a non-invasive functional MRI-based method to classify BipD from UniD.

METHOD

The degree of connectivity (degree centrality or DC) of every small unit (voxel) with every other unit of the brain was estimated in 22 patients with BipD and 22 age, gender, and depressive severity-matched patients with UniD and 22 healthy controls. Pattern classification analysis was carried out using a support-vector machine (SVM) approach.

RESULTS

Degree centrality pattern from 8-min resting fMRI discriminated BipD from UniD with an accuracy of 86% and diagnostic odds ratio of 9.6. DC was reduced in the left insula and increased in bilateral precuneus in BipD when compared to UniD. In this sample with a high degree of uncertainty (50% prior probability), positive predictive value of the DC test was 79%.

CONCLUSION

Degree centrality maps are potential candidate measures to separate bipolar depression from unipolar depression. Test performance reported here requires further pragmatic evaluation in regular clinical practice.

Outcome of universal newborn eye screening with wide-field digital retinal image acquisition system: a pilot study

PurposeTo evaluate the outcome of universal newborn eye screening with wide-field digital retinal imaging (WFDRI) system.MethodsIn this pilot study, we examined 1152 apparently healthy newborn infants in the obstetrics and gynecology ward of a civil hospital in Eastern India over 1.5 years. The examination included external eye examination, red reflex test and fundus imaging by WFDRI (RetCam II, Clarity medical system, Pleasanton, CA, USA) by a trained optometrist. The pathologies detected, net monetary gain and skilled manpower saved were documented. The results were compared with three similar studies thus far published in the literature.ResultsOcular abnormality of any kind was seen in 172 (14.93%) babies. Retinal hemorrhage in 153 babies (88.9% of all abnormal findings) was the most common abnormality; it was bilateral in 118 (77.12%) babies and 4 babies had foveal hemorrhage. Other abnormalities included vitreous hemorrhage (n=1), congenital glaucoma (n=2), uveal coloboma (n=2), retinopathy mimicking retinopathy of prematurity (n=2), and cystic fovea (n=3). The retinal hemorrhages resolved spontaneously in all eyes. One baby with congenital glaucoma received surgery and the other was treated medically. The benefits included savings in skilled manpower, a net monetary gain of INR 4.195 million (US$ 62,612) and skilled manpower saving by 319.4 h.ConclusionsThe universal neonatal eye screening using WFDRI detected pathologies that needed immediate care or regular follow up; saved skilled manpower with a net monetary gain. But compared to a red reflex test the benefits were marginal in terms of detecting treatment warranting ocular pathologies.

Frequency, Distribution of Congenital Anomaly and Associated Maternal Risk Factors

This study was done to find out the maternal risk factors associated with congenital anomaly. This cross-sectional observational study was carried out in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka, Bangladesh from January 2011 to December 2011. During this study period 78 patients had pregnancy with congenital anomaly and delivered in the Department of Obstetrics and Gynaecology. Women with ultrasound report of congenitally abnormal fetus irrespective of gestational age were included. Clinical evaluation of neonates was done by experienced neonatologist. The frequency of congenital anomaly was 3.46%. Most of the women belong to age <35 years (97.43%). Congenital anomalies more commonly were seen in the primiparas (64.10%). Most frequent associated risk factor was the history of abortions (35.89%). Maternal infections during antenatal period were also high (15.58%). There were 58 males (74.35%) and 20 females (25.64%). There was positive history of delivery of congenital abnormal babies in 6 cases (7.6%). Mothers of eight cases (10.25%) had history of drug ingestion during pregnancy. Four cases (5.12%) of mothers had hypothyroidism and 6 cases of mothers (7.69%) had diabetes mellitus respectively.

Medication Adherence in Kidney Transplant Recipients in an Urban Indian Setting

Medication nonadherence is a known problem after renal transplantation and can vary from one setting to another. Since it can lead to negative outcomes, it is important to develop intervention strategies to enhance adherence in a given setting using determinants identified through exploratory studies. We explored nonadherence in renal transplant recipients. A longitudinal survey was done with adult renal transplant recipients at a tertiary care public and two private hospitals of Kolkata. Subjects were followed-up for 1 year. After screening for medication adherence status by the four-item Morisky Medication Adherence Scale, those admitting to potential nonadherence were probed further. A patient was deemed to be nonadherent if failing to take medicines on appointed time (doses missed or delayed by more than 2 h) more than three times in any month during the observation period. A pretested questionnaire was used to explore potential determinants of nonadherence. Data of 153 patients recruited over a 2-year were analyzed. The extent of nonadherence with immunosuppressant regimens was about 31% overall; 44% in the public sector and 19% in the private sector (P < 0.001). Nonadherence with other medication was around 19% in both the sectors. Several potential demographic, socioeconomic and psychosocial determinants of nonadherence were identified on univariate analysis. However, logistic regression analysis singled out only the economic status. This study had updated the issue of nonadherence in renal transplant recipients in the Indian setting. Strategies to improve medication adherence can be planned by relevant stakeholders on the basis of these findings.

Imaging Carotid Atherosclerosis Plaque Ulceration: Comparison of Advanced Imaging Modalities and Recent Developments

Atherosclerosis remains the leading cause of long-term mortality and morbidity worldwide, despite remarkable advancement in its management. Vulnerable atherosclerotic plaques are principally responsible for thromboembolic events in various arterial territories such as carotid, coronary, and lower limb vessels. Carotid plaque ulceration is one of the key features associated with plaque vulnerability and is considered a notable indicator of previous plaque rupture and possible future cerebrovascular events. Multiple imaging modalities have been used to assess the degree of carotid plaque ulceration for diagnostic and research purposes. Early diagnosis and management of carotid artery disease could prevent further cerebrovascular events. In this review, we highlight the merits and limitations of various imaging techniques for identifying plaque ulceration.

Multimodal CT provides improved performance for lacunar infarct detection

BACKGROUND AND PURPOSE

Lacunar infarcts account for approximately 25% of acute ischemic strokes. Compared with NCCT alone, the addition of CTP improves sensitivity for detection of infarcts overall. Our aim was to systematically evaluate the diagnostic benefit and interobserver reliability of an incremental CT protocol in lacunar infarction.

MATERIALS AND METHODS

Institutional review board approval and patient consent were obtained. One hundred sixty-three patients presenting with a lacunar syndrome ≤4.5 hours from symptom onset were enrolled. Images were reviewed incrementally by 2 blinded readers in 3 separate sessions (NCCT only, NCCT/CTA, and NCCT/CTA/CTP). Diagnostic confidence was recorded on a 6-point scale with DWI/ADC as a reference. Logistic regression analysis calculated differences between actual and observed diagnoses, adjusted for confidence. Predictive effects of observed diagnostic accuracy and confidence score were quantified with the entropy r(2) value. Sensitivity, specificity, and confidence intervals were calculated accounting for multiple readers. Receiver operating characteristic analyses were compared among diagnostic strategies. Interobserver agreement was established with Cohen κ statistic.

RESULTS

The final study cohort comprised 88 patients (50% male). DWI/ADC-confirmed lacunar infarction occurred in 59/88 (67%) with 36/59 (61%) demonstrating a concordant abnormal finding on CTP. Sensitivity for definite or probable presence of lacunar infarct increased significantly from 9.3% to 42.4% with incremental protocol use, though specificity was unchanged (range, 91.9%-95.3%). The observed diagnosis was significantly related to the actual diagnosis after adjusting for CTP confidence level (P = .04) and was 5.1 and 2.4 times more likely to confirm lacunar infarct than NCCT or CTA source images. CTP area under the curve (0.77) was significantly higher than that of CTA source images (0.68, P = .006) or NCCT (0.55, P < .001).

CONCLUSIONS

CTP offers an improved diagnostic benefit over NCCT and CTA for the diagnosis of lacunar infarction.

Evaluation of retinopathy of prematurity screening in reverse Kangaroo Mother Care: a pilot study

PURPOSE

To evaluate retinopathy of prematurity (ROP) screening practice in reverse Kangaroo Mother Care (R-KMC) with respect to stress and pain to the infant.

METHODS

In a pilot study we evaluated ROP screening practice in R-KMC in 20 babies at risk of ROP. The R-KMC differed from the conventional KMC with respect to the baby position where the baby lay supine on mother's chest. With the mother lying supine and the baby in R-KMC position, screening examinations were done with indirect ophthalmoscope. The outcome measures included stress (quantified by pulse, respiration, and oxygen saturation) and pain to the baby by observing facial expression (eye squeezing, crying, and brow bulge). The heart rate, respiratory rate, and SpO2 (%) were compared before and immediately after the procedure using paired t-test.

RESULT

Mean (±SD) gestational age and birth weight were 30.8±2.3 weeks and 1362.5±253.9 g, respectively. During examination in R- KMC position 8 babies (40%) were completely relaxed (no eye squeezing and crying), 10 (50%) were partially relaxed (no brow bulge) and 2 babies (10%) were not relaxed. A change in heart and respiration rate both by 10 per minute was recorded in 12 (60%) and 10 (50%) babies, respectively. Five babies (25%) had reduction in blood oxygen concentration below 92%. The majority of the mothers (19 of 20) were relaxed.

CONCLUSION

ROP screening in R-KMC can be a baby friendly screening practice with respect to stress and pain to the infant and needs further evaluation in a larger cohort.

How to interpret computed tomography of the lumbar spine

Computed tomography (CT) of the spine has remained an important tool in the investigation of spinal pathology. This article helps to explain the basics of CT of the lumbar spine to allow the clinician better use of this diagnostic tool.

Synthesis and biological evaluation of 177Lu-DOTA-porphyrin conjugate: a potential agent for targeted tumor radiotherapy detection

A novel unsymmetrically substituted water soluble porphyrin derivative namely, 5-(p-amino-propylene--oxyphenyl)-10,15,20-tris-(p-carboxy-methyl-ene-oxyphenyl)porphyrin was synthesized and coupled with a bifunctional chelating agent, viz. p-NCS-benzyl-DOTA (p-isothiocyanatobenzyl-1,4,7,10-tetra-aza-cyclodo-decane-1,4,7,10-tetra-acetic acid) for developing a suitable conjugate for use in targeted tumor therapy. The porphyrin-p-NCS-benzyl-DOTA conjugate was radiolabeled with 177Lu in good radiolabeling yield. Biodistribution studies performed in Swiss mice bearing fibrosarcoma tumors revealed high tumor uptake (5.33±1.11% injected activity per gm of tumor) within 30 min post-injection. The complex exhibited favorable tumor to blood and tumor to muscle ratios at various post-administration time points. Fast clearance of the non-accumulated activity was observed mostly through the renal pathway. Scintigraphic imaging studies performed in Swiss mice bearing fibrosarcoma tumors also exhibited selective accumulation of activity in the tumor.

Interface properties of atomic layer deposited TiO2/Al2O3 films on In(0.53)Ga(0.47)As/InP substrates

Electrical and interfacial properties of metal-oxide-semiconductor (MOS) capacitors fabricated using atomic layer deposited bilayer TiO2/Al2O3 films on In0.53Ga0.47As/InP substrates are reported. Vacuum annealing at 350 °C is shown to improve the interface quality. Capacitance-voltage (C-V) characteristics with higher accumulation capacitance, negligible frequency dispersion, small hysteresis and low interface state density (∼1.5 × 10(11) cm(-2) eV(-1)) have been observed for MOS capacitors. Low frequency (1/f) noise characterization and inelastic electron tunneling spectroscopy (IETS) studies have been performed to determine defects and interface traps and explain the lattice dynamics and trap state generation mechanisms. Both the IETS and 1/f noise studies reveal the spatial locations of the traps near the interface and also the nature of the traps. The IETS study further revealed the dynamic evolution of trap states related to low frequency noise sources in the deposited TiO2/Al2O3 stacks. It is shown that deposition of an ultrathin layer of TiO2 on Al2O3 can effectively control the diffusion of As in the dielectric and the oxidation states of In and Ga at the In0.53Ga0.47As surface.

ROS-PIASγ cross talk channelizes ATM signaling from resistance to apoptosis during chemosensitization of resistant tumors

With the existing knowledge of ATM's role in therapeutic resistance, the present study aimed at identifying the molecular mechanisms that influence ATM to oscillate between chemoresistance and chemosensitivity. We observed that the redox status of tumors functions as a major determinant of ATM-dependent ‘resistance-to-apoptosis' molecular switch. At a low reactive oxygen species (ROS) condition during genotoxic insult, the ATM/sumoylated-IKKγ interaction induced NFκB activation that resisted JNK-mediated apoptosis, whereas increasing cellular ROS restored ATM/JNK apoptotic signaling. A search for the upstream missing link revealed that high ROS induces oxidation and ubiquitin-mediated degradation of PIASγ, thereby disrupting PIASγ-IKKγ cross talk, a pre-requisite for IKKγ sumoylation and subsequent NFκB activation. Interruption in the PIASγ-mediated resistance pathway channels ATM signaling toward ATM/JNK pro-death circuitry. These in vitro results also translated to sensitive and resistant tumor allograft mouse models in which low ROS-induced resistance was over-ruled in PIASγ knockout tumors, while its overexpression inhibited high ROS-dependent apoptotic cues. Cumulatively, our findings identified an unappreciated yet critical combinatorial function of cellular ROS and PIASγ in regulating ATM-mediated chemosensitization of resistant tumors. Thus, therapeutic strategies employing ROS upregulation to inhibit PIASγ during genotoxic therapy may, in future, help to eliminate the problems of NFκB-mediated tumor drug resistance.

Dark-coloured semen in nonobstructive azoospermia: a report of four cases

Dark-coloured semen is rarely observed in men with nonobstructive azoospermia in absence of genital tract bleeding. Dark-coloured semen is also observed rarely in men with spinal cord injury with or without genital tract bleeding. However, this condition has not been reported in the literature in absence of genital tract bleeding or spinal cord injury. Here, we report men with nonobstructive azoospermia with dark-coloured semen and without genital tract bleeding or spinal cord injury. The study included four subjects with dark-coloured semen. All the samples first investigated for the presence of red blood cells as well as haemoglobin. All the cases were examined in details with seminal, hormonal and genetic parameters. In addition, an elemental electron microscopy and inductively coupled plasma-atomic emission spectrometry evaluation for heavy metals was performed. The semen parameters showed normal volume, pH, leucocyte count and azoospermia or oligoazoospermia. Dark-coloured semen specimens contained neither red blood cells nor haeme pigment. Electron microscopy showed presence of platinum in all the cases, whereas inductively coupled plasma-atomic emission spectrometry revealed increased levels of lead, manganese and nickel in serum as compared to controls. The results indicate dark-coloured semen may be linked with heavy metals found in seminal cells.