Effectiveness of psycho-educational intervention in improving outcome of unipolar depression: results from a randomised clinical trial

OBJECTIVES

Depressive disorders are one of the leading components of the global burden of disease with a prevalence of up to 14% in the general population. Numerous studies have demonstrated that pharmacotherapy combined with non-pharmacological measures offer the best treatment approach. Psycho-education as an intervention has been studied mostly in disorders such as schizophrenia and dementia, less so in depressive disorders. The present study aimed to assess the impact of psycho-education of patients and their caregivers on the outcome of depression.

METHODS

A total of 80 eligible depressed subjects were recruited and randomised into 2 groups. The study group involved an eligible family member and all were offered individual structured psycho-educational modules. Another group (controls) received routine counselling. The subjects in both groups also received routine pharmacotherapy and counselling from the treating clinician and were assessed at baseline, 2, 4, 8, and 12 weeks using the Hamilton Depression Rating Scale (HDRS), Global Assessment of Functioning (GAF), and Psychological General Well-Being Index (PGWBI). Results from both groups were compared using statistical methods including Chi-square test, Fisher's exact test, Student's t test, Pearson's correlation coefficient, as well as univariate and multiple regression analyses.

RESULTS

Baseline socio-demographic and assessment measures were similar in both groups. The study group had consistent improvement in terms of outcome measures with HDRS, GAF, and PGWBI scores showing respective mean change of -15.08, 22, and 60 over 12 weeks. The comparable respective changes in the controls were -8.77, 18.1, and 43.25.

CONCLUSION

Structured psycho-education combined with pharmacotherapy is an effective intervention for people with depressive disorders. Psycho-education optimises the pharmacological treatment of depression in terms of faster recovery, reduction in severity of depression, and improvement in subjective wellbeing and social functioning.

Estimation of Costunolide and Dehydrocostus Lactone in Saussurea lappa and its Polyherbal Formulations followed by their Stability Studies Using HPLC-DAD

BACKGROUND

Saussurea lappa is one of the popular Ayurvedic herb; costunolide and dehydrocostus lactones are well-known sesquiterpene lactones contained in many plants used as popular herbs, such as S. lappa, and have been considered as potential candidates for the treatment of various types of tumor.

OBJECTIVE

The present study was used for the quantification of costunolide and dehydrocostus lactone in S. lappa and its polyherbal formulations, stability studies of markers and characterization of their degradants.

MATERIALS AND METHODS

HPLC analysis was performed on Waters NOVAPAK HR C18 column (300 mm × 3.9 mm i.d., 6 μm) using isocratic elution with acetonitrile and water (60:40% v/v).

RESULTS

The calibration curves of both analytes showed good linearity within the established range 5-100 μg/ml. The limits of detection (LOD) and quantification (LOQ) were 1.5 and 4.6 μg/ml for costunolide and 1.3 and 4.0 μg/ml for dehydrocostus lactone, respectively. Good results were achieved with respect to repeatability (%RSD < 2.0) and recovery (99.3-101.8%).

CONCLUSION

The method was found to be precise, accurate, specific, and was successfully used for analyzing costunolide and dehydrocostus lactone in S. lappa and its polyherbal formulations. The developed method was found to be suitable for stability studies of markers and characterization of their degradation products.

Skin testing with raw egg does not predict tolerance to baked egg in egg-allergic children

BACKGROUND

Most children with egg allergy tolerate egg in baked foods, such as cake, but tolerance cannot be predicted with conventional allergy testing. We hypothesized that the skin prick test (SPT) wheal to unprocessed raw egg might predict tolerance of baked egg at formal oral food challenge (OFC).

METHODS

We conducted a retrospective chart review to assess the utility of SPT wheal to egg extract (EE), raw egg (RE), and the ratio of EE:RE in predicting outcome of baked-egg OFC in children presenting to our tertiary referral centers with a physician diagnosis of egg allergy and following complete egg avoidance in their diet, between 2009 and 2013. OFC were performed following a standardized protocol using baked egg in cake, to a total dose equivalent to 3g egg protein.

RESULTS

Data were analyzed from 186 completed challenges: OFC was positive in 64 (34%) children and negative in 122 (66%). Six children experienced anaphylaxis at OFC. Children tolerant to baked egg were more likely to have a lower SPT to egg extract/raw egg and EE:RE (median 0.56) than their allergic counterparts (0.70, p < 0.05). However, ROC curve analysis demonstrated poor predictivity of challenge outcome, with AUC for SPT to egg extract, raw egg and EE:ER equal to 0.71, 0.63 and 0.60, respectively.

CONCLUSION

EE:RE was not helpful in predicting outcome of baked-egg OFC. Indeed, SPT to egg extract was slightly better at predicting outcome than either SPT to raw egg or EE:RE. Unfortunately, tolerance to baked egg can only be predicted from previous history or through controlled exposure.

Determination of volatile organic compounds and associated health risk assessment in residential homes and hostels within an academic institute, New Delhi

The purpose of this study was to investigate the concentrations of volatile organic compounds (VOCs) in different indoor microenvironments of residential homes and hostels in an academic institute, in New Delhi, during March-May 2011. Eleven VOCs (aromatic and halogenated) were assessed. Sampling and analytical procedure were based on National Institute for Occupational Safety and Health (NIOSH) standard method. The lifetime cancer and non-cancer risk were calculated for targeted VOCs using US Environmental Protection Agency guidelines. The mean concentrations of ∑ VOCs (sum of monitored VOCs) and individual VOC were found to be higher indoors as compared to outdoors at both types of premises. Indoor to outdoor (I/O) ratios of the targeted VOCs exceeded 1.0, suggesting the significant presence of indoor sources. Strong correlations between I/O concentrations of VOCs in the current study suggest the presence of common sources. Factor analysis (FA) was used for source evaluation separately at two premise types. The estimated lifetime cancer risks in the current study for all occupants at both premises exceeded 10(-6) .

Multifocal central nervous system demyelination and Lhermitte's phenomenon secondary to combination chemotherapy for chronic lymphocytic leukaemia

The CRF regime (cyclophosphamide, rituximab and fludarabine) is used for the treatment of chronic lymphocytic leukaemia. We report a case of diffuse CNS demyelination following treatment with CRF, presenting with Lhermitte's phenomenon, and imaging and neurophysiological evidence of demyelination. Fludarabine is the most likely causative agent, although CNS demyelination has not been previously described in low dose therapy.

Effect of feeding tannin degrading bacterial culture (Streptococcus gallolyticus strain TDGB 406) on nutrient utilization, urinary purine derivatives and growth performance of goats fed on Quercus semicarpifolia leaves

To study the effect of supplementation of tannin degrading bacterial culture (Streptococcus gallolyticus strain TDGB 406) on growth performance, nutrient utilization and urinary purine derivatives of goats fed on oak (Quercus semicarpifolia) leaves. For growth study, eighteen billy goats (4 month old, average body weight 9.50 ± 1.50 kg) were distributed into three groups of six animals each. The animals of group 1 served as control while animals of groups 2 (T1) and 3 (T2) were given (@ 5 ml/kg live weight) autoclaved and live culture of isolate TDGB 406 (10(6) cells/ml) respectively. The animals were fed measured quantity of dry oak leaves as the main roughage source and ad libitum maize hay along with fixed quantity of concentrate mixture. The feeding of live culture of isolate TDGB 406 (probiotic) did not affect dry matter intake and digestibility of nutrients except that of dry matter and crude protein, which was higher in T2 group as compared to control. All the animals were in positive nitrogen balance. There was no significant effect of feeding isolate TDGB 406 on urinary purine derivatives (microbial protein production) in goats. The body weight gain and average live weight gain was significantly higher (p = 0.071) in T2 group as compared to control. Feed conversion efficiency was also better in the goats fed on live culture of TDGB 406 (T2). The feeding of tannin degrading bacterial isolate TDGB 406 as probiotic resulted in improved growth performance and feed conversion ratio in goats fed on oak leaves as one of the main roughage source.

Dual diagnosis vs. triple diagnosis in HIV: a comparative study to evaluate the differences in psychopathology and suicidal risk in HIV positive male subjects

INTRODUCTION

The problem of triple diagnosis of HIV, substance abuse and psychiatric disorders is a complex one with difficult solutions. HIV disease progression is affected by substance use as well as psychiatric illness burden due to both direct as well as indirect factors. Continuing substance abuse with poor drug adherence coexists with psychiatric disorders leading to increased morbidity and mortality.

METHOD

A total of 100 HIV positive subjects comprising of two groups each having 50 subjects with and without substance abuse were assessed using detailed history, mental state examination, WHO schedule for clinical assessment in neuropsychiatry (SCAN 2.0) and Beck's Scale for Suicidal Ideation (BSS). Statistical analysis used Chi-Square test, Fischer's exact test, Student's t-test, Pearson's correlation coefficient, univariate and multiple regression analysis, univariate and multiple logistic regression analysis. p-Value<0.05 was considered to denote statistical significance.

RESULTS

Subjects with substance use disorder had higher rates of psychiatric morbidity (52% vs. 24%, 95% CI=0.5200, p<0.05). The rate of antiretroviral therapy default was almost double in subjects with substance abuse, as compared to subjects without substance use. Suicidal risk was significantly increased (p<0.05) in subjects with co-morbid medical disorders but substance abuse did not increase the risk.

CONCLUSION

Substance abuse inflicts a much greater burden on HIV positive individuals as compared to subjects without substance use. Concomitant substance abuse resulted in significantly increased duration of illness and psychiatric morbidity.

Study of Mutations in β-Thalassemia Trait among Blood Donors in Eastern Uttar Pradesh

BACKGROUND

Knowledge on distribution of different mutations of thalassaemia, which are prevalent in a particular area, is a prerequisite for prenatal diagnosis.

OBJECTIVES

Studying mutations in β - thalassaemia trait among blood donors in eastern Uttar Pradesh, India.

MATERIAL AND METHODS

One thousand non - remunerated voluntary blood donors who were between 18 - 40 years of age, were included in the study. Both replacement and voluntary healthy blood donors were included. 4ml of venous blood was collected and it was stored at 4°C. Complete Blood Count (CBC), Haemoglobinopathy Screening and Molecular Analysis by ARMS - PCR (Amplification Refractory Mutation System - PCR) were done. Screening for β thalassaemia was done in a blood bank by using D - 10, Bio Rad, which was based on High Performance Liquid Chromatography (HPLC).

RESULTS

Twenty Eight subjects with β- thalassaemia trait were found among 1000 voluntary blood donors. IVS 1-5 (G-C) mutation was most common type (50%), followed by FS 8/9 (+G) 25% which was the second most common type. In our study, a rare mutation of CD 16 (-C) was also found. Out of 14 subjects who had IVS 1-5 (G-C) mutation (most common), six were from Varanasi (6/261) and five of them were Sindhis. It was seen that FS 41/42 (TCTT) mutation was distributed among all groups of populations which had higher prevalences of β-thalassaemia trait.

CONCLUSION

A comprehensive knowledge on beta thalassaemia mutations is necessary for determining a prenatal diagnosis. The occurrence of mutations may vary according to geographic region. Therefore, this study dealt with current problem of unknown mutations, in order to avoid complications.