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Chilukuri S, Mallick I, Agrawal A, Maitre P, Arunsingh M, James FV, Kataria T, Narang K, Gurram BC, Anand AK, Utreja N, Dutta D, Pavamani S, Mitra S, Mallik S, Mahale N, Chandra M, Chinnachamy AN, Shahid T, Raghunathan MS, Kannan V, Mohanty SK, Basu T, Hotwani C, Panigrahi G, Murthy V. Multi-Institutional Clinical Outcomes of Biopsy Gleason Grade Group 5 Prostate Cancers Treated With Contemporary High-Dose Radiation and Long-Term Androgen Deprivation Therapy. Clin Oncol (R Coll Radiol) 2023; 35:454-462. [PMID: 37061457 DOI: 10.1016/j.clon.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023]
Abstract
AIMS This multicentric retrospective study reports long-term clinical outcomes of non-metastatic grade group 5 prostate cancers treated with external beam radiotherapy (EBRT) alone with long-term androgen deprivation therapy (ADT). MATERIALS AND METHODS Patients treated across 19 institutions were studied. The key endpoints that were evaluated were 5-year biochemical recurrence-free survival (bRFS), metastases-free survival (MFS), overall survival, together with EBRT-related acute and late toxicities. The impact of various prognostic factors on the studied endpoints was analysed using univariate and multivariate analyses. RESULTS Among the 462 patients, 88% (405) had Gleason 9 disease and 31% (142) had primary Gleason pattern 5. A prostate-specific membrane antigen positron emission tomography-computed tomography scan was used for staging in 33% (153), 80% (371) were staged as T3/T4 and 30% (142) with pelvic nodal disease. The median ADT duration was 24 months; 66% received hypofractionated EBRT and 71.4% (330) received pelvic nodal irradiation. With a median follow-up of 56 months, the 5-year bRFS, MFS and overall survival were 73.1%, 77.4% and 90.5%, respectively. Primary Gleason pattern 5 was associated with worse bRFS, MFS and overall survival with hazard ratios of 0.51 (95% confidence interval 0.35 to 0.73, P < 0.001), 0.64 (95% confidence interval 0.43 to 0.96, P = 0.031) and 0.52 (95% confidence interval 0.28 to 0.97, P = 0.040), respectively, whereas pelvic nodal disease was associated with worse bRFS (hazard ratio 0.67, 95% confidence interval 0.46 to 0.98, P = 0.039) and MFS (hazard ratio 0.56, 95% confidence interval 0.37 to 0.85, P = 0.006). The acute and late radiation-related toxicities were low overall and pelvic nodal irradiation was associated with higher toxicities. CONCLUSION Contemporary EBRT and long-term ADT led to excellent 5-year clinical outcomes and low rates of toxicity in this cohort of non-metastatic grade group 5 prostate cancers. Primary Gleason pattern 5 and pelvic node disease portends inferior clinical outcomes.
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Affiliation(s)
- S Chilukuri
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - A Agrawal
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India
| | - P Maitre
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - F V James
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - T Kataria
- Division of Radiation Oncology, Cancer Institute, Medanta, Sector-38, Gurugram, India
| | - K Narang
- Division of Radiation Oncology, Cancer Institute, Medanta, Sector-38, Gurugram, India
| | - B C Gurram
- Department of Radiation Oncology, Yashoda Cancer Institute, Somajiguda, Hyderabad, India
| | - A K Anand
- Max Super Speciality Hospital, Saket, New Delhi, India
| | - N Utreja
- Max Super Speciality Hospital, Saket, New Delhi, India
| | - D Dutta
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, India
| | - S Pavamani
- Department of Radiation Oncology, Christian Medical College, Vellore, India
| | - S Mitra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - S Mallik
- Department of Radiation Oncology, Narayana Superspeciality Hospital, Howrah, India
| | - N Mahale
- Nirali Memorial Radiation Centre and Bharat Cancer Hospital, Surat, India
| | - M Chandra
- Department of Radiation Oncology, Jupiter Hospital, Thane, India
| | - A N Chinnachamy
- Department of Radiation Oncology, VN Cancer Centre, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | - T Shahid
- Department of Radiation Oncology, Apollo Multispeciality Hospitals, Kolkata, India
| | - M S Raghunathan
- Department of Radiotherapy, Kovai Medical Centre and Hospital, Coimbatore, India
| | - V Kannan
- Department of Radiation Oncology, P.D Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - S K Mohanty
- Department of Radiation Oncology, Sterling Cancer Hospital, Rajkot, Gujrat, India
| | - T Basu
- Department of Radiation Oncology, HCG Cancer Centre, Mumbai, India
| | - C Hotwani
- Department of Radiation Oncology, Alexis Multi-Speciality Hospital, Nagpur, India
| | - G Panigrahi
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India.
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Bhowmik S, Chandra M, Anand K, Dahuja S. A Single-Blind Randomized Control Trial on the Effectiveness of Adjunct Cognitive Stimulation Therapy on Cognitive Outcomes in Dementia. Ann Indian Acad Neurol 2023; 26:225-234. [PMID: 37538411 PMCID: PMC10394451 DOI: 10.4103/aian.aian_928_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/06/2023] [Accepted: 02/15/2023] [Indexed: 08/05/2023] Open
Abstract
Background Dementia is characterized by neurocognitive decline which interferes with daily function and independence. Cognitive stimulation therapy (CST) is an evidence-based cognitive psychosocial intervention for people with dementia. Materials and Methods A prospective interventional study of single-blind RCT design conducted in the Department of Neurology at ABVIMS and Dr RML Hospital amongst patients with DSM-V major neurocognitive disorder aged more than 50 years. Participants were randomized to CST and control groups using a block-randomized design. The control group participants received treatment as usual while the CST group delivered 45-min virtual group CST sessions for a total of 14 sessions over seven weeks. All participants in both groups were assessed at baseline and eight weeks using the Montreal Cognitive Assessment Scale (MoCA), Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog), neuropsychiatric inventory, instrumental activities of daily living, and Zarit Burden Interview for Caregiver Burden (ZBI) by a rater blind to group randomization. Results Total MoCA scores improved significantly in the CST group, compared to the control group which showed a statistically significant decrease. The mean total ADAS-Cog score in the CST group improved significantly compared to controls. The Lawton Instrumental Activities of Daily Living Scale showed a statistically significant change in the control group compared to the intervention group. From the comparison of the mean total neuropsychiatric inventory scale, it was observed that there was a statistically significant decrease in the severity of Behavioural and Psychological Symptoms of Dementia (BPSD) symptoms in the CST group. The mean total ZBI score decreased significantly in the CST group favoring less caregiver burden. Conclusion This study proved that CST has a significant impact on cognitive outcomes in dementia and it also proved its effectiveness in controlling the BPSD outcomes and caregiver burden in dementia.
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Affiliation(s)
- Soumya Bhowmik
- Department of Neurology, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Mina Chandra
- Department of Psychiatry, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Kuljeet Anand
- Department of Neurology, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Shrishti Dahuja
- Department of Psychiatry, ABVIMS and Dr. RML Hospital, New Delhi, India
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Kumar CS, Varghese M, Duddu V, Vaitheswaran S, Srivastava S, Shaji KS, George S, Singh NK, Goyal N, Bakhla A, Shaji S, Menon V, Hussain T, Grover S, Mehra A, Singh LK, Purushotham A, Desousa A, Shah N, Karia S, Anand I, Afroon S, Mehta R, Kukreja G, Dadarwala D, Vidya KL, Sivakumar PT, Sinha P, Reddy S, Isaac T, Chandra M. Indian Psychiatric Society multicentre study: Diagnostic patterns, comorbidity and prescription practices for patients with Dementia. Indian J Psychiatry 2023; 65:52-60. [PMID: 36874514 PMCID: PMC9983449 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_736_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 06/26/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There are more than 5 million people with dementia in India. Multicentre studies looking at details of treatment for people with dementia In India are lacking. Clinical audit is a quality improvement process which aims to systematically assess, evaluate, and improve patient care. Evaluating current practice is the key to a clinical audit cycle. AIM This study aimed to assess the diagnostic patterns and prescribing practices of psychiatrists for patients with dementia in India. METHOD A retrospective case file study was conducted across several centers in India. RESULTS Information from the case records of 586 patients with dementia was obtained. Mean age of the patients was 71.14 years (standard deviation = 9.42). Three hundred twenty one (54.8%) were men. Alzheimer's disease (349; 59.6%) was the most frequent diagnosis followed by vascular dementia (117; 20%). Three hundred fifty five (60.6%) patients had medical disorders and 47.4% patients were taking medications for their medical conditions. Eighty one (69.2%) patients with vascular dementia had cardiovascular problems. Majority of the patients (524; 89.4%) were on medications for dementia. Most frequently prescribed treatment was Donepezil (230; 39.2%) followed by Donepezil-Memantine combination (225; 38.4%). Overall, 380 (64.8%) patients were on antipsychotics. Quetiapine (213, 36.3%) was the most frequently used antipsychotic. Overall, 113 (19.3%) patients were on antidepressants, 80 (13.7%) patients were on sedatives/hypnotics, and 16 (2.7%) patients were on mood stabilizers. Three hundred nineteen (55.4%) patients and caregivers of 374 (65%) patients were receiving psychosocial interventions. CONCLUSIONS Diagnostic and prescription patterns in dementia which emerged from this study are comparable to other studies both nationally and internationally. Comparing current practices at individual and national levels against accepted guidelines, obtaining feedback, identifying gaps and instituting remedial measures help to improve the standard of care provided.
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Affiliation(s)
- Ct Sudhir Kumar
- Alzheimer's and Related Disorders Society of India (ARDSI) - Kottayam Chapter, Aymanam, Kerala, India
| | - Mathew Varghese
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | | | - Sridhar Vaitheswaran
- Dementia Care in SCARF - DEMCARES, Schizophrenia Research Foundation (SCARF) Chennai, Tamil Nadu, India
| | - Shrikant Srivastava
- Department of Geriatric Mental Health, King George's Medical University, Lucknow, UP, India
| | - K S Shaji
- Kerala University of Health Sciences, Thrissur, Kerala, India
| | - Sanju George
- Department of Psychology, Rajagiri College of Social Sciences, Kalamassery, Ernakulam, Kerala, India
| | - Narendra Kumar Singh
- Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India
| | - Nishant Goyal
- Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India
| | - Ajay Bakhla
- Department of Psychiatry, Rajendra Institute of Medical Sciences, Bariyatu, Ranchi, India
| | - S Shaji
- Bethseda Hospital, Vengola, Perumbavoor, Kerala, India
| | - Vikas Menon
- Department of Psychiatry, JIPMER, Puducherry, India
| | - Tajamul Hussain
- Department of Psychiatry, Government Medical College, Baramulla, Jammu and Kashmir, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aseem Mehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lokesh Kumar Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - A Purushotham
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Avinash Desousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College Mumbai, Maharashra, India
| | - Nilesh Shah
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College Mumbai, Maharashra, India
| | - Sagar Karia
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College Mumbai, Maharashra, India
| | - I Anand
- Department of Psychiatry, PSGIMS&R, Peelamedu Coimbatore, Tamil Nadu, India
| | - Shafana Afroon
- Department of Psychiatry, PSGIMS&R, Peelamedu Coimbatore, Tamil Nadu, India
| | - Ritambhara Mehta
- Department of Psychiatry, Government Medical College, Surat, Gujarat, India
| | - Gargi Kukreja
- Department of Psychiatry, Government Medical College, Surat, Gujarat, India
| | - Dimple Dadarwala
- Department of Psychiatry, Government Medical College, Surat, Gujarat, India
| | - K L Vidya
- Department of Geriatric Mental Health, King George's Medical University, Lucknow, UP, India
| | - P T Sivakumar
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Preeti Sinha
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | | | - Thomas Isaac
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Mina Chandra
- Department of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Sharma S, Chandra M, Harsha Kota S. Four year long simulation of carbonaceous aerosols in India: Seasonality, sources and associated health effects. Environ Res 2022; 213:113676. [PMID: 35728639 DOI: 10.1016/j.envres.2022.113676] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/26/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
India's air quality is in a dismal state, with many studies ascribing it to PM2.5. Most of these corroborate that carbonaceous aerosol (CA) constitute significant fraction of PM2.5. However, investigations on the effect of long-term meteorological or emission changes on PM2.5 and its components, and their associated health effects are rare. In this work, WRF-Chem simulations for three seasons over four years (2016-2019) were carried out to cogitate the spatial and temporal changes in PM2.5 and its components in India. Model predicted PM2.5 concentrations were in good agreement with the ground-based observations for 25 cities. PM2.5 was highest in winter and lowest in pre-monsoon. PM2.5 reduced by ∼8% in Indo-Gangetic Plain (IGP) but increased by ∼38% and ∼130% in south and northeast India, respectively, from 2016 to 2019. IGP witnessed three times higher average PM2.5 concentrations than south India. No significant interannual change in CA contributions was observed, however, it peaked in the winter season. Other inorganics (OIN) were the major component of PM2.5, contributing more than 40%. Primary organic aerosol (POA) fractions were higher in north India, while secondary inorganic aerosol (SIA) dominated south India. Transport and residential sectors were the chief contributors to CA across India. Biomass burning contributed up to ∼23% of PM2.5 in regions of IGP during post-monsoon, with CA fractions up to 50%. Associations between PM2.5 and its components with daily inpatient admissions from a tertiary care centre in Delhi showed that PM2.5 and OIN had lower associations with daily hospital admissions than CA. Every 10 μg/m3 increase in POA, black carbon (BC), and secondary organic aerosol (SOA) were associated with ∼1.09%, ∼3.07% and ∼4.93% increase in the risk of daily hospital admissions. This invigorates the need for more policies targeting CA rather than PM2.5 to mitigate associated health risks, in India.
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Affiliation(s)
- Shubham Sharma
- Department of Civil Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110 016, India
| | - Mina Chandra
- Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Sri Harsha Kota
- Department of Civil Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110 016, India; Arun Duggal Centre of Excellence for Research in Climate Change and Air Pollution (CERCA), IIT Delhi, New Delhi, 110016, India.
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Murthy V, Chilukuri S, Mallick I, Maitre P, Agarwal A, Moses A, James F, Narang K, Kataria T, Anand A, Dutta D, Mitra S, Pavamani S, Mallick S, Mahale N, Chandra M, Narayan A, Shahid T, Sairam M, Kannan V, Mohanty S, Basu T, Hotwani C, G B. OC-0606 Multi-institutional outcomes of Gleason grade group 5 prostate cancers treated with EBRT and ADT. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lakshminarayanan M, Vaitheswaran S, Srinivasan N, Nagarajan G, Ganesh A, Shaji KS, Chandra M, Krishna M, Spector A. Cultural adaptation of Alzheimer's disease assessment scale-cognitive subscale for use in India and validation of the Tamil version for South Indian population. Aging Ment Health 2022; 26:423-430. [PMID: 33491464 PMCID: PMC7613307 DOI: 10.1080/13607863.2021.1875192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Currently no standardized tools are available in the Indian languages to assess changes in cognition. Our objectives are to culturally adapt the Alzheimer's disease Assessment Scale-Cognitive Subscale (ADAS-Cog) for use in India and to validate the Tamil version in an urban Tamil-speaking older adult population. METHODS Two panels of key stakeholders and a series of qualitative interviews informed the cultural and linguistic adaptation of the ADAS-Cog-Tamil. Issues related to levels of literacy were considered during the adaptation. Validation of the ADAS-Cog-Tamil was completed with 107 participants - 54 cases with a confirmed diagnosis of mild-moderate dementia, and 53 age, gender and education matched controls. Concurrent validity was examined with the Vellore Screening Instrument for Dementia (VSID) in Tamil. Internal consistency using Cronbach's alpha, sensitivity and specificity data using the Area under the Receiver Operating Characteristics (AUROC) curve values were computed. Inter-rater reliability was established in a subsample. RESULTS The ADAS-Cog-Tamil shows good internal consistency (α = 0.91), inter-rater reliability and concurrent validity (with VSID-Patient version: r = -0.84 and with VSID-Caregiver version: r = -0.79). A cut-off score of 13, has a specificity of 89% and sensitivity of 90% for the diagnosis of dementia. CONCLUSION ADAS-Cog-Tamil, derived from a rigorous, replicable linguistic and cultural adaptation process involving service users and experts, shows good psychometric properties despite the limitations of the study. It shows potential for use in clinical settings with urban Tamil speaking populations. The English version of the tool derived from the cultural adaptation process could be used for further linguistic adaptation across South Asia.
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Affiliation(s)
- Monisha Lakshminarayanan
- Dementia Care in Schizophrenia Research Foundation (DEMCARES), R/7A, North Main Road, Anna Nagar West Extension, Chennai 600101, Tamil Nadu, India
| | - Sridhar Vaitheswaran
- Dementia Care in Schizophrenia Research Foundation (DEMCARES), R/7A, North Main Road, Anna Nagar West Extension, Chennai 600101, Tamil Nadu, India,Corresponding Author: Dementia Care in Schizophrenia Research Foundation (DEMCARES), R/7A, North Main Road, Anna Nagar West Extension, Chennai 600101, Tamil Nadu, India;
| | - Nivedhitha Srinivasan
- Dementia Care in Schizophrenia Research Foundation (DEMCARES), R/7A, North Main Road, Anna Nagar West Extension, Chennai 600101, Tamil Nadu, India
| | - Gayathri Nagarajan
- Dementia Care in Schizophrenia Research Foundation (DEMCARES), R/7A, North Main Road, Anna Nagar West Extension, Chennai 600101, Tamil Nadu, India
| | - Ahalya Ganesh
- Masters Student, Master’s Degree Programme in Gender Studies, Tampere University Keskustakampus, Kalevantie 4, Tampere 33100, Finland
| | - Kunnukatil S Shaji
- Department of Psychiatry, Jubilee Mission Medical College & Research Institute, Thrissur 680005, Thrissur, Kerala, India
| | - Mina Chandra
- Department of Psychiatry, Centre of Excellence in Mental Health, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Murali Krishna
- Department of Research, Foundation for Research and Advocacy in Mental Health (FRAMe), Mysore, India
| | - Aimee Spector
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
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Chandra M, Rai CB, Kumari N, Sandhu VK, Chandra K, Krishna M, Kota SH, Anand KS, Oudin A. Air Pollution and Cognitive Impairment across the Life Course in Humans: A Systematic Review with Specific Focus on Income Level of Study Area. Int J Environ Res Public Health 2022; 19:ijerph19031405. [PMID: 35162428 PMCID: PMC8835599 DOI: 10.3390/ijerph19031405] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/23/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023]
Abstract
Cognitive function is a crucial determinant of human capital. The Lancet Commission (2020) has recognized air pollution as a risk factor for dementia. However, the scientific evidence on the impact of air pollution on cognitive outcomes across the life course and across different income settings, with varying levels of air pollution, needs further exploration. A systematic review was conducted, using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Guidelines to assess the association between air pollution and cognitive outcomes across the life course with a plan to analyze findings as per the income status of the study population. The PubMed search included keywords related to cognition and to pollution (in their titles) to identify studies on human participants published in English until 10 July 2020. The search yielded 84 relevant studies that described associations between exposure to air pollutants and an increased risk of lower cognitive function among children and adolescents, cognitive impairment and decline among adults, and dementia among older adults with supportive evidence of neuroimaging and inflammatory biomarkers. No study from low- and middle-income countries (LMICs)was identified despite high levels of air pollutants and high rates of dementia. To conclude, air pollution may impair cognitive function across the life-course, but a paucity of studies from reLMICs is a major lacuna in research.
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Affiliation(s)
- Mina Chandra
- Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India; (C.B.R.); (N.K.); (V.K.S.)
- Correspondence: ; Tel.: +91-98-1183-1902
| | - Chandra Bhushan Rai
- Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India; (C.B.R.); (N.K.); (V.K.S.)
| | - Neelam Kumari
- Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India; (C.B.R.); (N.K.); (V.K.S.)
| | - Vipindeep Kaur Sandhu
- Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India; (C.B.R.); (N.K.); (V.K.S.)
| | - Kalpana Chandra
- Delhi Jal Board, Government of National Capital Territory of Delhi, New Delhi 110094, India;
| | - Murali Krishna
- JSS Academy of Higher Education & Research, Mysore 570015, Karnataka, India;
| | - Sri Harsha Kota
- Department of Civil Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India;
| | - Kuljeet Singh Anand
- Department of Neurology, Atal Bihari Vajpayee Institute of Medical Sciences (Formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India;
| | - Anna Oudin
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umea, Sweden;
- Department of Laboratory Medicine, Lund University, 901 87 Umea, Sweden
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Javed R, Narang D, Kaur P, Chandra M, Filia G, Singh ST. A fluorescence polarization assay using recombinant protein ESAT-6 for the detection of antibodies against pathogenic Mycobacterium bovis in bovine. Iran J Vet Res 2022; 23:204-209. [PMID: 36425598 PMCID: PMC9681983 DOI: 10.22099/ijvr.2022.38558.5613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Bovine tuberculosis (bTB) is a major bacterial disease that causes significant economic disruption across the globe. AIMS Our study was based on using a fluorescence polarization assay (FPA) that used fluorescein-labeled ESAT-6 protein to detect Mycobacterium bovis antibodies in bovine serum. METHODS The ESAT-6 protein was used in a FPA. Positive TB reactors were determined by the comparative intradermal test (CID) and interferon gamma test (IFN-γ). Antibodies against M. bovis were detected using a fluorescein isothiocyanate (FITC) labeled tracer and a whole culture FITC labeled tracer in the positive cattle. RESULTS Of the 192 animals tested for bTB, 37 were found to be positive by either the CID or IFN-γ assays. Using the mP values from five culture-positive serum samples, a cutoff value of more than >127 mp provided the best discrimination between positive reactors and negative bTB animals. The ESAT-6 results of FPA in comparison with CID results revealed sensitivity of 92.9% and specificity of 64.6%, and in comparison with results IFN-γ, showed sensitivity of 95.7% and specificity of 49%. FPA using FITC labelled ESAT-6 as a tracer has better sensitivity (95.7%) and specificity (49.1%) than IFN-γ test in humoral immune response in animals. CONCLUSION This work revealed that the ESAT-6 protein as an antigen can be used in diagnosing bTB using a practical and sensitive humoral test.
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Affiliation(s)
- R. Javed
- Ph.D. Student, Department of Veterinary Microbiology, College of Veterinary Science (COVS), Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
| | - D. Narang
- Department of Veterinary Microbiology, College of Veterinary Science (COVS), Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
| | - P. Kaur
- Department of Veterinary Microbiology, College of Veterinary Science (COVS), Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
| | - M. Chandra
- Department of Veterinary Microbiology, College of Veterinary Science (COVS), Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
| | - G. Filia
- Animal Disease Research Centre (ADRC), College of Veterinary Science (COVS), Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
| | - S. T. Singh
- Directorate of Livestock Farms, Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
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Stoner CR, Lakshminarayanan M, Mograbi DC, Vaitheswaran S, Bertrand E, Schimidt Brum P, Durgante H, Ferri CP, Mkenda S, Walker R, Dotchin C, Paddick SM, Chandra M, Krishna M, Du B, Shaji KS, Fisher E, Spector A. Development and acceptability of a brief, evidence-based Dementia Awareness for Caregivers course in low- and middle-income countries. Dementia (London) 2021; 21:598-617. [PMID: 34886707 PMCID: PMC8811332 DOI: 10.1177/14713012211055316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Knowledge of and attitudes towards dementia vary across countries, and for caregivers in low- and middle-income countries (LMICs), access to information can be challenging. There is an urgent need for brief, easily accessible and culturally appropriate educational courses for caregivers of persons with dementia, providing much needed information whilst addressing important psychological concepts such as stigma. Methods An international and multidisciplinary team developed Dementia Awareness for Caregivers (DAC) courses in four stages: (1) scoping review and module agreement, (2) development of an International template (DAC-International) containing a standardised process for adding information, (3) development of local DACs using a standardised format and (4) acceptability of courses in Brazil, India and Tanzania. Findings The DAC-International was developed, comprising three modules: ‘What is dementia?’; ‘Positive engagement’ and ‘Caring for someone with dementia’. Three local versions were developed from this (DAC-Brazil, DAC-India and DAC-Tanzania), where additions of country-specific information included prevalent stereotypes and the addition of culturally relevant case studies. An initial field test was conducted in each country (n = 85), which indicated acceptability to participants. Conclusions The methods used here resulted in culturally valid and acceptable educational courses for carers of people with dementia. Future work will consist of large-scale, formal evaluations and the development of additional local courses.
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Affiliation(s)
- Charlotte R Stoner
- Centre for Chronic Illness and Ageing, Institute for Lifecourse Development, School of Human Sciences, University of Greenwich, London, UK
| | - Monisha Lakshminarayanan
- Dementia Care in Schizophrenia Research Foundation (DEMCARES in SCARF), Chennai, Tamil Nadu, India
| | - Daniel C Mograbi
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Brazil; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sridhar Vaitheswaran
- Dementia Care in Schizophrenia Research Foundation (DEMCARES in SCARF), Chennai, Tamil Nadu, India
| | | | | | - Helen Durgante
- Psychology Department, Universidade Federal do Rio Grande (FURG), Rio de Janeiro, Brazil
| | - Cleusa P Ferri
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil; Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, Brazil
| | - Sarah Mkenda
- Occupational Therapy Department, Kilimanjaro Christian Medical University College, Tanzania
| | - Richard Walker
- Population Health Sciences Institute, Newcastle University, UK
| | - Catherine Dotchin
- Population Health Sciences Institute, Newcastle University, UK; North Tyneside General Hospital, Northumbria Healthcare National Health Service Foundation Trust, UK
| | - Stella-Maria Paddick
- Clinical and Translational Medicine, Newcastle University, Tyne and Wear, UK; Gateshead Health NHS Foundation Trust, UK
| | - Mina Chandra
- Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly Post Graduate Institute of Medical Education and Research) and Dr Ram Manohar Lohia Hospital, India
| | - Murali Krishna
- Foundation for Research and Advocacy in Mental Health (FRAMe), Mysore, India
| | - Bharath Du
- Foundation for Research and Advocacy in Mental Health (FRAMe), Mysore, India; Viveka Hospital, Mysore, India
| | | | - Emily Fisher
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Aimee Spector
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
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Pareek V, Bhalavat R, Chandra M, Nellore L, George K, Borade D. Clinical Outcomes and Toxicity Profile With IMRT or Brachytherapy Boost in Oropharyngeal Malignancies: A Randomized, Open Label Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Raine-Bennett T, Fassett M, Chandra M, Armstrong MA, Shi JM, Chiu VY, Alabaster A, Alexeeff S, Xie F, Im TM, Pisa F, Getahun D. POSTER ABSTRACTS. Contraception 2021. [DOI: 10.1016/j.contraception.2021.07.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Agarwal D, Agarwal M, Chandra M, Mishra A, Agarwal R. Knowledge assessment and outcomes of otolaryngology practice amidst the COVID-19 pandemic in a busy ENT department. Ann R Coll Surg Engl 2021; 103:589-598. [PMID: 34464553 DOI: 10.1308/rcsann.2021.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Otolaryngology health personnel are at high risk of acquiring COVID-19 disease and, hence, are likely to have high stress levels. This study was designed to evaluate the feedback of otolaryngology healthcare workers in ENT departments who are managing patients in the coronavirus pandemic. METHODS A questionnaire focused on all aspects of healthcare delivery was completed by otolaryngology healthcare workers. RESULTS The findings, based on statistical analyses, included high stress levels and inadequate disease-related information in these workers. CONCLUSIONS Healthcare authorities need to take care of issues related to mental health in healthcare professionals in addition to spreading awareness about safe practices. Further studies are needed to continuously monitor feedback from personnel as the coronavirus pandemic unravels in the future.
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Affiliation(s)
- D Agarwal
- King George's Medical University, Lucknow, India
| | - M Agarwal
- Intern, Era's Lucknow Medical College, Lucknow, India
| | - M Chandra
- King George's Medical University, Lucknow, India
| | - A Mishra
- King George's Medical University, Lucknow, India
| | - R Agarwal
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Abstract
UNLABELLED Dementia is a global public health issue with an urgent need for developing newer and more effective treatment strategies. Research in the area of dementia, however, poses unique ethical and legal challenges. Epidemiological studies, studies on pharmacological and non-pharmacological interventions have to deal with obtaining consent from persons with cognitive impairments, those from diverse cultural groups and need to contend with privacy and confidentiality issues. The caregiver support intervention research has not yet translated into policy change and effective clinical care. Biomedical research that involves invasive procedures may not translate into short- or long-term therapeutic benefits but is necessary research. Palliative care research in dementia has to deal with ethical issues involving people at end-of-life research. Proposed research may not receive approval, citing necessary safeguards to the vulnerable older people against invasive studies even when it is least invasive. This article aims to review the ethical aspects for safeguarding vulnerable older people with dementia and the potential challenges in conducting dementia research from a researcher's perspective. Some of the safeguards for ethical research include determining capacity to consent, obtaining advanced directives in early stages and proxy consent from caregivers, obtaining informed consent in cognitively impaired individuals. Future research policies need to consider the logistics of involving older people in research, enhancing caregiver support, and encouraging supportive decision-making. It will also need to address developing capacity assessment tools while addressing advanced care planning that will ensure the well-being of subjects in research. BACKGROUND Dementia has become a global public health issue, with hospitalization rates being 65% higher in seniors with dementia than others.1,2 The pressures on healthcare systems mean an urgent need to develop robust preventive and treatment strategies for dementia, which requires multidisciplinary research. However, the patient's stage of illness and ability to engage in discussions around the merits of participating in research and caregiver concerns is an important aspect of dementia research.Hence, dementia research poses unique ethical challenges compared to populations with other diseases, which has led to the evolution of an ethical framework for dementia research. This article aims to review and give a viewpoint on the ethical aspects for safeguarding vulnerable older people with dementia and the potential challenges in conducting dementia research from a researcher's perspective.
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Affiliation(s)
- Mina Chandra
- Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | | | - Harbandna Sawhney
- Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
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Abstract
The rising aging population in India has led to an increased caregiving burden, and accordingly, the number of residential care facilities is also burgeoning. There is no regulatory framework or registration authority specifically for residential care homes in India. The article's objective is to understand the need for a regulatory framework in India in the context of historic and global experiences in the UK, USA, and Europe. Although there is a lack of literature comparing the community home-based care and residential care, one study reported a preference for home-based care in the South Asian context. Elder abuse and deprivation of rights of seniors are common, and there is a need to bring in more safeguards to prevent these from the perspective of the older adults, their family members, the care providers, and the state. While the main priority of meeting care needs in long-term care is a challenge given the lack of trained care staff, the quality control mechanisms also need to evolve. A review of adverse incidents, complaints, and litigations also highlights the need for regulation to improve the standards and quality of care. The article explores lacunae of residential care facilities in the Indian context and provides recommendatory parameters for evaluating the quality of care provided. Relevant sections of the statutory new Mental Healthcare Act of 2017 in India could provide a regulatory framework ensuring rights and liberties of the residents are upheld. The authors propose a state-run model for elderly care homes and commencement of framing regulations appropriate to the Indian context.
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Affiliation(s)
| | - Mahesh Gowda
- Spandana Healthcare, Nandini Layout, Bangalore, Karnataka, India
| | - Saraswati Tenagi
- Dept. of Psychiatry, Belgaum Institute of Medical Sciences, Belagavi, Karnataka, India
| | - Mina Chandra
- Dept. of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Shaji K, Chandran N, Chandra M, Kumar R. Assessment of Dementia Under Prevailing Indian Laws and Its Implications. Indian J Psychol Med 2021; 43:S13-S18. [PMID: 34732949 PMCID: PMC8543616 DOI: 10.1177/02537176211023272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- K.S. Shaji
- Office of Dean Research, University of Health Sciences, Thrissur, Kerala, India
| | - Nimmy Chandran
- Dept. of Psychiatry, Government Medical College, Palakkad, Kerala, India
| | - Mina Chandra
- Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Rajeev Kumar
- College of Medicine, Qatar University and Senior Consultant in Liaison Psychiatry, Hamad Medical Corporation, Doha, Qatar
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Pareek V, Bhalavat R, Chandra M, Nellore L, George K, Borade D. OC-0023 IMRT or Brachytherapy boost in oropharyngeal malignancies: A Randomized, open label study. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Pareek V, Chandra M, Bhalavat R. PO-0180 Impact of hybrid brachytherapy in cervical cancer: A survival and toxicity profile assessment. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06339-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Du B, Lakshminarayanan M, Krishna M, Vaitheswaran S, Chandra M, Kunnukattil Sivaraman S, Goswami SP, Rangaswamy T, Spector A, Stoner CR. Psychometric properties of outcome measures in non-pharmacological interventions of persons with dementia in low-and middle-income countries: A systematic review. Psychogeriatrics 2021; 21:220-238. [PMID: 33336529 PMCID: PMC7986620 DOI: 10.1111/psyg.12647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/07/2020] [Accepted: 11/26/2020] [Indexed: 02/06/2023]
Abstract
Despite high burden of dementia in low-and middle-income countries (LMICs), only a small number of clinical trials of psychosocial interventions for persons with dementia (PwD) have been conducted in these settings. It is essential that such trials use appropriate outcome measures that are methodologically robust and culturally appropriate to evaluate the effectiveness of interventions. We carried out a systematic review to examine the evidence base and psychometric properties of measures employed in these studies in LMICs. A systematic search of published literature on randomised controlled trials (RCT) of psychosocial interventions for PwD in LMICs between 2008 and April 2020 was carried out. Measures employed in each of the eligible studies were identified and through a focused search, we further explored the evidence base and psychometric properties employing Terwee criteria. Data extraction and quality appraisal were conducted by two independent reviewers. The review identified 41 measures from 17 RCTS which fulfilled eligibility criteria and they examined effectiveness across the domains of cognition (n = 16), behaviour and psychological symptoms (n = 11) and quality of life (n = 8). Of these 41, we were able to access relevant literature only for 18 and they were subject to psychometric analysis. Psychometric properties of these 18 instruments were at best modest, with Terwee scores ranging from 3 (low) to 15 (moderate). A majority of the studies were from China (n = 5) and Brazil (n = 6). The evidence base for the routinely employed measures in RCTs of non-pharmacological interventions for PwD in LMICs is limited. The quality of adaptation and validation of these instruments is variable and studies are largely uninformative about their psychometric properties and cultural appropriateness to the study setting. There is an urgent need to develop scientifically robust instruments in LMIC settings that can be confidently employed to measure outcomes in trials of psychosocial interventions for PwD.
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Affiliation(s)
- Bharath Du
- Foundation for Research and Advocacy in Mental health (FRAMe), Mysore, India
| | | | - Murali Krishna
- Foundation for Research and Advocacy in Mental health (FRAMe), Mysore, India
| | | | - Mina Chandra
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Juneja A, Anand K, Chandra M, Deshpande S, Dhamija R, Kathuria P, Mahajan R. Neuropsychiatric Symptoms and Caregiver Burden in Parkinson's Disease. Ann Indian Acad Neurol 2021; 23:656-660. [PMID: 33623267 PMCID: PMC7887493 DOI: 10.4103/aian.aian_91_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 11/09/2022] Open
Abstract
Objective: Parkinson’s disease (PD) is a neurodegenerative disorder. It has a significant impact on the quality of life of patients and their caregivers. The present study aims to study the phenomena of neuropsychiatric symptoms and their association with caregiver burden in PD. Methods: The study was conducted in 100 patients of Parkinson’s disease and their primary caregivers. The patients of PD were diagnosed on the basis of UK Brain Bank criteria; severity/staging of Parkinson’s disease was done by Movement Disorder Society - Unified Parkinson’s disease rating scale (MDS-UPDRS-III). Patients who fulfilled inclusion and exclusion criteria were recruited for the study. The neuropsychiatric evaluation was based on Neuropsychiatric Inventory-Questionnaire (NPI-Q). Caregiver burden was assessed with the Zarit Caregiver Burden Inventory (ZCBI). Results: Mean age of PD patients was 61.48 ± 6.71 years, majority of them were males (68%). Mean total NPI score of patients was 44.46 ± 5.38. Mean age of caregivers was 52.26 ± 6.80 years, majority of them were females (72%) and spouse (76%) in relation to the patient. Caregiver burden was significantly related to age of the patient, duration of illness, severity of illness, and total NPI score. Conclusion: Neuropsychiatric symptoms significantly contribute to the caregiver burden in Parkinson’s disease.
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Affiliation(s)
| | - Kuljeet Anand
- Department of Neurology, Dr. RML Hospital, Delhi, India
| | - Mina Chandra
- Department of Psychiatry, Dr. RML Hospital, Delhi, India
| | | | - Rajinder Dhamija
- Department of Neurology, LHMC and Sucheta Kriplani Hospital, Delhi, India
| | - Parul Kathuria
- Department of Psychiatry, Dr. RML Hospital, Delhi, India
| | - Rahul Mahajan
- Department of Neurology, Dr. RML Hospital, Delhi, India
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Chandra M, Raveendranathan D, Johnson Pradeep R., Patra S, Rushi, Prasad K, Brar JS. Managing Depression in Diabetes Mellitus: A Multicentric Randomized Controlled Trial Comparing Effectiveness of Fluoxetine and Mindfulness in Primary Care: Protocol for DIAbetes Mellitus ANd Depression (DIAMAND) Study. Indian J Psychol Med 2020; 42:S31-S38. [PMID: 33487800 PMCID: PMC7802038 DOI: 10.1177/0253717620971200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Suboptimal management of depression in type 2 diabetes mellitus (T2DM) often translates into poor glycemic control, medical complications, and impaired quality of life. Feasibility and effectiveness of collaborative care models of depression in diabetes in low- and middle-income countries (LMICs) remain unexplored. DIAbetes Mellitus ANd Depression (DIAMAND) study, a multicentric single-blind randomized controlled trial (SBRCT) comparing effectiveness of fluoxetine and mindfulness in primary care settings, addresses this gap in scientific literature. METHODS This trial conducted in diverse geographic settings of New Delhi, Bengaluru, and Bhubaneswar will comprise module-based training of primary care providers (PCPs) for screening, diagnosing, and managing depression in diabetes in phase I. Phase II will involve four-arm parallel group RCT on 350 participants with T2DM with comorbid depressive episode randomly allocated to receive fluoxetine, mindfulness therapy, fluoxetine plus mindfulness therapy, or treatment as usual at primary care settings. Interventions would include fluoxetine (up to 60 mg/day) and/or sessions of mindfulness for 16 weeks. Primary outcomes on standardized rating scales include depression scores (Hamilton Depression Rating Scale), treatment adherence (Adherence to Refill and Medication Scale), self-care (Diabetes Self-Management Questionnaire), diabetes-related distress (Diabetes Distress Scale), and glycemic control. Secondary outcomes include quality of life (World Health Organization Quality of Life Brief version [WHO-QOL BREF]) and mindfulness (Five Facets Mindfulness Questionnaire). DISCUSSION This RCT will investigate the effectiveness of module-based training of PCPs and feasibility of collaborative care model for managing depression in T2DM in primary care settings in LMICs and effectiveness of fluoxetine and/or mindfulness in improving diverse outcomes of T2DM with major depression.
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Affiliation(s)
- Mina Chandra
- Dept. of Psychiatry, Deaddiction Services & Resource Centre for Tobacco Control, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (Formerly PGIMER) and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Johnson Pradeep R.
- Dept. of Psychiatry, Medical Ethics, Institutional Ethics Committee, St. John’s Medical College, Bengaluru, Karnataka, India
| | - Suravi Patra
- Dept. of Psychiatry, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Rushi
- Dept. of Clinical Psychology, Centre of Excellence in Mental Health, Deaddiction Services & Resource Centre for Tobacco Control, Atal Bihari Vajpayee Institute of Medical Sciences (Formerly PGIMER) and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Konasale Prasad
- Dept. of Psychiatry and Bioengineering, University of Pittsburgh, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Jaspreet S Brar
- Dept. of Psychiatry, Community Care Behavioral Health Organization, Western Psychiatric Hospital of UPMC, Pittsburgh, Pennsylvania, USA
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21
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Pareek V, Bhalavat R, Chandra M, Bauskar P, Kumar N, Kotilingala E, Iyer P. PO-0965: Cardiac dosimetry with or without ABC in left breast cancer irradiation: Single institute experience. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00983-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Kapoor A, Bhalavat R, Chandra M, Bakshi C, Bauskar P, Kumar N, Markana S, Amar S, Pareek V. Assessment of Impact of Bone Marrow Sparing for Hematological and Gastrointestinal Toxicities in Cervical Cancer with External Beam Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Getahun D, Chandra M, Fassett M, Shi J, Alexeeff S, Chiu V, Xie F, Armstrong M, Im T, Stern J, Takhar H, Asiimwe A, Raine-Bennett T. P68 Risk factors for ectopic pregnancy among women of reproductive age. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stoner CR, Chandra M, Bertrand E, Du B, Durgante H, Klaptocz J, Krishna M, Lakshminarayanan M, Mkenda S, Mograbi DC, Orrell M, Paddick SM, Vaitheswaran S, Spector A. A New Approach for Developing "Implementation Plans" for Cognitive Stimulation Therapy (CST) in Low and Middle-Income Countries: Results From the CST-International Study. Front Public Health 2020; 8:342. [PMID: 32850583 PMCID: PMC7411173 DOI: 10.3389/fpubh.2020.00342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Even with a strong evidence base, many healthcare interventions fail to be translated to clinical practice due to the absence of robust implementation strategies. For disorders such as Alzheimer's disease and other dementias, access to evidence-based interventions beyond research settings is of great importance. Cognitive Stimulation Therapy (CST) is a brief, group-based intervention, with consistent evidence of effectiveness. Methods: An implementation focused, three-phase methodology was developed using extensive stakeholder engagement. The methods resulted in a standardized Implementation Plan for the successful translation of CST from research to practice. The methodology was developed using the Consolidated Framework for Implementation Research (CFIR) and refined in three countries that vary in levels of economic development and healthcare systems (Brazil, India and Tanzania). Results: Five Implemention Plans for CST were produced. Each plan contained implementation strategies and action plans devised in conjunction with policy professionals, healthcare professionals, people with dementia and family carers, and an international team of researchers and clinicians. Conclusion: This novel methodology can act as a template for implementation studies in diverse healthcare systems across the world. It is an effective means of devising socio-culturally informed Implementation Plans that account for economic realities, health equity and healthcare access.
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Affiliation(s)
- Charlotte R Stoner
- Centre for Chronic Illness and Ageing, Centre for Mental Health, Institute for Lifecourse Development, School of Human Sciences, University of Greenwich, London, United Kingdom
| | - Mina Chandra
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Bangabandhu Sheikh Mujeeb Marg, New Delhi, India
| | - Elodie Bertrand
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Helen Durgante
- Department of Psychology, Federal University of Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brazil
| | - Joanna Klaptocz
- Newcastle University Hospitals NHS Foundation Trust, Royal Vic Infirmary, Newcastle upon Tyne, United Kingdom
| | | | | | - Sarah Mkenda
- Occupational Therapy Department, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Daniel C Mograbi
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stella-Maria Paddick
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sridhar Vaitheswaran
- Dementia Care in Schizophrenia Research Foundation (DEMCARES in SCARF), Chennai, India
| | - Aimee Spector
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, United Kingdom
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Pareek V, Bhalavat R, Chandra M, Nellore L, George K, Borade D, Bauskar P. Clinical outcomes and Toxicity profile with IMRT or Brachytherapy boost in oropharyngeal malignancies: A Randomized, open label study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Slathia P, Narang D, Chandra M, Sharma A, Narang A. Detection of non-tuberculous mycobacterial species using PCR-RFLP analysis in trans-tracheal washes in cattle and buffaloes with respiratory distress. Iran J Vet Res 2020; 21:136-140. [PMID: 32849894 PMCID: PMC7430363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Bovine tuberculosis (bTB) is a chronic disease of cattle with high economic importance in livestock farming caused by Mycobacterium bovis and bears a zoonotic potential. There are some non-tuberculous mycobacteria (NTM) which cause disease similar to bTB and interfere with diagnosis of bTB. Non-tuberculous mycobacteria are saprophytic in nature but some of them may cause pulmonary infections, mastitis, lesions in respiratory tract and lymph nodes of cattle, due to which they are being recognized worldwide and interfere with the diagnosis of bTB. AIMS The aim of the study was to detect NTM species from cattle and buffaloes with respiratory distress using biochemical test and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis (PRA). METHODS A total of 50 trans-tracheal washes were collected from cattle (n=41) and buffaloes (n=9) with respiratory distress. The samples were inoculated on Middlebrook 7H10 media after proper decontamination with 4% NaOH. The isolate obtained was identified by biochemical testing. Extracted DNA from samples and isolate was subjected to PRA which involved hsp65 gene amplification (439 bp) and RFLP analysis of amplified product. RESULTS Out of 50 trans-tracheal washes only one isolate of Mycobacterium kansasii (n=1) (2%) was obtained which was confirmed by biochemical testing and PRA. Mycobacterium kansasii (n=4) (8%), Mycobacterium intracellulare (n=1) (2%), and Mycobacterium vaccae (n=1) (2%) were identified by PRA. CONCLUSION The study emphasizes the importance of NTM in animals. Polymerase chain reaction-restriction fragment length polymorphism analysis is a more reliable and rapid method for identification of NTM than conventional methods.
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Affiliation(s)
- P. Slathia
- Ph.D. Student in Veterinary Microbiology, Department of Veterinary Microbiology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, Punjab, India
| | - D. Narang
- Department of Veterinary Microbiology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, Punjab, India
| | - M. Chandra
- Department of Veterinary Microbiology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, Punjab, India
| | - A. Sharma
- Department of Veterinary Medicine, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, Punjab, India
| | - A. Narang
- Department of Veterinary Medicine, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, Punjab, India
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Brahma D, Narang D, Chandra M, Singh ST. Comparison of multiplex and ordinary PCR for diagnosis of paratuberculosis and tuberculosis in blood samples (buffy coat) of cattle and buffaloes. Iran J Vet Res 2020; 21:52-56. [PMID: 32368226 PMCID: PMC7183380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 05/30/2019] [Accepted: 06/24/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Paratuberculosis and tuberculosis (TB) caused by Mycobacterium avium paratuberculosis (MAP) and Mycobacterium tuberculosis complex (MTC), respectively are economically important, chronic debilitating diseases affecting the dairy herds and are also potential zoonotic threats. AIMS Differential diagnosis of paratuberculosis and TB in blood samples of cattle and buffaloes. METHODS In this study, an in-house developed multiplex polymerase chain reaction (PCR) targeting MAP, Mycobacterium bovis and Mycobacterium smegmatis was used in blood samples (buffy coat) parallel with IS900 PCR and esxB PCR for diagnosis of paratuberculosis and TB, respectively; in a total of 202 cattle and buffaloes. RESULTS Out of 202 animals, 12 (5.9%) and 17 (8.4%) animals were positive for MAP by multiplex PCR and IS900 PCR, respectively; from which only 8 (4%) animals were positive by both tests; whereas 4 and 9 animals were exclusively positive by multiplex PCR and IS900 PCR, respectively. None of the animals were found to be positive for M. bovis and M. smegmatis by the multiplex PCR. However, the esxB PCR detected 13 (6.4%) animals positive for TB. In fact, 3 (1.5%) animals were found to be co-infected by both paratuberculosis and TB. CONCLUSION The in-house multiplex PCR detected MAP in buffy coat and there was a fair degree of agreement between the multiplex PCR and IS900 PCR in detection of MAP DNA though the latter detected more number of animals to be positive for MAP. Besides, esxB PCR showed a high diagnostic potential and can be used for diagnosis of TB from blood.
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Affiliation(s)
- D. Brahma
- MVSc Student in Veterinary Microbiology, Department of Veterinary Microbiology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, Punjab, India
| | - D. Narang
- Department of Veterinary Microbiology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, Punjab, India
| | - M. Chandra
- Department of Veterinary Microbiology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, Punjab, India
| | - S. T. Singh
- Directorate of Livestock Farm, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, Punjab, India
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Pareek V, Chandra M, Bhalavat R, Kumar N, George K, Nellore L, Borade D. OC-084: Hybrid Brachytherapy in locally advanced Cervical cancer: A Survival and toxicity profile assessment. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(20)30453-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Pareek V, Chandra M, Bhalavat R, Ambekar U, John S, Jain D, Iyer L. OC-085: Role of intervention-Patient reported sexual adjustment following brachytherapy for cervical cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(20)30454-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lo JC, Grimsrud CD, Ott SM, Chandra M, Hui RL, Ettinger B. Atypical femur fracture incidence in women increases with duration of bisphosphonate exposure. Osteoporos Int 2019; 30:2515-2520. [PMID: 31555883 PMCID: PMC7449240 DOI: 10.1007/s00198-019-05112-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/24/2019] [Indexed: 01/28/2023]
Abstract
UNLABELLED In a northern California population of older women who were treated with oral bisphosphonate drugs, the incidence of atypical femur fracture, a rare complication of treatment, increased with longer duration of bisphosphonate exposure. These findings align with those previously reported in an independent southern California population. INTRODUCTION The age-adjusted incidence of atypical femur fracture (AFF) reported in southern California increased with bisphosphonate (BP) exposure, ranging up to 113 per 100,000 person-years for 8-10-year exposure. This study examines the incidence of AFF in a northern California population. METHODS Women age 45-89 years who initiated oral BP during 2002-2014 in Kaiser Permanente Northern California were followed for AFF outcome, defined by a primarily transverse diaphyseal femur fracture through both cortices, with focal periosteal/endosteal hypertrophy, minimal trauma, and minimal/no comminution. Total BP exposure was determined from dispensed prescriptions. The incidence of AFF, calculated for 2-year BP categories ranging from < 2 to > 10 years, was age-adjusted using the 2000 US Census. RESULTS Among 94,542 women, 107 experienced an AFF during or < 1 year after BP cessation (mean exposure 6.6 ± 3.0 years and total days' supply 5.7 ± 2.8 years at AFF). A strong relationship between AFF incidence and increasing BP exposure was seen, more than doubling for each 2-year category until 8-10 years. Among women with 2- to < 4-year BP, the crude and age-adjusted incidence was 18 and 9 per 100,000 person-years but increased over 2- and 5-fold for women with 4- to < 6- and 6- to < 8-year BP, respectively. For those receiving ≥ 8-year BP, the crude and age-adjusted incidence peaked at 196 and 112 per 100,000 person-years exposure. CONCLUSION Incidence of AFF increases markedly after 4-6 years of BP. These trends align with southern California and confirm a strong BP duration-related risk of this rare but serious event.
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Affiliation(s)
- J C Lo
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - C D Grimsrud
- Department of Orthopedic Surgery, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA
| | - S M Ott
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - M Chandra
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - R L Hui
- Pharmacy Outcomes Research Group, Kaiser Permanente California, 1800 Harrison Street, Oakland, CA, 94612, USA
| | - B Ettinger
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
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Pareek V, Bhalavat R, Chandra M. Hippocampal avoidance in WBRT for metastases: Comparative neurocognitive and dosimetric assessment. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz419.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pareek V, Bhalavat R, Chandra M. Impact of combined interstitial and intracavitary brachytherapy in locally advanced cervical cancer: A survival and toxicity profile assessment. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz426.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pareek V, Bhalavat R, Chandra M. Ventricular–Subventricular zone involvement: A predictive factor for survival in glioblastoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz431.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Anand K, Chandra M, Juneja A, Kathuria P. Determinants of caregiver burden in Parkinson’s disease. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pareek V, Chandra M, Bhalavat R. Impact of combined interstitial and intracavitary brachytherapy in locally advanced cervical cancer: A survival and toxicity profile assessment. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pareek V, Bhalavat R, Chandra M. Predictive factors and survival outcomes with stereotactic body radiation therapy in treatment of oligometastases in colorectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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38
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Pareek V, Bhalavat R, Chandra M. Spirituality and religious coping for cancer patients and providers: An ‘Almighty’ belief for palliative care. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz261.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chandra M, Pareek V, Kumar N, Bhalavat R, George K, Nellore L, Bauskar P. Impact of Combined Interstitial and Intracavitary Brachytherapy in Locally Advanced Cervical Cancer: A Feasibility, Survival, and Toxicity Profile Assessment. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Spector A, Stoner CR, Chandra M, Vaitheswaran S, Du B, Comas-Herrera A, Dotchin C, Ferri C, Knapp M, Krishna M, Laks J, Michie S, Mograbi DC, Orrell MW, Paddick SM, Ks S, Rangawsamy T, Walker R. Mixed methods implementation research of cognitive stimulation therapy (CST) for dementia in low and middle-income countries: study protocol for Brazil, India and Tanzania (CST-International). BMJ Open 2019; 9:e030933. [PMID: 31434784 PMCID: PMC6707660 DOI: 10.1136/bmjopen-2019-030933] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In low/middle-income countries (LMICs), the prevalence of people diagnosed with dementia is expected to increase substantially and treatment options are limited, with acetylcholinesterase inhibitors not used as frequently as in high-income countries (HICs). Cognitive stimulation therapy (CST) is a group-based, brief, non-pharmacological intervention for people with dementia that significantly improves cognition and quality of life in clinical trials and is cost-effective in HIC. However, its implementation in other countries is less researched. This protocol describes CST-International; an implementation research study of CST. The aim of this research is to develop, test, refine and disseminate implementation strategies for CST for people with mild to moderate dementia in three LMICs: Brazil (upper middle-income), India (lower middle-income) and Tanzania (low-income). METHODS AND ANALYSIS Four overlapping phases: (1) exploration of barriers to implementation in each country using meetings with stakeholders, including clinicians, policymakers, people with dementia and their families; (2) development of implementation plans for each country; (3) evaluation of implementation plans using a study of CST in each country (n=50, total n=150). Outcomes will include adherence, attendance, acceptability and attrition, agreed parameters of success, outcomes (cognition, quality of life, activities of daily living) and cost/affordability; (4) refinement and dissemination of implementation strategies, enabling ongoing pathways to practice which address barriers and facilitators to implementation. ETHICS AND DISSEMINATION Ethical approval has been granted for each country. There are no documented adverse effects associated with CST and data held will be in accordance with relevant legislation. Train the trainer models will be developed to increase CST provision in each country and policymakers/governmental bodies will be continually engaged with to aid successful implementation. Findings will be disseminated at conferences, in peer-reviewed articles and newsletters, in collaboration with Alzheimer's Disease International, and via ongoing engagement with key policymakers.
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Affiliation(s)
- Aimee Spector
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Charlotte R Stoner
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Mina Chandra
- Department of Psychiatry, Centre of Excellence in Mental Health, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Bharath Du
- Department of Research, Foundation for Research and Advocacy in Mental Health (FRAMe), Mysore, India
| | - Adelina Comas-Herrera
- Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science (LSE), London, UK
| | - Catherine Dotchin
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Cleusa Ferri
- Postgraduate Program of the Psychobiology Department, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Martin Knapp
- Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science (LSE), London, UK
| | - Murali Krishna
- Department of Research, Foundation for Research and Advocacy in Mental Health (FRAMe), Mysore, India
| | - Jerson Laks
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Daniel C Mograbi
- Department of Psychology, PUC-Rio, Rio de Janeiro, Brazil
- Institute of Psychiatry, King's College London, London, UK
| | | | | | - Shaji Ks
- Department of Psychiatry, Government Medical College, Kerala, India
| | - Thara Rangawsamy
- Department of Research, Schizophrenia Research Fondation (SCARF), Chennai, India
| | - Richard Walker
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Pareek V, Bhalavat R, Chandra M. Predictive factors and survival outcomes with stereotactic body radiation therapy in treatment of oligometastases in colorectal cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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42
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Coppus SF, Chandra M, Opmeer BC, Johnson N, van der Veen F, Bossuyt PMM, Mol BWJ, Boldingh Q, Coomarasamy A. Chlamydia antibody titer testing versus hysterosalpingography for detection of tubal pathology in subfertile women. Hippokratia 2019. [DOI: 10.1002/14651858.cd007433.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sjors F Coppus
- UMC St Radboud; Obstetrics and Gynaecology; Geert Grooteplein 10 Nijmegen Netherlands 6525 GA
| | - M Chandra
- Máxima Medical Centre; Obstetrics and Gynaecology; De Run 4600 Veldhoven Netherlands 5500 MB
| | - Brent C Opmeer
- Academic Medical Centre; Clinical Epidemiology and Biostatistics; PO Box 22660 Amsterdam Netherlands 1100 AD
| | - Neil Johnson
- The University of Adelaide; Discipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research Institute; Norwich Centre Ground Floor, 55 King William Road North Adelaide Adelaide South Australia Australia 5006
| | - Fulco van der Veen
- Amsterdan UMC, University of Amsterdam; Center for Reproductive Medicine; Meibergdreef 9 Amsterdam Netherlands 1105 AZ
| | - Patrick MM Bossuyt
- Academic Medical Center, University of Amsterdam; Department of Clinical Epidemiology, Biostatistics and Bioinformatics; Room J1b-217, PO Box 22700 Amsterdam Netherlands 1100 DE
| | - Ben Willem J Mol
- Monash University; Department of Obstetrics and Gynaecology; 246 Clayton Road Clayton Victoria Australia 3168
| | - Quirine Boldingh
- Amsterdam Medical Center, University of Amsterdam; Amsterdam Netherlands
| | - Arri Coomarasamy
- University of Birmingham; Tommy’s National Centre for Miscarriage Research, Institute of Metabolism and Systems Research; C/o Academic Unit, 3rd Floor, Birmingham Women's Hospital Foundation Trust Mindelsohn Way Birmingham UK B15 2TG
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Pareek V, Bhalavat R, Chandra M, Bakshi C, Bhambhani N. EP-2128 Rectal toxicity with MUPIT Interstitial Brachytherapy – Predictors, clinical and dosimetric outcomes. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32548-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pareek V, Bhalavat R, Chandra M. EP-1263 Hippocampal avoidance in WBRT for Metastases – Comparative Neurocognitive and Dosimetric Assessment. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31683-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pareek V, Bhalavat R, Chandra M, Bakshi C, Bhambhani N. PO-1060 Role of intraluminal brachytherapy as palliative treatment in advanced esophageal cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31480-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pareek V, Bhalavat R, Chandra M. PO-092 Can Brachytherapy help reduce the dose to DARS in Head and Neck cancer? A Clinical experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sikand M, Arshad R, Beniwal RP, Chandra M, Hiwale S. Perceived parental style, cognitive style, and resilience in females with dissociative disorder in India. Indian J Psychiatry 2019; 61:177-183. [PMID: 30992613 PMCID: PMC6425806 DOI: 10.4103/psychiatry.indianjpsychiatry_404_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Dissociative disorders are theorized to be caused by extremely stressful situations, including abuse, kidnapping, incest, rape, and other threats of death. Such childhood experiences alter one's cognitive style as well as one's ability to deal with adverse situations. It is important to understand how cognitive style influences the relationship between parental style and resilience to help in the management. We aimed to assess the relationship between perceived parental styles and resilience mediated by cognitive styles in females with dissociative disorder. MATERIALS AND METHODS Sample comprised 60 females between 18 and 50 years of age with dissociative disorder (International Classification of Diseases-10 criteria) in a cross-sectional observational study. Perceived parental style of the participant was assessed using s-EMBU, cognitive style using the Cognitive Style Inventory, and resilience using the Conner and Davidson's Resiliency Scale. Data were analyzed using Shapiro-Wilk to assess the normality of the data and Spearman rank correlation for determining the relationship between the variables. RESULTS The results indicated a significant relationship between emotional warmth and systematic-cognitive style (r s= 0.398, P = 0.01) and between systematic-cognitive style and high resilience (r s= 0.256, P = 0.05). A significant regression equation was found (F[1, 58] = 9.146, P < 0.004), with an R2= 0.136 to predict systematic-cognitive style based on emotional warmth as the perceived parental style. To predict resilience based on systematic-cognitive style, a significant regression equation was found (F[1, 58] = 6.006, P < 0.017), with an R2= 0.094. CONCLUSION The more emotional warmth was perceived by the participants, the more systematic they were in their perception of the environment, in turn being more resilient. The study findings help in establishing protective psychological factors in dissociative disorder.
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Affiliation(s)
- Mehak Sikand
- Department of Clinical Psychology, Centre of Excellence in Mental Health, Post Graduate Institute of Medical Education and Research-Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Rushi Arshad
- Department of Clinical Psychology, Centre of Excellence in Mental Health, Post Graduate Institute of Medical Education and Research-Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Ram Pratap Beniwal
- Department of Psychiatry and Drug De-addiction, Centre of Excellence in Mental Health, Post Graduate Institute of Medical Education and Research-Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Mina Chandra
- Department of Psychiatry and Drug De-addiction, Centre of Excellence in Mental Health, Post Graduate Institute of Medical Education and Research-Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Surabhi Hiwale
- Department of Psychiatry and Drug De-addiction, Centre of Excellence in Mental Health, Post Graduate Institute of Medical Education and Research-Dr Ram Manohar Lohia Hospital, New Delhi, India
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Pareek V, Bhalavat R, Chandra M, Nellore L, George K, Borade D, Kalariya K, Moosa Z, Reddy N, Srivastava A, Kapoor A, Kawale D, Bauskar P. PO-100 HDR Interstitial brachytherapy in Recurrent Head and Neck cancer: An effective Salvage option. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30266-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chandra M, Rana P, Chandra K, Arora VK. Tuberculosis - Depression syndemic: A public health challenge. Indian J Tuberc 2019; 66:197-202. [PMID: 30878069 DOI: 10.1016/j.ijtb.2019.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/16/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Depression is common in Tuberculosis (TB) and associated with adverse outcomes through pathogenic mechanisms and impaired self-care behaviours including reduced treatment adherence. Undiagnosed depression can threaten the robustness of DOTS model despite large public health investment. The Depression-Tuberculosis Syndemic requires collaborative partnership with mental health professionals. AIM To study the evidence base for Depression-Tuberculosis Syndemic. METHODOLOGY A Pubmed and Google Scholar search was conducted using the key words "Depression", "Tuberculosis" and "Syndemic" and abstracts screened for appropriateness and relevance. RESULT Depression-TB Syndemic is common with a bidirectional relationship. Depression is associated with higher hazard ratio and increased prevalence of TB. Depression is independently associated with higher morbidity, mortality, drug resistance, risk of TB reactivation and community TB transmission. The underlying biopsychosocial mechanism of Depression- Tuberculosis Syndemic includes biological factors like inflammatory cascade, HPA axis dysregulation and psychosocial factors like perceived stigma and treatment non-adherence. DISCUSSION Depression is a poor prognostic factor in TB. The National Mental Health Programme (NMHP) and National Strategic Plan (NSP) for Tuberculosis Elimination (2017-2025) work in independent verticals with no integration at policy or at ground level. This results in lack of identification and appropriate management of depression in patients with Tuberculosis despite repeated contact with health care personnel in DOTS centres. A collaborative approach for early diagnosis and management of depression in patients with Tuberculosis (Secondary Prevention) can help decrease the burden of disease and improve outcomes. CONCLUSION Depression-TB Syndemic requires collaborative approaches at the program level and at the point of service delivery.
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Affiliation(s)
- Mina Chandra
- Centre of Excellence in Mental Health, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India.
| | - Proteesh Rana
- Department of Pharmacology, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India.
| | - Kalpana Chandra
- Department of TB and Chest Diseases, Santosh University, Ghaziabad, UP, India.
| | - Vijay Kumar Arora
- Santosh University, Ghaziabad, UP, India; National Institute of Tuberculosis and Respiratory Diseases, Delhi, India; JIPMER, Pondicherry, India.
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Arora VK, Chandra K, Chandra M. Occupational tuberculosis in sewage workers: A neglected domain. Indian J Tuberc 2019; 66:3-5. [PMID: 30797278 DOI: 10.1016/j.ijtb.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/14/2018] [Indexed: 06/09/2023]
Affiliation(s)
- V K Arora
- Santosh University, Ghaziabad, Uttar Pradesh, India
| | | | - Mina Chandra
- Department of Psychiatry, PGIMER and Dr RML Hospital, New Delhi, India
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