QEEG Predictors of Treatment Response in Major Depressive Disorder- A Replication Study from Northwest India

Background: Predicting treatment response with antidepressant is a challenging task for clinicians and researchers. An important limitation of an antidepressant trial is the increased time spent before an adequacy of trial can be decided. Quantitative Electroencephalography has shown some evidence in identifying early changes seen with antidepressants. No data has been reported from Indian population on its predictive capabilities. Aim: To examine whether early changes in frontal and prefrontal theta value in QEEG could predict antidepressant treatment response. Methods: Structured clinical assessments were conducted at baseline and after one week in a sample of treatment-seeking adults with major depressive disorder (n = 50). Patients were started on SSRI (Escitalopram, fluoxetine, paroxetine or sertraline) and followed for 8 weeks. QEEG recordings were carried out at baseline and week 1 and its parameters (relative theta power and cordance) were assessed to identify its predictive value for treatment response. Treatment response was assessed using Hamilton depression rating scale with 50% reduction after 8 weeks being considered as response. Results: Mean age of the sample was 39 ± 10 years and majority of them were females (64%). A significant reduction was found in relative frontal theta value (p = 0.021) from baseline to one week in responders. However, linear regression revealed that this change could not predict the treatment response (p = 0.37). Conclusions: QEEG changes are observed in initial phase of antidepressant treatment but these changes can't predict the treatment response.

Physiological and psychological stress response of blood donors during the blood donation process

BACKGROUND AND OBJECTIVES

Blood donation can be a potentially stressful event, leading to the activation of an acute stress response. Knowing and identifying potential stressors could help in optimizing the donation experience. The present study aimed to measure the physiological and psychological stress changes before, during and after blood donation.

MATERIALS AND METHODS

Physiological and psychological stress response was assessed in 70 blood donors. To evaluate physiological stress response, pulse rate, respiratory rate, blood pressure (BP), beat-to-beat BP and lead II electrocardiogram were recorded. Baroreflex sensitivity was calculated using the available software. Psychological stress response was assessed using the State-Trait Anxiety Inventory scale.

RESULTS

A significant increase in systolic blood pressure, diastolic blood pressure and mean arterial pressure was observed in the pre-donation period (p < 0.001). Among the time-domain parameters, SDSD (standard deviation of differences between adjacent respiratory rate intervals) and RMSSD (root mean square of the successive differences) were significantly lower during the post-donation period (p < 0.005, p < 0.007, respectively). Among the frequency-domain parameters, LF nu (relative power of the low-frequency band in normalized units), HF nu (relative power of the high-frequency band in normalized units) and LF% (relative power of the low-frequency band in percentage) were significantly lower before donation compared to during donation (p < 0.001, p < 0.001 and p < 0.012, respectively). LF nu, LF% and LF/HF ratio were also significantly lower during donation compared to after donation (p < 0.05, p < 0.016 and p < 0.042, respectively). Baroreflex sensitivity was also statistically higher during the pre-donation period. State score was significantly higher among the blood donors during the pre-donation period.

CONCLUSION

Physiological and psychological stress is experienced by blood donors during the pre-donation period. A pre-donation informative conversation should be carried out with each blood donor and potential stressors should be identified in each.

Degradation studies of bisphenol S by ultrasound activated persulfate in aqueous medium

The degradation of recalcitrant organic pollutants by sulphate radical (SO4•-) represents one of the most recent developments in oxidation-based water treatment. In most cases, persulfate (PS) acts as a precursor of sulphate radicals. This study employed ultrasound-activated PS to generate reactive species, facilitating the degradation of bisphenol S (BPS), a well-known contaminant of emerging concern (CECs). An ultrasound with a frequency of 620 kHz and 80 W power was utilised for the degradation studies. The applied oxidation system successfully resulted in the complete degradation of BPS in both pure and real environmental water samples. Additionally, the Chemical oxygen demand (COD) was reduced to an acceptable limit in both matrices, with a reduction of 85 % in pure water and 73 % in river water. The degradation was monitored by varying chemical parameters such as pH, inorganic ions, and organics concentration. The results indicate that under specific pH conditions, the degradation efficiency followed the order of pH 3 > 4 > 7 > 11. The presence of coexisting matrices suppressed the efficiency by scavenging the reactive species. Utilizing high-resolution mass spectrometry (HRMS) analysis, this study identified seven intermediate products during identified during the degradation of BPS. Furthermore, a comprehensive mechanism has been deduced for the transformation and degradation process. All the results presented in this study underscore the applicability of the US/PS system in the removal of CECs.

Surface plasmon resonance in metal nanospheres explained with LCR circuits

The manuscript details various simple LCR circuits to explain the experimentally observed surface plasmon resonance behavior of spherical metal nanoparticles. The results of the circuit's performance simulated using standard software like "QUCS" show similarity with SPR results in the literature, thus successfully explaining the size-effect, the influence of the surrounding dielectric medium and the proximity effect of densely packed metal nanoparticles. The study also explains these material dependent observations in terms of circuital parameters. This opens an avenue to detail the exact role of the material parameters in the influence of the surrounding dielectric medium and the proximity effect.

A Community-Based Study of Antenatal and Neonatal Risk Factors in Autism Spectrum Disorder

Objective: To assess children in the community for autism spectrum disorder (ASD) and associated risk factors.

Methods: In this 2-stage, cross-sectional study, children between 1.5 and 10 years of age were screened using the Chandigarh Autism Screening Instrument. Those with a score above the cutoff of 10 were assessed in detail using the Childhood Autism Rating Scale and the Autism Diagnostic Interview-Revised, and a detailed pediatric assessment was conducted. Risk factors were evaluated, and karyotype and fragile X genetic testing was done for those diagnosed with ASD. The study was conducted from July 2014 to December 2017.

Results: Compared to the control group, mothers of ASD children had more pregnancy-induced hypertension (PIH) and bleeding per vaginum (BPV) during the antenatal period. In the multivariate analysis, there was 6.3 times higher odds of having history of PIH (P = .02) and 7.7 times higher odds of BPV (P = .011) among children with ASD. There were much higher odds of having birth asphyxia (OR = 12.6), cardiorespiratory problems (OR = 10), metabolic abnormalities (hypoglycemia/ hypocalcemia) (OR = 12), and neonatal sepsis (OR = 16) in the ASD group compared to controls.

Conclusions: ASD patients experienced more antenatal and neonatal problems compared to controls.

Trial Registration: Clinical Trials Registry-India (CTRI/2017/02/007935).

Telomerase enzyme activity in patients with major depressive disorder: A pre and post-treatment study

BACKGROUND

Telomerase is a cellular enzyme that prevents telomere shortening and promoting viability. The literature has reported shortened telomere length in patients with major depressive disorder (MDD).

METHODS

35 patients with diagnosis of major depressive disorder (MDD) fulfilling DMS-5 criteria in the age range of 18-60 years, treatment-naïve after assessing the severity on HAM-D and HAM-A and 35 age and sex matched healthy controls were included in the study. Baseline peripheral blood monocytes (PBMC) telomerase enzyme was assessed in cases and controls and repeated in cases of MDD at 8th week after intervention with escitalopram for 8 weeks.

RESULTS

Pretreatment telomerase activity (TA) was elevated in cases as compared to controls and it was also significantly correlated to the severity of depression (p = 0.00). There was a significant positive difference in telomerase activity between non-responders (higher TA) and responders at baseline (p = 0.001) and 8th week (p = 0.012). The TA did not vary significantly amidst pretreatment and post-treatment, although it was slightly lower in the post-treatment group.

LIMITATIONS

The study has few limitations in the form of small sample size, shorter duration of follow-up, and leucocyte telomeres length (LTL) was not assessed.

CONCLUSION

The index study concludes that TA is higher in drug naïve patients with MDD than age and sex matched healthy control. The non-responders had significantly higher TA as compared to responders at baseline and post-treatment which indicates TA as a potential biomarker in the underlying biological mechanism of MDD and in response to antidepressant pharmacotherapy.

Analysis of daily COVID-19 death bulletin data during the first two waves of the COVID-19 pandemic in Thiruvananthapuram district, Kerala, India

Context

Coronavirus disease 2019 (COVID-19) mortality trends can help discern the pattern of outbreak evolution and systemic responses.

Aim

This study aimed to explore patterns of COVID-19 deaths in Thiruvananthapuram district from 31 March 2020 to 31 December 2021.

Setting and Design

Secondary data analysis of COVID-19 deaths in Thiruvananthapuram district was performed.

Materials and Methods

Mortality data were obtained from the district COVID-19 control room, and deaths in the first and second waves of COVID-19 were compared.

Statistical Analysis

We summarised data as proportions and medians with the inter-quartile range (IQR) and performed Chi-square tests to make comparisons wherever applicable.

Results

As on 31 December 2021, 4587 COVID-19 deaths were reported in Thiruvananthapuram district, with a case fatality rate of 0.91%. We observed high mortality among older persons (66.7%) and men (56.6%). The leading cause of death was bronchopneumonia (60.6%). The majority (88.5%) had co-morbidities, commonly diabetes mellitus (54.9%). The median interval from diagnosis to hospitalisation was 4 days (IQR 2-7), and that from hospitalisation to death was 2 days (IQR 0-6). The deaths reported during the second wave were four times higher than those of the first wave with a higher proportion of deaths in the absence of co-morbidities (p < 0.001). The majority of the deceased were unvaccinated. Ecological analysis with vaccine coverage data indicated 5.4 times higher mortality among unvaccinated than those who received two vaccine doses.

Conclusions

The presence of co-morbidities, an unvaccinated status, and delay in hospitalisation were important reasons for COVID-19 deaths. Primary level health providers can potentially help sustaining vaccination, expeditious referral, and monitoring of COVID-19 patients.

Development and psychometric testing of the Knowledge, Attitude, and Practice Questionnaire to assess knowledge, attitude, and practices regarding COVID-19 among patients attending COVID screening outpatient department in a tertiary care hospital in North India

BACKGROUND

COVID-19 pandemic has hit the world leading to major disruptions globally. Due to its highly contagious nature and associated mortality, a wide array of emotional and behavioral reactions were seen which indirectly reflected the knowledge, attitudes, and practices (KAP) of individuals. Understanding the KAP of individuals is fundamental when it comes to decreasing future COVID cases.

AIM

The study aimed to develop a Knowledge, Attitude, and Practice Questionnaire regarding COVID-19 (COVID-KAPQ) among patients attending screening outpatient department (OPD) in a tertiary care hospital in North India and evaluate its psychometric properties.

MATERIALS AND METHODS

The study procedure consisted of step-wise procedure starting with item generation, expert evaluation for categorization of items into domains of KAP and testing for psychometric properties. The items were generated and evaluated by the Delphi method based on 8 experts. Reliability and validity were assessed using data from 200 patients attending COVID screening OPD. Content validity was evaluated using content validity index (CVI); construct validity was examined using exploratory factor analysis and Cronbach's alpha coefficient was computed for internal consistency.

RESULTS

The final COVID-KAPQ consisted of three domains and 29 items. Cronbach's alpha coefficient for the entire questionnaire was 0.734, 0.710 for knowledge domain, 0.614 for attitudes domain, and 0.759 for practice domain. CVI ranged from 0.86 to 1. Five factors each for knowledge and attitudes domain and two factors for practice domain were extracted by principal factor analysis and varimax rotation, with a cumulative contribution of 70.19%, 71.54%, and 66.77% variance in KAP domain.

CONCLUSIONS

A questionnaire COVID-KAPQ (KAP regarding COVID-19) was developed. Psychometric testing indicated that it had adequate validity and reliability for use in COVID research in the general population. This questionnaire might help the public health researchers to map the level of KAP in the population and plan awareness and prevention strategies accordingly.

Use of Smart Phone Among Students with Intellectual and Developmental Disability

Use of Smart phones had created new opportunities for individuals with developmental disabilities for the meaningful engagement in different activities during the pandemic situation. Online learning provides extensive opportunities for individuals during this pandemic situation when everything is closed due to the fear of transmission of COVID-19. Similarly individuals with developmental disabilities are also getting opportunity to learn online through Smartphone. Special educators were conducting online classes with students with developmental disabilities to make them meaningfully engaged during this pandemic situation. 415 students and their parents with developmental disabilities were approached by their special educators on telephone to know if they can use smartphone. This paper reports on use of Smart phones by individuals with developmental disabilities. It was found that they can learn academics like others if there is availability of Smart phones during daytime and proper training and assistance provided by parents or sibling.

Understanding of Behavioral Problems Among Young Persons with Intellectual Disability: A Self-Report

Background  Behavioral problems among young persons with intellectual disabilities (IDs) are pronounced, and it has been of significant concern for field practitioners. Different investigators have used various techniques and methods to study behavioral problems among persons with intellectual disabilities.

Objective  The study was conducted to examine the concept of behavioral problems from persons with intellectual disabilities.

Materials and Methods  Persons with ID ( n  = 13) with DSM 5 diagnosis of mild ID (IQ: 50–69) in ages ranging from 16 to 27 years were selected. For the present study, the qualitative method using Focused Group Discussion (FGD) was used.

Results  The results suggest that persons with intellectual disabilities have an adequate understanding of their behavioral problems and can make efforts to control their anger and aggression.

Conclusion  The study's findings showed that persons with an intellectual disability did not have knowledge of only the concept of behavioral problems, but they also employed methods to overcome these behavioral problems. The community needs to be made aware of this to get better opportunities in community participation, thus helping them contribute to society.

Psychiatric morbidity and substance use in migrant workers: A population based study

BACKGROUND

The prevalence of mental health problems and substance abuse in the migrant population is higher than the general population.

AIMS AND OBJECTIVES

To assess the prevalence and pattern of mental health issues and substance use in the migrant population and highlight the association with the reverse migration of migrant workers.

METHODOLOGY

The field staff visited the shelter homes for migrant population in four cities of Northern India (Chandigarh (UT), Bhatinda (Punjab), Panchkula (Haryana) and Jaipur (Rajasthan). After maintaining the social distance and wearing masks by the staff and migrants, written informed consent was taken for participation in the study. The socio-demographic details of reverse migrants were noted down and Hindi version of Patient Health Questionnaire (PHQ-9) for mental health problems and screening tool for pattern of substance abuse was administered. Geographically matched undisplaced were also administered these tools.

RESULTS

A total of 275 reverse migrants and 276 undisplaced were included in the study. The prevalence of ever use for all the substances among reverse migrants was 44.4% (122/275) and among undisplaced, it was 45.3%. The prevalence of alcohol, tobacco and cannabis was higher than the general population. The prevalence of at least one diagnosis on PHQ-9 is 13.45% (reverse migrants 19.3% and undisplaced 7.6) and the prevalence of other depressive disorder is significantly higher in reverse migrants (17.1%) than undisplaced (4.0%).

CONCLUSION

The study concludes that prevalence of mental health issues and substance abuse in migrant population is significantly higher than the general population and the prevalence of at least one diagnosis and other depressive disorder is significantly higher in reverse migrants than undisplaced.

Subjective Well-being Among Migrant Workers Residing in a Shelter Home During Lockdown: A Pilot Survey From North India

Objective: To explore the impact of lockdown due to coronavirus disease 2019 (COVID-19) on the subjective well-being of migrant workers staying in a shelter home in India.

Methods: A total of 54 residents of the shelter home participated in this exploratory survey study. Baseline assessments included sociodemographic profile, the Subjective Well-Being Inventory (SUBI), and the Perceived Stress Scale. The participants were reassessed with the SUBI after 2 weeks of staying in the shelter home. The survey was administered April 11 to May 10, 2020.

Results: The mean ± SD age of the participants was 23.54 ± 11.68 years, and the majority were men and in the age group 21-30 years (45%). At baseline assessments, the mean ± SD stress level score was 17.39±4.62. The mean ± SD SUBI score was 81.44 ± 4.62 at baseline and increased to 100.65±5.95 after 2 weeks of staying in the shelter home.

Conclusions: The survey findings demonstrate that the levels of subjective well-being among participants improved after their physical and mental health needs were met during their stay in the shelter home. The findings could help policy planners and senior public health administrators minimize gaps to better understand the multiple issues related to the subjective well-being of this population.

Feasibility of a truncated surveillance schedule for patients following curative intent treatment for carcinoma of the oral cavity

The purpose of this study was to determine whether a regular follow-up schedule with examination by clinicians results in a better detection rate of disease recurrence and eventual better clinical outcomes when compared to patients who present with symptoms to the clinic and are subsequently detected to have a recurrence of oral squamous cell carcinoma. Retrospective data from 642 patients who underwent treatment for oral squamous cell carcinoma at a tertiary level cancer centre were analysed. Of the 642 patients, 197 had recurrences of which 108 were detected on regular follow-up and 87 were detected in patients presenting out of schedule with symptoms; two patients were detected to have recurrence at another centre, but their mode of detection could not be ascertained. There was no difference in the loco-regional recurrence-free survival or disease-free survival between the two groups. A strict follow-up schedule in the first year followed by a more flexible symptom-based schedule in the subsequent years, with supplementation of imaging if clinically indicated, should be an adequate surveillance plan for oral cancer patients.

Anxiety and depression in the elderly due to COVID-19 pandemic: a pilot study

Background

The elderly are a vulnerable section of the population who are prone to physical, mental, social, and economic deprivation. The effect of COVID-19 had a worldwide impact on all age groups, with a particularly higher mortality and morbidity rate among the elderly population. The present study was undertaken to know about the psychological morbidity in the geriatric population during the period of the COVID-19 pandemic. The study was cross-sectional and was done through a telephonic survey. Eligible elderly subjects were contacted telephonically, and the Geriatric Anxiety Scale and the Geriatric Depression Scale were administered. To evaluate the functional ability of elderly subjects, the Everyday Abilities Scale for India (EASI) scale was administered. For the telephonic survey, verbal consent was sought.

Results

A total of 92 elderly subjects were included. Male outnumbered the females with a ratio of 1.8:1. Spouse and children were primary caregivers in 83.7% of the subjects. 90.2% were married, and 66.3% had earned a graduate/professional level of education. Chronic illness was present in 50% of subjects. The most common co-morbidities were hypertension (27.2%) and diabetes (21.7%). The proportion of elderly with anxiety and depression was 8.7% and 15.2% respectively.

Conclusion

The elderly showed lower levels of anxiety and depression. Higher resilience among the elderly and good family support may be the reasons for such an unexpected finding. However, more studies are required to validate the findings of the current study.

Theory of Mind and Executive Functions in Children With Attention Deficit Hyperactivity Disorder and Specific Learning Disorder

BACKGROUND

Children with attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD) generally have difficulties in social cognition and display impairments involving emotion and face and prosody perception and reduced empathy, indicating theory of mind (ToM) impairment. The objective of this work was to assess and compare the executive functions and ToM in children with ADHD and SLD.

METHODS

Twenty children diagnosed with ADHD, 20 children diagnosed with SLD, and 20 normal healthy children in the age group of 7 to 15 years, IQ between 90 and 110 (average intelligence) of any gender, were recruited. All participants were assessed using neuropsychological tests of executive functions and ToM.

RESULTS

Significant differences were found on early ToM, basic ToM, advanced ToM, and mean scores on ToM inventory between ADHD and control groups (P ≤ 0.001). Similarly, significant differences were found between ADHD and SLD groups on early, basic, advanced, and mean ToM inventory scores (P < 0.001). No significant differences were found between the control and SLD groups on ToM measures. Further, in the ToM task battery, on task D and task G, significant differences were found between the SLD and control groups at P = 0.04 and P = 0.03 respectively. Differences between ADHD and control groups were also statistically significant on task D and task G at P < 0.001 and P = 0.033. Executive functions in the form of set-shifting and response inhibition were significantly poor in the ADHD group and SLD group at P < 0.001 and P < 0.05 levels, respectively, when compared to the control group.

CONCLUSION

Children with ADHD displayed more deficits in the ToM inventory and tasks than children having SLD and healthy children of their similar age and educational background. Executive functions (set-shifting and response inhibition) were poorer in children with ADHD and children with SLD when compared to healthy children of their similar age and educational background.

Sexuality Among Adolescents and Young Adults With Intellectual Disability: Knowledge, Attitude, and Practices

Context:

It is generally believed that persons with intellectual disability (PWID) do not have sufficient knowledge about sex and sexuality. As there is not much published work from India, such an attitude of clinicians and caregivers appears more to be an assumption. The scant information from other countries on sex and sexuality of the PWID cannot be generalized to India because of cultural differences.

Aims and Objectives:

The study was conducted to find out knowledge, attitude, and sexual practices among persons with mild intellectual disability (ID).

Settings and Design:

Thirteen participants with DSM-5 diagnosis of mild ID (intellect quotient [IQ] between 50 and 69) in the age ranging from 16 to 27 years (mean IQ and age was 56.69 and 21.0, respectively) were selected from the Government Rehabilitation Institute for Intellectual Disabilities, Chandigarh. For this study, exploratory method using focus group discussion (FGD) was used. Data was collected using qualitative method of FGD.

Results:

The results showed that persons with mild ID have knowledge about sex and sexual practices and they are sexually active and are indulging in sexual acts.

Conclusion:

Based on the findings derived from this research, it is concluded that PWID have knowledge and skills to experience sexual activities. However, findings of this study are limited to only persons with mild ID (IQ: 50-69). Need to sensitize and provide appropriate sexual health care for persons with ID are discussed.

Factors Leading to Reverse Migration Among Migrant Workers During the COVID-19 Pandemic: A Multicenter Study From Northwest India

OBJECTIVE

To examine the various psychosocial factors associated with reverse migration among migrant workers during the coronavirus disease 2019 (COVID-19) lockdown in India.

METHODS

A cross-sectional multicenter study was conducted at 4 sites in Northwest India. The migrant workers were recruited from various shelter homes, and information was gathered from reverse migrant workers and controls using various tools including a sociodemographic profile; knowledge, attitudes, and practices questionnaire; and reasons for migration and reverse migration questionnaires. A total of 275 reverse migrant workers and 276 controls participated in the study.

RESULTS

There was a considerable difference between reverse migrant workers and controls regarding the question of whether it was safe to travel during lockdown (76.0% vs 26.4%, respectively). The most common route of spread of COVID-19 infection was through touching and sneezing, and symptoms were fever, dry cough, and sore throat in both groups. Reverse migrant workers had low self-esteem and were reluctant to participate in customs of their migration city. A large number of reverse migrant workers reported that they had no money to survive, worried about family back home at their village, felt pressured by family members to come back to the village, and had been terminated from their job.

CONCLUSIONS

Reverse migrant workers had the attitude that it was safe to travel during the lockdown. About one-fifth of the reverse migrant workers reported no place to live and fear of getting an infection. The reverse migrant workers also reported feeling low and gloomy, restless, and uncertain about the future and fear of death. Lack of jobs was a major factor driving migrant workers from their native homes.

Psychosocial intervention model for migrant workers during extended lockdown: The Chandigarh model

BACKGROUND

Human suffering and future uncertainty due to extended lockdown is enormous and this is much more among migrant workers.

AIM

The aim of this study was to design and utilize a model for psychosocial intervention for migrant workers during the extended lockdown.

MATERIALS AND METHODS

In Chandigarh, due to lockdown, 61 migrant workers from various states were lodged in a shelter home at village Maloya, located in the outskirt of Chandigarh. Since no specific model was available to handle the psychosocial issues of this specific population, hence, an attempt was made to prepare a model for psychosocial intervention using Maslow's hierarchy of needs.

RESULTS

Changes in infrastructure and facilities provided to migrant workers due to implementation of this model for psychosocial intervention helped the participants seeing beyond their problems.

CONCLUSION

Psychosocial intervention model based on Maslow's theory was found suitable for migrant workers in shelter home in Chandigarh.

Can EEG Predict Response to Atomoxetine in attention deficit hyperactivity disorder at 1 Week?

Objective: The objective of the study is to predict the early changes in electroencephalography (EEG) at 1 week and its correlation to clinical response at 6 weeks after treatment with atomoxetine in children with ADHD. Method: In 50 children (6-14 years) with ADHD (Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-5]), Vanderbilt ADHD Parent Rating Scale (VADPRS) and Vanderbilt ADHD Teachers Rating Scale (VADTRS) were applied at baseline, 1, 4, and 6 weeks. EEG was recorded using International 10-20 System of electrode placement at baseline and at 1 week after atomoxetine treatment. EEG changes at 1 week after atomoxetine therapy was correlated to clinical response at 6 weeks. Results: Patients were classified as responders or nonresponders based on the VADPRS/VADTRS findings. After 1 week of treatment, responders' theta cordance values were decreased, whereas nonresponders' values didn't decrease significantly. Conclusion: Patients with decreased theta cordance values, especially in the left temporoparietal region, at 1 week were likely to respond to atomoxetine while those without any such change were likely to be nonresponders.

Survey of autism spectrum disorder in Chandigarh, India

Background & objectives:

Prevalence of autism spectrum disorder (ASD) has been reportedly on the rise in western literature. However, accurate data from India are not available. The present study was planned to assess the community-based prevalence of ASD in Chandigarh, India.

Methods:

This study was a two-stage survey of representative child population of Chandigarh using stratified random sampling technique, covering 8820 children between the ages 1.5 and 10 yr. Proportionate population from urban (82.3%), rural (4.3%) and slum area (13.4%) were included in the study and screened using Chandigarh autism screening instrument (CASI). Thirty two children scored above cut-off, of whom two had shifted to other places before they could be assessed and 30 were assessed in detail. Detailed assessment was done using Autism Diagnostic Interview–Revised and Childhood Autism Rating Scale-2; diagnosis was made according to the Diagnostic and Statistical Manual-5. Nineteen were diagnosed with ASD.

Results:

Of the 8451 children screened between the age group of one and a half to 10 yr, 19 (10 boys and 9 girls) were diagnosed as ASD, thus the prevalence of ASD was found to be 2.25 per 1000 (0.69-5.19, 95% confidence interval) children in Chandigarh. No child below the cut-off on the screening instrument was diagnosed as ASD.

Interpretation & conclusions:

The results suggest that the prevalence of ASD in Chandigarh was in tandem with other reports from across India and was lower than western countries.

Application of Random Forest and data integration identifies three dysregulated genes and enrichment of Central Carbon Metabolism pathway in Oral Cancer

BACKGROUND

Studies of epigenomic alterations associated with diseases primarily focus on methylation profiles of promoter regions of genes, but not of other genomic regions. In our past work (Das et al. 2019) on patients suffering from gingivo-buccal oral cancer - the most prevalent form of cancer among males in India - we have also focused on promoter methylation changes and resultant impact on transcription profiles. Here, we have investigated alterations in non-promoter (gene-body) methylation profiles and have carried out an integrative analysis of gene-body methylation and transcriptomic data of oral cancer patients.

METHODS

Tumor and adjacent normal tissue samples were collected from 40 patients. Data on methylation in the non-promoter (gene-body) regions of genes and transcriptome profiles were generated and analyzed. Because of high dimensionality and highly correlated nature of these data, we have used Random Forest (RF) and other data-analytical methods.

RESULTS

Integrative analysis of non-promoter methylation and transcriptome data revealed significant methylation-driven alterations in some genes that also significantly impact on their transcription levels. These changes result in enrichment of the Central Carbon Metabolism (CCM) pathway, primarily by dysregulation of (a) NTRK3, which plays a dual role as an oncogene and a tumor suppressor; (b) SLC7A5 (LAT1) which is a transporter dedicated to essential amino acids, and is overexpressed in cancer cells to meet the increased demand for nutrients that include glucose and essential amino acids; and, (c) EGFR which has been earlier implicated in progression, recurrence, and stemness of oral cancer, but we provide evidence of epigenetic impact on overexpression of this gene for the first time.

CONCLUSIONS

In rapidly dividing cancer cells, metabolic reprogramming from normal cells takes place to enable enhanced proliferation. Here, we have identified that among oral cancer patients, genes in the CCM pathway - that plays a fundamental role in metabolic reprogramming - are significantly dysregulated because of perturbation of methylation in non-promoter regions of the genome. This result compliments our previous result that perturbation of promoter methylation results in significant changes in key genes that regulate the feedback process of DNA methylation for the maintenance of normal cell division.

Migrant Workers' Needs and Perceptions While Lodged in a Shelter Home in India During the COVID-19 Pandemic

Objective

India is combating a large-scale migrant crisis in many states during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to identify migrant workers needs and perceptions regarding lockdown while staying in a shelter home during the COVID-19 crisis.

Methods

This exploratory study was conducted with 54 migrants staying in a makeshift shelter home in Chandigarh, India. Three discussions were conducted with groups consisting of 15-20 participants to maintain social distancing. Five discussion questions were designed to facilitate group discussions.

Results

One important theme among migrants was their eagerness to return to their native homes. Participants were also concerned about pending agriculture-related work, their families back home, and job insecurity. Most of the migrants supported the government-mandated lockdown and agreed that they would follow all instructions.

Conclusions

Physiologic requirements, safety, and security were the predominant needs of the migrant workers while staying in the shelter home during lockdown. The participants feared contracting COVID-19 and were uncertain about when and how they would return to their native homes.

Phase Space Reconstruction of EEG Signals for Classification of ADHD and Control Adults

Attention deficit hyperactivity disorder (ADHD) is a childhood behavioral disorder that can persist into adulthood. Electroencephalography (EEG) plays a significant role in assessing the neurophysiology of ADHD because of its ability to reveal complex brain activity. The present study proposes an EEG-based diagnosis system using the phase space reconstruction technique to classify ADHD and control adults. Electric activity is recorded for 47 ADHD and 50 control adults during the eyes-open, eyes-closed, and Continuous Performance Test (CPT) condition. Various statistical features are extracted from Euclidean distances based on phase space reconstruction of signals. The proposed system is evaluated with 2 feature selection methods (correlation-based feature selection and particle swarm optimization) and 5 machine learning methods (neural dynamic classifier, support vector machine, enhanced probabilistic neural network, k-nearest neighbor, and naive-Bayes classifier). Experimental results showed the highest testing accuracy of 93.3% under the eyes-open, 90% under the eyes-closed, and 100% under the CPT condition. This study focused on the utility of phase space reconstruction of brain signals to discriminate between ADHD and control adults.

Role of turmeric extract in minimising mucositis in patients receiving radiotherapy for head and neck squamous cell cancer: a randomised, placebo-controlled trial

OBJECTIVE

To determine the role of turmeric extract in reducing mucositis in patients undergoing radiotherapy for head and neck cancer.

METHODS

Sixty-one patients who underwent radiotherapy were included in the study and randomised into groups A and B. Patients in group A received 500 mg of turmeric extract (BCM-95) thrice daily, while patients in group B received placebo until radiotherapy completion. All patients were assessed for oral mucositis on a weekly basis during treatment and two months post-treatment using the National Cancer Institute Common Terminology Criteria for Adverse Events and World Health Organization criteria.

RESULTS

Both groups had a similar grade of mucositis in first two weeks of treatment. The severity of mucositis was progressive in the control group, with four patients developing grade 3 mucositis by week four. In group A, however, the majority of patients (73.3 per cent) had grade 1 mucositis after four weeks of treatment. The difference was statistically significant from the third week onwards (p < 0.001).

CONCLUSION

Turmeric extract reduces the incidence and severity of radiation-induced mucositis, which can benefit patients undergoing radiation for head and neck cancer.

Event-Related Potential Analysis of ADHD and Control Adults During a Sustained Attention Task

Background. Event-related potentials (ERPs) of attention deficit hyperactivity disorder (ADHD) population have been extensively studied using the time-domain representation of signals but time-frequency domain techniques are less explored. Although, adult ADHD is a proven disorder, most of the electrophysiological studies have focused only on children with ADHD. Methods. ERP data of 35 university students with ADHD and 35 control adults were recorded during visual continuous performance task (CPT). Gray level co-occurrence matrix-based texture features were extracted from time-frequency (t-f) images of event-related EEG epochs. Different ERP components measures, that is, amplitudes and latencies corresponding to N1, N2, and P3 components were also computed relative to standard and target stimuli. Results. Texture analysis has shown that the mean value of contrast, dissimilarity, and difference entropy is significantly reduced in adults with ADHD than in control adults. The mean correlation and homogeneity in adults with ADHD were significantly increased as compared with control adults. ERP components analysis has reported that adults with ADHD have reduced N1 amplitude to target stimuli, reduced N2 and P3 amplitude to both standard and target stimuli than controls. Conclusions. The differences in texture features obtained from t-f images of ERPs point toward altered information processing in adults with ADHD during a cognitive task. Findings of reduction in N1, N2, and P3 components highlight deficits of early sensory processing, stimulus categorization, and attentional resources, respectively, in adults with ADHD.

Development of a screening instrument for autism spectrum disorder: Chandigarh Autism Screening Instrument

Background & objectives:

There is a paucity of trained professionals for the diagnosis of autism spectrum disorder (ASD), and a large number of cases go undetected and are diagnosed only during adolescence. There is no screening instrument specifically developed for screening of Indian population for ASD. This study was undertaken to develop a screening instrument to screen ASD in north Indian Hindi speaking population by multipurpose health workers.

Methods:

A 37-item instrument in Hindi with dichotomous yes/no responses [Chandigarh Autism Screening Instrument (CASI)] was developed to be applied on children aged 1.5-10 yr. The instrument was pilot tested and then reliability and validity of this instrument were tested. The sample included children with intellectual disability (n=75), ASD (n=83), other developmental disorders (n=87) and typically developing children (n=160).

Results:

Reliability, construct and content validity testing of the instrument were performed, and a score of 10 as cut-off had sensitivity of 89.16 per cent, specificity of 89.13 per cent, positive predictive value of 67.89 per cent and negative predictive value of 96.96 per cent. A shorter four-item version (CASI Bref) has also been developed with good sensitivity (73.49%) and specificity (90.68%) at a cut-off score of 2.

Interpretation & conclusions:

CASI was found to be a valid instrument for screening general Hindi speaking population of north India with adequate sensitivity and specificity.

Comparison of efficacy of haloperidol and olanzapine in the treatment of delirium

OBJECTIVE

Till date, typical antipsychotic haloperidol is the treatment of choice for delirium. But, due to higher side effects with haloperidol, newer atypical antipsychotics (e.g., olanzapine) are increasingly being used in the treatment of delirious patients. The aim of the current research was to study the efficacy and tolerability of haloperidol and olanzapine in the treatment of delirium.

MATERIALS AND METHODS

This was an open-label, randomized controlled study carried out in a tertiary care hospital at Chandigarh, India. A total of 100 patients admitted in medicine, surgery, and orthopedic wards and diagnosed as having delirium on Confusion Assessment Method scale were included in the study. Patients were given either haloperidol (1-4 mg/day either orally or by nasogastric tube) or olanzapine (2.5-10 mg/day either orally or by nasogastric tube). Severity of delirium and pattern of symptom improvement were assessed by Memorial Delirium Assessment Scale (MDAS). Extrapyramidal side effects were assessed by Simpson-Angus Scale.

RESULTS

There was an improvement in delirium severity in both groups with treatment. Mean daily dose of haloperidol and olanzapine used per patient was 2.10 and 5.49 mg, respectively, and the mean duration of treatment in olanzapine group and haloperidol group was 3.57 days and 3.37 days, respectively. There was no significant difference in the mean duration of treatment in both groups. At the end of study period, the MDAS scores in olanzapine and haloperidol groups were 8.43 and 8.00, respectively, and the difference was not significant statistically with P = 0.765. Five patients experienced drug-related mild side effects.

CONCLUSION

Low-dose haloperidol and olanzapine were equally efficacious and well tolerated in delirium.

Stress and suicidal ideation among adolescents having academic difficulty

BACKGROUND AND OBJECTIVES

Academically typically achieving adolescents were compared with students having academic difficulty on stress and suicidal ideas.

MATERIALS AND METHODS

In a cross-sectional study, 75 academically typically achieving adolescents were compared with 105 students with academic difficulty and 52 students with specific learning disability (SLD). Academic functioning was assessed using teacher's screening instrument, intelligence quotient, and National Institute of Mental Health and Neurosciences index for SLD. Stress and suicidal ideas were assessed using general health questionnaire, suicide risk-11, and Mooney Problem Checklist (MPC). Appropriate statistical methods were applied.

RESULTS

Three groups were comparable on age, gender, mother's working status, being only child, nuclear family, self-reported academic decline, and type of school. About half of adolescents reported psychological problems on General Health Questionnaire (mean score >3 in all the groups). Academically typically achieving adolescents showed higher stressors in peer relationships, planning for future and suicidal ideation compared to adolescents with academic difficulty. Adolescents face stress regarding worry about examinations, family not understanding what child has to do in school, unfair tests, too much work in some subjects, afraid of failure in school work, not spending enough time in studies, parental expectations, wanting to be more popular, worried about a family member, planning for the future, and fear of the future. Significant positive correlation was seen between General Health Questionnaire scores and all four subscales of MPC. Suicidal ideas showed a negative correlation with MPC.

INTERPRETATIONS AND CONCLUSIONS

Adolescents experience considerable stress in multiple areas irrespective of their academic ability and performance. Hence, assessment and management of stress among adolescents must extend beyond academic difficulties.

Therapeutic Neck Dissection in Oral Squamous Cell Carcinoma: Is Selective Neck Dissection the Way Ahead?

Background Selective neck dissection in multimodality treatment protocols is slowly being accepted for the management of N+ neck in many centers. This is because the functional disability is lower than modified radical neck dissection. Objective This study compares the regional recurrence rates between patients who underwent selective neck dissection and patients underwent comprehensive neck dissection for node positive oral squamous cell carcinoma. Method A retrospective study comparing patients with node positive oral squamous cell carcinoma who underwent either selective neck dissection or comprehensive neck dissection between August 2011 and January 2014 was done, with a mean follow up period of 12 months. Regional failures were assessed to whether they were isolated neck failures or associated with a local or distant failure. Result A total of 131 neck dissections were performed which included 93 selective neck dissections and 38 comprehensive neck dissections. A total of 17 patients developed regional recurrence, of which 11 patients had ipsilateral neck recurrence. Of the 11 patients with ipsilateral neck recurrence one patient also had contralateral neck nodes and in two patients there was associated distant metastasis. Conclusion Selective neck dissection for management of node positive neck disease is based on sound scientific principles and a randomised controlled trial comparing it with modified radical neck dissection would probably give the answer regarding the optimal procedure for these patients.

Impact of psychoeducation intervention module on parents of children with autism spectrum disorders: A preliminary study

Context:

Parents of children with autism spectrum disorders (ASD) in India face a host of challenges, while seeking care which ranges from unavailability of information to difficulty in availing services.

Aims:

To develop a psycho-education intervention module for parents of children with ASD and to study its impact on parent stress and knowledge.

Settings and Design:

Child Guidance Clinic Department of Psychiatry, Government Medical College and Hospital, Chandigarh. Interventional study.

Methodology:

Parents of children diagnosed with ASD as per Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition criteria, recruited through consecutive sampling. Total number of 18 participants participated in the two phase study. Phase I included preparation of a parent training module through a four stage process and Phase II was evaluation of impact of the final version of the module on parental stress and knowledge.

Statistical Analysis:

Wilcoxon Signed-Rank test using SPSS version 17.0.

Results:

There was an improvement in all the domains of parenting stress and knowledge. Social stress score and total stress score showed significant improvement.

Conclusions:

Parent psycho-education intervention module on ASD decreases parenting stress, and improves knowledge about ASD. Psycho-education intervention module is a feasible and acceptable way of parent empowerment.

Comparative efficacy of methylphenidate and atomoxetine in oppositional defiant disorder comorbid with attention deficit hyperactivity disorder

BACKGROUND

Oppositional defiant disorder (ODD) is frequently comorbid with attention deficit hyperactivity disorder (ADHD) and is associated with substantial functional impairments. Methylphenidate and atomoxetine are well-established drugs for the management of ADHD. Some studies from Western countries have reported these drugs to be effective in the management of ODD comorbid with ADHD. This study aimed to assess if methylphenidate and atomoxetine are efficacious in treating Indian children with ODD comorbid with ADHD.

SUBJECTS AND METHODS

In this prospective, open-label study, 37 patients of age 6-14 years with a diagnosis of ODD comorbid with ADHD randomly received either methylphenidate (dose 0.2-1 mg/kg/day) or atomoxetine (dose 0.5-1.2 mg/kg/day) for 8 weeks. Improvements in ADHD and ODD symptoms were assessed using Vanderbilt ADHD diagnostic parent rating scale (VADPRS).

RESULTS

At 8 weeks, there were statistically significant improvements in both ADHD and ODD symptoms in both methylphenidate and atomoxetine groups, as per VADPRS. The improvements produced and tolerability was comparable in the two groups. 80% of the patients from methylphenidate group and 64.3% patients from atomoxetine group ceased to fulfill the criteria for the presence of ODD at 8 weeks.

CONCLUSIONS

Methylphenidate and atomoxetine are effective in the treatment of ODD comorbid with ADHD in short duration.

Cross-sectional study of self-reported ADHD symptoms and psychological comorbidity among college students in Chandigarh, India

BACKGROUND

Existence of attention deficit hyperactivity disorder (ADHD) in adults is scantily researched in India. There is dearth of information on prevalence of ADHD in college students worldwide. Further, fewer studies in the past have evaluated the impact of ADHD on the psychological well-being of college students.

AIMS

To study the prevalence of ADHD among college students and psychological problems related to ADHD.

DESIGN

Cross-sectional study.

SUBJECTS AND METHODS

A total of 237 students were recruited from various medical, engineering, and commerce and arts colleges of Chandigarh, India. They were administered the Adult ADHD Self Report Scale v1.1(ASRS) and the Wender Utah Rating Scale (WURS) to diagnose adult ADHD. To assess comorbidities; General Health Questionnaire-12 (GHQ); Zung Depression Rating Scale (ZDRS); Rosenberg's Self-Esteem Scale (RSES);and questions on emotional stability, social problems, and substance use (alcohol, tobacco, and cannabis) were administered on all participants.

RESULTS

A total of 13 students (5.48%) fulfilled the criteria for adult ADHD. These students experienced significantly higher emotional instability and low self-esteem than those without ADHD (N = 224). The occurrence of psychological problems, depression, social problems, and substance abuse was comparable in students with and without ADHD.

CONCLUSIONS

ADHD is prevalent among the college students studying in the most competitive institutes as well. Students with ADHD experience higher emotional instability and poor self-esteem than others. It has little effect on their psychological well-being and social adjustment. Prompt detection and management of ADHD in college students may help them deal with these problems effectively.