Course and outcome of bipolar I disorder among Indian patients: A retrospective life-chart study

BACKGROUND

Indian studies on the course and outcome of bipolar disorder (BD) are scarce and their methodologies vary. Nevertheless, differences from Western ones have been noted.

METHODS

A systematic random sample of 200 patients with BD attending a general hospital psychiatric unit was chosen. They were assessed using the clinician and self-rated versions of the National Institute of Mental Health-Retrospective Life Charts, the lifetime version of the Columbia Suicide Severity Rating Scale, the Medication Adherence Questionnaire, the Indian Disability Evaluation and Assessment Scale, and the Presumptive Stressful Life Events Scale.

RESULTS

The mean age of onset of BD was 26 years. About 11%-13% of the illness was spent in acute episodes, mostly in depression (60%). Episode frequency was 0.4-0.6 annually. The first episode was more likely to be manic, and manic episodes outnumbered depressive episodes. The average duration of episodes was 3 months. Depressive episodes were longer and the time spent in depression was greater than mania. Psychotic symptoms (48%), a mania-depression-interval pattern (61%), and recurrent mania (19%) were common while rapid cycling and seasonal patterns were uncommon. Comorbidity (40%), functional impairment (77%), and lifetime nonadherence (58%) were high, whereas lifetime suicide attempts (16%) were low. Stressful life events were very common prior to episodes (80%), particularly early in the illness.

CONCLUSION

This study suggests differences between Indian and Western patients in the demographic profile and the course and outcome of BD. A more benign presentation in the current study including Indian studies is indicated by their later age of presentation and illness onset, higher rates of marriage, education, and employment, a mania predominant course, lower rates of rapid cycling, comorbidity, and suicidal attempts. Factors associated with better outcomes such as longer time to recurrence, Manic Depressive pattern of illness, and low rates of hospitalizations also appear to be commoner in our study and also in other Indian studies.

Self-Transport and Manipulation of Aqueous Droplets on Oil-Submerged Diverging Groove

We report experimental study of self-transport of aqueous droplets along an oil-submerged diverging groove structure. The migration phenomenon is illustrated, and the effect of various parameters such as droplet size d, oil layer thickness h, groove angle 2θ, and groove thickness δ on the droplet transport behavior (i.e., migration velocity and length) is investigated. Our study reveals that complete engulfment of aqueous droplets in the oil layer, that is attributed to a positive spreading parameter ( S > 0), is a prerequisite for the droplet transport. The results show that only droplets of diameter larger than the oil layer thickness (i.e., d ≥ h) get transported owing to a differential Laplace pressure between the leading and trailing faces of a droplet because of the diverging groove. Using experimental data, the variation of droplet migration velocity with distance along the diverging groove is correlated as U( x) = ψ x^-0.9, where ψ = d^0.32θ^-2.2 h^-1.5δ^0.7. The submerged groove structure was used to demonstrate simultaneous and sequential coalescence and transport of multiple droplets. Finally, the submerged groove structure was employed for extraction of aqueous droplets from oil. The proposed technique opens up a new avenue for evaporation and contamination free transport and coalescence of droplets for chemical and biological applications.

Cerebral organoids reveal early cortical maldevelopment in schizophrenia-computational anatomy and genomics, role of FGFR1

Studies of induced pluripotent stem cells (iPSCs) from schizophrenia patients and control individuals revealed that the disorder is programmed at the preneuronal stage, involves a common dysregulated mRNA transcriptome, and identified Integrative Nuclear FGFR1 Signaling a common dysregulated mechanism. We used human embryonic stem cell (hESC) and iPSC-derived cerebral organoids from four controls and three schizophrenia patients to model the first trimester of in utero brain development. The schizophrenia organoids revealed an abnormal scattering of proliferating Ki67+ neural progenitor cells (NPCs) from the ventricular zone (VZ), throughout the intermediate (IZ) and cortical (CZ) zones. TBR1 pioneer neurons and reelin, which guides cortico-petal migration, were restricted from the schizophrenia cortex. The maturing neurons were abundantly developed in the subcortical regions, but were depleted from the schizophrenia cortex. The decreased intracortical connectivity was denoted by changes in the orientation and morphology of calretinin interneurons. In schizophrenia organoids, nuclear (n)FGFR1 was abundantly expressed by developing subcortical cells, but was depleted from the neuronal committed cells (NCCs) of the CZ. Transfection of dominant negative and constitutively active nFGFR1 caused widespread disruption of the neuro-ontogenic gene networks in hESC-derived NPCs and NCCs. The fgfr1 gene was the most prominent FGFR gene expressed in NPCs and NCCs, and blocking with PD173074 reproduced both the loss of nFGFR1 and cortical neuronal maturation in hESC cerebral organoids. We report for the first time, progression of the cortical malformation in schizophrenia and link it to altered FGFR1 signaling. Targeting INFS may offer a preventive treatment of schizophrenia.

Use of modified bilateral electroconvulsive therapy during pregnancy: A case series

There is limited literature on the use of electroconvulsive therapy (ECT) during pregnancy. ECT is considered as a treatment of last resort during pregnancy. In this case series, we present the data of five patients who were administered ECT during pregnancy. The use of ECT required multidisciplinary approach involving psychiatrist, gynecologist, anesthetist and neonatologist. Two patients received ECT during the second trimester and three patients received ECT during the third trimester. In all the patients, ECT was administered by placing the patients in the left lateral position, glycopyrrolate was used for premedication, thiopentone was used for induction, and succinylcholine was used for muscle relaxation. Patients who were administered ECT close to the full-term were given injection betamethasone 12 mg intramuscularly on two consecutive days before starting of first ECT to promote fetal lung maturity. In all the five cases, no adverse maternal and fetal outcomes were encountered except for possible precipitation of labor in one case.

Dynamics of a Water Droplet over a Sessile Oil Droplet: Compound Droplets Satisfying a Neumann Condition

We report the dynamics of compound droplets with a denser liquid (water) droplet over a less dense sessile droplet (mineral oil) that satisfies the Neumann condition. For a fixed size of an oil droplet, depending on the size of the water droplet, either it attains the axisymmetric position or tends to migrate toward the edge of the oil droplet. For a water droplet-to-oil droplet at volume ratio V_w/V_o ≥ 0.05, stable axisymmetric configuration is achieved; for V_w/V_o < 0.05, migration of water droplet is observed. The stability and migration of water droplets of size above and below critical size, respectively, are explained using the force balance at the three-phase contact line and film tension. The larger and smaller droplets that initially attain the axisymmetric position or some radial position, respectively, evaporate continuously and thus migrate toward the edge of the oil droplet. The radial location and migration of the water droplets of different initial sizes with respect to time are studied. Experiments with water droplets on a flat oil-air interface did not show migration, which signified the role of the curved oil-air interface for droplet migration. Finally, coalescence of water droplets of size above the critical size at the axisymmetric position is demonstrated. Our compound droplet studies could be beneficial for applications involving droplet transport where contamination due to direct contact and pinning of droplets on solid surfaces is of concern. Migration and coalescence of water droplets on curved oil-air interfaces could open new frontiers in chemical and biological applications including multiphase processing and biological interaction of cells and atmospheric chemistry.

Reasons for referral and diagnostic concordance between physicians/surgeons and the consultation-liaison psychiatry team: An exploratory study from a tertiary care hospital in India

BACKGROUND

Very few studies have evaluated the reasons for referral to consultation-liaison (CL) psychiatry teams.

AIM

This study aimed to evaluate the psychiatric morbidity pattern, reasons for referral and diagnostic concordance between physicians/surgeons and the CL psychiatry team.

MATERIALS AND METHODS

Two hundred and nineteen psychiatric referrals made to the CL psychiatry team were assessed for reason for referral and diagnostic concordance in terms of reason of referral and psychiatric diagnosis made by the CL psychiatry team.

RESULTS

In 57% of cases, a specific psychiatric diagnosis was mentioned by the physician/surgeon. The most common specific psychiatric diagnoses considered by the physician/surgeon included depression, substance abuse, and delirium. Most common psychiatric diagnosis made by the CL psychiatric services was delirium followed by depressive disorders. Diagnostic concordance between physician/surgeon and psychiatrist was low (κ < 0.3) for depressive disorders and delirium and better for the diagnosis of substance dependence (κ = 0.678) and suicidality (κ = 0.655).

CONCLUSIONS

The present study suggests that delirium is the most common diagnosis in referrals made to CL psychiatry team, and there is poor concordance between the psychiatric diagnosis considered by the physician/surgeon and the psychiatrist for delirium and depression; however, the concordance rates for substance dependence and suicidal behavior are acceptable.

Novel Bio-Markers for Prediction of Preeclampsia

Pre-eclampsia (PE) is a pregnancy related disorder. It is an important cause of maternal and perinatal morbidity and mortality worldwide. Two to eight percent of pregnancies were affected by PE. It is characterized by de novo hypertension and proteinuria after 20 weeks of gestation. The etiology and pathogenesis of the disease is unknown, but recent studies have revealed that placenta is the place of origin of this disorder and widespread maternal endothelial dysfunction is the characteristic feature of the disease. Some biochemical molecules are identified recently which are involved in the pathogenesis of the disease, which may help in early identification of patients at risk and help in providing proper prenatal care. Several promising biomarkers have been proposed, alone or in combination. Maternal serum concentrations of these biomarkers either increase or decrease in PE during gestation. This review focuses on the various biomarkers available and their utility in prediction and diagnosis of pre-eclampsia.

Typing of Plasmodium falciparum DNA from 2 years old Giemsa-stained dried blood spots using nested polymerase chain reaction assay

A panel of 129 Giemsa-stained thick blood spots (TBS) confirmed for Plasmodium falciparum infection having different levels of parasite density were collected from a malaria endemic area. DNA was extracted and nested polymerase chain reaction (PCR) assay was performed to amplify P. falciparum DNA. Nested PCR assay successfully amplified P. falciparum DNA at a very low parasitaemia of ~10 parasites/μl of blood. Current PCR assay is very simple and can be used retrospectively to monitor the invasion and prevalence of different Plasmodium species in endemic areas.

Prioritizing areas for malaria control using geographical information system in Sonitpur district, Assam, India

OBJECTIVE

To identify the malaria hot spots at health subcentre level in an endemic district using a geographical information system (GIS). The results will be useful for rapid retrieval of malaria information, and to prioritize malaria control efforts in identified hot spots.

STUDY DESIGN

Extraction, analysis and synthesis of relevant data.

METHODS

Malaria epidemiological data from 2006 to 2009 were analysed to determine the annual parasitic index, slide positivity rate, annual blood examination rate and Plasmodium falciparum percentage for each health subcentre in the district. Maps were produced using GIS, and integrated to identify the malaria hotspots.

RESULTS

Out of 288 health subcentres, GIS identified 10 hot spots at extremely high risk of malaria and 14 hot spots at high risk of malaria. Malaria may flare up in these hot spots whenever favourable transmission conditions arise. Health authorities have been advised to establish control measures in these selected hot spots for timely prevention.

CONCLUSION

There is a need for adequate monitoring and allocation of available resources for better interventions in the malaria hotspots. The GIS model used in this study can be used, even at village or cluster level, to pin point the malaria hot spots, and information can be updated and retrieved easily.

Epidemiology and Risk Analysis of Malaria among Pregnant Women

Malaria remains a complex problem during the pregnancy, which threatens > 35 millions pregnant women every year. Malaria pathogenesis in pregnancy results in accumulation of infected RBCs in the intervillous spaces causing severe alterations leading to the reduced materno-foetal exchanges. In this article we have revisited the current evidences of clinical implications and overall burden of malaria in pregnancy. Many adverse aftermaths including, low birth weight, intrauterine growth retardation, preterm delivery, stillbirth and anemia were found associated with malaria in pregnant women. Despite of worldwide comprehensive control programmes for malaria in pregnancy, the disease control has been a daunting task everywhere. Socio cultural, economical, lack of awareness and various logistic problems compound the disease in developing countries. Thorough evidence based information and estimates, education and awareness and strengthening of prevention programmes are needed urgently to achieve success in malaria control in pregnancy.