Building psychological resilience in Armed Forces worldwide

Psychological resilience among troops can be enhanced through relatively simple interventions. Globally, various Armed Forces have successfully implemented modules for building psychological resilience. Programs from different countries are listed, evaluated and their underpinnings explored. Recommendations for a variety of feasible and culturally acceptable interventions targeted at individuals, families, units, community and organizations in the Indian context have been made; ranging from mindfulness training to embedded combat psychologists. Interventions are likely to succeed if integrated within existing basic training and unit/career programs.

Circulating microRNA profiling identifies microRNAs linked to prediabetes associated with alcohol dependence syndrome

BACKGROUND

MicroRNAs are abundant in serum and have emerged as important regulators of gene expression, implicating them in a wide range of diseases. The purpose of this study was to discover and validate serum miRNAs in prediabetes associated with alcohol dependence syndrome (ADS).

METHOD

Serum samples from ADS patients with or without prediabetes and normoglycemic controls were subjected to microarray. Validation of identified candidate miRNAs was performed by RT-qPCR. Additionally, GO and KEGG pathway analyses were carried out to uncover target genes anticipated to be controlled by the candidate miRNAs.

RESULTS

Notably, 198, and 172 miRNAs were differentially expressed in ADS-patients with or without prediabetes compared to healthy controls, and 7 miRNAs in ADS-patients with prediabetes compared to ADS-normoglycemic patients, respectively. Furthermore, hsa-miR-320b and hsa-miR-3135b were differentially expressed exclusively in ADS-patients with prediabetes, and this was further validated. Interestingly, GO and KEGG pathway analysis revealed that genes predicted to be modulated by the candidates were considerably enriched in numerous diabetes-related biological processes and pathways.

CONCLUSION

Our findings revealed that ADS-patients with or without prediabetes have different sets of miRNAs compared to normoglycemic healthy subjects. We propose serum hsa-miR-320b and hsa-miR-3135b as potential biomarkers for the diagnosis of prediabetes in ADS-patients.

Depression among rheumatoid arthritis patients and barriers to seeking professional help: An observational study

Background

A few studies have reported the association of rheumatoid arthritis (RA) with emotional changes including anxiety and depression. There is a paucity of Indian studies in this area.

Aim

To assess depression and its correlates in diagnosed cases of RA.

Materials and Methods

This was a cross-sectional and hospital-based study. A total of 70 patients with RA fulfilled the inclusion and exclusion criteria. Their demographic characteristics were recorded. They were individually assessed with the Clinical Disease Activity Index, Numerical Pain Rating Scale, Barriers to Access Care Evaluation, and Beck Depression Inventory. Statistical analysis was undertaken with SPSS.

Results

In the patients with RA the prevalence of depression was 44.2%. Analysis revealed that there was a significant positive correlation between depression with the severity of RA. Barriers to help-seeking were mainly attitudinal rather than stigma-related or instrumental barriers.

Conclusion

In the RA patients, the prevalence of depression was 44.2%. Clinical disease activity and the pain index were higher in patients with depression.

Adding pre-emptive anticholinergics to antipsychotics: Is it justified?

Anti-psychotics are the mainstay of treatment for Schizophrenia and psychotic disorders. Historically, anticholinergics have been prescribed to prevent or treat extrapyramidal side effects (EPS) associated with first-generation antipsychotics (FGAs). Even though newer antipsychotics are associated with markedly lower rates of EPS, concurrent anticholinergic use remains high. Use of these medications has potential for long-term side effects, worsening of EPS and poor adherence. We have briefly discussed the limited association between second-generation antipsychotics (SGAs) and EPS, the efficacy of anticholinergics for different types of EPS, and summarized various national and international guidelines on the subject. In conclusion, there is no evidence for prophylactic use of anticholinergics with antipsychotics. Clinicians need to guard against this tendency to be unduly cautious.

Identifying entrustable professional activities for postgraduation in psychiatry: What should a psychiatrist be able to do?

BACKGROUND

Competency-based medical education (CBME) has been the mandate by regulatory bodies of medical education in India, and implementation is an evolving process. This study aimed to identify and propose a set of entrustable professional activities (EPAs) for a master's degree in psychiatry. An attempt has been made to present it in the form of a portfolio.

METHODOLOGY

Faculty experts in psychiatry went through phases of review to select appropriate EPAs for postgraduate residents from divergent thinking to development of portfolio.

RESULTS

One hundred and sixty-seven EPAs were identified and are presented. These were divided according to expertise required. Of these, 54% were considered vital, 30% essential, and 16% desirable.

CONCLUSION

It is envisaged that the use of EPAs and portfolios will be instrumental in implementation and success of CBME in psychiatry. It is expected that medical universities will incorporate them in their curricula. It is also expected that data will be generated to identify challenges, which shall guide future refinement of the EPAs.

Neurobiological underpinnings of emotions

Emotion is a stirred-up state caused by physiological changes occurring as a response to some event and which tends to maintain or abolish the causative event. Understanding the neuroanatomical basis of the genesis and control of emotions is quintessential in understanding how biology affects the mind and in turn, helps in understanding our own nature. We present a short communication explaining the neurological basis of emotions.

Mental health impact of COVID-19 among health-care workers: An exposure-based cross-sectional study

BACKGROUND

Health-care workers (HCWs) in COVID-19 pandemic have faced the major impact in providing care to infected persons. Most of the studies on mental health impact among HCW have not incorporated paramedical staff. Furthermore, they have not compared psychological morbidity among HCW on the basis of high COVID exposure (HCE) and low COVID exposure (LCE). To address the above gap, this study aimed at evaluating mental health impact among HCW and its associated risk factors.

MATERIALS AND METHODS

Consecutive 200 HCWs each in the HCE and LCE groups (between the age group of 18 and 60 years) were enrolled from two tertiary care hospitals providing COVID-19 treatment from August 1, 2020. After collection of sociodemographic data, participants were administered Impact of Event Scale-Revised, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 Scale.

RESULTS

The difference in stress, depression, and anxiety symptom scores between the HCE and LCE groups was not statistically significant. Multiple regression analysis revealed that female sex was associated with higher scores in all the three domains. The effect remained significant even after adjusting for effect of other risk factors.

CONCLUSION

HCE or LCE was associated with similar impact in terms of stress, depression, and anxiety among HCWs. Female HCWs had a higher prevalence of stress, depression, and anxiety. Doctors, nurses, and paramedics had a similar prevalence of stress, depression, and anxiety when odds were adjusted.

Prevalence and risk factors associated with Internet gaming disorder: A cross-sectional study

BACKGROUND

Internet gaming disorder (IGD) is an entity of clinical attention prominent among schoolgoing students. The reported nature and extent of Internet gaming varies widely, as does the extent of its effects.

AIM

This study aimed to assess the prevalence of IGD and factors associated with it.

METHODS

After institution ethics approval, individual assent, and parental consent, a cross-sectional study was conducted among 142 students of a school in western Maharashtra. A specially designed sociodemographic pro forma and IGD Scale were administered to the students. Data thus generated were statistically analyzed and compared with published literature.

RESULTS

The prevalence of IGD was 10.6% among 13-19-year-old students. It was significantly higher among male students (15.3%) than female students (3.5%). Multivariate logistic regression found IGD to be significantly associated with male gender and lower age at first gameplay.

CONCLUSIONS

IGD affects a tenth of our schoolgoing population with a male preponderance. Lower age at first gameplay had an adverse association.

Risk factors of postpartum depression

BACKGROUND

Postpartum depression (PPD) is one of the most common puerperal psychiatric illnesses impairing quality of life and mental health of the mother and also the child.

AIM

The aim is to study the prevalence and risk factors of PPD.

MATERIALS AND METHODS

This cross-sectional observational study was done on a sample of 295 mothers who delivered and were followed up at a tertiary care hospital. The mothers were administered Edinburgh Postnatal Depression Scale, and demographic, psychosocial, and clinical data were collected.

RESULTS

The age of the participant mothers ranged from 18 to 35 years and age at marriage ranged from 21 to 24 years. In most of the mothers, the parity was 2 and they had institutional vaginal delivery. The prevalence of PPD in this population of mothers was 30.84%. The factors that had a statistically significant association with PPD included: lower educational status of mother, lower family income, rural place of residence, higher parity, preterm delivery, and adverse events in newborn.

CONCLUSION

PPD is a common mental health problem in the postpartum period. Sociodemographic factors such as low educational status of mothers, rural population, and low monthly family income were found to be associated with PPD. Primipara status, preterm delivery, and adverse events in newborn were also significantly associated.

Lorazepam challenge test: A unique clinical response in catatonia

Catatonia is a psychomotor behavioral syndrome characterized as a complex syndrome of bizarre motor behavior, impaired volition, and vegetative abnormalities. Catatonia is a medical emergency and if not recognized on time may have potentially fatal outcomes. We present a case series of three patients with catatonia, in whom Injection lorazepam 4 mg administered intravenously (Lorazepam Challenge) produced quick, optimum outcome.

Alzheimer's disease: Newer biomarkers

Fifty million people are affected with dementia worldwide with Alzheimer's disease (AD) accounting for 70%-80% of these cases. In India alone, 4.1 million people suffered from dementia in 2015. To date, there are no definitive treatment options for AD and the overall treatment gap in India stands at 90%. Attempts have been made to define AD biologically. This has been made possible due to advances in the identification of biomarkers that indicate the neuropathological changes responsible for AD. Identification of these biomarkers has implications for disease staging, prognostication, and identifying drug targets. Here, we summarize the advances in the field of biomarkers in AD.

Assessment of depression, anxiety and stress in COVID-19 infected individuals and their families

Background

Pandemics have been associated with widespread psychological distress in the normal population due to quarantine and lockdown, however there are only few studies on psychiatric symptoms in COVID infected patients and their families. This study was planned to assess the depressive, anxiety and stress symptoms in individuals and their families infected with COVID19, during current pandemic.

Methods

A cross-sectional, observational study was conducted on hospitalised, COVID infected patients and their immediate family members. Ninety-three, COVID patients and fifty-four family members were studied through Google forms which contained socio-demographic proforma and Depression Anxiety Stress Scale-21 (DASS21). Collected data was tabulated to assess depression, anxiety and stress symptoms in the given population and study their relation with various sociodemographic variables.

Results

Almost one-third of the sample showed increased score on depression and anxiety subscales and one-fifth on stress subscales. 30–45% of the family members studied had higher score on either of the subset. There was also a high correlation between the scores of depression, anxiety and stress subset in the study sample.

Conclusion

This study, reflects high magnitude of depression, anxiety and stress symptoms in these patients and their families which alert us to the need for definitive interventions in these affected individuals.

Impact of breathing and relaxation training (Sudarshan Kriya) on cases of alcohol dependence syndrome

BACKGROUND

Alcohol abuse is a public health problem and the course of alcohol dependence syndrome (ADS) is known for its relapsing nature. Additional interventions with empirical evidence are worthy of consideration. Breathing and Relaxation Training, like Sudarshan Kriya (SK) is recommended for stress management, and have been shown to positively affect outcomes in stress-related disorders. The aim of this study was to assess the effect of an intervention of Breathing and Relaxation Training, on drinking behavior in patients of ADS.

METHODOLOGY

Eighty in-patients diagnosed with ADS were included after obtaining informed consent, in this prospective study and were randomized into two groups. They were administered Alcohol Use Disorder Identification Test (AUDIT) at admission and 6-months after discharge. The Study group (n = 40) underwent a 6-day intervention of Breathing and relaxation Training (SK) apart from the standard therapy. "WHO-5 Well-Being Index" was administered before and after the training. The Control group was exposed to the standard therapy for ADS. A follow-up on a monthly basis and finally at 6-month interval was done to assess alcohol consumption status.

RESULTS

Socio-demographically both the groups were comparable. The breathing and relaxation training (study) group had a significant rise in "WHO-5 Well-Being Index" (P < 0.001). There was a significant reduction in AUDIT scores after 6 months in both groups. AUDIT scores were significantly lower in the study group (11.20 ± 2.81) than the control group (15.30 ± 4.05) after 6 months (P < 0.001). The study group also reported fewer days of drinking (P = 0.004) and reduced overall drinking in the intervening period (P < 0.001).

CONCLUSION

The addition of Breathing and Relaxation Training (SK) in the management of ADS provided additional therapeutic benefits in the form of fewer days of drinking and reduced total alcohol consumption.

Stress induced modifications in photosystem II electron transport, oxidative status, and expression pattern of acc D and rbc L genes in an oleaginous microalga Desmodesmus sp

The study aimed at understanding the biochemical and molecular level modifications in Desmodesmus sp. under lipid inducing stress conditions. The low-temperature (5 °C) incubation and nitrogen starvation reduced the PS II electron transport in microalga with a maximum reduction of 50-57% in ET₀/ABS values. The PS II electron transport recovered in UV treated cultures after an initial reduction of 87-93% in ET₀/ABS values. A 2.7-4.4 fold increase in ROS and MDA levels was observed under low-temperature incubation, and nitrogen starvation. The UV treatment caused 1.3-2.4 fold higher ROS and MDA levels than control. The low-temperature incubated, nitrogen starved, and UV treated cultures showed 2.4-4 fold higher acc D gene expression. A higher rbc L gene expression was observed under low-temperature stress. The study showed modifications in PS II electron transport, oxidative status, and expression of acc D and rbc L genes under stress conditions.

Role of various lifestyle and behavioral strategies in positive mental health across a preventive to therapeutic continuum

There is growing interest in lifestyle and behavioral strategies not only in prevention but also in the management of psychiatric morbidity. Available literature in this direction was accessed, and the role of various lifestyle and behavioral factors was explored. There is strong evidence of the role of good sleep, nutritious diet, exercise, social connectedness, enhanced self-esteem, sense of purpose in life, resilience, mindfulness, and environmental mastery in the promotion of mental well-being and prevention and management of psychiatric disorders. There is a significant scope of lifestyle and behavioral intervention in ensuring positive mental health spanning from preventive to therapeutic dimension.

Workplace based assessment: A review of available tools and their relevance

Workplace-based assessment (WPBA) appears to be a promising tool for more comprehensive assessment of the learners. Relevant literature in this direction was collated and analyzed for its relevance, salience, and merit. Many WPBA tools are being used by various educational institutions which spans across multiple domains and over the entire duration of the workplace learning. It caters to holistic assessment with structured measures, real-time feedback, and continuous professional development. It is being used more for formative assessment and has limited utility in summative assessment as on date. WPBA tools have promising prospect in bringing novelty, objectivity, and holistic approach in assessment.

Available videoconferencing freeware and medical education

BACKGROUND

Traditionally medical education involves classroom teaching, small group discussions and bed-side clinics. These have become difficult to conduct in times of the COVID-19 pandemic. Video-conferencing software and apps provide pragmatic alternatives for medical education in this scenario. However, the apps are not designed specifically for medical education. In this background, we aimed to review available video-conferencing freeware (platforms/apps) for their suitability in imparting post-graduate medical education.

METHODOLOGY

Software and apps were searched on Android and iOS platforms. Freeware were selected based on pre-defined criteria. They were evaluated for features supporting post-graduate medical education like participant numbers, time limit, user comfort and security features.

RESULTS

Our search yielded 118 video conferencing software and apps. Of these, 07 free apps met the initial inclusion and exclusion criteria. 'Say Namaste' was included post-hoc. Most apps allowed adequate numbers of participants and were comfortable for users. Only two apps had end-to-end encryption.

CONCLUSION

Video-conferencing freeware can serve as a viable alternative for some aspects of medical teaching. Provision of certain additional features would make these apps more effective for post-graduate medical education.

Strategies for enhancement of alpha-linolenic acid rich lipids in Desmodesmus sp. without compromising the biomass production

The indigenous freshwater microalga Desmodesmus sp. produces ALA rich lipids (about 23%). The phytohormones (DAH and KIN; 0.5 mg L^-1) increased the biomass yield and lipid content of microalga by 1.4-1.7 fold. Mixotrophic cultivation (500 mM glucose and 100 mM sodium acetate) enhanced the biomass yield and lipid content by 1.8-2.7 fold. The sodium azide (1.0 mM) led to a 1.5 fold and 1.7 fold enhancement in the lipid content and ALA fraction of total fatty acids, respectively without affecting the biomass yield. The low temperature (5 °C) as the second stage of cultivation enhanced the ALA fraction of total fatty acids by 1.2-1.5 fold for untreated, phytohormone supplemented and mixotrophic cultures, without affecting the biomass yield. These cultivation strategies could, therefore, be used for enhancement of ALA rich lipids in microalgae without compromising the biomass production.

Enhanced accumulation of alpha-linolenic acid rich lipids in indigenous freshwater microalga Desmodesmus sp.: The effect of low-temperature on nutrient replete, UV treated and nutrient stressed cultures

The indigenous microalga, Desmodesmus sp. produced alpha-linolenic acid (ALA) rich lipids in response to low temperature and UV treatment. Incubation at 5 °C showed a 1.5 fold increase in lipid content (34% w/w) with 44% ALA fraction of total fatty acids. The UV treatment (UV 60 min) exhibited a 1.4 fold increase in biomass productivity and 1.6 fold increase in lipid content (37% w/w) with ALA fraction as 31% of total fatty acids. The nitrogen stress enhanced the lipid content (39% w/w) with a reduced ALA fraction (18%) of total fatty acids. The UV treated cultures (UV 40 and 60 min) on incubation at 5 °C showed maximum lipid accumulation (59 to 62% w/w) with ALA fraction of total fatty acids as 39 to 42%. The incubation of nutrient-replete and UV treated cultures at low-temperature could therefore be used for the production of ALA-rich lipids in microalgae.

To identify predictors of relapse in cases of alcohol dependence syndrome in relation to life events

BACKGROUND AND OBJECTIVES

Relapse is a complex and dynamic phenomenon that appears to be determined by biological, psychological, and social factors and an interaction among these. This study examined the association between demographic variables, clinical parameters, and psychosocial factors that predict the vulnerability to relapse in cases of alcohol dependence syndrome.

MATERIALS AND METHODS

Structured assessments of clinical/demographic parameters, relapse precipitants, life events, and dysfunction were carried out among patients with alcohol dependence syndrome (n = 100) who had relapsed and compared with those (n = 100) who had managed to remain abstinent.

RESULTS

Patients who had relapsed were found to have significantly more positive family history of substance use, past history of alcohol-related comorbidity, experienced a higher number of undesirable life events, and higher negative mood states and social anxiety and dysfunction in social, vocational, personal, family, and cognitive spheres compared to patients who had remained abstinent.

CONCLUSIONS

Relapse in alcohol dependents is an interaction of many factors, and multiple layers of assessment may be required to predict relapse. This study provided further evidence in support of the importance of certain clinical/psychosocial factors in relapse in substance dependence. It provides the basis for investigating the correlates of relapse in a wide range of behavioral and substance use problems.

Growth and biochemical characteristics of an indigenous freshwater microalga, Scenedesmus obtusus, cultivated in an airlift photobioreactor: effect of reactor hydrodynamics, light intensity, and photoperiod

The freshwater green algae, Scenedesmus obtusus, was cultivated in a 3.4 L airlift photobioreactor. The hydrodynamic parameters were estimated at different inlet gas flow rates (1, 2, 3, and 4 LPM) and their subsequent impact on the growth and biochemical characteristics of microalgae was studied. The biomass concentration and productivity increased with an increase in flow rates from 1 to 4 LPM. A maximum of 0.07 g L^-1 day^-1 productivity of biomass was attained at 3 LPM. An increase of total carbohydrate content from 19.6 to 26.4% was noticed with increment in the inlet flow rate of gas from 1 to 4 LPM. Major variations in total fatty acid content were not observed. The impact of light irradiance on growth and biochemical characteristics of S. obtusus was also evaluated. A maximum biomass productivity of 0.103 g L^-1 day^-1 was attained at an illumination of 150 μmol m^-2 s^-1 under continuous light. The major fatty acids reported were palmitic acid (C16:0), α-linolenic acid (C18:3), linoleic acid (C18:2), and oleic acid (C18:1). Biodiesel properties of the microalgae were estimated under various culture conditions. The light profile inside the airlift reactor was experimentally measured and the predictive modelling of light profile was also attempted.

Fibroblast growth factor 2 (FGF2) and vascular endothelial growth factor A (VEGFA) synergistically promote steroidogenesis and survival of cultured buffalo granulosa cells

The present study investigated the combined effect of fibroblast growth factor 2 (FGF2) and vascular endothelial growth factor A (VEGF-A) on estradiol (E₂) secretion and relative abundance of mRNA for aromatase enzyme (CYP19A1), proliferating cell nuclear antigen (PCNA) and BCL-2 associated X protein (BAX) in cultured buffalo granulosa cells (GCs). Follicles were isolated and classified into four groups based on size and E₂ concentration in follicular fluid (FF): Small, 4-6mm diameter, E₂<0.5ng/ml; Medium, 7-9mm, E₂=0.5-5ng/ml; Large, 10-13mm, E₂=5-40ng/ml; Preovulatory (PFs), >14mm, E₂>180ng/ml. The GCs of PF were cultured in 24 well cell culture plates and allowed to become 75-80% confluent. Then cultured GCs were treated with FGF2 (200ng/ml) and VEGF-A (100ng/ml) separately and in combination for three incubation periods (24, 48 and 72h). Estradiol secretion was greater in GCs treated with FGF2+VEGF-A compared to FGF2 or VEGF-A at all incubation periods and was greatest (P<0.05) at 72h of incubation. The relative abundance of CYP19A1 and PCNA mRNA were relatively consistent with the amount E₂ secretion. In contrast, the relative abundance of Bax mRNA was less in GCs treated with the combination of FGF2 and VEGF-A as compared to either FGF2 or VEGF-A alone and the least concentration (P<0.05) was at 72h of incubation. Findings with use of immunocytochemistry of cells treated with these factors were consistent to the relative abundance of mRNA transcript for the factor. The present findings indicate that FGF2 and VEGF-A may function in a synergistic manner to promote steroidogenesis and survival of cultured buffalo GCs.

Valproate induced hyperammonemic encephalopathy treated by haemodialysis

Valproate (VPA)-induced hyperammonemic encephalopathy is an unusual, but serious, adverse effect of divalproex sodium (DVPX) treatment and if untreated can lead to raised intracranial pressure, seizures, coma, and eventually death. It can, however, be reversed if an early diagnosis is made. It is therefore extremely important to recognize it and discontinue DVPX treatment. Our patient developed sudden deterioration of sensorium, drowsiness, lethargy, and later severe comatose state after few days of starting DVPX with high levels of serum ammonia despite therapeutic levels of VPA and normal liver function test. He responded to hemodialysis, cerebral decongestants, and other intensive supportive measures.

Cross-sectional study of anxiety symptoms in students in preexamination period

BACKGROUND

Preexamination period is an exceptionally stressful time for schoolgoing children and adolescents, and the propensity of having anxiety symptoms increases.

AIM

This study aimed to assess the presence of anxiety symptoms in students in preexamination period.

MATERIALS AND METHODS

The study was carried on 619 children from Class VIII to XI. All of them were given a structured questionnaire for sociodemographic profile and Screen for Child Anxiety Related Emotional Disorders questionnaire. Association of various variables with presence of anxiety symptoms was assessed. Statistics was analyzed with SPSS version 17.0 software.

RESULTS

Totally 170 children (27.5%) had anxiety symptoms, similarly the various subgroups had increased frequency compared to the known prevalence in this age group. Age, years spent in the current school, living with parents, presence of domestic stressors, and grade deterioration, all were significantly associated with increased frequency of these symptoms. Similarly, association with various subgroups is described.

CONCLUSION

This study attempts to give evidence of increased anxiety symptoms, during preexamination phase, compared to the reported prevalence in this age group, and thus to address this becomes imperative which will improve their performance and also the mental health preventing distress along with psychological and behavioral problems.

Removal of nutrients and organic pollution load from pulp and paper mill effluent by microalgae in outdoor open pond

A mixed culture of microalgae, containing two Scenedesmus species, was analysed to determine its potential in coupling of pulp and paper mill effluent treatment and microalgal cultivation. Laboratory studies suggested that 60% concentration of wastewater was optimum for microalgal cultivation. A maximum of 82% and 75% removal of BOD and COD respectively was achieved with microalgal cultivation in outdoor open pond. By the end of the cultivation period, 65% removal of NO3-N and 71.29% removal of PO4-P was observed. The fatty acid composition of mixed microalgal culture cultivated with effluent showed the palmitic acid, oleic acid, linoleic acid and α-linolenic acid as major fatty acids. The results obtained suggest that pulp and paper mill effluent could be used effectively for cultivation of microalgae to minimise the freshwater and nutrient requirements.

Two cases of male genital self-mutilation

Male genital self-mutilation (GSM) is a rare but serious phenomenon. Some of the risk factors for this act are the presence of religious delusions, command hallucinations, low self-esteem, and feelings of guilt associated with sexual offences. Other risk factors include failures in the male role, problems in the early developmental period, such as experiencing difficulties in male identification and persistence of incestuous desires, depression, and having a history of GSM. The eponym Klingsor Syndrome, which involves the presence of religious delusions, is proposed for GSM. Psychiatric case reports of male GSM in the literature are rare and mostly anecdotal.

Nonhealing Wounds—A Therapeutic Dilemma

Chronic wounds of the lower extremity are a therapeutic dilemma. In India, chronic wounds are caused by factors other than impaired circulation and diabetes, which account for most of this clinical problem in Western societies. A study of 2 topical agents, placental extract and phenytoin powder, is presented in this paper. One hundred fifty patients were randomly assigned to these treatments or to saline dressings (control). It was observed that patients receiving active topical treatments responded better than those in the control group. The importance of this finding should be viewed with the perspective that these topical treatments are inexpensive and easily available in India. The study also piloted measurements of angiogenic responses in 1 group, and the findings encourage further exploration with the technique and topical agent.

Evaluation of indigenous fresh water microalga Scenedesmus obtusus for feed and fuel applications: Effect of carbon dioxide, light and nutrient sources on growth and biochemical characteristics

Scenedesmus obtusus, a freshwater microalga, was evaluated for its growth and biochemical characteristics under various culture conditions. S. obtusus was tolerant at all tested CO2 concentrations up to 20%. Among the different nitrogen sources, urea showed enhanced biomass productivities up to 2-fold compared to control, where the nitrogen source was sodium nitrate. Light intensity and photoperiod had a significant effect on growth rate and biomass productivity. The growth rate was observed maximum under continuous light exposure at the light intensities, 30μmolm(-2)sec(-1) and 60μmolm(-2)sec(-1) The species was able to tolerate the salinity levels up to 25mM NaCl, where, the increase in the concentration of NaCl suppressed the growth. Ammonium acetate and glycine showed better growth rate and biomass productivity indicating mixotrophic ability of S. obtusus. Supplementation of acetate and bicarbonate significantly enhanced the biomass productivity. Biodiesel properties of S. obtusus cultivated at various culture conditions were estimated.

Social Support and Treatment Outcome in Alcohol Dependence Syndrome in Armed Forces

INTRODUCTION

Social factors play vital role in unfolding of alcohol use disorders in any given population. Several factors beyond the confines of treatment settings influence treatment outcome in alcohol dependence syndrome. Social support has positive effect in treatment outcome of alcohol dependence syndrome. This has not been much studied in India in past. Therefore we decided to study the perception of social support in cases of alcohol dependence syndrome admitted in a busy hospital in armed forces.

AIM

The aim was to study the perception of social support across relapsed and abstinent group and see if it reached any statistical proportion and also to see if any socio-demographic variables also affected perception of social support.

MATERIALS AND METHODS

Fifty five consecutive male patients of alcohol dependent syndrome without a co-morbid neurological/psychiatric diagnosis were assessed for their perception of social support after taking informed consent. They were explained the procedure and their alcoholic milestones were recorded in specially designed pro-forma. Subjects were then divided in abstinent and relapsed group. Subsequently they were assessed for their perception of social support by administering Social provision scale and Social support questionnaire.

STATISTICAL ANALYSIS

Data were tabulated and statistically analysed by using chi square test, Mann Whitney U-Test and Rank ANOVA test where applicable p-value <.05 was taken as significant.

RESULTS

Results indicated that perception of social support across abstinent (n=18) and relapsed (n= 37) group reached significant statistical proportion as measured by social provision scale and social support questionnaire. Duration of use, dependence and family history of alcoholism did not influence perception of social support across patient population. There was inverse relationship between patients with alcohol related problem and their perception of social support. Professional and qualified soldiers perceived higher social support than soldiers and lesser qualified individuals.

CONCLUSION

Abstinent group perceived better social support than relapsed group and soldiers in upper socio-occupational status and less alcohol related problems perceived more social support than soldiers with lower socioeconomic status and more alcohol related problems. Psychosocial therapy must be incorporated in management of Alcohol dependence syndrome.

Defatted algal biomass as a non-conventional low-cost adsorbent: surface characterization and methylene blue adsorption characteristics

The present study investigates the use of defatted algal biomass (DAB) as a non-conventional low cost adsorbent. The maximum adsorption capacity of biomass (raw, defatted and sulfuric acid pretreated DAB) was determined by liquid phase adsorption studies in batch mode for the removal of methylene blue present at various concentrations (1, 2, 3, 4, and 5 mg L(-1)) from aqueous solutions. The data was well fitted with Langmuir and Freundlich isotherms. The maximum adsorption capacity for raw, defatted and sulfuric acid pretreated DAB was found to be 6.0, 7.73 and 7.80 mg g(-1), respectively. The specific surface area of raw, defatted and sulfuric acid pretreated DAB was estimated to be 14.70, 18.94, and 19.10 m(2) g(-1), respectively. To evaluate the kinetic mechanism that controls the adsorption process, pseudo-first order, pseudo-second order, intraparticle diffusion and particle diffusion has been tested. The data fitted quite well with pseudo-second order kinetic model.

Statistical optimization of thermal pretreatment conditions for enhanced biomethane production from defatted algal biomass

The present study analyzes the effect of thermal pretreatment for enhancing the biomethane potential of defatted algal biomass of Scenedesmus dimorphus through statistically guided experimental design. To this end, defatted microalgal biomass at various concentrations (1, 3 and 5 g L(-1)) was pretreated at elevated temperatures (100, 120 and 150°C) for 20, 40 and 60 min. The solubilised TOC was favourably enhanced up to 71 mg L(-1) after pretreatment at a temperature of 150°C for reaction time of 60 min. The methane yield was substantially enhanced (up to 60%) and could be correlated with an increase in organic matter solubilisation and enhanced biodegradability via thermal pretreatment. The optimisation of the integrated thermal pretreatment-biomethanation process resulted in up to 1.6-fold increase in methane yield.

Localized rotational activation in the left atrium during human atrial fibrillation: relationship to complex fractionated atrial electrograms and low-voltage zones

BACKGROUND

In humans, the existence of rotors or reentrant sources maintaining atrial fibrillation (AF) and the underlying electroanatomic substrate has not been well defined.

OBJECTIVE

Our aim was to determine the prevalence of localized rotational activation (RotA) in the left atrium (LA) during human AF and whether complex fractionated atrial electrograms (CFAEs) or low-voltage areas colocalize with RotA sites.

METHODS

We prospectively studied 32 patients (mean age 57 ± 8 years; 88% with persistent AF) undergoing AF catheter ablation. Bipolar electrograms were recorded for 2.5 seconds during AF using a roving 20-pole circular catheter in the LA. RotA was defined as sequential temporal activation of bipoles around the circular catheter. Bipolar electrogram fractionation index and bipolar voltage were used to define CFAEs and low-voltage areas, respectively.

RESULTS

In 21 (66%) patients, 47 RotA sites were identified. Few (9%) lasted 2.5 seconds (cycle length 183 ± 6 ms), while the majority (91%) were nonsustained (duration 610 ± 288 ms; cycle length 149 ± 11 ms). RotA was most common in the pulmonary vein antrum (71%) and posterior LA (25%). CFAEs were recorded from 18% ± 12% of LA area, and most (92% ± 7%) were not associated with RotA sites. However, 85% of RotA sites contained CFAEs. Very low voltage (<0.1 mV) areas comprised 12% ± 10% of LA area and were present in 23% of RotA sites.

CONCLUSIONS

In patients with predominantly persistent AF, localized RotA is commonly present but tends to be transient (<1 second). Although most CFAEs do not colocalize with RotA sites, the high prevalence of CFAEs and very low voltages within RotA sites may indicate slow conduction in diseased myocardium necessary for their maintenance.

Selection and evaluation of CO2 tolerant indigenous microalga Scenedesmus dimorphus for unsaturated fatty acid rich lipid production under different culture conditions

Five indigenous microalgal strains of Scenedesmus, Chlorococcum, Coelastrum, and Ankistrodesmus genera, isolated from Indian fresh water habitats, were studied for carbon-dioxide tolerance and its effect on growth, lipid and fatty acid profile. Scenedesmus dimorphus strain showed maximum growth (1.5 g/L) and lipid content (17.83% w/w) under CO2 supplementation, hence selected for detailed evaluation. The selected strain was alkaline adapted but tolerated (i) wide range of pH (5-11); (ii) elevated salinity levels (up to 100 mM, NaCl) with low biomass yields and increased carotenoids (19.34 mg/g biomass); (iii) elevated CO2 levels up to 15% v/v with enhancement in specific growth rate (0.137 d(-1)), biomass yield (1.57 g/L), lipid content (19.6% w/w) and CO2 biofixation rate (0.174 g L(-1) d(-1)). Unsaturated fatty acid content (alpha linolenic acid) increased with CO2 supplementation in the strain.

Psychiatric morbidity in asymptomatic human immunodeficiency virus patients

BACKGROUND

Psychiatric morbidity in human immunodeficiency virus (HIV) patients is being studied all over the world. There is paucity of Indian literature particularly in asymptomatic HIV individuals.

AIM

The aim of the following study is to establish the prevalence and the determinants of psychiatric morbidity in asymptomatic HIV patients.

MATERIALS AND METHODS

A cross-sectional study was undertaken to assess psychiatric morbidity as per ICD-10 dacryocystorhinostomy criteria in 100 consecutive asymptomatic seropositive HIV patients and an equal number of age, sex, education, economic and marital status matched HIV seronegative control. All subjects were assessed with the general health questionnaire (GHQ), mini mental status examination, hospital anxiety and depression scale (HADS) and sensation seeking scale (SSS) and the scores were analyzed statistically.

RESULTS

Asymptomatic HIV positive patients had significantly higher GHQ caseness and depression but not anxiety on HADS as compared to HIV seronegative controls. On SSS asymptomatic HIV seropositive subjects showed significant higher scores in thrill and adventure seeking, experience seeking and boredom susceptibility as compared to controls. HIV seropositive patients had significantly higher incidence of total psychiatric morbidity. Among the individual disorders, alcohol dependence syndrome, sexual dysfunction and adjustment disorder were significantly increased compared with HIV seronegative controls.

CONCLUSION

Psychiatric morbidity is higher in asymptomatic HIV patients when compared to HIV seronegative controls. Among the individual disorders, alcohol dependence syndrome, sexual dysfunction and adjustment disorder were significantly increased compared with HIV seronegative controls. High sensation seeking and substance abuse found in HIV seropositive patients may play a vital role in engaging in high-risk behavior resulting in this dreaded illness.

The chemistry, pharmacologic, and therapeutic applications of Polyalthia longifolia

Medicinal plants are nature's gift to human beings to lead a disease-free, healthy life. They play a vital role in preserving our health. India is one of the most medicoculturally diverse countries in the world, where the medicinal plant sector is part of a time-honored tradition that is respected even today. Medicinal plants are believed to be much safer and proved as elixir in the treatment of various ailments. In our country, more than 2000 medicinal plants are recognized. Polyalthia longifolia cv. pendula (Annonaceae) is native to the drier regions of India and is locally known as “Ashoka” and is commonly cultivated in Pakistan and Sri Lanka. This plant is used as an antipyretic agent in indigenous systems of medicine. Pharmacologic studies on the bark and leaves of this plant show effective antimicrobial activity, cytotoxic function, antiulcer activity, hypoglycemic activity, and hypotensive effect. The present article includes the detailed exploration of pharmacologic properties of P. longifolia in an attempt to provide a direction for further research.

In vivo analysis of translation initiation sites in Plasmodium falciparum

Regulation of gene expression in the malaria parasite Plasmodium falciparum is tightly controlled and little is known about the many steps involved. One step i.e. translation initiation is also poorly understood and in P. falciparum, choice of the translation initiation site (TIS) is a critical decision largely due to the high frequency of AUGs in the relatively long 5' untranslated regions of parasite mRNAs. The sequences surrounding the TIS have a major role to play in translation initiation and this report evaluates these sequences by mutational analysis of the heat shock protein 86 gene, transient transfection and reporter assays in the parasite. We find that purines at the -3 and +4 positions are essential for efficient translation in P. falciparum, similar to other eukaryotes. Interestingly, a U at the -1 position results in 2.5-fold higher reporter activity compared to wild type. Certain classes of protein biosynthetic genes show higher frequencies of U at the -1 position, suggesting that these genes may exhibit higher levels of translation. This work defines the optimal sequences for TIS choice and has implications for the design of efficient expression vectors in an important human pathogen.

Lifestyle, reproductive factors and risk of gallbladder cancer

INTRODUCTION

Lifestyle and dietary habits play an important role in carcinogenesis. Carcinoma of the gallbladder is no different. The present study was carried out to evaluate the roles of lifestyle, menstrual and reproductive factors in gallbladder cancer.

METHODS

A prospective case-control study involving 78 newly-diagnosed cases of carcinoma of the gallbladder and 78 age- and gender-matched controls with cholelithiasis were investigated for their lifestyle history, with an emphasis on habits with chewing betel nut and tobacco, alcohol consumption and smoking. Besides this, female patients were investigated for their menstrual and reproductive factors. Odds-ratio and significance were calculated.

RESULTS

A Hindu preponderance was seen. About half of the patients with carcinoma of the gallbladder and gallstone were either illiterate or had a very low level of education (primary or below). Religion, education, family income, chewing of tobacco as well as smoking were comparable. But numbers of chewing tobacco and smoking per day differed significantly. Alcohol was consumed by 11.6 percent of carcinoma and 4.1 percent of gallstone patients. Lower age of menarche, higher number of pregnancies and higher age at menopause had a significantly increased risk of gallbladder carcinogenesis. A significant difference in carcinogenesis was seen in the postmenopausal women compared with the menopausal group.

CONCLUSION

Carcinoma of the gallbladder was common in tobacco chewers. Females with lower age at menarche, higher number of pregnancies and childbirths and higher age at last childbirth had an increased risk of gallbladder cancer.

Blood stage malaria antigens induce different activation-induced cell death programs in splenic CD4+T cells

CD4(+) T cells respond to antigen immunization through a process of activation, clonal expansion to generate activated effector T cells followed by activation-induced clonal deletion of the responding T cells. While loss of responding T cells in post-activation death by apoptosis is a major factor regulating immune homeostasis, the precise pathways involved in downsizing of Plasmodium falciparum antigen-induced T cell expansions are not well characterized. We report in this study that splenic CD4(+) T cells from mice immunized with nonreplicating immunogens like OVA or recombinant blood stage P. falciparum antigens, PfMSP-3 and PfMSP-1(19) or crude parasite antigen (PfAg) undergo sequential T cell activation, proliferation followed by activation-induced cell death (AICD) in a dose- and time-dependent manner after Ag restimulation. While PfMSP-3 and OVA-induced AICD was mediated through a death receptor-dependent apoptotic program, PfMSP-1(19) and PfAg-induced AICD was via a mechanism dependent on the activation of mitochondria apoptosis signalling pathway through Bax activation. These results provide insights into the mechanism through which two blood stage merozoite antigens trigger different apoptotic programs of AICD in splenic CD4(+) T cells.

Tudor domain proteins in protozoan parasites and characterization of Plasmodium falciparum tudor staphylococcal nuclease

RNA-binding proteins play key roles in post-transcriptional regulation of gene expression. In eukaryotic cells, a multitude of RNA-binding proteins with several RNA-binding domains/motifs have been described. Here, we show the existence of two Tudor domain containing proteins, a survival of motor neuron (SMN)-like protein and a Staphylococcus aureus nuclease homologue referred to as TSN, in Plasmodium and other protozoan parasites. Activity analysis shows that Plasmodium falciparum TSN (PfTSN) possesses nuclease activity and Tudor domain is the RNA-binding domain. A specific inhibitor of micrococcal nucleases, 3',5'-deoxythymidine bisphosphate (pdTp) inhibits the nuclease as well as RNA-binding activities of the protein. PfTSN shows a predominant nuclear localization. Treatment of P. falciparum with pdTp, inhibited in vitro growth of both chloroquine-sensitive and chloroquine-resistant strains of P. falciparum, while a four fold concentration of pdTp did not have any significant effect on the mammalian cell line, Huh-7D12. Altogether, these results suggest that PfTSN is an essential enzyme in the parasite's life cycle.

Alpha,beta-dehydrophenylalanine containing cecropin-melittin hybrid peptides: conformation and activity

Synthesis and conformational studies of a cecropin-melittin hybrid pentadecapeptide CA(1-7)MEL(2-9), and its three alpha, beta-dehydrophenylalanine (DeltaPhe) containing analogs in water-TFE mixtures are described. DeltaPhe is placed at strategic positions in order to preserve the amphipathicity of the molecule. The wild type CAMEL0 and its three analogs, containing one, two and three DeltaPhe residues namely CAMELDeltaPhe1, CAMELDeltaPhe2 and CAMELDeltaPhe3 respectively were synthesized in solid phase and their conformation determined by CD and NMR. CAMELDeltaPhe2 and CAMELDeltaPhe3 peptides exhibit the presence of 3(10)-helix and beta-turns in the former and only turns in the latter. CAMELDeltaPhe1 peptide was found to have a largely extended conformation. Antibacterial and hemolytic activities of the peptides were also evaluated. CAMELDeltaPhe2 peptide is maximally potent against both Staphylococcus aureus ATCC 259230 and Escherichia coli ATCC 11303. CAMELDeltaPhe1 with a single DeltaPhe at the center shows minimal hemolysis.

Immune Responses to Asexual Blood-Stages of Malaria Parasites

The blood stage of the malaria parasite's life cycle is responsible for all the clinical symptoms of malaria. The development of clinical disease is dependent on the interplay of the infecting parasite with the immune status and genetic background of the host. Following repeated exposure to malaria parasites, individuals residing in endemic areas develop immunity. Naturally acquired immunity provides protection against clinical disease, especially severe malaria and death from malaria, although sterilizing immunity is never achieved. Given the absence of antigen processing in erythrocytes, immunity to blood stage malaria parasites is primarily conferred by humoral immune responses. Cellular and innate immune responses play a role in controlling parasite growth but may also contribute to malaria pathology. Here, we analyze the natural humoral immune responses acquired by individuals residing in P. falciparum endemic areas and review their role in providing protection against malaria. In addition, we review the dual potential of cellular and innate immune responses to control parasite multiplication and promote pathology.

Stabilization of unusual structures in peptides using α,β-dehydrophenylalanine: Crystal and solution structures of Boc-Pro-ΔPhe-Val-ΔPhe-Ala-OMe and Boc-Pro-ΔPhe-Gly-ΔPhe-Ala-OMe

The structures of two dehydropentapeptides, Boc-Pro-DeltaPhe-Val-DeltaPhe-Ala-OMe (I) and Boc-Pro-DeltaPhe-Gly-DeltaPhe-Ala-OMe (II) (Boc: t-butoxycarbonyl), have been determined by nuclear magnetic resonance (NMR), circular dichroism (CD), and X-ray crystallographic studies. The peptide I assumes a S-shaped flat beta-bend structure, characterized by two partially overlapping type II beta-bends and absence of a second 1 <-- 4 (N4--H . . . O1') intramolecular hydrogen bond. This is in contrast to the generally observed 3(10)-helical conformation in peptides with DeltaPhe at alternate positions. This report describes the novel conformation assumed by peptide I and compares it with that of the conserved tip of the V3 loop of the HIV-1 envelope glycoprotein gp120 (sequence, G:P319 to F:P324, PDB code 1ACY). The tip of the V3 loop also assumes a S-shaped conformation with Arg:P322, making an intramolecular side-chain-backbone interaction with the carbonyl oxygen of Gly:P319. Interestingly, in peptide I, C(gamma)HVal(3) makes a similar side-chain-backbone C--H . . . O hydrogen bond with the carbonyl oxygen of the Boc group. The observed overall similarity indicates the possible use of the peptide as a viral antagonist or synthetic antigen. Peptide II adopts a unique turn followed by a 3(10)-helix. Both peptides I and II are classical examples of stabilization of unusual structures in oligopeptides.

Incisional hernia—comparison of mesh repair with Cardiff repair: an university hospital experience

BACKGROUND

Incisional hernia is a frequent complication of abdominal surgery. Various types of repair are recommended for incisional hernia. Suture and mesh repair are compared in the present study.

METHOD

One hundred seventy one patients with incisional hernia underwent Cardiff repair (far and near sutures with reinforcement sutures) which was used as an open suture repair while onlay polypropylene mesh was used in the mesh repair technique.

RESULT

Cardiff repair was performed in 116 patients with no mortality with recurrence in two patients with mean follow up of 7.1 years. Both these patients with recurrence had a defect measuring more than 10 cm in width. Mesh repair was carried out in 55 patients with no recurrence in mean follow up of 37 months. Seroma formation was noted in 7 (12.72%) with mesh repair as compared to 4 (3.44%) patients with Cardiff repair.

CONCLUSION

We recommend Cardiff repair for primary and small to medium size incisional hernias. Onlay polypropylene mesh is ideal for tension-free hernia repair, recurrent incisional hernia and hernia defects wider than 10 cm.

Allophylus serratus: a plant with potential anti-ulcerogenic activity

Allophylus serratus is known to possess various therapeutic properties. We evaluated the anti-ulcerogenic property of crude ethanolic extract of Allophylus serratus (AS) in different ulcer models in Sprague-Dawley rats. The extract at 400 mg/kg body weight, once daily, orally has a significant effect in cold restraint (CRU, 2 h cold restraint stress), aspirin (ASA, 150 mg/kg body weight, orally), alcohol (AL, 1 ml/200 gm of absolute alcohol) and pyloric ligation (PL, 4h ligation) induced gastric ulcer models as it showed protection index of 71.28, 62.50, 90.84 and 64.29% protection, respectively whereas, standard drug omeprazole (OMZ, 10mg/kg body weight) has shown protection index of 85.70, 74.99 and 74.99 in CRU, ASA and PL model respectively. Sucralfate (SUC, 500 mg/kg body weight) as a standard drug in AL model has 93.20% protection. Furthermore, AS has significantly decreased the free acidity (72.41%), total acidity (47.97%) and peptic activity (24.59%), respectively as well as has significantly increased the mucus secretion (29.41%). Conclusively the ulcer protective effect of AS may be due to its anti-secretory along with cytoprotective mechanism.