Lateral Cephalometric Landmark Annotation Using Histogram Oriented Gradients Extracted from Region of Interest Patches

Introduction

Two-dimensional cephalometric image analysis plays a crucial role in orthodontic diagnosis and treatment planning. While deep learning-based algorithms have emerged to automate the laborious task of anatomical landmark annotation, their effectiveness is hampered by the challenges of acquiring and labelling clinical data. In this study, we propose a model that leverages conventional machine learning techniques to enhance the accuracy of landmark detection using limited dataset.

Materials and methods

Our methodology involves coarse localization through region of interest (ROI) extraction and fine localization utilizing histogram-oriented gradient (HOG) feature. The image patch containing landmark pixels is classified using the light gradient boosting machine (LGBM) algorithm. To evaluate our model's performance, we conducted rigorous tests on the ISBI Cephalometric dataset and Dental Cepha dataset, aiming to achieve accuracy within a 2 mm radial precision range. We also employed cross-validation to assess our approach, providing a robust evaluation.

Results

Our model's performance on the ISBI Cephalometric dataset showed an accuracy rate of 77.11% within the desired 2 mm radial precision range. The cross-validation results further confirmed the effectiveness of our approach, yielding a mean accuracy of 78.17%. Additionally, we applied our model to the Dental Cepha dataset, where we achieved a remarkable landmark detection accuracy of 84%.

Conclusion

The results demonstrate that traditional machine learning techniques can be effective for accurate landmark detection in cephalometric images, even with limited data. Our findings highlight the potential of these techniques for clinical applications, where large datasets of labelled images may not be available.

Graphene-Wrapped MgO/Poly(vinyl alcohol) Composite Sheets: Dielectric and Electromagnetic Interference Shielding Properties at Elevated Temperatures

Different amounts of graphene-wrapped magnesium oxide (G@MgO) powders are uniformly dispersed in poly(vinyl alcohol) (PVA) solution in different experiments to obtain solutions which are coagulated to obtain solid materials, which are then hot pressed at 413 K and 3 t of pressure to finally obtain 1 mm thick freestanding G@MgO/PVA composite sheets in which the constituents, namely, graphene and MgO (in the form of G@MgO), are the nanofillers in PVA matrix. During synthesis of G@MgO powder, MgO nanoparticles are in situ wrapped by the graphene nanosheets as revealed by electron microscopy. Uniformity of G@MgO dispersion in PVA was confirmed by secondary electron micrographs and the consistency in X-ray diffraction and Raman scattering data collected from different locations of the samples. Temperature (303-393 K) dependent complex permittivity of G@MgO/PVA composite sheets (including those prepared by casting) in low frequency (20 Hz to 2 MHz) and high frequency (i.e., X-band, 8.2-12.4 GHz) ranges are measured. In both frequency ranges, G@MgO/PVA composite sheets prepared by coagulation exhibited dielectric properties superior to those of PVA and G@MgO/PVA composite sheets prepared by casting. A strong interfacial polarization is observed in coagulated and as-cast G@MgO/PVA composite sheets. It is noticed from the calculated activation energies that conduction is the dominating mechanism for energy transfer in both composite sheets' cases, while it is predominating in coagulated composite sheets due to the better network formation of the fillers in the coagulated samples than in the cast composite samples. The electromagnetic interference shielding effectiveness (EMI SE) values in the X-band frequency range (i.e., 8.2-12.4 GHz) of the G@MgO/PVA composite sheets prepared by coagulation are more than those prepared by casting for a particular weight fraction of G@MgO. At 393 K, for a particular G@MgO/PVA composite sheet prepared by coagulation, an excellent EMI SE of ∼27.5 dB is measured. It is also experimentally elucidated that the absorption is the dominating mechanism for EMI SE in the prepared composite sheets.

Attached flow structure and streamwise energy spectra in a turbulent boundary layer

On the basis of (i) particle image velocimetry data of a turbulent boundary layer with large field of view and good spatial resolution and (ii) a mathematical relation between the energy spectrum and specifically modeled flow structures, we show that the scalings of the streamwise energy spectrum E_{11}(k_{x}) in a wave-number range directly affected by the wall are determined by wall-attached eddies but are not given by the Townsend-Perry attached eddy model's prediction of these spectra, at least at the Reynolds numbers Re_{τ} considered here which are between 10^{3} and 10^{4}. Instead, we find E_{11}(k_{x})∼k_{x}^{-1-p} where p varies smoothly with distance to the wall from negative values in the buffer layer to positive values in the inertial layer. The exponent p characterizes the turbulence levels inside wall-attached streaky structures conditional on the length of these structures. A particular consequence is that the skin friction velocity is not sufficient to scale E_{11}(k_{x}) for wave numbers directly affected by the wall.

Large spontaneous exchange bias in a weak ferromagnet Pb6Ni9(TeO6)5

We report the magnetic and dielectric behavior of Pb₆Ni₉(TeO₆)₅, a new compound comprising the honeycomb-like layers of S = 1 spins, through detailed structural, magnetic and dielectric investigation. An antiferromagnetic-type transition at 25 K (T _N ) with weak-ferromagnetic behavior is revealed. Interestingly, a large value of coercive field of 1.32 T at 2 K is observed. The isothermal magnetization after zero-field-cooled condition, it exhibits the presence of large spontaneous exchange bias (SEB) with a magnitude of 0.19 T at 2 K; which is rare in single bulk materials, especially without external doping. The value of |H _EB| further enhances to 0.24 T under 16 T field-cooled condition, confirming the presence of large exchange bias in the material.

Co-morbidity in Attention-Deficit Hyperactivity Disorder: A Clinical Study from India

OBJECTIVE

To assess the prevalence of neurodevelopmental and psychiatric co-morbidities in children and adolescents diagnosed with attention-deficit hyperactivity disorder at a tertiary care child and adolescent psychiatry centre.

METHODS

A total of 63 children and adolescents who were diagnosed with attention-deficit hyperactivity disorder and fulfilled the inclusion criteria were comprehensively assessed for neurodevelopmental and psychiatric co-morbidities. The tools used included the Mini-International Neuropsychiatric Interview for Children and Adolescents, Attention Deficit Hyperactivity Disorder Rating Scale IV (ADHD-RS), Children's Global Assessment Scale, Clinical Global Impression Scale, Vineland Social Maturity Scale, and Childhood Autism Rating Scale.

RESULTS

All except 1 subject had neurodevelopmental and / or psychiatric disorder co-morbid with attention-deficit hyperactivity disorder; 66.7% had both neurodevelopmental and psychiatric disorders. Specific learning disability was the most common co-existing neurodevelopmental disorder and oppositional defiant disorder was the most common psychiatric co-morbidity. The mean baseline ADHD-RS scores were significantly higher in the group with psychiatric co-morbidities, especially in the group with oppositional defiant disorder.

CONCLUSION

Co-morbidity is present at a very high frequency in clinic-referred children diagnosed with attention-deficit hyperactivity disorder. Psychiatric co-morbidity, specifically oppositional defiant disorder, has an impact on the severity of attention-deficit hyperactivity disorder. Co-morbidity needs to be explicitly looked for during evaluation and managed appropriately.

Is physical access an impediment to tuberculosis diagnosis and treatment? A study from a rural district in North India

SETTING

All designated microscopy centres (DMCs) in Fatehgarh Sahib District, Punjab, India.

OBJECTIVE

To study the association of distance (physical access) to DMCs with loss to follow-up (LTFU) of presumptive tuberculosis (TB) cases while undergoing diagnostic sputum examination and failure to initiate treatment among smear-positive TB patients after diagnosis.

DESIGN

A cross-sectional, record-based study was undertaken to analyse patient records from routine laboratory registers in all DMCs from January to June 2012.

RESULT

More than 50% of presumptive TB cases had to travel >7 km to reach the DMC, totalling >28 km for two sputum examinations for the evaluation of an episode. The distance (>10 km) to the diagnostic facility was found to be significantly associated (P < 0.01), both with LTFU during diagnosis and with a delay (>7 days) in initiating treatment after diagnosis. There was a significant correlation (r = 0.7) between distance to the DMC and time to initiate treatment among smear-positive TB cases.

CONCLUSION

Distance from the nearest facility represents a significant risk for LTFU during diagnosis and delayed initiation of treatment after diagnosis. Further decentralisation of TB care services to the community level is required by expanding the network of DMCs or by organising sputum collection and transportation.

Childhood autism spectrum disorders with and without epilepsy: clinical implications

This prospective cross-sectional study compared 25 children with pervasive developmental disorder and epilepsy and 25 children having pervasive developmental disorder without epilepsy on pervasive developmental disorder scores, Childhood Autism Rating Scale scores, language disability, presence of regression, and epileptiform abnormalities. Epilepsy phenotype was also studied. Children with pervasive developmental disorder and epilepsy had higher pervasive developmental disorder scores (P = .001), higher Childhood Autism Rating Scale scores (P = .016), and lower social quotient (P = .09). More than 50% of children with pervasive developmental disorder and epilepsy and 12% of children having pervasive developmental disorder without epilepsy had epileptiform abnormalities in electroencephalography (EEG). Regression of milestones was significantly associated with epilepsy and epileptiform abnormalities. Children with pervasive developmental disorder and epilepsy might have a worse developmental trajectory requiring intensive management. A behavioral phenotype of autism may coexist often in children with epilepsy, EEG abnormalities, and regression. Seizures might be difficult to control in these children despite adequate compliance. Studies with larger sample size and longitudinal follow-up will provide better understanding.

Synthesis and characterization of CoFe2O4/polyaniline nanocomposites for electromagnetic interference applications

The Cobalt ferrite (CoFe2O4) powders were synthesized by Co-precipitation method. The as prepared ferrite powders were incorporated into a polyaniline matrix at various volumetric ratios. The as prepared composites of ferrite and polyaniline powders were characterized using X-ray diffraction (XRD), transmission electron microscope (TEM). The particle size of CoFe2O4 is found to be 20 nm. The saturation magnetization (M(s)) of all the composites was found to be decreasing with decrease of ferrite content, while coercivity (H(c)) remained at the value corresponding to pure cobalt ferrite nanopowders. The complex permittivity (epsilon' and epsilon") and permeability (mu' and mu") of composite samples were measured in the range of 1 MHz to 1.1 GHz. The value of epsilon' and mu' found to be increased with ferrite volume concentration.

Exchange bias effect in Au-Fe3O4 nanocomposites

We report exchange bias (EB) effect in the Au-Fe3O4 composite nanoparticle system, where one or more Fe3O4 nanoparticles are attached to an Au seed particle forming 'dimer' and 'cluster' morphologies, with the clusters showing much stronger EB in comparison with the dimers. The EB effect develops due to the presence of stress at the Au-Fe3O4 interface which leads to the generation of highly disordered, anisotropic surface spins in the Fe3O4 particle. The EB effect is lost with the removal of the interfacial stress. Our atomistic Monte Carlo studies are in excellent agreement with the experimental results. These results show a new path towards tuning EB in nanostructures, namely controllably creating interfacial stress, and opens up the possibility of tuning the anisotropic properties of biocompatible nanoparticles via a controllable exchange coupling mechanism.

Feasibility and efficacy of yoga as an add-on intervention in attention deficit-hyperactivity disorder: An exploratory study

CONTEXT

Attention deficit-hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders. Stimulant medication is frequently used in management, with significant adverse effects. There is a growing interest in complementary treatments like yoga.

AIMS

To study the effects of yoga as a complementary therapy in children with moderate to severe ADHD.

SETTINGS AND DESIGN

The study was performed on children (consent was taken from parents) admitted in a child psychiatry unit using an open-label exploratory study.

MATERIALS AND METHODS

Children between 5 and 16 years of age diagnosed with ADHD and co-operative for yoga were included. Subjects with other serious psychiatric and medical illnesses were excluded. The participants were given yoga training daily during their in-patient stay. They were rated on Conners' abbreviated rating scale - (CARS), ADHD-rating scale-IV (ADHD - RS IV) and clinical global impression (CGI)-Severity, at the beginning of study, at discharge and subsequently at the end of 1(st), 2(nd) and 3(rd) month by a research associate not involved in yoga instruction. Paired t-test was employed to compare the means of scores between baseline and follow-ups.

RESULTS

A total of 9 children (8 males, 1 female) were recruited into the study. All, but one were on medications. An average of 8 yoga training sessions was given to subjects. They were able to learn yoga reasonably well. There was a significant improvement in the ADHD symptoms as assessed on CARS (P-0.014), ADHD-RS IV (P=0.021) and CGI- S scales (P=0.004) at the time of discharge.

Clinical and life style variables in functional dyspepsia and its sub-types

BACKGROUND

Several definitions and classifications have been designed to characterize functional dyspepsia (FD), the recent one being the ROME III criteria. There have been many studies in the western population which aimed at identifying the risk factors involved in functional dyspepsia. There are fewer studies from south Asian countries.

AIM

To determine the clinical and life style variables influencing functional dyspepsia and its sub-types in patients attending a tertiary care referral centre in the Indian subcontinent.

METHODS

Consecutive patients with upper gastrointestinal symptoms including, epigastric pain/burning, early satiety, postprandial fullness, heartburn and/or chest discomfort, alone or in combination, on more than 3 occasions a week, within the preceding 6 months and with a normal endoscopy were included in the study. Demographic details and the symptom profile including frequency of symptoms were recorded in a pre-structured, validated, modified proforma as per the ROME III criteria and analyzed to test the study hypothesis.

RESULTS

Of the 170 patients, the median age of presentation was 49 yrs and the male to female ratio was 0.62 (65:105). The mean BMI was 23.8 kg/m2. Women had a higher BMI than men. More than half of the study subjects were from the low socio-economic groups.77.6% had ulcer type symptoms and showed a decreasing trend with age. It was more common in patients with higher per capita income. Reflux type comprised of 60.6% with predominance in women. 7% had early satiety and 13.5% had postprandial fullness. Nausea and belch as an isolated (associated) phenomenon comprised of 18.8% and 17.1% respectively. None of the lifestyle variables or demographic characteristics showed a significant influence on symptom occurrence.

CONCLUSIONS

There was a considerable overlap of various sub-types of dyspepsia. There were no differences in life style characteristics or significant risk factors in the various subtypes of dyspepsia.

Language in tuberculosis services: can we change to patient-centred terminology and stop the paradigm of blaming the patients?

The words 'defaulter', 'suspect' and 'control' have been part of the language of tuberculosis (TB) services for many decades, and they continue to be used in international guidelines and in published literature. From a patient perspective, it is our opinion that these terms are at best inappropriate, coercive and disempowering, and at worst they could be perceived as judgmental and criminalising, tending to place the blame of the disease or responsibility for adverse treatment outcomes on one side-that of the patients. In this article, which brings together a wide range of authors and institutions from Africa, Asia, Latin America, Europe and the Pacific, we discuss the use of the words 'defaulter', 'suspect' and 'control' and argue why it is detrimental to continue using them in the context of TB. We propose that 'defaulter' be replaced with 'person lost to follow-up'; that 'TB suspect' be replaced by 'person with presumptive TB' or 'person to be evaluated for TB'; and that the term 'control' be replaced with 'prevention and care' or simply deleted. These terms are non-judgmental and patient-centred. We appeal to the global Stop TB Partnership to lead discussions on this issue and to make concrete steps towards changing the current paradigm.

Global guidelines for treatment of tuberculosis among persons living with HIV: unresolved issues

The Revised National Tuberculosis Control Programme (RNTCP) in India uses a fully intermittent thrice-weekly rifampicin-containing regimen for all tuberculosis (TB) patients, including those who are human immunodeficiency virus (HIV) infected, whereas the World Health Organization (WHO) recommends daily anti-tuberculosis treatment at least during the intensive phase. The WHO recommendation was based on the results of a meta-analysis demonstrating increased risk of recurrence and failure among HIV-infected TB patients receiving intermittent TB treatment compared to a daily regimen. Review of the primary evidence indicates limited, low-quality information on intermittency, mostly from observational studies in the pre-antiretroviral treatment (ART) era. Molecular epidemiology in India indicates that most of the recurrences and many of the failures result from exogenous re-infection, suggesting poor infection control and high transmission rather than poor regimen efficacy. Subsequently published studies have shown acceptable treatment outcomes among HIV-infected TB patients receiving intermittent anti-tuberculosis regimens with concomitant ART. Treatment outcomes among HIV-infected TB patients treated under programmatic conditions show low failure rates but high case fatality; death has been associated with lack of ART. The highest priority is therefore to reduce mortality by linking all HIV-infected TB patients to ART. While urgently seeking to reduce death rates among HIV-infected TB patients, given the poor evidence for change and operational advantages of an intermittent regimen, the RNTCP intends to collect the necessary evidence to inform national policy decisions through randomised clinical trials.

Are all patients diagnosed with tuberculosis in Indian medical colleges referred to the RNTCP?

To assess the proportion of tuberculosis (TB) patients diagnosed in three medical colleges in the states of West Bengal and Meghalaya who benefited from the services provided under the Revised National Tuberculosis Control Programme (RNTCP), a line list of patients with reports of investigations suggesting probable or confirmed TB was prepared from the records of the pathology, radiology and microbiology departments. This was compared with another line list prepared using RNTCP records. Only 150 (36%) of 420 probable or confirmed TB patients were referred to the RNTCP services. This suggests a need for more intensive supervision and training of medical college faculty.

Treatment outcomes of new adult tuberculosis patients in relation to HIV status in Zimbabwe

SETTING

All public health facilities in Chitungwiza District, Zimbabwe.

OBJECTIVE

To determine, in new tuberculosis (TB) patients registered in 2009, 1) the proportion of persons human immunodeficiency virus (HIV) tested, stratified by age, sex and type of TB, and 2) treatment outcomes in relation to type of TB and HIV status.

DESIGN

Retrospective cohort study.

RESULTS

Of 1800 TB patients, 1100 (61%) were tested, of whom 877 (80%) were HIV-positive and 75 (9%) were documented as receiving antiretroviral treatment (ART). HIV testing and HIV positivity were similar between patients with different types of TB. Overall, the treatment success rate was 70%, and 17% had transferred out. Being HIV-positive on ART was associated with better treatment success and lower transfer out; age ≥55 years was associated with poor treatment success and higher death rates. Defaulting was more common in those who did not undergo smear testing or in extra-pulmonary TB patients, while deaths were higher in males.

CONCLUSION

In a Zimbabwe district, less than two thirds of TB patients were tested. Better treatment success was observed in patients documented as HIV-positive and on ART. Important lessons for improved TB control include increasing HIV testing uptake for better access to ART, more comprehensive recording practices on ART and better reporting on true outcomes of transfer-out patients.

Tuberculosis 'retreatment others': profile and treatment outcomes in the state of Andhra Pradesh, India

SETTING

The Government of India's Revised National Tuberculosis Control Programme (RNTCP), Andhra Pradesh, South India.

OBJECTIVES

To study the basic characteristics and treatment outcomes of tuberculosis (TB) patients classified as 'retreatment others' and compare their treatment outcomes with smear-positive retreatment TB cases (relapse, failure, and treatment after default [TAD]).

DESIGN

Retrospective record and report review of a patient cohort (n = 1237) registered as 'retreatment others' under the RNTCP from July to September 2008.

RESULTS

Of 1009 patient records of 'retreatment others' reviewed, 674 (67%) were males, 892 (88%) were aged 15-64 years, 847 (84%) were pulmonary sputum smear-negative, 843 (84%) had unknown human immunodeficiency virus (HIV) status and 55 (5.5%) were HIV-positive. All patients were treated with the RNTCP intermittent (thrice weekly) retreatment regimen. Eighty per cent were successfully treated (cured plus treatment completed). Successful outcomes were higher in females (84%), in patients with extra-pulmonary TB (87%) and in HIV-negative patients (87%). The treatment outcomes were significantly better for 'retreatment others' (P < 0.05) than among the sputum smear-positive retreatment cases (78% for relapses, 59% for failures and 73% for TAD).

CONCLUSIONS

'Retreatment others' were predominantly sputum smear-negative TB, with significantly better treatment outcomes than among smear-positive retreatment patients. Future studies may assess the accuracy of the diagnoses and factors contributing to the occurrence of 'retreatment others'.

Surveillance for MDR-TB: is there an obligation to ensure treatment for individuals identified with MDR-TB?

This article raises ethical issues that result if individuals, during the course of research to measure the prevalence of drug-resistant tuberculosis, are identified with the disease but are not provided with or referred for appropriate treatment. It draws attention to and applauds recently published World Health Organization guidelines on the subject. Questions posed are: 1) Should treatment be provided for individuals identified through surveillance projects for MDR-TB, whatever their purpose (specific research or 'routine' national prevalence studies)? 2) If treatment availability is a problem, who is responsible for assuring this?

Initial default among diagnosed sputum smear-positive pulmonary tuberculosis patients in Andhra Pradesh, India

BACKGROUND

Under the Indian Revised National TB Control Programme (RNTCP), smear-positive pulmonary tuberculosis (PTB) patients not confirmed as starting treatment are reported as 'initial defaulters'.

SETTING

Twenty districts of Andhra Pradesh State, India.

OBJECTIVE

To evaluate reasons for treatment non-initiation in smear-positive PTB patients diagnosed and reported as initial defaulters by the NTP.

DESIGN

A cross-sectional survey conducted of all reported initial defaulters during the period July-September 2006.

RESULTS

Of 1304 reported initial defaulters, 619 (47.5%) had been placed on treatment, having been incorrectly reported due to poor documentation of patients referred for treatment in the same district or whose treatment initiation was delayed until the subsequent quarter. Of the 685 (4.5% of the total diagnosed) who were confirmed initial defaulters, 350 (51%) were untraceable, 152 (22%) had died before treatment initiation, 38 (5.5%) were treated privately, 93 (13.5%) had other reasons (e.g., refusal of treatment, chronic case, etc.) and no data were available for 52 (8%).

CONCLUSIONS

Nearly 5% of smear-positive PTB patients diagnosed in the study period were confirmed as not having initiated treatment under the RNCTP. Improvements in address recording may assist efforts to retrieve these patients for treatment. Additional evaluations are needed of improved counselling of TB suspects to prevent initial default, and of reasons for death before treatment initiation.

Perinatal factors affecting expression of obsessive compulsive disorder in children and adolescents

OBJECTIVE

To examine whether adverse perinatal experiences of children are associated with obsessive compulsive disorder (OCD) in youth.

METHODS

Subjects were 130 children and adolescents with OCD recruited from a family genetic study of pediatric OCD and 49 matched controls from a contemporaneous family case-control study of attention-deficit/hyperactivity disorder (ADHD). Subjects were comprehensively assessed in multiple domains of function. A systematic history of pregnancy, delivery, and infancy complications was obtained.

RESULTS

Compared to normal controls, children with OCD had mothers with significantly higher rates of illness during pregnancy requiring medical care (chi(2) +/- 8.61, p +/- 0.003) and more birth difficulties (induced labor, forceps delivery, nuchal cord, or prolonged labor) (chi(2) +/- 7.51, p +/- 0.006). Among the OCD-affected children, we found several significant associations between adverse perinatal experiences and earlier age at onset, increased OCD severity, and increased risk for comorbid ADHD, chronic tic disorder, anxiety disorder, and major depressive disorder.

CONCLUSION

Although exploratory, our analyses found that children with OCD had higher rates of several adverse perinatal experiences compared with controls. Among OCD-affected children, comorbid psychopathology was predicted by specific perinatal risk factors. Prospective studies of perinatal adverse events that minimize potential recall bias and type I errors are needed.

Static and dynamic magnetic properties of Co nanoparticles

Co nanoparticles have been synthesized using wet-chemical methods. As-synthesized particles show a sharp low temperature peak in zero-field cooled (ZFC) magnetization well below the blocking transition temperature and this feature is associated with surface spin disorder. We have investigated the dynamic magnetic properties of Co using ac susceptibility and resonant RF transverse susceptibility (TS). We also studied the memory and relaxation effects in these nanoparticle systems. From these measurements we show a typical blocking behavior of an assembly of superparamagnetic nanoparticles with a wide distribution of blocking temperatures. The transverse susceptibility measurements on these particles show the presence of anisotropy even above the blocking temperature. The role of surface anisotropy and the size distribution of the particles on the observed memory and magnetic relaxation effects are discussed.

Comparison of P-POSSUM and O-POSSUM in predicting mortality after oesophagogastric resections

BACKGROUND

P-POSSUM (Physiological and Operative Severity Score for the enumeration of Mortality and morbidity) predicts mortality and morbidity in general surgical patients providing an adjunct to surgical audit. O-POSSUM was designed specifically to predict mortality and morbidity in patients undergoing oesophagogastric surgery.

AIM

To compare P-POSSUM and O-POSSUM in predicting surgical mortality in patients undergoing elective oesophagogastric cancer resections.

METHODS

Elective oesophagogastric cancer resections in a district general hospital from 1990 to 2002 were scored by P-POSSUM and O-POSSUM methods. Observed mortality rates were compared to predicted mortality rates in six risk groups for each model using the Hosmer-Lemeshow goodness-of-fit test. The power to discriminate between patients who died and those who survived was assessed using the area under the receiver-operator characteristic (ROC) curve.

RESULTS

313 patients underwent oesophagogastric resections. 32 died within 30 days (10.2%). P-POSSUM predicted 36 deaths (chi2 = 15.19, df = 6, p = 0.019, Hosmer-Lemeshow goodness-of-fit test), giving a standardised mortality ratio (SMR) of 0.89. O-POSSUM predicted 49 deaths (chi2 = 16.51, df = 6, p = 0.011), giving an SMR of 0.65. The area under the ROC curve was 0.68 (95% confidence interval 0.59 to 0.76) for P-POSSUM and 0.61 (95% confidence interval 0.50 to 0.72) for O-POSSUM.

CONCLUSION

Neither model accurately predicted the risk of postoperative death. P-POSSUM provided a better fit to observed results than O-POSSUM, which overpredicted total mortality. P-POSSUM also had superior discriminatory power.

Is bipolar II disorder misdiagnosed as major depressive disorder in children?

OBJECTIVES

To estimate the lifetime prevalence of bipolar II disorder in children and adolescents presenting with DSM-IV major depressive disorder (MDD).

METHODS

Sixty-one consecutive subjects aged < or =18 years attending the outpatient services of the Child and Adolescent Psychiatric (CAP) services of the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India with a diagnosis of MDD were evaluated using the Missouri Assessment of Genetics Interview for children (MAGIC). Two psychiatrists, one of whom was a child psychiatrist diagnosed hypomania by consensus.

RESULTS

Twelve children had a past episode of hypomania (20%), which was hitherto undiagnosed clinically.

LIMITATIONS

We recruited subjects from a psychiatric hospital, thus limiting the generalizability of the finding. Sample size was relatively small and assessments were cross-sectional.

CONCLUSIONS

: Our study shows that bipolar II disorder is often misdiagnosed as MDD in children. The study also highlights that the chance of diagnosing bipolarity is enhanced by using semi-structured interview in routine clinical practice.

Comorbidity of attention deficit hyperactivity disorder in juvenile bipolar disorder

OBJECTIVE

There is some evidence to suggest that attention deficit hyperactivity disorder (ADHD) and juvenile bipolar disorder could be related. This is based on studies of comorbidity and some preliminary family study data. However, doubts continue to be raised about the relationship between the two disorders. This study examined the comorbidity of disruptive behavior disorders (DBD) that include ADHD, oppositional defiant disorder (ODD) and conduct disorder (CD) in juvenile bipolar disorder.

METHOD

Seventy-three subjects with onset of bipolar disorder at age 18 years or younger were evaluated using structured interviews (Missouri Assessment of Genetics Interview for Children, Structured Clinical Interview for DSM-IV Axis I disorders--Clinician Version, and Operational Criteria Checklist for Psychotic Disorders version 3.4). Information was collected from subjects as well as from their parents. Patients with comorbid DBD were compared with patients without DBD.

RESULTS

Ten subjects (14%) had one or more comorbid DBD. ADHD, CD, and ODD were present in three (4%), two (3%), and eight (11%) subjects, respectively. Those with DBD had earlier onset of bipolar disorder and spent more time ill compared to those without DBD.

CONCLUSIONS

The rates of comorbid DBD in juvenile bipolar disorder are low. The study does not support a definite relationship between ADHD and juvenile bipolar disorder. Higher rates reported previously may be due to differing methods of subject ascertainment. Samples recruited from community and general psychiatric settings may help to clarify the relationship between bipolar disorder and ADHD.

Observation of a new magnetic anomaly below the ferromagnetic Curie temperature in Yb14MnSb11

Yb14MnSb11 is an unusual ferromagnet with a Curie temperature of 52 +/- 1 K. Recent optical, Hall, magnetic, and thermodynamic measurements indicate that Yb14MnSb11 may be a rare example of an underscreened Kondo lattice. We report the first experimental observation of a new magnetic anomaly in this system at around 47 K, a few degrees below T(c). Systematic investigations of the ac and dc susceptibilities of Yb14MnSb11 single crystals reveal features associated with possible spin reorientation at this temperature. This new anomaly is extremely sensitive to the applied measurement field and is absent in temperature-dependent dc magnetization data for fields above 50 Oe. The origin of this could be due to decoupling of two distinct magnetic sublattices associated with MnSb4 tetrahedra.

Is juvenile obsessive-compulsive disorder a developmental subtype of the disorder?--Findings from an Indian study

Juvenile obsessive-compulsive disorder (OCD) has been hypothesized to be different from adult-onset OCD suggesting that juvenile OCD may be a developmental subtype of the disorder. There is some evidence that juvenile OCD may be phenotypically different from juvenile-onset adult OCD. This study examines the phenotypic characteristics of juvenile OCD (current age < or = 18 years, n = 39), juvenile-onset adult OCD (onset < or = 18 years, current age >18 years, n = 87) and adult-onset OCD (onset > 18 years, n = 105). Qualified psychiatrists expert in evaluating OCD subjects conducted clinical and structured interviews. In the multinomial logistic regression analysis, controlling for chronological age and gender, the juvenile OCD was associated with male preponderance, elevated rates of certain obsessive-compulsive symptoms, attention-deficit hyperactivity disorder, chronic tics, body dysmorphic disorder and major depression. In addition, juvenile-onset adult OCD differed from juvenile OCD by having later age-at-onset and low rate of ADHD. The juvenile-onset adult OCD was positively associated with social phobia and chronic tics compared to adult-onset OCD. The juvenile OCD appears to be different from both juvenile-onset adult OCD and adult-onset OCD supporting previous observations that juvenile OCD could be a developmental subtype of the disorder.

The relationship of obsessive-compulsive disorder to putative spectrum disorders: results from an Indian study

The relationship between obsessive-compulsive disorder (OCD) and putative obsessive-compulsive (OC) spectrum disorders is unclear. This study investigates the prevalence of putative OC spectrum disorders in OCD subjects in a controlled clinical design. The putative OC spectrum disorders studied included somatoform disorders (body dysmorphic disorder [BDD] and hypochondriasis), eating disorders, tic disorders (e.g., Tourette's syndrome [TS]), and impulse control disorders (e.g., trichotillomania). Only those disorders that are commonly noted to be possibly related to OCD are studied. Included in this study were 231 subjects with a diagnosis of OCD according to DSM-IV criteria and 200 controls who were not screened for psychiatric morbidity. The subjects and controls were assessed in detail by extensive clinical and semistructured interviews by expert clinical psychiatrists. The lifetime diagnoses were made by consensus of two psychiatrists. Prevalence of tic disorders, hypochondriasis, BDD, and trichotillomania was significantly greater in OCD subjects compared to controls. However, the prevalence of sexual compulsions, pathological gambling, eating disorders, and depersonalization disorder was not greater in the OCD subjects compared to controls. The findings of this comorbidity study suggest that tic disorders, hypochondriasis, BDD, and trichotillomania are perhaps part of the OC spectrum disorders. There is a need to evaluate evidence from other sources such as epidemiological, neurobiological, and family studies to further our understanding of the concept of OC spectrum disorders.

A follow-up study of juvenile obsessive-compulsive disorder from India

OBJECTIVE

To study the long-term course and outcome of juvenile obsessive-compulsive disorder (OCD).

METHOD

Two to 9-year follow-up of largely self-referred, drug-naïve subjects (n = 58) by employing catch-up longitudinal design.

RESULTS

The mean follow-up period was 5 years. Nearly three-fourth of the sample was adequately treated with medications. Only 21% of the subjects had clinical OCD at follow-up and 48% were in true remission (no OCD and not on treatment). Earlier age-at-onset was associated with better course and outcome.

CONCLUSION

Juvenile OCD has favorable outcome. Our findings are applicable to psychiatric hospital settings in India and perhaps to the general psychiatric settings in the Western countries. Whether the better outcome in this sample is the result of differing clinical characteristics or because of true cross-cultural variation in the course needs further exploration. It is speculated that early onset OCD could be a subtype of juvenile OCD with better outcome.

A family study of juvenile obsessive-compulsive disorder

OBJECTIVES

To determine whether juvenile obsessive-compulsive disorder (OCD) is familial and whether the rate of Tourette syndrome (TS) and tic disorders is higher among relatives of patients with OCD than among relatives of controls subjects.

METHOD

We assessed first-degree relatives of 35 juvenile OCD probands (aged 16 years or less) and 34 matched, psychiatrically unaffected control subjects, using the Diagnostic Interview for Children and Adolescents-Revised (DICA-R) (unpublished), a Questionnaire for tic disorders, the Children's Version of Leyton's Obsessional Inventory (CV-LOI), and the Children's Version of the Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Similarly, we assessed adult relatives, using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN), Leyton's Obsessional Inventory (LOI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and a Questionnaire for tic disorders. The diagnoses were determined by consensus, using DSM-III-R criteria. We calculated age-corrected morbid risk, using Weinberg's method.

RESULTS

The morbid risk for OCD among the relatives of OCD probands was 4.96%, while none of the relatives of unaffected control subjects had OCD. We did not diagnose TS in any of the relatives of either OCD probands or control subjects. We diagnosed chronic motor tic disorders in only 1 of the relatives of OCD probands, while none of the relatives of control subjects had any tic disorder.

CONCLUSION

Most juvenile cases of OCD are nonfamilial and unrelated to tic disorders, while only a few are familial. There is a need to re-examine the issue of familiality in cases of OCD, as well as its relation to TS, using larger community samples to better understand the hypotheses of familial transmission and comorbidity with tic disorders.

Juvenile bipolar disorder

OBJECTIVE

Bipolar disorder in children and adolescents is less well studied than bipolar disorder in adults. This review addresses issues related to its underdiagnosis, precursors of bipolarity, comorbidity, natural course and treatment.

METHOD

Literature from Medline and other searches, and earlier relevant articles including references from recent review articles on juvenile bipolarity were reviewed.

RESULTS

Bipolar disorder in juveniles is underdiagnosed and misdiagnosed on various counts. Few recent studies have reported high rates of comorbid attention deficit and disruptive disorders, prompting some researchers to consider them as probable developmental precursors of juvenile bipolarity. There is also evidence to suggest that some juvenile depression could be pre-bipolar, and that certain temperamental predispositions are probable precursors to bipolarity. Limited data on the natural course and outcome suggest that juvenile bipolar disorder is a highly recurring illness as in adults, and that it is associated with significant functional impairment. The psychopharmacological treatment of juvenile bipolar disorder is remarkably understudied, and treatment is often based on studies of adults.

CONCLUSION

There is a need for epidemiological studies of juvenile bipolar disorder. Similarly, there is an urgent need for the methodologically rigorous studies to establish the efficacy of various antimanic drugs. Finally, issues related to comorbidity and temperamental predispositions to juvenile bipolarity need greater clarity, as they may have important treatment and research implications.

Comorbidity in juvenile obsessive-compulsive disorder: a report from India

OBJECTIVE

Using minimal exclusion criteria, to assess systematically the psychiatric comorbidity in children and adolescents with obsessive-compulsive disorder (OCD) and compare the findings with those of previous studies.

METHOD

Fifty-four children and adolescents who satisfied DSM-III-R criteria for OCD were assessed using a structured interview schedule, the Children's version of the Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and the questionnaire for tic disorders. All 54 subjects were recruited from the Child and Adolescent Psychiatry (CAP) services of the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, South India. Diagnoses were determined consensually after a review of all the available data.

RESULTS

Comorbidity was found in 69% of the sample: 22% were diagnosed with disruptive disorders; 20% met criteria for mood disorders; 19% had anxiety disorders; and 17% had tic disorders. Only 1 subject had bipolar disorder, and none had psychosis. The rates for individual diagnoses--in particular, the rates for disruptive disorders, bipolar disorder, and psychosis--were considerably lower than those reported in previous studies.

CONCLUSIONS

Patterns of comorbidity in this study differed from those previously reported. Novel patterns of comorbidity with disruptive disorders, bipolar disorder, and psychosis reported in a few recent studies were not replicated in this study. These differences are probably due to different ascertainment methods. Comorbidity needs to be assessed in large epidemiological samples before definite associations can be made between certain comorbid disorders and juvenile OCD.

Family interview for stress and coping in mental retardation (fisc-mr) : a tool to study stress and coping in families of children with mental retardation

Stress and coping in the families caring for their member with mental retardation has recently received worldwide research attention. There is no comprehensive instrument to study these issues in India. This study reports on development and standardization of a new instrument to fill this lacuna. Family Interview for Stress and Coping in Mental Retardation (FISC - MR), a semi-structured interview schedule, was developed as a part of two years prospective study of efficacy of brief family intervention for 157 children with mental retardation (funded by ICMR). The tool consists of 2 sections - one measuring stress (daily care, emotional, social and financial) and the other measuring mediators of stress or coping strategies (awareness, attitudes, expectations, rearing practices and social support). Results indicate moderate to high reliability (internal consistency, inter-rater reliability and test-retest reliability) and validity (factorial, criterion and construct) of the instrument. It is concluded that FISC -MR is a useful, reliable and valid instrument for both clinical and research purposes.