A double-blind, randomised, controlled Phase II trial of Heliox28 gas mixture in lung cancer patients with dyspnoea on exertion

Helium has a low density and the potential of reducing the work of breathing and improving alveolar ventilation when replacing nitrogen in air. A Phase II, double-blind, randomised, prospective, controlled trial was undertaken to assess whether Heliox28 (72% He/28% O₂) compared with oxygen-enriched air (72% N₂/28% O₂) or medical air (78.9% N₂/21.1% O₂) could reduce dyspnoea and improve the exercise capability of patients with primary lung cancer and dyspnoea on exertion (Borg >3). A total of 12 patients (seven male, five female patients, age 53–78) breathed the test gases in randomised order via a facemask and inspiratory demand valve at rest and while performing 6-min walk tests. Pulse oximetry (SaO₂) was recorded continuously. Respiratory rate and dyspnoea ratings (Borg and VAS) were taken before and immediately post-walk. Breathing Heliox28 at rest significantly increased SaO₂ compared to oxygen-enriched air (96±2 cf. 94±2, P<0.01). When compared to medical air, breathing Heliox28 but not oxygen-enriched air gave a significant improvement in the exercise capability (P<0.0001), SaO₂ (P<0.05) and dyspnoea scores (VAS, P<0.05) of lung cancer patients.

Hypertension the 'Missed Modifiable Risk Factor' for Diabetic Neuropathy: a Systematic Review

Diabetes and hypertension stand as the major non-infectious diseases affecting 34.2 million and 1.28 billion people respectively. The literature on the impact of diabetes on hypertension and vice versa is evolving. The major objectives of this review were to compile the evolving literature establishing the role of hypertension in diabetic neuropathy, derive the exact mechanisms for its pathogenesis, and describe evidence-based precise individualized management of diabetic neuropathy in patients having diabetes complicated by hypertension. A systematic review was conducted by searching databases of PubMed, Embase, and Scopus covering the literature from inception to 2022. We included all observational and experimental studies, including both human and animal studies looking into the correlation between diabetic neuropathy and hypertension. Hypertension poses to be the leading modifiable risk factor for the development of diabetic neuropathy, especially distal symmetrical polyneuropathy, producing abnormal nerve conduction parameters and increased vibration perception threshold in patients with diabetes mellitus. Thus, we advocate that good glycemic control in patients with diabetes needs to be supported with strict blood pressure control for preventing and delaying the onset of diabetic neuropathy.

Broken Heart Syndrome: Evolving Molecular Mechanisms and Principles of Management

Broken Heart Syndrome, also known as Takotsubo Syndrome (TS), is sudden and transient dysfunction of the left and/or right ventricle which often mimics Acute Coronary Syndrome (ACS). Japan was the first country to describe this syndrome in the 1990s, and since then it has received a lot of attention from researchers all around the world. Although TS was once thought to be a harmless condition, recent evidence suggests that it may be linked to serious complications and mortality on par with Acute Coronary Syndrome (ACS). The understanding of TS has evolved over the past few years. However, its exact etiology is still poorly understood. It can be classified into two main types: Primary and Secondary TS. Primary TS occurs when the symptoms of myocardial damage, which is typically preceded by emotional stress, are the reason for hospitalization. Secondary TS is seen in patients hospitalized for some other medical, surgical, obstetric, anesthetic, or psychiatric conditions, and the dysfunction develops as a secondary complication due to the activation of the sympathetic nervous system and the release of catecholamines. The etiopathogenesis is now proposed to include adrenergic hormones/stress, decreased estrogen levels, altered microcirculation, endothelial dysfunction, altered inflammatory response via cardiac macrophages, and disturbances in the brain-heart axis. The role of genetics in disease progression is becoming the focus of several upcoming studies. This review focuses on potential pathophysiological mechanisms for reversible myocardial dysfunction observed in TS, and comprehensively describes its epidemiology, clinical presentation, novel diagnostic biomarkers, and evolving principles of management. We advocate for more research into molecular mechanisms and promote the application of current evidence for precise individualized treatment.

Piperidinium 3-[(4-hydroxy-5-dimethyl-2-oxo-2H-chromen-3-yl)-phenylmethyl]-5,7-dimethyl-2-oxo-2H-chromen-4-olate

In the title salt, C5H12N+*C29H23O6-, both benzopyran systems are planar. Intermolecular N--H...O hydrogen bonds and a short O--H...O intramolecular hydrogen bond are observed in the structure.

Impact of Air Pollution on Neurological and Psychiatric Health

Air pollution is a critical global issue with extensive implications beyond respiratory health, significantly affecting neurological and psychiatric disorders. Emerging evidence establishes a link between exposure to fine particulate matter (PM < 2.5 µm), sulfur dioxide (SO2), and nitrogen dioxide (NO2) and heightened risks of dementia, Alzheimer's disease, schizophrenia, ADHD, stroke, Parkinson's disease, and multiple sclerosis. Mechanistic pathways include neuroinflammation, oxidative stress, microglial activation, cerebrovascular dysfunction, and blood-brain barrier disruption. Epidemiological studies indicate increased susceptibility among urban residents, particularly men, middle-aged individuals, and married persons, to the mental health impacts of air pollution. Additionally, socioeconomic factors, such as GDP per capita, access to health resources, green spaces, and sports facilities, modulate these health outcomes. Addressing this public health challenge necessitates stricter industrial emission controls, sustainable agricultural practices, promotion of cleaner energy sources, and incorporation of pollution exposure history into clinical assessments. Enhanced public awareness and interdisciplinary research are vital for mitigating the detrimental effects of air pollution on neurological and psychiatric health, ultimately striving for a cleaner and healthier environment for future generations.

Epicardial adipose tissue thickness in young Indian overweight and obese individuals

Epicardial adipose tissue (EAT) has been found to be an important reliable marker for future coronary events. Deposition of the EAT in young individuals is not well known. We studied EAT in 25 young overweight or obese individuals. In spite of the high visceral fat and total body fat, EAT thickness was not found to be high in the participants of our study.

Psychological Assessment of Family Caregivers of Patients With COVID-19 in the United States of America and India

Background and objective

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the shortcomings worldwide in terms of preparedness protocols related to epidemics. A key area of research that is evidently overlooked across the globe is the mental health of family caregivers taking care of patients with COVID-19. In light of this, this study aimed to engage in a comparative analysis between the two worst affected countries, India and the United States of America (USA), which differ considerably in their demography, socio-epidemiological factors, and health system efficiency.

Methods

A cross-sectional study was conducted among 1,250 family caregivers of patients with COVID-19 in India and the USA to assess their stress, anxiety, and sleep disturbance levels using the 10-item Perceived Stress Scale (PSS-10), the 7-item Generalized Anxiety Disorder (GAD-7) scale, and the Pittsburgh Sleep Quality Index (PSQI), respectively. Psychological assessment questionnaires were administered through online mode, which gathered demographic information and responses on several self-reporting scales. The main outcome measures were self-reported ratings on PSS, GAD-7 scale, and PSQI.

Results

We found that 75.4% of the family members of COVID-19 patients suffered from mental health issues. The scores of all three scales were higher in caregivers from the USA than in India, more evident and pronounced in caregivers of hospitalized patients. The test scores were statistically significant (p<0.05) indicating a negative impact of having a dependent member in the family, being married, being of younger age, and having a longer duration of COVID-19 infection. Vaccines were found to have a life-enhancing effect.

Conclusion

Our findings highlight that the mental health of family caregivers is an ignored aspect and must be addressed. We recommend the implementation of well-researched and appropriate legislation, treatment programs, and health policies that involve not only the patients but also their families.

Determinants of Unsupervised Medical Termination of Pregnancy Pill Usage Among Women: A Cross-Sectional Study From North India

Background Medical termination of pregnancy (MTP) pills, primarily comprising mifepristone and misoprostol, have proven highly effective and safe under medical supervision. However, unsupervised MTP pill use is on the rise, posing serious health risks. Unsafe abortions remain a global public health concern, with a high incidence in developing countries like India. Methods We conducted a cross-sectional study at a tertiary healthcare center in India from February to April 2023. We enrolled 150 women with a history of unsupervised MTP pill use. Data were collected using structured questionnaires, including demographic information, awareness, sources of information, reasons for self-medication, and knowledge of complications. Results The majority of participants (50%) were aged 25-29 years. Low-income women (<3000pc) constituted 46.66% of the sample. Husbands played a significant role in advocating MTP pill use (57.33%). Ninety percent of pills were obtained directly from pharmacies. Shockingly, 97.3% of women were unaware of MTP pill complications, and 84% did not follow the recommended regimen. Significant associations were found between income, religion, education, age, parity, and reasons for self-medication, as well as recommendations for MTP pill use. Conclusion Our study revealed a diverse demographic of women seeking unsupervised MTP pill intake. Low-income women were disproportionately affected, emphasizing the need for improved healthcare access and education. Husbands played a crucial role in advocating MTP pill use, highlighting the importance of including men in reproductive health discussions. Lack of awareness and non-adherence to recommended regimens posed substantial risks. To combat unsafe abortions, a multifaceted approach is needed. Reproductive health education, regulatory measures, improved healthcare accessibility, and tailored interventions are essential.

Sushruta: The Father of Indian Surgical History

Sushruta, an ancient surgeon from 600 BCE in Kashi, India, is a pioneering figure in medical history. His innovations in surgical techniques, predating Hippocrates and Galen, have left an indelible mark in the field. This review article focuses on Sushruta's contributions to surgery, particularly his foundational work in plastic and reconstructive procedures. We delve into the Sushruta Samhita, the oldest surgical text, covering essential principles, pathology, anatomy, and surgical management. Sushruta's approach emphasized cleanliness, cadaver dissection, and innovative practices in anesthesia. Our article underscores the enduring impact of Sushruta's work on modern surgical science.

Aggravation of Obsessive-Compulsive Disorder Due to Excessive Porn Consumption: A Case Report

The past few decades have seen a significant rise in pornography consumption. This has brought into existence a new behavioral addiction, addiction to internet pornography, which impacts the psycho-somatic health of the individuals and people around them. The accessibility, affordability, and anonymity of online pornography have fed the growing popularity of online pornography. The International Classification of Diseases (ICD-11) has included pornography in Compulsive Sexual Behavior Disorder with it being categorized as an impulse control disorder and not necessarily an addictive disorder. However, the recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) does not recognize a diagnosis of sexual addiction/compulsion (including internet pornography). Psychiatry remains an ever-evolving branch, and as the understanding evolves, the schools of thought change as well. The constantly evolving literature on behavioral addictions has helped the understanding that any source capable of stimulating the reward circuitry in an individual can become addictive. The stigma associated with behavioral addictions, particularly pornographic addiction, as well as a lack of awareness, contribute to under-reporting, making the reported cases just the tip of the iceberg. Addictions have been associated with various complications and other psychiatric phenomena. We describe a case of a 28-year-old male with mild features of obsessive-compulsive disorder (OCD) that took major shape with the advent of pornographic addiction. The patient was a known case of exam anxiety, panic attacks, auditory hallucinations, and mild obsessive and compulsive symptoms. However, with the death of his girlfriend's father, a breakup with his girlfriend, and coronavirus disease 2019 (COVID-19), he indulged in porn consumption which soon shifted to religious pornographic content leading to guilt with a fair insight. This later culminated in the aggravation of his OCD with repetitive cleaning activities. The patient was started on pharmacological and behavioral therapy and has responded well in follow-ups. In light of the special presentation of this case, we strongly recommend better reporting of such complications aiding in broadening the understanding of the spectrum of possible psychiatric impacts of pornographic consumption.

Streptomyces Paradigm in Anticancer Therapy: A State-of-the Art Review

Abstract:

Cancer is one of the biggest threats to human health with a global incidence of 23.6 million, mortality of 10 million, and an estimated 250 million lost in disability-adjusted life years (DALYs) each year. Moreover, the incidence, mortality, and DALYs have increased over the past decade by 26.3%, 20.9%, and 16.0%, respectively. Despite significant evolutions in medical therapy and advances in the DNA microarray, proteomics technology, and targeted therapies, anticancer drug resistance continues to be a growing concern and invites regular discovery of potent agents. One such agent is the microbe-producing bioactive compounds like Streptomyces, which are proving increasingly resourceful in anticancer therapy of the future. Streptomyces, especially the species living in extreme conditions, produce bioactive compounds with cytolytic and anti-oxidative activity which can be utilized for producing anticancer and chemo-preventive agents. The efficacy of the derived compounds has been proven on cell lines and some of these have already established clinical results. These compounds can potentially be utilized in the treatment of a variety of cancers including but not limited to colon, lung, breast, GI tract, cervix, and skin cancer. The Streptomyces, thus possess the armory to fuel the anticancer agents of the future and help address the problem of rising resistance to currently available anti-cancer drugs. We conducted a state-of-art review using electronic databases of PubMed, Scopus, and Google scholar with an objective to appraise the currently available literature on Streptomyces as a source of anti-cancer agents and to compile the clinically significant literature to update the clinicians.