Smoking blunts sertraline response in depression: A prospective observational cohort study.

Background: Smoking is common in patients of depression and is known to affect response to antidepressants. This study was undertaken to evaluate the effect of smoking on the antidepressant effect of sertraline. Method: Patients with depression were divided into smoker and nonsmoker cohorts and followed up for 8 weeks. Serum sertraline levels were estimated using the high-performance liquid chromatography system. Response to treatment was evaluated with the Hamilton Depression Rating Scale (HAM-D). Results: Serum sertraline levels did not differ between smokers and nonsmokers at 4 and 8 weeks. Nonsmokers responded better to sertraline than smokers after 8 weeks. Adverse drug reaction profile did not vary between the two groups and was not impacted by serum sertraline levels. Nonsmokers showed a greater fall in the HAM-D score than smokers. Conclusion: This study found depression among smokers to be less responsive to sertraline. This was not explained by serum sertraline levels. Treatment of depression in smokers with sertraline might require higher doses and duration, with more frequent reviews.

Impact of cognitive behavioural intervention on caregiver burden in mothers of children diagnosed with cancer.

Background: Mothers of children diagnosed with cancer are found to have coping difficulties in various studies. Most of the studies were done on parents after their child has been newly diagnosed with malignancy, and very few studies were done on coping skills intervention. Hence, this study has been done to assess the impact of cognitive behavioural intervention on caregiver burden in mothers of children diagnosed with cancer. Methods: Twenty mothers coming to the outpatient department of paediatric oncology from 01 September 2018 to 30 April 2019 were enrolled for the study. The participants were administered General Health Questionnaire, Brief Coping Operation Preference Enquiry Scale, Zung Self-Rating Anxiety Scale, and Coping Inventory for Stressful Situations-21 (CISS-21) Scale. Sixteen sessions of cognitive behavioural intervention were given over 8 weeks to all the participants. Reassessment was done after 3 months by use of the above mentioned scales. Results: Participants' mean anxiety score was 49.40 (standard deviation [SD] ±8.89). They used adaptive (active coping and positive reframing) more than the maladaptive (denial and self-blame) coping strategies. Task- and emotion-focused coping mean score on CISS-21 revealed 19.25 (SD ±6.20) and 18.90 (SD ±5.76), respectively. Reassessment after cognitive behavioural intervention revealed statistically significant improvement in maladaptive coping styles, mean anxiety index score, avoidance, and emotion-focused coping. Conclusion: The study has revealed mild to moderate anxiety and the use of both adaptive and maladaptive coping strategies by participants. There is statistically significant improvement in anxiety, maladaptive coping strategies with cognitive behavioural intervention.

Longitudinal study of the course and outcome of first-episode psychosis.

Background: Study of first episode psychosis (FEP), an episode of psychotic nature, which manifests for the first time in an individual in the longitudinal continuum of his/her illness, has been a matter of research interest in recent years, as this may give more insight to the overall phenomenology and course of psychotic illnesses. Methods: A study was undertaken to evaluate course and outcome of first episode psychosis. A total of 100 consecutive inpatients were selected for the study. Informed consent was obtained. Structured Proforma was used for recording psychosocial profiles and relevant medical history. Brief Psychiatric Rating Scale (BPRS) was given to assess the severity of psychopathology; Positive and Negative Symptom Scale (PANSS) to assess the severity of psychosis; Becks Suicidal Ideation Scale (BSI) to assess the extent of suicidality and Global Assessment of Functioning (GAF) to assess global functioning of the individual. The assessment was done at baseline, at six months, and at one year. Results: First episode psychosis constituted around a tenth of the caseload. It commonly affected people in the third decade of life. There was an improvement in 92% of the cases over a year of study. Schizophrenia constituted the majority of first episode psychosis. The history of smoking was relatively higher in acute and transient psychotic disorders. Age inversely correlated with the severity of psychopathology. There was no difference in improvement in psychopathology over time in patients of schizophrenia and related disorder vis--vis other psychotic disorders. Conclusion: Our study did not find any significantly varied sociodemographic factors in the course and outcome of the illness. It also refuted the schism between various types of psychosis based on the current classificatory system. It draws our attention toward the unitary concept of psychosis and is a call to re-think our strategies in the management of psychosis.

Study of Correlation of Serum Calcium Level with Disease Severity in Dengue Patients.

Dengue fever is the world's fastest growing vector borne viral disease. Dengue infection has high morbidity and mortality unless managed promptly and appropriately. Calcium regulates many physiological processes such as neuromuscular transmission, heart contractility, hormonal release, blood coagulation and is essential for cell function. Low calcium level is present in almost 80% of dengue cases and is more associated with severe cases. Hypocalcemia enhances the binding of the dengue virus to monocyte macrophages and cells of T cell and B cell lineages in dengue infection. However, there is scarcity of literature on calcium homeostasis in dengue infection, and current guidelines do not address the necessity to monitor or correct blood calcium levels in dengue patients. In present study, we evaluated serum calcium level in dengue patients and correlated it with disease severity. MATERIAL: The present observational cross-sectional study conducted in the Department of Medicine and Biochemistry, VMMC and Safdarjung Hospital, New Delhi, included 60 patients of dengue infection, satisfying the inclusion and exclusion criteria over a period of 18 months. Inclusion criteria were patients with age above 12 years, any gender, and diagnosed as having dengue infection, either by NS1Ag or by IgM ELISA for dengue antibodies, were clinically classified as Dengue Fever (DF), Dengue Haemorrhagic Fever (DHF), and Dengue Shock Syndrome (DSS) as per National Guidelines for Clinical Management of Dengue Fever developed by NVBDCP. Exclusion criteria were patients with diseases like hypertension, diabetes, cardiac disease, liver disease, malabsorption syndrome, renal dysfunction and patients taking drugs causing hypocalcemia and oral calcium and vitamin D supplements. In present study, serum calcium level used was corrected for hypoalbuminemia. OBSERVATION: The mean age was 27 years with a male and female ratio of approximately 3:2. The present study shows that the mean serum calcium level (mg/dL) of patients in Dengue Fever, Dengue Haemorrhagic Fever and Dengue Shock Syndrome was 8.85, 8.27 and 7.95 respectively(p<0.0001). Serum calcium level was lower in DSS and DHF patients than DF patients. Negative correlation between severity of dengue infection and serum calcium level was found with correlation coefficient of -0.892. CONCLUSION: The present study revealed significant negative correlation between Serum calcium level and severity of dengue infection. Therefore, it can be considered to use serum calcium level as a potential biomarker in order to identify severe dengue patients and this investigation will help in early identification, diagnosis and management of dengue infection but further studies are required to support this.

Surgical cancellation rates due to peri-operative hypertension: implementation of multidisciplinary guidelines across primary and secondary care.

Patients with uncontrolled hypertension are at increased risk of complications during general anaesthesia but the number of patients whose surgery is delayed or cancelled due to hypertension remains unknown. Prospective, regional multicentre service evaluations were performed on consecutive patients undergoing elective surgery before and after the publication of new guidelines from the Association of Anaesthetists and the British Hypertensive Society. The aim was to quantify the number of operations cancelled due to hypertension alone and to assess impact of the guidelines on cancellation rates. In October 2013 (before the publication of the guidelines), 1.37% (95%CI 0.69-2.11%) of patients listed for elective surgery were cancelled solely due to raised blood pressure. This reduced significantly to 0.54% (95%CI 0.20-0.92%, p < 0.001) in 2018. There was a significant reduction in inappropriate cancellations for stage 1 or 2 hypertension from 2013 to 2018 (72 vs. 14, respectively, p < 0.001) in keeping with the recommendations in the guidelines. Furthermore, the number of patients being referred back to primary care for the management of hypertension reduced from 2013 to 2018 (85 vs. 30, respectively, p < 0.001). Our data suggest achievement of three major outcomes: reduced surgical cancellations due to hypertension alone; improved detection of significant hypertension before elective surgery; and reduced referral back to primary care from hospital for hypertension management. To the best of our knowledge, this is the first time the successful implementation of guidelines from the Association of Anaesthetists has been assessed on such a broad scale. Our data indicate that these guidelines have been effectively implemented in both primary and secondary care, which is likely to have made a positive psychosocial, physical and economic impact on patients and the NHS.

Diffuse, fracturing systemic skeletal histiocytosis of unknown type: a novel metabolic bone disease.

We describe a novel disease of diffuse skeletal histiocytosis associated with multiple fragility fractures and high osteoclast activity. Clinical, radiographic, biochemical, genetic, and histopathological investigations were performed to characterize the diagnosis of an Asian man who presented with hip fracture and diffuse skeletal lytic lesions. After excluding malignancy and other common metabolic bone diseases, open bone biopsy yielded several pathological samples all showing extensive skeletal histiocytosis likely to explain the diffuse axial and appendicular lytic lesions. Rare disorders such as Langerhans histiocytosis, Erdheim-Chester disease, and diffuse cystic skeletal angiomatosis were excluded through careful pathological examination and lack of CD1a and S-100 staining. Whole exome sequencing did not yield diagnostic findings to explain this likely acquired disease. High markers of osteoclast activity suggested excessive focal bone resorption but normalized after zoledronic acid treatment. A novel disease of skeletal histiocytosis with high bone turnover is differentiated from other histiocytic and lytic skeletal diseases.

Anti-calculus efficacy of Periogen® oral rinse in gingivitis patients.

Dental biofilm is a complex, organized microbial community that is the primary etiologic factor for plaque, the most frequently occurring oral contamination for gingivitis, dental caries and periodontal diseases. In dentistry, calculus is a form of hardened dental plaque, caused by precipitation of calcium (Ca) and phosphorous (P) ions deposited from saliva and gingival crevicular fluid. Although the dental biofilm cannot be eliminated, it can be controlled with comprehensive mechanical and chemotherapeutic oral hygiene practices. Chemotherapeutic agents have difficulty penetrating the polysaccharide matrix to reach and affect the microorganisms. The purpose of the present study was to evaluate the anti-calculus efficiency of a mouthwash containing an association of sodium tripolyphosphate, tetrapotassium pyrophosphate, sodium bicarbonate and citric acid in patients affected with gingivitis.

Microbiological results of improvement in periodontal condition by administration of oral probiotics.

Oral bacteria that degrade sulphur-containing amino acids (cysteine, cystine, and methionine) produce volatile sulphur compounds (VSCs = hydrogen sulphide, methyl mercaptan, and dimethyl sulphide) highly correlated with halitosis. When these bacteria are given the right environment, i.e. periodontal disease, cariogenic biofilm or food source they can grow in number very quickly and will start to convert proteins to VSC that, together with volatile fatty acids are largely responsible for oral malodor. Recently, the prevention of dental caries and periodontal diseases using various probiotics has been attempted. The purpose of this study was to investigate the effects of probiotics based on in vitro analysis, such as antibacterial activity, and to evaluate the neutralizing effect of probiotics on halitosis, the levels of VSCs were measured by gas chromatography. .

Clinical results of improvement in periodontal condition by administration of oral probiotics.

Dental plaque-related diseases (cavities, gingivitis, periodontitis and halitosis) have been traditionally controlled by mechanical non-specific removal of plaque. However, many novel treatment approaches aim to inhibit the growth of pathogenic bacteria or to remove their toxins. Probiotics are viable microorganisms which, when administered in adequate amounts, provide a health benefit to the host. Recently, probiotics have been applied as new tools for the improvement of dental health. They have been used to substitute existing antibiotic treatments due to increased resistant bacteria. Probiotics not only have antibacterial activity, but they also have inhibitory effects on the reappearance of oral pathogenic bacteria. The aim of this study was to assess the clinical effect of the administration of probiotics agents in the treatment of mild to moderate periodontitis.

Orthodontic forces modulate insulin-like growth factor binding protein-5 changes in gingival crevicular fluid.

Orthodontic tooth movement results from the response of the periodontal tissue to orthodontic force, which leads to modeling and remodeling of the surrounding alveolar bone. The response is considered to occur through the activation of specific signaling pathways, many of which are known, all acting to ultimately result in tooth movement. Much is known about the actions of these two cells, and the signaling pathways that affect them, both in bone and orthodontic literature, however, to date, little work has been carried out to examine the effect of the insulin-like growth factor binding proteins (IGFBP) in orthodontics. Therefore, we investigated the presence of IGFBP-5 in the gingival crevicular fluid (GCF) of 6 healthy subjects, and assessed the effects of orthodontic treatment on the levels and molecular state of this protein.

Relative bioavailability of folate from the traditional food plant Moringa oleifera L. as evaluated in a rat model.

Moringa oleifera is an affordable and rich source of dietary folate. Quantification of folate by HPLC showed that 5-formyl-5,6,7,8-tetrahydrofolic acid (502.1 µg/100 g DW) and 5,6,7,8-tetrahydrofolic acid (223.9 µg/100 g DW) as the most dominant forms of folate in M. oleifera leaves. The bioavailability of folate and the effects of folate depletion and repletion on biochemical and molecular markers of folate status were investigated in Wistar rats. Folate deficiency was induced by keeping the animals on a folate deficient diet with 1 % succinyl sulfathiazole (w/w). After the depletion period, animals were repleted with different levels of folic acid and M. oleifera leaves as a source of folate. Feeding the animals on a folate deficient diet for 7 weeks caused a significant (3.4-fold) decrease in serum folate content, compared to non-depleted control animals. Relative bioavailability of folate from dehydrated leaves of M. oleifera was 81.9 %. During folate depletion and repletion, no significant changes in liver glycine N-methyl transferase and 5-methyltetrahydrofolate-homocysteine methyltransferase expression were recorded. In RDA calculations, only 50 % of natural folate is assumed to be bioavailable. Therefore, the bioavailability of folate from Moringa is much higher, suggesting that M. oleifera based food can be used as a significant source of folate.

Osteogenic differentiation and gene expression of dental pulp stem cells under low-level laser irradiation: a good promise for tissue engineering.

The effects of low-level laser therapy (LLLT) has been the focus of recent studies as being assumed responsible for promoting photostimulatory and photobiomodulatory effects in vivo and in vitro, increasing cell metabolism, improving cell regeneration and invoking an anti-inflammatory response. A positive effect of LLLT on the bone proliferation of some cell types has been observed, but little is known about its effect on dental pulp stem cells (DPSCs). Here, we accurately describe the technical procedure to isolate mesenchymal DPSCs, and assay their osteogenic capacity when irradiated with an LLLT source. These preliminary results show that LLLT irradiation influences the in vitro proliferation of DPSCs and increases the expression of essential proteins for bone formation, although it is necessary to carry out further experiments on other cell types and to uniform the methodological designs.

Effect of dehydration methods on retention of carotenoids, tocopherols, ascorbic acid and antioxidant activity in Moringa oleifera leaves and preparation of a RTE product.

Fresh leaves of M. oleifera plants were analysed for nutritionally important phytoconstituents and feasible commercially used dehydration method were evaluated to preserve these in dehydrated leaves. Trans-lutein, trans-ß-carotene and trans-zeaxanthin were found as the major carotenoids in fresh leaves, accounting for 36.9, 18.2 and 5.5 mg/100 g FW, respectively. Similarly, high amounts of ascorbic acid, α-tocopherol and total phenolic content (271.0, 36.9 and 512.0 mg/100 g FW), respectively were recorded in leaves. α-tocopherol was the most stable vitamin under all drying conditions (86.4 % retention during oven drying), compare to other studied phytoconstituents. Cabinet tray drying was found as efficient as lyophilisation to retain maximum content of total carotenoids (60.1 %), trans-ß-carotene (90.1 %), 13-cis-lutein (93.2 %), and DPPH activity, however, lutein (51.3 %) and ascorbic acid (97.8 %) was best preserved by lyophilisation. During dehydration, significant trans to cis isomerization of ß-carotene and lutein was also recorded. A ready to eat (RTE) chutney powder (adjunct) was developed from dehydrated leaves. The product was evaluated using Quantitative Descriptive Analysis and was accepted with a high overall quality score. The present investigation explores the nutritional potential of M. oleifera leaves and suitable methods of drying that could be useful for processed food formulation.

Effect of curcumin on the diffusion kinetics of a hemicyanine dye, LDS-698, across a lipid bilayer probed by second harmonic spectroscopy.

The diffusion kinetics of a hemicyanine dye, LDS-698, across model membrane bilayers was studied in real time by the surface specific second harmonic technique. Using liposomes made from different headgroups, it has been established that the diffusion is initiated by electrostatic adsorption of the positively charged dye to the outer surface of negatively charged liposomes and its time constant is affected by the rigidity of the bilayer. In the presence of the liphophilic drug curcumin (curcumin/lipid mole ratio ~ 0.2), the diffusion of LDS-698 was observed to be faster by ~56 times (from 780 to 14 s) at 25 °C. Under similar curcumin concentration, when cholesterol containing liposomes are used at 2 °C, the observed diffusion time constant increases from 14 to 65 s, showing that the effect of curcumin is superior to the effect of increasing bilayer rigidity on the diffusion process. Control experiments with other lipophilic molecules such as DPH and Nile Red showed that the effect of liposomal curcumin is superior. Consistent with previous reports of curcumin affecting the bilayer organization, this study additionally demonstrates increased permeability of liposomal curcumin, in particular against organic cations. It is speculated that origin of this enhanced membrane permeability by lipophilic molecules may depend upon the interaction of the molecule with the polar headgroup region of the lipid which, in turn, is expected to depend on the chemical structure of the molecule.