Prevalence of depression in hypertensive patients and its associated factors in India: A systematic review and meta-analysis.

BACKGROUND: Hypertension is a prevalent health challenge in India, with a bidirectional link to depression. Recognizing the prevalence of depression among hypertensive patients and associated factors are important for better health outcomes. METHODS: A comprehensive search was conducted in PubMed, Embase, Scopus, and Google Scholar databases to identify relevant studies. R software was used for analysis, employing a random effects model with a 95% confidence interval. Subgroup analyses were done to explore sources of heterogeneity within the included studies. RESULTS: The prevalence of depression among hypertensive patients in India was 39.8% (95% CI: 28.6; 52.1). Despite a higher prevalence observed in South region (44.7%) compared to North (26.9%), the difference was not significant (p=0.39). Studies utilizing different assessment scales and varying sample sizes yielded similar prevalence. However, a temporal trend analysis indicated a higher prevalence in studies published between 2020 and 2023 (52.6%) compared to those published between 2016 and 2019 (35.5%) (p=0.03). Major factors associated with depression included lower socioeconomic status, low education level, female gender, uncontrolled hypertension, and COVID-19 related factors. CONCLUSIONS: A significant proportion of hypertensive patients suffer from depression. Therefore, screening for depression in hypertensive patients is essential to improve hypertension management in India.

Prospective Phase II Study of Radiotherapy Dose Escalation in Grade 4 Glioma Using 68Ga-Pentixafor PET Scan.

AIMS: Local failure remains the major concern in grade 4 glioma or glioblastoma (GBM). Pilot studies have shown a radiotherapy (RT) dose-response relationship in GBM. Here we present our preliminary data of RT dose escalation using 68Ga-Pentixafor PET scan. High 68Ga-pentixafor uptake in glioma cells helps in sharp demarcation between tumour and normal brain. MATERIALS AND METHODS: This phase II prospective study was conducted from 2018 to 2020. Thirty, biopsy-proven cases of grade 4 glioma were included. All patients underwent post-operative MRI of the brain and 68Ga-Pentixafor PET scan. RT was planned in 2-phases. Phase-1 GTV (GTV1) comprised of T2/flair abnormality, PET-avid disease and post-op cavity. A margin of 2cm was given to GTV-1 to create phase-1 CTV (CTV1), which was further expanded to 0.5cm to generate phase-1 PTV (PTV1). A radiation dose of 46Gy/23fr was prescribed to PTV-1. Phase-2 GTV (GTV2) consisted of CT/MRI contrast-enhancing lesion, PET avid disease and post-op cavity. A margin of 0.5 cm was given to GTV2 to create phase-2 CTV (CTV2) which was expanded to 0.5 cm to create phase-2 PTV (PTV2). RT dose of 14 Gy/7 fr was prescribed to PTV2. PET avid disease was delineated as GTV PET and a margin of 3mm was given to generate PTV-PET which received escalated RT dose of 21 Gy/7fr by simultaneous integrated boost (SIB) in phase 2 (Total dose to PTV PET = 67 Gy/30 fr). All patients received concurrent and adjuvant temozolomide. The data was prospectively maintained in Microsoft Excel sheet. SPSS v 23 was used for statistical analysis. The primary endpoints were estimation of the overall survival (OS) and progression-free survival (PFS), and secondary endpoint was to measure the incidence of radiation necrosis. Categorical variables were reported as frequency and percentage and quantitative variables were reported as median and range. RESULTS: Data from thirty patients were analysed. A median OS of 23 months was observed with estimated 1, 2 and 3 years OS of 90%, 40% and 17.8% respectively. A significant association of OS was seen with the extent of surgery (p = 0.04) and kernofsky performance status (p = 0.007). No patient developed significant radiation necrosis. CONCLUSIONS: The index study did not show any survival benefit from dose escalation RT. However, all of the patients tolerated the treatment well and none of them developed radiation necrosis. Considering the small sample size as a limitation of the index study, the role of 68Ga-pentixafor PET scan for radiation dose escalation should be further explored. CLINICAL TRIAL NUMBER: CTRI/2019/05/019146.

An objective way to predict remission and relapse in Cushing disease using Bayes' theorem of probability.

OBJECTIVE: In this study on patients with Cushing disease, post-transsphenoidal surgery (TSS), we attempt to predict the probability of remaining in remission, at least for a year and relapse after that, using Bayes' theorem and the equation of conditional probability. The number of parameters, as well as the weightage of each, is incorporated in this equation. DESIGN AND METHODS: The study design was a single-centre ambispective study. Ten clinical, biochemical, radiological and histopathological parameters capable of predicting Cushing disease remission were identified. The presence or absence of each parameter was entered as binary numbers. Bayes' theorem was applied, and each patient's probability of remission and relapse was calculated. RESULTS: A total of 145 patients were included in the study. ROC plot showed a cut-off value of the probability of 0.68, with a sensitivity of 82% (range 73-89%) and a specificity of 94% (range 83-99%) to predict the probability of remission. Eighty-one patients who were in remission at 1 year were followed up for relapse and 23 patients developed relapse of the disease. The Bayes' equation was able to predict relapse in only 3 out of 23 patients. CONCLUSIONS: Using various parameters, remission of Cushing disease can be predicted by applying Bayes' theorem of conditional probability with a sensitivity and a specificity of 82% and 94%, respectively. This study provided an objective way of predicting remission after TSS and relapse in patients with Cushing disease giving a weightage advantage to every parameter.

Embryonal tumors with multilayered rosettes: A tertiary care centre experience.

BACKGROUND: Embryonal tumors with multilayered rosettes (ETMR) is an extremely rare and highly aggressive tumor. It includes three distinct entities i.e, embryonal tumor with abundant neuropil and true rosettes (ETANTR), ependymoblastoma (EBL) and medulloepithelioma (MEPL). Here, we present our institutional experience of seven ETMR cases treated over a period of five years. MATERIALS AND METHODS: Patients' records from 2015 to 2019 were reviewed manually and electronically to retrieve the data. Clinicopathological and outcome details of ETMR cases were entered in a predesigned proforma. RESULTS: A total of seven cases of ETMR were registered from 2015 to 2019 with a median age at presentation of four years (range 3-7 years). All patients underwent surgery. However, only three patients completed the planned adjuvant treatment, comprising of focal radiotherapy (RT) alone, craniospinal irradiation (CSI) alone and CSI followed by six cycles of chemotherapy in one patient each respectively. Two patients commenced CSI but deteriorated during RT and thereafter needed best supportive care. Two patients could not be started on any adjuvant treatment. Unfortunately, six patients succumbed to their disease within one year of their diagnosis. Only one patient who received both CSI and adjuvant chemotherapy is alive at 15 months of diagnosis. CONCLUSION: ETMR is a rare and aggressive entity. Majority of the patients die within one year of the diagnosis despite multimodality treatment.

Remission in Cushing's disease is predicted by cortisol burden and its withdrawal following pituitary surgery.

AIM: To ascertain the predictors of remission and relapse in patients of Cushing's disease (CD) undergoing pituitary transsphenoidal surgery (TSS). METHODS: Patients with CD subjected to TSS over 35 years at a tertiary care center were included. Patients were grouped into remission and persistent disease at 1 year after surgery, and were further followed up for relapse. Demographic, clinical, biochemical, histological, radiological and post-operative follow-up parameters were analyzed. RESULTS: Of the 152 patients of CD, 145 underwent TSS. Remission was achieved in 95 (65.5%) patients at 1 year. Patients in remission had shorter duration of symptoms prior to presentation (p = 0.009), more frequent presence of proximal myopathy (p = 0.038) and a tumor size of < 2.05 cm (p = 0.016) in comparison to those with persistent disease. Post-TSS, immediate post-operative 0800-h cortisol (< 159.85 nmol/L; p = 0.001), histological confirmation of tumor (p = 0.045), duration of glucocorticoid replacement (median 90 days; p = 0.001), non-visualization of tumor on MRI (p = 0.003), new-onset hypogonadism (p = 0.001), 3-month 0800-h cortisol (< 384.9 nmol/L; p = 0.001), resolution of diabetes (p = 0.001) and hypertension (p = 0.001), and recovery of hypothalamic-pituitary-adrenal axis (p = 0.018) favored remission. In logistic regression model, requirement of glucocorticoid replacement (p = 0.033), and resolution of hypertension post-TSS (p = 0.003) predicted remission. None of the parameters could predict relapse. CONCLUSION: The study could ascertain the predictors of remission in CD. Apart from the tumor characteristics, surgical aspects and low post-operative 0800-h cortisol, the results suggest that baseline clinical parameters, longer glucocorticoid replacement, and resolution of metabolic complications post-TSS predict remission in CD. Long-term follow-up is essential to look for relapse.

Improvement of conception rate in postpartum flaxseed supplemented buffalo with Ovsynch+CIDR protocol.

The present study was conducted on lactating Murrah buffalo to assess the effect of crushed flaxseed (a source of omega-3 fatty acids) supplementation (300g/100kg bwt/day for 60 days), over and above the routine feed, on luteolytic signal (PGF2α), luteal function (progesterone) and conception rate. In first experiment, on day 50 post-calving, six non-supplemented buffalo were treated to synchronize time of ovulation using an Ovsynch+Controlled Internal Drug Release (CIDR) protocol followed by intravenous oxytocin treatment (OT; 100IU) on day 15 post-ovulation. Blood samples were collected at 15min interval, 1h before to 4h after OT challenge. Thereafter, the same buffalo were supplemented with flaxseed, treated to synchronize time of ovulation starting on day 35 post-supplementation using the same protocol and subjected to OT treatment and blood sampling on day 15 post-ovulation. The PGF2α response was measured as the venous concentration of 13,14-dihydro-15-keto PGF2α (PGFM). The mean hourly concentration of PGFM subsequent to flaxseed supplemented was less (P<0.05) than in the pre-supplementation period at all the occasions. Flaxseed supplementation did not affect plasma fatty acids and other plasma metabolites except for an increase (P<0.05) in plasma cholesterol and plasma alanine transaminase. In the second experiment, 31 buffalo were randomly assigned to a control (n=16) and flaxseed supplemented (n=15) group. The latter group was supplemented with flaxseed starting from day 15 post-calving. On day 50-post-calving, buffalo of both groups were treated to synchronize time of ovulation among animals as described for the first experiment followed by artificial insemination (AI). Post-AI luteal phase plasma progesterone was greater (P<0.05) in the supplemented group compared to controls. Conception rate on day 63 post-AI was 66.7% in supplemented and 31.2% in controls (P<0.05). The present study indicated the beneficial impact of dietary supplementation of crushed flaxseed on conception rate through attenuation of luteolytic signal and improvement in post-breeding luteal profile.

Cirsoid aneurysm of the right pre-auricular region: an unusual cause of tinnitus managed by endovascular glue embolisation.

OBJECTIVE: We report an interesting case of a right temporal pre-auricular arteriovenous fistula (cirsoid aneurysm) causing intractable tinnitus successfully managed by transarterial n-butyl cyanoacrylate glue embolisation. CASE REPORT: A 52-year-old female presented with a one-year history of tinnitus and pulsatile swelling in the right pre-auricular region. A colour Doppler ultrasound test and magnetic resonance angiography revealed a high-flow scalp arteriovenous fistula with a feeder vessel from the distal superficial temporal artery, which drained into the corresponding, dilated, tortuous vein. The patient underwent diagnostic digital subtraction angiography. This was followed by transarterial embolisation of the fistula using a 50 per cent mixture of n-butyl cyanoacrylate glue and Lipiodol®, with manual distal venous occlusion. A successful outcome was achieved with instant relief of symptoms. CONCLUSION: Cirsoid aneurysms of the facial region, an uncommon cause of tinnitus, can be effectively managed by endovascular embolisation. This treatment obviates the need for surgery, which is associated with an increased risk of complications such as scarring, deformity and bleeding.

The collision-induced polarizability of a pair of hydrogen molecules.

Collision-induced light scattering, impulsive stimulated scattering, and subpicosecond-induced birefringence all depend on the transient changes Deltaalpha in molecular polarizabilities that occur when molecules collide. Ab initio results for Deltaalpha are needed to permit comparisons with accurate experimental results for these spectra and for refractive index virial coefficients and dielectric virial coefficients. In this work, we provide results for Deltaalpha for a pair of hydrogen molecules, treated at CCSD(T) level, with an aug-cc-pV5Z (spdf) basis set. Our values replace the best previous ab initio results for the variation of Deltaalpha with intermolecular separation, the self-consistent-field results obtained by Bounds [Mol. Phys. 38, 2099 (1979)] with a relatively small (3s2p) basis set for H2. For the six geometrical configurations studied by Bounds, the inclusion of correlation and improvements in the basis tend to increase both the trace Deltaalpha(0)0 and the anisotropy Deltaalpha2m of the pair polarizability. The change in the anisotropy is relatively small, but our values for the trace differ by factors of 2 or more from Bounds' results. For use in computing experimental line shapes, intensities, and virial coefficients, we have calculated Deltaalpha for 18 different relative orientations of a pair of H2 molecules, with the intermolecular separation R ranging from 2 a.u. (3 a.u. for a linear pair) to 10 a.u. The H2 bond length is fixed at the vibrationally averaged internuclear separation in the ground state r=1.449 a.u. Our results agree well with the CCSD(T) results for Deltaalpha obtained by Maroulis [J. Phys. Chem. A 104, 4772 (2000)] for two pair configurations of H2...H2 (linear and T-shaped) at a fixed internuclear distance of R=6.5 a.u. in a [6s4p1d] basis. As the intermolecular distance increases (for R>or=8 a.u.), the spherical-tensor components of Deltaalpha converge to the results from a long-range model that includes dipole-induced-dipole (DID) interactions, higher-multipole induction, nonuniformity of the local field, hyperpolarization, and van der Waals dispersion. Deviations from the first-order DID model are still evident for R between 8 and 10 a.u. in most orientations of the pair. At shorter range, overlap damping, exchange, and orbital distortion reduce both Deltaalpha0(0) and Deltaalpha(2)0 below their long-range limiting forms.

A comparative study on lipid peroxidation, activities of antioxidant enzymes and viability of cattle and buffalo bull spermatozoa during storage at refrigeration temperature.

A comparative study was conducted to monitor the activities of some antioxidant enzymes, lipid peroxidation and viability of cattle and buffalo bull spermatozoa during storage of semen at refrigeration temperature over a period of 72 h. Semen samples, collected from six cross bred cattle bulls (group I) and six Murrah buffalo bulls (group II), were diluted in egg-yolk-citrate and the spermatozoa were separated from seminal plasma by centrifugation at 4 degrees C in a refrigerated centrifuge. The malondialdehyde (MDA) production in group I increased from 1.17+/-0.29 at 0 h to 7.50+/-0.52 nmol/10(8)spermatozoa after 72 h of storage while in group II it increased from 1.99+/-0.26 to 8.70+/-0.10 nmol/10(8)spermatozoa in the same period. However, buffalo bull spermatozoa had a significantly higher (p<0.05) lipid peroxidation at 0 h as well as at 12, 24 and 48 h (p<0.01) periods. The activities of antioxidant enzymes viz. SOD, GPx and G6PD in both the groups showed a similar pattern of change i.e. the activities declined successively in spermatozoa and increased in the seminal plasma. However, the activities of these three enzymes remained significantly higher in the cattle bull spermatozoa than that in buffalo bull spermatozoa. Amount of MDA produced in spermatozoa of both the groups was negatively correlated while SOD, GPx and G6PD activities in spermatozoa were positively correlated to the motility and viability of spermatozoa. Sperm motility as well as viability was significantly less (p<0.05) in group II than that in group I. SOD, GPx and G6PD activities in spermatozoa of both the groups were negatively correlated to lipid peroxidation of spermatozoa cell membrane. The results showed that the less activities of antioxidant enzymes in buffalo bull spermatozoa was due to higher lipid peroxidation that indicated that they were more prone to oxidative stress as compared to cattle bull spermatozoa when stored at refrigeration temperature.

Status of lipid peroxidation, some antioxidant enzymes and erythrocytic fragility of crossbred cattle naturally infected with Theileria annulata.

Erythrocytic lipid peroxidation, activities of some antioxidant enzymes and osmotic fragility of red blood cells was studied in adult (>1 year) crossbred cattle naturally infected with Theileria annulata. Twenty clinically healthy animals (group I) and 15 clinical cases (group II) of tropical theileriosis were selected. Cattle suffering from theileriosis had significantly higher (p<0.01) erythrocytic lipid peroxidation and osmotic fragility. Activities of antioxidant enzymes, viz. glucose-6-phosphate dehydrogenase (G6PD) and glutamate peroxidase (GPx) were also significantly increased (p<0.01) in group II. However, superoxide dismutase and catalase did not show significant changes. The results indicated that infection with theileria led to increased oxidative stress to the animals, and even a significant rise in the activities of antioxidant enzymes. G6PD and GPx could not lower this oxidative stress. However, the increase in the activities of antioxidant enzymes pointed towards the body's defence mechanism against lipid peroxidation during oxidative stress in theileriosis.

Pregnancy rate following GnRH + PGF 2alpha treatment of low body condition, anestrous Bos taurus by Bos indicus crossbred cows during the summer months in a tropical environment.

Anestrous and lactating Bos taurus by Bos indicus crossbred cows with minimum body condition were studied to determine the efficacy of GnRH+PGF 2alpha combinations for induction of estrus and/or ovulation on pregnancy rate during the months of the year when temperatures are greater. On day 0 (start of treatment), cows were assigned randomly to either treatment or control groups. Treated cows (n = 74) received i.m. 200 microg of GnRH on day 0 and 150 microg of PGF 2alpha 7 days later (day 7). On day 7, treated cows were equally distributed to each of three protocols: (1) Select Synch (n = 25), artificial insemination (AI) 12 h after exhibiting estrus from day 7 (PGF 2alpha injection) until day 12; (2) Ovsynch (n = 24), 200 microg of GnRH at 48 h after PGF 2alpha (day 9) + timed-AI (TAI) 16-20 h later; (3) CO-Synch (n = 25), 200 microg of GnRH + TAI at 48 h after PGF 2alpha (day 9). Control cows (n = 25) received no treatment + AI 12 h after exhibiting estrus from days 0 to 12. Detection of estrus was performed daily during the early morning and evening hours from days 0 to 7 in all the cows, and from days 7 to 12 in the cows treated with Select Synch and in the control group, with the aid of a sterilized bull. Palpation per rectum and transrectal ultrasonography were used on days -30, -20, -10 and 0 to confirm anestrus (absence of CL and no signs of estrus at each evaluation) but with ovarian follicles > or = 10 mm on day 0. Pregnancy rate was 0% for Select Synch, 21% for Ovsynch and 28% for CO-Synch (P < 0.05). In conclusion, the Ovsynch and CO-Synch protocols resulted in greater pregnancy rates compared with the Select Synch protocol in Bos taurus/Bos indicus cows with minimum body condition that were anestrous and lactating during the summer months in a tropical environment.

Body condition and suckling as factors influencing the duration of postpartum anestrus in cattle: a review.

Prolonged postpartum anestrus is a main factor limiting reproductive efficiency in cattle, particularly in Bos indicus and Bos taurus/Bos indicus cows from tropical regions, because it prevents achievement of a 12 month calving interval. During anestrus, ovulation does not occur despite ovarian follicular development, because growing follicles do not mature. Although many factors affect postpartum anestrus, nutrition and suckling are the major factors influencing the resumption of postpartum ovarian cycles, as they affect hypothalamic, pituitary and ovarian activity and thus inhibit follicular development. Under-nutrition contributes to prolonged postpartum anestrus, particularly among cows dependent upon forages to meet their feed requirements and it apparently interacts with genetic, environmental or management factors to influence the duration of anestrus. The nutritional status or balance of an animal is evaluated through body condition score (BCS), as it reflects the body energy reserves available for metabolism, growth, lactation and activity. There is a converse relationship between energy balance and time to resumption of postpartum ovarian activity; inadequate nutrient intake results in loss of weight and BCS and finally cessation of estrous cycles. Suckling interferes with hypothalamic release of GnRH, provoking a marked suppression in pulsatile LH release, resulting in extended postpartum anestrus. The effects of suckling on regulation of tonic LH release are determined by the ability of the cow to identify a calf as her own or as unrelated. Vision and olfaction play critical roles in the development of the maternal-offspring bond, allowing the cow to identify her own calf, and abolition of both senses attenuates the negative effects of suckling on LH secretion. Thus, the maternal-offspring bond is essential for prolonged postpartum suckling-induced anovulation, and the suppressive influence of suckling is independent of neurosensory pathways within the teat or udder.

Induction of ovulation with GnRH and PGF2alpha in lactating Bos taurus x Bos indicus cows.

Induction of ovulation for timed artificial insemination (TAI) with the Ovsynch protocol was evaluated in 49 anoestrous and lactating Bos taurus x Bos indicus cows. Palpation per rectum and transrectal ultrasonography were used on Days -30, -20, -10 and 0 (start of treatment) to confirm anoestrus but with the presence of follicles > or = 10 mm, and every other day during treatment to determine ovarian activity. Cows were randomly assigned to: (1) Ovsynch (n = 24; Day 0, 200 microg GnRH; Day 7, 150 microg PGF2alpha; Day 9, 200 microg GnRH + TAI 16 to 20 h later) and (2) control (n = 25; no treatment). Rates of ovulation for the first GnRH injection, detection of a corpus luteum (CL) at PGF2alpha injection, pregnancy and induction of cyclicity were greater (P < 0.05) with Ovsynch. There was no effect of body condition score (P > 0.05). In conclusion, the Ovsynch protocol was not effective in obtaining acceptable pregnancy rate for TAI, but it was effective for induction of cyclicity in anoestrous and lactating Bos taurus x Bos indicus cows under tropical conditions.