Death of a child due to venom toxicity following multiple honey bee stings: A case report.

Most bee stings are not life-threatening. Bee venom often causes local, mild allergic reactions in people, but even a single bee sting may induce a fatal anaphylactic reaction. Usually, anaphylactic reaction is the cause of death, but, when a child suffers multiple stings (more than 30), direct toxicity of venom can also be fatal. A three-year-old male child was brought to the hospital with pain, swelling and redness at the sting sites. He had more than 35 stings at various sites over his face, on his tongue and over his body. He died 10 hours after the incidence of the honey bee stings and was maintaining oxygen saturation until the terminal stage of his life. At autopsy, the honey bee sting sites showed redness, swelling and a small effusion of blood surrounding the stinger tracks. On the tongue two stingers were found in situ. Facial puffiness and eyelid swelling, along with congested organs, were also found, but features suggestive of anaphylactic death like airway oedema, mucous plug or cyanosis were absent. Hospital treatment records show that blood pressure remained low with tachycardia despite treatment. Having regard for all the evidence it was concluded that death was due to multiple honey bee stings that caused direct venom toxicity.

Gallaphosphene L(Cl)GaPGaL: A novel phosphinidene transfer reagent.

Gallaphosphene L(Cl)GaPGaL 1 (L=HC[C(Me)N(Ar)]2; Ar=2,6-iPr2C6H3) reacts with N-heterocyclic carbenes RNHC (RNHC=[CMeN(R)]2C; R=Me, iPr) to RNHC-coordinated phosphinidenes RNHC→PGa(Cl)L (R=Me 2 a, iPr 2 b) and with isonitriles RNC (R=iPr, Cy) to 1,3-phosphaazaallenes L(Cl)GaP=C=N-R (R=iPr 3 a, Cy 3 b), respectively. Quantum chemical calculations reveal that 2 a/2 b possess two localized lone pair of electrons, whereas 3 a/3 b only show one localized lone pair as was reported for gallaphosphene 1. 2 b reacts with 2.5 equivalents of a borane (THF ⋅ BH3) to the NHC-stabilized phosphinidene-borane complex [iPrNHC→P(BH2)]2(BH3)3 4 with concomitant formation of LGa(H)Cl 5. 2-5 are characterized by heteronuclear (1H, 13C{1H}, 31P{1H}) NMR and IR spectroscopy, elemental analysis, and single crystal X-ray diffraction (sc-XRD).

Syntheses and Structures of 5-Membered Heterocycles Featuring 1,2-Diphospha-1,3-Butadiene and Its Radical Anion.

LGa(P2 OC)cAAC 2 features a 1,2-diphospha-1,3-butadiene unit with a delocalized π-type HOMO and a π*-type LUMO according to DFT calculations. [LGa(P2 OC)cAAC][K(DB-18-c-6)] 3[K(DB-18-c-6] containing the 1,2-diphospha-1,3-butadiene radical anion 3⋅- was isolated from the reaction of 2 with KC8 and dibenzo-18-crown-6. 3 reacted with [Fc][B(C6 F5 )4 ] (Fc=ferrocenium) to 2 and with TEMPO to [L-H Ga(P2 OC)cAAC][K(DB-18-c-6)] 4[K(DB-18-c-6] containing the 1,2-diphospha-1,3-butadiene anion 4- . The solid state structures of 2, 3K(DB-18-c-6], and 4[K(DB-18-c-6] were determined by single crystal X-ray diffraction (sc-XRD).

Modulating the frontier orbitals of L(X)Ga-substituted diphosphenes [L(X)GaP]2 (X = Cl, Br) and their facile oxidation to radical cations.

Modulating the electronic structures of main group element compounds is crucial to control their chemical reactivity. Herein we report on the synthesis, frontier orbital modulation, and one-electron oxidation of two L(X)Ga-substituted diphosphenes [L(X)GaP]2 (X = Cl 2a, Br 2b; L = HC[C(Me)N(Ar)]2, Ar = 2,6-i-Pr2C6H3). Photolysis of L(Cl)GaPCO 1 gave [L(Cl)GaP]22a, which reacted with Me3SiBr with halide exchange to [L(Br)GaP]22b. Reactions with MeNHC (MeNHC = 1,3,4,5-tetramethylimidazol-2-ylidene) gave the corresponding carbene-coordinated complexes L(X)GaPP(MeNHC)Ga(X)L (X = Cl 3a, Br 3b). DFT calculations revealed that the carbene coordination modulates the frontier orbitals (i.e. HOMO/LUMO) of diphosphenes 2a and 2b, thereby affecting the reactivity of 3a and 3b. In marked contrast to diphosphenes 2a and 2b, the cyclic voltammograms (CVs) of the carbene-coordinated complexes each show one reversible redox event at E 1/2 = -0.65 V (3a) and -0.36 V (3b), indicating their one-electron oxidation to the corresponding radical cations as was confirmed by reactions of 3a and 3b with the [FeCp2][B(C6F5)4], yielding the radical cations [L(X)GaPP(MeNHC)Ga(X)L]B(C6F5)4 (X = Cl 4a, Br 4b). The unpaired spin in 4a (79%) and 4b (80%) is mainly located at the carbene-uncoordinated phosphorus atoms as was revealed by DFT calculations and furthermore experimentally proven in reactions with n Bu3SnH, yielding the diphosphane cations [L(X)GaPHP(MeNHC)Ga(X)L]B(C6F5)4 (X = Cl 5a, Br 5b). Compounds 2-5 were fully characterized by NMR and IR spectroscopy as well as by single crystal X-ray diffraction (sc-XRD), and compounds 4a and 4b were further studied by EPR spectroscopy, while their bonding nature was investigated by DFT calculations.

Client perspectives on perceived barriers to homework adherence in psychotherapy: An exploratory study from India.

We explored perceived barriers to homework adherence in clients receiving individual psychotherapy. Ninety-four adults with at least four individual psychotherapy sessions were recruited from outpatient services of a tertiary hospital in India and assessed on the Barriers to CBT Homework Completion Scale, Homework Compliance Scale, and Clinical Global Impressions scale. More than one-fourth completed some portion of the homework. Participants reported a high level of overall perceived barriers to homework, with more task-and-patient related factors. Higher perceived barriers were associated with lower adherence. Findings highlight the importance of understanding perceived barriers to homework adherence and addressing them systematically.

Psychological Well-Being amongst Cancer Palliative Care Professionals working in Bengaluru, India.

Objectives: Increased levels of psychological distress and burnout in cancer palliative care professionals have implications on their psychological well-being, quality of patient care they provide and for their employing organisations. There is a dearth of studies on psychological well-being with no published study available on psychological well-being amongst cancer palliative care professionals in India. The aim of the present study was to assess psychological well-being amongst cancer palliative care professionals. Materials and Methods: The study was cross-sectional and quantitative which was carried out at four cancer palliative care centers (one hospice and three hospitals) in Bengaluru city of India. The tools sociodemographic and professional datasheet and psychological well-being (PWB-20) scale were administered with 65 participants (Mean Age = 32.5, SD = 11.78). Purposive sampling method was used to recruit the participants working full-time at respective centers after obtaining permissions and ethical approvals. Descriptive, correlational, and inferential analysis of the quantitative data was carried out based on normality of the distribution. Results: The results revealed above average levels of self-acceptance and engagement and growth, below average levels of mastery and competence, while average levels of positive relations and PWB (total score). Significant differences in PWB domains based on age (P < 0.05) and self-care practices (P < 0.05) were seen. Sense of engagement and growth was found to be positively correlated with age and income earned per month (P = 0.01). Conclusion: Findings from the present study suggest that cancer palliative care professionals had moderate levels of PWB with implications in training and future research.

Bis-Phosphaketenes LM(PCO)2 (M=Ga, In): A New Class of Reactive Group 13 Metal-Phosphorus Compounds.

Phosphaketenes are versatile reagents in organophosphorus chemistry. We herein report on the synthesis of novel bis-phosphaketenes, LM(PCO)2 (M=Ga 2 a, In 2 b; L=HC[C(Me)N(Ar)]2 ; Ar=2,6-i-Pr2 C6 H3 ) by salt metathesis reactions and their reactions with LGa to metallaphosphenes LGa(OCP)PML (M=Ga 3 a, In 3 b). 3 b represents the first compound with significant In-P π-bonding contribution as was confirmed by DFT calculations. Compounds 3 a and 3 b selectively activate the N-H and O-H bonds of aniline and phenol at the Ga-P bond and both reactions proceed with a rearrangement of the phosphaethynolate group from Ga-OCP to M-PCO bonding. Compounds 2-5 are fully characterized by heteronuclear (1 H, 13 C{1 H}, 31 P{1 H}) NMR and IR spectroscopy, elemental analysis, and single crystal X-ray diffraction (sc-XRD).

Selective 1,2 addition of polar X-H bonds to the Ga-P double bond of gallaphosphene L(Cl)GaPGaL.

Gallaphosphene L(Cl)GaPGaL 1 (L = HC[C(Me)N(2,6-i-Pr2-C6H3)]2) reacts at ambient temperature with a series of polar X-H bonds, i.e. ammonia, primary amines, water, phenol, thiophenol, and selenophenol, selectively with 1,2 addition at the polar Ga-P double bond. The gallium atom serves as electrophile and the phosphorous atom is protonated in all reactions. The resulting complexes L(Cl)GaP(H)Ga(X)L (X = NH22, NHi-Pr 3, NHPh 4, OH 5, OXyl 6, SPh 7, SePh 8) were characterized by IR and heteronuclear (1H, 13C{1H}, 31P{1H}) NMR spectroscopy, elemental analysis, and single-crystal X-ray diffraction.

Men with and without Alcohol Dependence: A Comparative Study of Triguna, Nonattachment, Personality and Subjective Well-Being.

Context: Indian models of personality are seldom explored in relation to alcohol dependence. Triguna is an Indian model of personality originating from the Sankhya philosophy, whereby three gunas, Sattva, Rajas and Tamas describe personality features. Additionally, the trait of Non attachment which is a concept discussed extensively in Bhagavad Gita is also studied along with Triguna. Aims: The current study discusses these concepts and attempts to explore their relationship with personality and subjective well-being, among men with and without alcohol dependence. Subjects and Methods: A cross-sectional survey method was adopted, with a sample of 84 men from the community without alcohol dependence, screened through alcohol use disorders identification test and 30 men diagnosed with alcohol dependence. Informed consent was obtained from all the participants. Statistical Analysis Used: The data were analyzed using descriptive statistics, independent sample t-test, and Mann-Whitney U-test. Results: Men without alcohol dependence scored significantly higher on variables such as Sattva, extraversion and conscientiousness, positive affect, and life satisfaction, than men in the clinical group. Men who were diagnosed with alcohol dependence, scored significantly higher on Tamas, neuroticism, and negative affect. Conclusions: This novel understanding of the personality structure of patients with alcohol dependence from the Triguna perspective may be helpful in the development of indigenous psychological interventions for alcohol dependence.

Pathways to mental health consultations: A study from a tertiary care setting in India.

BACKGROUND: Research indicates that help seeking for mental health is low and often delayed. Understanding pathways to care is crucial to facilitate mental health referrals and reduce the time to consultation. METHODS: In the present study, 63 individuals were assessed on illness severity, attitudes towards help-seeking and pathways-to-care. RESULTS: Multiple pathways for therapy were noted, a delayed-pathway, two-step referral pathway and a direct-pathway. Most prominent pathway was the delayed-pathway. The direct-pathway had least treatment delay, contributed by timely recognition of symptoms by the patient. As first point of contact, patients preferred psychiatrists and popularly sought information about treatment via media. CONCLUSIONS: There are multiple pathways to consultations, often leading to treatment delay in care received. Timely recognition of symptoms was associated a direct pathway and the least delay. These findings have implications for strengthening routes to mental health specialists at early stages and increasing awareness about treatment available.

Outcome of simultaneous angioembolization and nephron sparing surgery in large renal angiomyolipomas.

AIM: To study the outcome of simultaneous angioembolization and nephron sparing surgery in large renal angiomyolipomas. MATERIALS AND METHODS: A prospective study of carried out from 2016 to 2019. A total of 15 patients were included in the study with a lesion (angiomyolipoma) more than 10 cm in size, suitable for nephron sparing surgery. The workup of the patients included history, baseline blood investigations, ultrasonography, and CT urography including angiographic films. All the patients were taken up for selective of angioembolization of the feeding vessels of the AML carried out by the interventional radiologist followed by nephron sparing surgery in the same sitting. The short term outcomes studied were warm ischemia time, average blood loss, and length of post-operative hospital stay. The oncological outcome was evaluated by noting the surgical margins of histopathological specimen and functional outcome by assessing the function of the preserved renal parenchyma. RESULTS: Twelve out of fifteen cases were female. The mean age was 42.25 years. All the patients had lesion more than 10 cm with seven tumors located at the lower pole, four at mid-pole, and four at upper pole. Eight patients had low complexity score on RENAL score (i.e. 4-6), five patients medium complexity score (i.e. 7-9), and two had high complexity score (i.e. ⩾10). Average blood loss was 200 ml, warm ischemia time was 18.46 min and postoperative stay was 3.55 days. All the 15 specimens sent for histopathology were confirmed as AML (angiomyolipomas) with margins free of tumor. Follow up CECT done at 4 months postoperatively revealed functioning residual renal parenchyma with prompt excretion of contrast. CONCLUSION: Large AML's are also amenable to nephron sparing surgery. However patient should always be warned about the possibility of total nephrectomy. Selective angioembolization helps in reducing the blood supply and risk of torrential bleeding thus facilitates in the removal of the tumor and increasing the chances of nephron sparing surgery.

Felt Needs of Cancer Palliative Care Professionals Working in India: A Qualitative Study.

OBJECTIVES: Cancer palliative care professionals face a plethora of challenges related to death, dying and suffering apart from limited workforce and other resources in India. However, the grief held by them is underappreciated and psychological needs are under explored. The aim of the present study was to explore felt needs of cancer palliative care professionals working in India. MATERIALS AND METHODS: The study was cross-sectional, qualitative and in-depth in nature. It was conducted across four cancer palliative care centers in Bengaluru city of India. sample consisted of 15 professionals (mean age = 42 years and standard deviation = 8.41) with at least six months of experience, involved in direct patient care who gave an additional consent for audio-recording. The tools used were sociodemographic and professional datasheet and semi-structured interview guide, which were developed for the present study and validated from five experts. Thematic analysis was used to generate and analyze patterns within the qualitative data. RESULTS: Five themes were identified, namely, death and grief; challenges in practice; strategies for self-care; positive professional experiences; and vision for palliative care. CONCLUSION: The cancer palliative care professionals need regular support in coping with death and grief, regular trainings and supervision across workplace to deal with occupational challenges, and to address their self-care and spiritual needs. The study highlights need to introduce more specialized training courses in handling pediatric patients, increase palliative care workforce, and hospice units. This can have implications in future research and training with development of innovative interventions to address these needs and challenges.

Mindfulness Integrated Cognitive Behavioural Intervention: Effects on Palliative Cancer Care Professionals.

OBJECTIVE: Being a palliative cancer care professional is challenging and stressful. In recent decades, there has been more interest in mindfulness to improve overall well-being of healthcare professionals. Mindfulness integrated cognitive behavioural interventions (MICBI) are more practical, flexible and understandable than traditional psychological therapies alone. There is a dearth of studies in India with no psychological intervention in palliative cancer care professionals to date. The aim was to examine the effects of MICBI for professional care workers at palliative cancer care centres in Bengaluru city of Southern India. METHODS: A single group study design was adopted with pre, post and 3-month follow-up assessment with a sample of 25 participants working full-time at a hospice. The MICBI programme was for six sessions, once a week for 2-2.5 hours. Outcome variables were professional quality of life measures (burnout, secondary traumatic stress and compassion satisfaction), psychological well-being score and mindfulness skills score (assessed using Professional Quality of Life Scale-V.5, Psychological Well-Being Scale and Five Facet Mindfulness Questionnaire). Wilcoxon signed rank test and Friedman test analysed differences between pre, post and follow-up data. RESULTS: The MICBI could significantly reduce burnout and secondary traumatic stress; it improved compassion satisfaction, psychological well-being and mindfulness skills; treatment gains were maintained at 3 months follow-up. CONCLUSIONS: MICBI was feasible and effective for palliative cancer care professionals with implications for training, practice and future research. PROSPERO REGISTRATION NUMBER: The study was registered under the Clinical Trials Registry- India (CTRI) (number: CTRI/2018/03/019170).

Reversible and Irreversible [2+2] Cycloaddition Reactions of Heteroallenes to a Gallaphosphene.

[2+2] Cycloaddition reactions of gallaphosphene L(Cl)GaPGaL 1 (L=HC[C(Me)N(2,6-i-Pr2 C6 H3 )]2 ) with carbodiimides [C(NR)2 ; R=i-Pr, Cy] and isocyanates [RNCO; R=Et, i-Pr, Cy] yielded four-membered metallaheterocycles LGa(Cl)P[µ-C(X)NR]GaL (X=NR, R=i-Pr 2, Cy 3; X=O, R=Et 4, i-Pr 5, Cy 6). Compounds 4-6 reversibly react with CO2 via [2+2] cycloaddition at ambient temperature to the six-membered metallaheterocycles LGa(Cl)P[µ-C(O)O]-µ-C(O)N(R)GaL (R=Et 7, i-Pr 8, Cy 9). Compounds 2-9 were characterized by IR and heteronuclear (1 H, 13 C{1 H}, 31 P{1 H}) NMR spectroscopy and elemental analysis, while quantum chemical calculations provided a deeper understanding on the energetics of the reactions.

An Open-Shell Singlet SnI †Diradical and H2 †Splitting.

The first SnI diradical [(ADCPh )Sn]2 (4) based on an anionic dicarbene (ADCPh ={CN(Dipp)}2 CPh; Dipp=2,6-iPr2 C6 H3 ) scaffold has been isolated as a green crystalline solid by KC8 reduction of the corresponding bis-chlorostannylene [(ADCPh )SnCl]2 (3). The six-membered C4 Sn2 -ring of 4 containing six π-electrons shows a diatropic ring current, thus 4 may also be regarded as the first 1,4-distannabenzene derivative. DFT calculations suggest an open-shell singlet (OS) ground state of 4 with a remarkably small singlet-triplet energy gap (ΔEOS-T =4.4 kcal mol-1 ), which is consistent with CASSCF (ΔES-T =6.6 kcal mol-1 and diradical character y=37 %) calculations. The diradical 4 splits H2 at room temperature to yield the bis-hydridostannylene [(ADCPh )SnH]2 (5). Further reactivity of 4 has been studied with PhSeSePh and MeOTf.

Metalloradical Cations and Dications Based on Divinyldiphosphene and Divinyldiarsene Ligands.

Metalloradicals are key species in synthesis, catalysis, and bioinorganic chemistry. Herein, two iron radical cation complexes (3-E)GaCl4 [(3-E).+ = [{(IPr)C(Ph)E}2 Fe(CO)3 ].+ , E = P or As; IPr = C{(NDipp)CH}2 , Dipp = 2,6-iPr2 C6 H3 ] are reported as crystalline solids. Treatment of the divinyldipnictenes {(IPr)C(Ph)E}2 (1-E) with Fe2 (CO)9 affords [{(IPr)C(Ph)E}2 Fe(CO)3 ] (2-E), in which 1-E binds to the Fe atom in an allylic (η3 -EECvinyl ) fashion and functions as a 4e donor ligand. Complexes 2-E undergo 1e oxidation with GaCl3 to yield (3-E)GaCl4 . Spin density analysis revealed that the unpaired electron in (3-E).+ is mainly located on the Fe (52-64 %) and vinylic C (30-36 %) atoms. Further 1e oxidation of (3-E)GaCl4 leads to unprecedented η3 -EECvinyl to η3 -ECvinyl CPh coordination shuttling to form the dications (4-E)(GaCl4 )2 .

A randomized controlled trial of mindfulness-based cognitive therapy vs stress management training for obsessive-compulsive disorder.

BACKGROUND: Recently, mindfulness-based therapies have emerged as a treatment modality for OCD, but there is sparse controlled data. We report the efficacy of mindfulness-based cognitive therapy (MBCT) in treating OCD in comparison with stress management training (SMT). METHODS: 60 outpatients with DSM-IV-TR OCD attending a specialty OCD clinic were randomly assigned in 1:1 ratio to either MBCT (n=30) or SMT (n= 30). Both the groups received 12 weekly sessions of assigned intervention. An independent blind rater assessed the primary outcome measure at baseline and at the end of 12 weeks. RESULTS: Significantly greater proportion of patients responded to MBCT than to SMT (80% vs. 27%, P <0.001). In the linear mixed-effects modelling for intent-to-treat analysis, there was a significant reduction in the illness severity measured using the Yale-Brown Obsessive-Compulsive Scale, obsessive beliefs of 'responsibility/threat estimation' and 'perfectionism/intolerance of uncertainty' measured using the Obsessive Beliefs Questionnaire and anxiety. LIMITATIONS: Small sample size with a relatively high attrition in the control group. Lack of a cognitive behaviour therapy (CBT) control group. CONCLUSIONS: Mindfulness-based cognitive therapy is efficacious in the treatment of OCD. Future studies should compare MBCT with CBT in larger representative samples and also examine the sustainability of change in longitudinal studies.

Multi-Talented Gallaphosphene for Ga-P-Ga Heteroallyl Cation Generation, CO2 Storage, and C(sp3 )-H Bond Activation.

Gallaphosphene L(Cl)GaPGaL (2; L=HC[C(Me)N(2,6-i-Pr2 C6 H3 )]2 ), which is synthesized by reaction of LGa(Cl)PCO (1) with LGa, reacts with [Na(OCP)(dioxane)2.5 ] to LGa(OCP)PGaL (3), whereas chloride abstraction with LiBArF 4 yields [LGaPGaL][BArF 4 ] (4; BArF 4 =B(C6 F5 )4 ). 4 represents a heteronuclear analog of the allyl cation according to quantum chemical calculations. Remarkably, 2 reversibly reacts with CO2 to yield L(Cl)Ga-P[µ-C(O)O]2 GaL (5), while reactions with acetophenone and acetone selectively give compounds 6 and 7 by C(sp3 )-H bond activation.

Isolation of a Ge(I) Diradicaloid and Dihydrogen Splitting.

The cyclic Ge(I) compound [(ADCPh)Ge]2 (4) (ADCPh = {CN(Dipp)}2CPh, Dipp = 2,6-iPr2C6H3) containing a 6π-electron C4Ge2 framework has been isolated as a red crystalline solid. CASSCF calculations reveal a closed-shell singlet ground state for 4 with a considerable diradical character (y = 34%). Thus, the diradicaloid 4 readily splits dihydrogen at room temperature to yield the elusive bis-hydridogermylene [(ADCPh)GeH]2 (5).

Illness perceptions and health beliefs in persons with common mental disorders.

INTRODUCTION: Help seeking is crucial in the context of illness management and care. Various psychological factors impact this process of help-seeking. In this background, the present study explored illness perceptions, attitudes to help-seeking, work and social adjustment in addition to clinical correlates, in a sample of 63 treatment seeking individuals. METHODS: The study adopted a cross-sectional single group design. Participants were assessed on the Brief Illness Perception Questionnaire, Attitudes Toward Seeking Professional Psychological Help Scale, General Self-efficacy Scale, Internalized Stigma and Work and Social Adjustment Scale. RESULTS: Majority had illness duration of about 6 years and had delayed seeking treatment for about one and half years. Participants reported higher emotional reactions to illness, concerns regarding effectiveness of treatment and understanding and meaning about illness on the BIPQ. Illness perceptions were significantly correlated with work and social adjustment and attitudes toward seeking professional psychological help. General self- efficacy and internalized stigma emerged as predictors of overall work and social adjustment. CONCLUSIONS: The study has implications for interventions that need to target beliefs about illness in order to maximize help-seeking and reduce treatment gap.