Development and validation of "Knowledge on screening and identification of mental illness (KSIM) questionnaire" among primary care nurses in India.

BACKGROUND: As stated in the World Health Organization's Mental Health Report 2022, 13%, or almost a billion people, had a mental health issue, and 82% of these people resided in low- and middle-income countries with limited access to mental health treatments. Successful integration of mental health services into primary healthcare depends on primary healthcare providers receiving the proper training and information required to provide basic mental health care in the community. Primary care nurses generally lack the confidence and skills to handle mental health issues while being in an excellent position to screen, identify, refer, and follow-up on a person with mental illness (PMI). The study aimed to develop and validate the KSIM questionnaire to assess the knowledge of primary care nurses in screening, identifying, referral, and follow-up persons with mental health issues in the community. MATERIALS AND METHODS: The study was conducted based on a sequential exploratory design in two phases: the development and the validation phases. An extensive literature search was done, and the themes derived from the two focus group discussion (FGD) and three direct interviews, and the inputs from the mental health experts were used to design the KSIM questionnaire. A panel of 17 experts validated the KSIM questionnaire through item-level content validity index (I-CVI) and scale-level CVI (S-CVI) for content validation, and the reliability test was done using the intraclass correlation coefficient ICC test-retest method. RESULTS: The draft version-1 of the KSIM questionnaire showed high content validity of individual items (I-CVI range: 0.82-1.00) and high overall content validity (S-CVI = 0.95), and suggestions from the experts were incorporated. The KSIM questionnaire consists of 30 multiple choice questions and 10 case vignettes. The KSIM questionnaire has a very good test-retest reliability using the single measure two-way mixed absolute agreement ICC value 0.97 with 95% CI. CONCLUSIONS: Using an iterative approach, the development and validation of the KSIM questionnaire demonstrated high I-CVI and S-CVI with good ICC test-retest reliability to assess the knowledge of primary care nurses on screening and identification, referral and follow-up of a PMI in the community. Primary care nurses' knowledge on how to screen for and identify people with mental health issues in the primary care setting can be evaluated with the help of the KSIM questionnaire, and providing need-based training may help to reduce the time taken for people with mental illness to receive professional help.

Nutritional and Health-Promoting Effects of Lichens Used in Food Applications.

PURPOSE OF REVIEW: Lichens have a huge significance which is used in nutrition due to the bioactive components within. Lichen is a nutrient-dense resourceful diet nearly every day meal and has long been used as food; also, these valuable natural resources are now being utilized for a wide range of other purposes. The purpose of this review was to evaluate the nutritional and edible qualities of lichens as well as the possible health benefits of lichens. It is interesting to note that lichen is a nutrient-dense and functional food. It is a nutritional resource that can mitigate the effects of malnutrition to some amount. RECENT FINDINGS: There is an indication that an intake of lichens as natural foods was associated with nutritional and health-promoting properties. Lichens have proven to have theoretically rich nutritional value, and their extracts and active constituents have also been shown to have multiple health benefits. Low-fat content, high carbohydrate, and crude fibre content; plentiful mineral components; and good protein sources are all thought to contribute to lichen's nutritional value. There is a lot of potential for using lichens as an effective food source and ensuring people's food production.

Understanding microplastic pollution of marine ecosystem: a review.

Microplastics are emerging as prominent pollutants across the globe. Oceans are becoming major sinks for these pollutants, and their presence is widespread in coastal regions, oceanic surface waters, water column, and sediments. Studies have revealed that microplastics cause serious threats to the marine ecosystem as well as human beings. In the past few years, many research efforts have focused on studying different aspects relating to microplastic pollution of the oceans. This review summarizes sources, migration routes, and ill effects of marine microplastic pollution along with various conventional as well as advanced methods for microplastics analysis and control. However, various knowledge gaps in detection and analysis require attention in order to understand the sources and transport of microplastics, which is critical to deploying mitigation strategies at appropriate locations. Advanced removal methods and an integrated approach are necessary, including government policies and stringent regulations to control the release of plastics.

Structural Characteristics, Physicochemical Properties, and Digestibility Analysis of Resistant Starch Type-V Prepared from Debranched Corn Starch and Fatty Acid Complexation.

Corn starch was gelatinized and treated with a metagenomic type 1 pullulanase (PulM), increasing the proportion of linear glucan chains. The debranched corn starch (DCS), containing amylose helices, was subjected to complexation with fatty acid molecules at moderate temperatures (50-60 °C). The amylose-lipid complexes prepared using saturated fatty acids, e.g., capric acid (CA) and lauric acid (LA), displayed higher CI values as compared to that of unsaturated fatty acid compounds, e.g., undecylenic acids (UAs) and oleic acid (OA). The DCS-fatty acid complex was estimated to contain about 14% of rapidly digested starch (RDS), 26% of slowly digested starch (SDS), and 60% of resistant starch V (RS-5). RS-5 samples exhibited high resistance toward digestive enzymatic hydrolysis. The surface microdetails of RS-5 were examined by scanning electron microscopy (SEM), depicting small spherulite-like structural aggregates. X-ray diffraction pattern analysis estimated about 46% of the crystallinity of RS-5. Thermal attributes of RS-5 were examined by thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC) analysis, depicting the increase in melting enthalpies after the complexation of fatty acid molecules with debranched corn starch. Comparative DSC thermograms divulged a relatively higher stability of RS-5 as compared to that of RS-3. The findings advocated the potentiality of RS-5 (nondigestible DCS-LA complex) as a functional, valuable ingredient in the food industry.

Refractive error changes and associated asthenopia observed after COVID-19 infection: Case reports from two continents.

COVID-19 infection has been linked to various ocular complications and complaints, but not to refractive errors. In this case report, we present ethnically diverse patients who reported asthenopic symptoms shortly after recovering from COVID-19 infection. The hyperopic shift in the refractive error, post-COVID could indicate the ciliary body muscle's inability to sustain accommodation, resulting in asthenopia. Hence, refractive errors should also be considered as a post-COVID complication, even if the magnitude is small, especially when patients have a headache and other asthenopic symptoms. Performing dynamic retinoscopy and cycloplegic refraction will also aid in the better management of these patients.

Unraveling congenital ptosis with the aid of the pediatric perimeter device.

Background: Ocular morbidity with an early onset can have a significant impact on the long-term development of an individual. Hence, careful assessment of visual functions early on is very important. However, testing infants always poses a challenge. Standard tools to assess infants' visual acuity, ocular motility, and so on rely on the clinician's quick subjective judgments of an infant's looking behavior. Eye movements are usually observed from head rotations or spontaneous eye movements in infants. Judging eye movements in the presence of strabismus is even more challenging. Purpose: This video shows a 4-month-old infant's viewing behavior captured during a visual field screening study. The recorded video aided in the examination of this infant that was referred to a tertiary eye care clinic. The additional information captured through the perimeter testing is discussed. Synopsis: The Pediatric Perimeter device was developed to address visual field extent and gaze reaction time assessment in the pediatric population. As a part of a large-scale screening study, infants' visual fields were tested. During this screening, a 4-month-old infant presented with a ptosis in the left eye. The infant was consistently missing the light stimuli presented in the left upper quadrant in the binocular visual field testing. The infant was referred to a tertiary eye care center to a pediatric ophthalmologist for further examination. During clinical examination, the infant was suspected to either have congenital ptosis or monocular elevation deficit. But the diagnosis of the eye condition was unsure owing to the poor cooperation of the infant. With the aid of Pediatric Perimeter, the ocular motility was consistent with limitation of elevation in abduction, indicating a possible monocular elevation deficit with congenital ptosis. The infant was also noted to have Marcus Gunn jaw-winking phenomenon. The parents were assured and asked for a review in 3 months. In the subsequent follow-up, the Pediatric Perimeter testing was performed, and the recording showed a full extraocular motility in both eyes. Hence, the diagnosis was changed to only congenital ptosis. The probable explanation for missing the target in the left upper quadrant in the first visit is postulated further. The left upper quadrant is the superotemporal visual field of the left eye and the superonasal visual field of the right eye. As the left eye had ptosis, the superotemporal visual field could have been obstructed and hence the stimuli missed. The normative extent for the nasal and superior visual field is just about 30° for a 4-month-old infant. Hence, the right eye also perhaps missed the stimuli in its superonasal visual field extent. This video highlights the utility of the Pediatric Perimeter device in providing a magnified view of the infant's face along with greater visibility of ocular features from the infrared video imaging. This can potentially help the clinician to easily observe different ocular/facial abnormalities such as extraocular motility disorders, lid functions, and in identifying unequal pupil size, media opacities, and nystagmus. Highlights: The presence of congenital ptosis in younger infants might predispose as superior visual field defect and could also masquerade as a limitation in elevation. Video link: https://youtu.be/Lk8jSvS3thE.

A systematic review on endophytic fungi and its role in the commercial applications.

MAIN CONCLUSION: EF have been explored for its beneficial impact on environment and for its commercial applications. It has proved its worth in these sectors and showed an impact on biological properties of plants by producing various bioactive molecules and enzymes. Endophytes are plant mutualists that live asymptomatically within plant tissues and exist in almost every plant species. Endophytic fungi benefit from the host plant nutrition, and the host plant gains improved competitive abilities and tolerance against pathogens, herbivores, and various abiotic stresses. Endophytic fungi are one of the most inventive classes which produce secondary metabolites and play a crucial role in human health and other biotic aspects. This review is focused on systematic study on the biodiversity of endophytic fungi in plants, and their role in enhancing various properties of plants such as antimicrobial, antimycobacterial, antioxidant, cytotoxic, anticancer, and biological activity of secondary metabolites produced by various fungal endophytes in host plants reported from 1994 to 2021. This review emphasizes the endophytic fungal population shaped by host genotype, environment, and endophytic fungi genotype affecting host plant. The impact of endophytic fungi has been discussed in detail which influences the commercial properties of plants. Endophytes also have an influence on plant productivity by increasing parameters such as nutrient recycling and phytostimulation. Studies focusing on mechanisms that regulate attenuation of secondary metabolite production in EF would provide much needed impetus on ensuring continued production of bioactive molecules from a indubitable source. If this knowledge is further extensively explored regarding fungal endophytes in plants for production of potential phytochemicals, then it will help in exploring a keen area of interest for pharmacognosy.

Biocolorants in food: Sources, extraction, applications and future prospects.

Color of a food is one of the major factors influencing its acceptance by consumers. At presently synthetic dyes are the most commonly used food colorant in food industry by providing more esthetically appearance and as a means to quality control. However, the growing concern about health and environmental due to associated toxicity with synthetic food colorants has accelerated the global efforts to replace them with safer and healthy food colorants obtained from natural resources (plants, microorganisms, and animals). Further, many of these biocolorants not only provide myriad of colors to the food but also exert biological properties, thus they can be used as nutraceuticals in foods and beverages. In order to understand the importance of nature-derived pigments as food colorants, this review provides a thorough discussion on the natural origin of food colorants. Following this, different extraction methods for isolating biocolorants from plants and microbes were also discussed. Many of these biocolorants not only provide color, but also have many health promoting properties, for this reason their physicochemical and biological properties were also reviewed. Finally, current trends on the use of biocolorants in foods, and the challenges faced by the biocolorants in their effective utilization by food industry and possible solutions to these challenges were discussed.

Development of Iron fortified potato fries through Vacuum assisted processing strategies.

Potato fries, a relatively an untapped food matrix for fortification, was fortified with iron using vacuum impregnation technique and impact of this fortification on quality attributes (structure, color, texture, flavor, acrylamide, sensory characteristics) of the product was assessed. Further, to reduce the dietary restraints of consumers for fried fries, fat reduction was achieved using vacuum frying. Ferrous ammonium sulphate hexahydrate was used as a fortificant to yield 3.15 mg iron from 30 g fries (RACC for snacks- Recommended Amount Customarily Consumed). Effect of iron fortificant level, blanching, vacuum and restoration time (independent variable) were evaluated on responses (iron impregnation level and firmness) of fries using box-behnken design of response surface methodology. Results showed that blanching time was the most significant variable affecting iron impregnation followed by iron concentration and vacuum time. Ferrous ammonium sulphate hexahydrate was found to be the most appropriate fortificant since reflecting the least colour and sensory changes in fries. A fortified raw potato fries when fried under vacuum, provided better retention of colour and reduced fat absorption (by 17.72%) with comparable crispiness (0.37 kg/sec vs 0.35 kg/sec), firmness (0.39 kg/sec vs 0.38 kg/sec), color (ΔE = 1.39) and sensory score (7.9 vs 8.1 on 9-point scale) with control fries.

An acid-tolerant and cold-active ß-galactosidase potentially suitable to process milk and whey samples.

A novel ß-galactosidase gene (galM) was cloned from an aquatic habitat metagenome. The analysis of its translated sequence (GalM) revealed its phylogenetic closeness towards Verrucomicrobia sp. The sequence comparison and homology structure analysis designated it a member of GH42 family. The three-dimensional homology model of GalM depicted a typical (ß/α)8 TIM-barrel containing the catalytic core. The gene (galM) was expressed in a heterologous host, Escherichia coli, and the purified protein (GalM) was subjected to biochemical characterization. It displayed ß-galactosidase activity in a wide range of pH (2.0 to 9.0) and temperature (4 to 60 °C). The heat exposed protein showed considerable stability at 40 and 50 °C, with the half-life of about 100 h and 35 h, respectively. The presence of Na, Mg, K, Ca, and Mn metals was favorable to the catalytic efficiency of GalM, which is a desirable catalytic feature, as these metals exist in milk. It showed remarkable tolerance of glucose and galactose in the reaction. Furthermore, GalM discerned transglycosylation activity that is useful in galacto-oligosaccharides' production. These biochemical properties specify the suitability of this biocatalyst for milk and whey processing applications. KEY POINTS: • A novel ß-galactosidase gene was identified and characterized from an aquatic habitat. • It was active in extreme acidic to mild alkaline pH and at cold to moderate temperatures. • The ß-galactosidase was capable to hydrolyze lactose in milk and whey.

Bioactive Compounds from Cocoa Husk: Extraction, Analysis and Applications in Food Production Chain.

Cocoa husk is considered a waste product after cocoa processing and creates environmental issues. These waste products are rich in polyphenols, methylxanthine, dietary fibers, and phytosterols, which can be extracted and utilized in various food and health products. Cocoa beans represent only 32-34% of fruit weight. Various extraction methods were implemented for the preparation of extracts and/or the recovery of bioactive compounds. Besides conventional extraction methods, various studies have been conducted using advanced extraction methods, including microwave-assisted extraction (MAE), ultrasonic-assisted extraction (UAE), subcritical water extraction (SWE), supercritical fluid extraction (SFE), and pressurized liquid extraction (PLE). To include cocoa husk waste products or extracts in different food products, various functional foods such as bakery products, jam, chocolate, beverage, and sausage were prepared. This review mainly focused on the composition and functional characteristics of cocoa husk waste products and their utilization in different food products. Moreover, recommendations were made for the complete utilization of these waste products and their involvement in the circular economy.

Molecular dissemination of emerging antibiotic, biocide, and metal co-resistomes in the Himalayan hot springs.

Growing resistance among microbial communities against antimicrobial compounds, especially antibiotics, is a significant threat to living beings. With increasing antibiotic resistance in human pathogens, it is necessary to examine the habitats having community interests. In the present study, a metagenomic approach has been employed to understand the causes, dissemination, and effects of antibiotic, metal, and biocide resistomes on the microbial ecology of three hot springs, Borong, Lingdem, and Yumthang, located at different altitudes of the Sikkim Himalaya. The taxonomic assessment of these hot springs depicted the predominance of mesophilic organisms, mainly belonging to the phylum Proteobacteria. The enriched microbial metabolism assosiated with energy, cellular processes, adaptation to diverse environments, and defence were deciphered in the metagenomes. The genes representing resistance to semisynthetic antibiotics, e.g., aminoglycosides, fluoroquinolones, fosfomycin, vancomycin, trimethoprim, tetracycline, streptomycin, beta-lactams, multidrug resistance, and biocides such as triclosan, hydrogen peroxide, acriflavin, were abundantly present. Various genes attributing resistance to copper, arsenic, iron, and mercury in metal resistome were detected. Relative abundance, correlation, and genome mapping of metagenome-assembled genomes indicated the co-evolution of antibiotic and metal resistance in predicted novel species belonging to Vogesella, Thiobacillus, and Tepidimona genera. The metagenomic findings were further validated with isolation of microbial cultures, exhibiting resistance against antibiotics and heavy metals, from the hot spring water samples. The study furthers our understanding about the molecular basis of co-resistomes in the ceological niches and their possible impact on the environment.

Psychological distress and body image disturbances after modified radical mastectomy among breast cancer survivors: A cross-sectional study from a tertiary care centre in North India.

Background: Breast cancer (BC) diagnosis and treatment can affect women both physically and psychologically. Women with BC undergo various painful and debilitating therapies as well as emotional trauma. Additionally, treatment modalities can bring about multiple changes, causing distress and alteration in one's appearance. This study aimed to assess the psychological distress and body image disturbances after modified radical mastectomy (MRM) among BC survivors. Methods: A descriptive, cross-sectional study was conducted at a tertiary care centre in North India on 165 female survivors of BC who underwent MRM and attended outpatient follow-up. The median (interquartile range) age was 42 (36-51) years. Patients were evaluated using MINI 6·0·0 to assess for psychiatric comorbidities. The Depression Anxiety and Stress Scale (DASS-21) was used to measure psychological distress. Additionally, the ten-item Body Image Satisfaction (BIS-10) scale was used to evaluate body image disturbances. Findings: The rates of depression, anxiety, and stress were 27·8%, 31·5%, and 24·8%, respectively. Most patients (92%) experienced body image disturbances, and BC survivors who completed treatment within 12 months were more likely (p < 0·01) to have body image disturbances than women who had a long time since completion of treatment. Body image disturbances were not associated with age or psychological distress. Interpretation: Depression, anxiety, stress, and body image issues are common among BC survivors. Follow-up management plans for BC survivors should also include evaluation and treatment of psychological distress and addressing body image disturbances in patients undergoing mastectomy. Funding: Not applicable.

Prevalence and Psychobiological Correlates of Depression Among Breast Cancer Patients.

The diagnosis of breast cancer (BC) is associated with psychological stress. Various factors that contribute to psychological reactions are from the diagnosis of cancer to long uncertain treatment. A patient develops many fears in their mind starting after the diagnosis of cancer. Fear of cancer being an incurable disease, changes in body image, fear of death, separation from loved ones, and fear of pain all contribute to psychological disorders and most common disorders in cancer patients are mood, anxiety, depression, and sexual functional disorders. Research studies focus more on cancer. Only a few studies emphasized the coexistence of stress, depression, and the abilities of the individual to cope with such stressors. Depression is a comorbid illness to cancer, and if neglected, it may complicate the treatment of both illnesses, which will result in poor adherence to treatment and less desirable outcome of both the illnesses. Studies from this perspective can have meaningful implications, and can address both areas. Every clinician involved in the care of BC should also plan assessment of stress and depression and arrange medical treatment or coping interventions if symptoms are present. This review article aims to find the prevalence and psychobiological correlates of depressive disorder and its effect on mortality in women diagnosed with BC.

To compare the optimal cytoreduction rate in advanced epithelial ovarian cancer stage III/IV after 3 versus 6 cycles of neoadjuvant chemotherapy.

This study aimed to compare the impact of 3 versus 6 cycles of neoadjuvant chemotherapy (NACT) on the optimal cytoreduction in patients of advanced ovarian malignancy during interval debulking surgery (IDS). Thirty patients with advanced-stage IIIc/IV epithelial ovarian cancer, fallopian tube cancer, and primary peritoneal cancer were randomly allocated to receive 6 cycles in the late IDS group versus 3 cycles in early IDS before undergoing interval debulking surgery. A higher percentage of patients achieved optimal cytoreduction in the late IDS group compared to the early IDS group (60 versus 23%) which was statistically significant (p = .010). Giving 6 cycles of NACT before surgery increased the odd of optimal cytoreduction by 10 than giving 3 cycles of NACT which was statistically significant (p = 0.046) Thus, we conclude that administering 6 cycles of neoadjuvant chemotherapy before debulking surgery helps in achieving optimal cytoreduction in a higher number of patients with lesser surgical morbidity.IMPACT STATEMENTWhat is already known on the subject? Currently, there are no established criteria that would help to determine the number of chemotherapy cycles before debulking surgery in patients with advanced ovarian malignancy.What do the results of this study add? Administering 6 cycles of neoadjuvant chemotherapy before debulking surgery helps in achieving optimal cytoreduction in a higher number of patients with lesser surgical morbidity in cases of advanced epithelial ovarian cancer.What are the implications of these findings for clinical practice and/or further research? We conclude that late interval debulking may be used as a treatment option in the advanced stage IIIc/stage IV. However, the findings need to be studied in a larger study group with a longer follow up period.

Validation of visual acuity applications for teleophthalmology during COVID-19.

PURPOSE: The objective of this study was to identify and validate smartphone-based visual acuity (VA) apps that can be used in a teleophthalmology portal. METHODS: The study was conducted in three phases: A survey to investigate if the SmartOptometry App was easy to download, understand and test (phase I), an in-clinic comparison of VA measured in a random testing order with four tools namely COMPlog, Reduced Snellen near vision, Peek Acuity (Distance VA) and SmartOptometry (Near VA) (phase II) and a repeatability study on these 4 tools by measuring VA again (phase III). The study recruited the employees of our institute and adhered to the strict COVID-19 protocols of testing. RESULTS: Phase I Survey (n = 40) showed 90% of participants used android phones, 60% reported that instructions were clear, and all users were able to self-assess their near VA with SmartOptometry App. Phase II (n = 68) revealed that Peek Acuity was comparable to COMPlog VA (P = 0.31), however SmartOptometry was statistically significantly different (within 2 log MAR lines) from Reduced Snellen near vision test, particularly for young (n = 44, P = 0.004) and emmetropic (n = 16, P = 0.04) participants. All the 4 tests were found to be repeatable in phase III (n = 10) with a coefficient of repeatability ≤0.14. CONCLUSION: Smartphone-based apps were easy to download and can be used for checking patient's distance and near visual acuity. An effect of age and refractive error should be considered when interpreting the results. Further studies with real-time patients are required to identify potential benefits and challenges to solve.

Relationship between histologic chorioamnionitis and genital tract cultures in pre term labour.

The objective was to determine the relationship of histological chorioamnionitis (HCA) with genital tract cultures in preterm birth. Among two hundred women recruited for the study, 100 were taken as cases with gestational age between ≥28 and <37 weeks and 100 women with gestational age >37 weeks were taken as controls. Vaginal swabs were taken for culture sensitivity and vaginal smears were made for performing whiff test and heat dry gram stained smear was examined for growth of microorganisms. Histopathologic examination of the placenta was done after delivery. 49 cases and 26 controls had evidence of histological chorioamnionitis. A significant difference was observed in relation to the presence of E. coli, presence of clue cells, positive whiff test and occurrence of bacterial vaginosis in subjects with and without histological chorioamnionitis. Thus, we conclude that the presence of histological chorioamnionitis is closely related to the presence of pathogenic microorganisms in the cervicovaginal region.IMPACT STATEMENTWhat is already known on the subject? Histologic chorioamnionitis has been regarded to reflect amniotic fluid infection and there are studies showing an association between histologic chorioamnionitis, amniotic fluid, and subchorionic plate cultures. Nevertheless, studies of the correlation of the cervical swab cultures with intrauterine infection in preterm birth remain inconclusive.What do the results of this study add? Histologic chorioamnionitis is closely related to the presence of pathogenic microorganisms in the cervicovaginal region.What are the implications of these findings for clinical practice and/or further research? High vaginal swab cultures and gram staining of vaginal smear is useful in detecting antenatal patients who are at a higher risk for preterm labour. After detection, early intervention may be done to avoid preterm deliveries in these high-risk pregnancies.