Psychiatric presentation in undiagnosed intracranial space-occupying lesions: A case series.

Intracranial space-occupying lesions (SOLs) account for about 5-10 deaths per 100,000 in India. They present with physical symptoms such as headache, nausea, vomiting, and weakness; neurological symptoms such as seizures, and focal neurological deficit; and behavioral changes manifesting as depression (15-20%), anxiety (30-50%), psychosis (<5%), and personality changes (16-76%). Therefore, it is necessary to do an appropriate general, neurological, and behavioral examination for proper diagnosis and management. A series of four cases who reported to psychiatric outpatient with behavioural complaints and no focal neurological deficits were reported. The most common presentation of SOLs is seizure, headache, vomiting, and loss of consciousness. Along with this complaint, some patients may present with abnormal behavior. However, it is very rare for a SOL to present solely with psychiatric or behavioral complaints. Therefore, it becomes imperative to keep a close watch on the symptoms and send for timely investigations.

Antisuicidal efficacy of ketamine infusion in suicidal patients of depressive disorder.

BACKGROUND: The efficacy of ketamine in the rapid alleviation of depressive and suicidal symptoms has been observed over the past few years around the globe. Exploration of rapid antisuicidal efficacy of ketamine in Indian subpopulation can be a good preventive pharmacological option for unprecedented rise in suicides in India. AIM: To assess efficacy of ketamine infusions on suicidal patients of depressive disorder. Severity of depression and suicidality were quantified daily over 1 week. MATERIALS AND METHODS: This was a randomized control study, comprised sixty patients of age group 18-60 years, with a diagnosis of depressive episode, having the Modified Scale for Suicidal Ideations (MSSI) score >20 with exclusion of severe medical or surgical illness, pregnancy, and breast-feeding females. Patient were assigned to ketamine and normal saline group. Three infusions were given over 1 week on day 0, day 2, and day 4. Assessments were made at baseline using the 17-item Hamilton Depression Rating Scale (HAM-D17) and MSSI, for depression and suicidality, respectively. Assessments were repeated at 6 h after first infusion and then every day for 1 week. RESULTS: There were significant reductions in HAM-D17 score and MSSI score within 6 h of the first dose in the ketamine group as compared to the normal saline group. Significant sustained improvement was seen on further days till 1 week in the ketamine group as compared to the normal saline group. CONCLUSION: Ketamine might be a reasonable choice to fulfil the efficacy gap created by the delayed antisuicidal onset of standard treatments.

Construction of a Chaotic Map-Based Authentication Protocol for TMIS.

Upgraded network technology presents an advanced technological platform for telecare medicine information systems (TMIS) for patients. However, TMIS generally suffers various attacks since the information being shared through the insecure channel. Recently, many authentication techniques have been proposed relying on the chaotic map. However, many of these designs are not secure against the known attacks. In spite of the fact that some of the constructions attain low computation overhead, they cannot establish an anonymous communication and many of them fail to ensure forward secrecy. In this work, our aim is to present authentication and key agreement protocol for TMIS utilizing a chaotic map to achieve both security and efficiency. The underlying security assumptions are chaotic theory assumptions. This scheme supports forward secrecy and a secure session is established with just two messages of exchange. Moreover, we present a comparative analysis of related authentication techniques.

Atropine eye-drop-induced acute delirium: a case report.

Atropine is an anticholinergic drug which is used in both parental and topical routes. Topical eye-drops of atropine sulfate are used as mydriatic and cycloplegics. Parental atropine-induced delirium is well known but topical atropine eye-drop-induced delirium cases are very limited in literature. In this case report, an elderly man underwent cataract surgery and developed delirium after the use of 1% atropine sulfate eye-drops as prescribed. This case supports the notion that even atropine eye-drops can cause delirium in patients at therapeutic doses in elderly.

Efficient and Secure Attribute Based Access Control Architecture for Smart Healthcare.

The smart health medical system is expected to enhance the quality of health care services significantly. These system keeps patients related record and provides the services over the insecure public channel which may cause data security and privacy concerns in a smart health system. On the other hand, ciphertext attribute-based encryption(CP-ABE) provides possible encrypted data security. There are some security flaws in CP-ABE, where the existing access policies are in the cleartext form for accessing encrypted sensitive data. On the other hand, it supports the small attribute universe, which restricts the practical deployments of CP-ABE. Moreover, outsider adversary observed the communication, which also creates a serious threat to CP-ABE model. To overcome security and privacy risk, efficient access control have been designed and devolved for medical services. Although we also demonstrate the security analysis of Zhang et al.'s scheme, which is vulnerable to inefficient security proof and man in the middle attack. In the proposed scheme, we proposed an efficient and security preserve scheme to overcome the weaknesses of Zhang's et al.'s system. The protocol satisfies the attribute values of the medical user with hidden access policies. It has been proved under the standard model, which ensure the security of the protocol. Moreover, performance analysis comparison shows that the proposed scheme is more efficient than the existing one.

Construction of RSA-Based Authentication Scheme in Authorized Access to Healthcare Services : Authorized Access to Healthcare Services.

Modern network technology yields new interface for telecare medicine information systems in short TMIS used for patient's healthcare. This system is used to provide healthcare services to patients at their home. It can be observed, telecare medicine information systems generally suffer several attacks as information being transmitted over a public network. Therefore, various authentication and key agreement schemes are proposed for TMIS to ensure secure and authorized patients communication over given public network. However, most of the schemes fail to achieve essential attributes discussed in this article. Although the key attributes of security and efficiency should be achieved in a common framework. This paper proposes construction of an RSA based authentication scheme for authorized access to healthcare services and achieves desirable key attributes of authentication protocols. Proof of security against polynomial time adversary is given in the random oracle to justify the security of proposed scheme. Communication analysis and computation analysis of proposed scheme indicates that proposed scheme's performance is comparable and having better security.

Acute onset clozapine-induced hyperglycaemia: A case report.

Clozapine is an atypical antipsychotic which is described to have higher efficacy among all available antipsychotic medications. Clozapine is reserved especially for resistant schizophrenia due to its side effects. Clozapine-induced metabolic syndrome and hyperglycaemia are common long-term side effects and are responsible for increased mortality in patients with schizophrenia. In this case, a patient with resistant schizophrenia was presented with acute-onset hyperglycaemia and delirium with the use of clozapine within a week. Withdrawal of clozapine in the patient led to the improvement in delirium and hyperglycaemia without the use of any hypoglycaemic agent. This case supports the notion that in certain cases clozapine can induce hyperglycemia through possible direct pathophysiological mechanisms within a shorter time frame.

C-reactive protein level in late-onset depression: A case-control study.

BACKGROUND: Late-onset depression (LOD) is less responsive to standard antidepressant medication compared to early-onset depressive disorder. A group of early-onset depressive episode is less responsive to antidepressant medication, and immune dysregulation is critically involved in it. LOD has been associated with increased vascular risk factor and atherosclerosis and immune dysregulation is critically involved in vascular disease. We hypothesized that increased inflammatory activity may be associated with late-onset depressive disorders. AIM: The aim of this study is to study the C-reactive protein (CRP) levels in LOD compared with age-matched controls and association between CRP levels and severity of depressive episode. SETTINGS AND DESIGN: This was a case-control study at tertiary care psychiatry department. MATERIALS AND METHODS: Depressed patients (as per International Classification of Disease 10 Diagnostic and Research Criteria) of age >55 years were recruited and age-matched control participant were recruited after informed consent. A complete clinical assessment, assessment of vascular risk factors, blood sample for the evaluation of serum CRP was obtained, and baseline depression severity was measured on Hamilton Depression Rating Scale (HDRS). STATISTICAL ANALYSIS: The quantitative and qualitative variables were described as means, standard deviation, and P value. The student's t-test for parametric data and the mann-whitney test for nonparametric data spearman correlation coefficient method were used. RESULTS: The mean age of cases (n = 25) was 64.7 ± 5.8 years, and mean age of controls (n = 25) was 64.2 ± 3.7 years. Patients with current depressive disorders had 40% times higher levels of CRP than control. Baseline HDRS of cases was 18 ± 3. CRP level and depression severity shows strong positive (r = 0.935, P = <0.001) correlation between CRP level and depression severity. CONCLUSION: LOD was associated with higher level of CRP compared to age-matched nondepressed patients. Raised CRP was associated with severity of depressive episode of LOD.

CADASIL syndrome (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) presenting as psychosis.

Cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL) is the most common monogenic form of cerebral small-vessel disease characterised by recurrent strokes. Behavioural disturbance also presents in a significant proportion of subjects as neurotic spectrum disorders and psychotic features are rarely reported. In this case report, we highlight a 32-year-old man with CADASIL syndrome, who had overt psychotic symptoms with neurological signs later on.

A Mutual Authentication Framework for Wireless Medical Sensor Networks.

Wireless medical sensor networks (WMSN) comprise of distributed sensors, which can sense human physiological signs and monitor the health condition of the patient. It is observed that providing privacy to the patient's data is an important issue and can be challenging. The information passing is done via the public channel in WMSN. Thus, the patient, sensitive information can be obtained by eavesdropping or by unauthorized use of handheld devices which the health professionals use in monitoring the patient. Therefore, there is an essential need of restricting the unauthorized access to the patient's medical information. Hence, the efficient authentication scheme for the healthcare applications is needed to preserve the privacy of the patients' vital signs. To ensure secure and authorized communication in WMSN, we design a symmetric key based authentication protocol for WMSN environment. The proposed protocol uses only computationally efficient operations to achieve lightweight attribute. We analyze the security of the proposed protocol. We use a formal security proof algorithm to show the scheme security against known attacks. We also use the Automated Validation of Internet Security Protocols and Applications (AVISPA) simulator to show protocol secure against man-in-the-middle attack and replay attack. Additionally, we adopt an informal analysis to discuss the key attributes of the proposed scheme. From the formal proof of security, we can see that an attacker has a negligible probability of breaking the protocol security. AVISPA simulator also demonstrates the proposed scheme security against active attacks, namely, man-in-the-middle attack and replay attack. Additionally, through the comparison of computational efficiency and security attributes with several recent results, proposed scheme seems to be battered.

Understanding security failures of two authentication and key agreement schemes for telecare medicine information systems.

Smart card based authentication and key agreement schemes for telecare medicine information systems (TMIS) enable doctors, nurses, patients and health visitors to use smart cards for secure login to medical information systems. In recent years, several authentication and key agreement schemes have been proposed to present secure and efficient solution for TMIS. Most of the existing authentication schemes for TMIS have either higher computation overhead or are vulnerable to attacks. To reduce the computational overhead and enhance the security, Lee recently proposed an authentication and key agreement scheme using chaotic maps for TMIS. Xu et al. also proposed a password based authentication and key agreement scheme for TMIS using elliptic curve cryptography. Both the schemes provide better efficiency from the conventional public key cryptography based schemes. These schemes are important as they present an efficient solution for TMIS. We analyze the security of both Lee's scheme and Xu et al.'s schemes. Unfortunately, we identify that both the schemes are vulnerable to denial of service attack. To understand the security failures of these cryptographic schemes which are the key of patching existing schemes and designing future schemes, we demonstrate the security loopholes of Lee's scheme and Xu et al.'s scheme in this paper.

On the security flaws in ID-based password authentication schemes for telecare medical information systems.

Telecare medical information systems (TMIS) enable healthcare delivery services. However, access of these services via public channel raises security and privacy issues. In recent years, several smart card based authentication schemes have been introduced to ensure secure and authorized communication between remote entities over the public channel for the (TMIS). We analyze the security of some of the recently proposed authentication schemes of Lin, Xie et al., Cao and Zhai, and Wu and Xu's for TMIS. Unfortunately, we identify that these schemes failed to satisfy desirable security attributes. In this article we briefly discuss four dynamic ID-based authentication schemes and demonstrate their failure to satisfy desirable security attributes. The study is aimed to demonstrate how inefficient password change phase can lead to denial of server scenario for an authorized user, and how an inefficient login phase causes the communication and computational overhead and decrease the performance of the system. Moreover, we show the vulnerability of Cao and Zhai's scheme to known session specific temporary information attack, vulnerability of Wu and Xu's scheme to off-line password guessing attack, and vulnerability of Xie et al.'s scheme to untraceable on-line password guessing attack.

A secure and efficient chaotic map-based authenticated key agreement scheme for telecare medicine information systems.

Advancement in network technology provides new ways to utilize telecare medicine information systems (TMIS) for patient care. Although TMIS usually faces various attacks as the services are provided over the public network. Recently, Jiang et al. proposed a chaotic map-based remote user authentication scheme for TMIS. Their scheme has the merits of low cost and session key agreement using Chaos theory. It enhances the security of the system by resisting various attacks. In this paper, we analyze the security of Jiang et al.'s scheme and demonstrate that their scheme is vulnerable to denial of service attack. Moreover, we demonstrate flaws in password change phase of their scheme. Further, our aim is to propose a new chaos map-based anonymous user authentication scheme for TMIS to overcome the weaknesses of Jiang et al.'s scheme, while also retaining the original merits of their scheme. We also show that our scheme is secure against various known attacks including the attacks found in Jiang et al.'s scheme. The proposed scheme is comparable in terms of the communication and computational overheads with Jiang et al.'s scheme and other related existing schemes. Moreover, we demonstrate the validity of the proposed scheme through the BAN (Burrows, Abadi, and Needham) logic.

Cryptanalysis and improvement of Yan et al.'s biometric-based authentication scheme for telecare medicine information systems.

Remote user authentication is desirable for a Telecare Medicine Information System (TMIS) for the safety, security and integrity of transmitted data over the public channel. In 2013, Tan presented a biometric based remote user authentication scheme and claimed that his scheme is secure. Recently, Yan et al. demonstrated some drawbacks in Tan's scheme and proposed an improved scheme to erase the drawbacks of Tan's scheme. We analyze Yan et al.'s scheme and identify that their scheme is vulnerable to off-line password guessing attack, and does not protect anonymity. Moreover, in their scheme, login and password change phases are inefficient to identify the correctness of input where inefficiency in password change phase can cause denial of service attack. Further, we design an improved scheme for TMIS with the aim to eliminate the drawbacks of Yan et al.'s scheme.

Security enhancement of a biometric based authentication scheme for telecare medicine information systems with nonce.

Telecare medicine information systems (TMIS) present the platform to deliver clinical service door to door. The technological advances in mobile computing are enhancing the quality of healthcare and a user can access these services using its mobile device. However, user and Telecare system communicate via public channels in these online services which increase the security risk. Therefore, it is required to ensure that only authorized user is accessing the system and user is interacting with the correct system. The mutual authentication provides the way to achieve this. Although existing schemes are either vulnerable to attacks or they have higher computational cost while an scalable authentication scheme for mobile devices should be secure and efficient. Recently, Awasthi and Srivastava presented a biometric based authentication scheme for TMIS with nonce. Their scheme only requires the computation of the hash and XOR functions.pagebreak Thus, this scheme fits for TMIS. However, we observe that Awasthi and Srivastava's scheme does not achieve efficient password change phase. Moreover, their scheme does not resist off-line password guessing attack. Further, we propose an improvement of Awasthi and Srivastava's scheme with the aim to remove the drawbacks of their scheme.