A Rapid Review of the Effects of the COVID-19 Vaccine Among Individuals Taking Clozapine.

BACKGROUND: The COVID-19 pandemic prompted the rapid development of vaccines to combat the virus. Several COVID-19 vaccines have proven effective in preventing infection, hospitalization, and death. Vaccination has been especially recommended for vulnerable populations, such as individuals with psychiatric illnesses who face increased risks due to comorbidities and socioeconomic factors. This rapid review identifies and analyzes the effects of COVID-19 vaccines among individuals taking clozapine. METHODS: The review included articles from PubMed, OVID, Clinical Key, Web of Science, and Google Scholar, published between September 2020 and December 2023. Inclusion criteria were peer-reviewed journals, English language, patients on clozapine receiving a COVID-19 vaccine, and documented vaccine-related adverse effects. RESULTS: Twelve articles were included, consisting of 8 case reports, 1 cross-sectional study, and 3 prospective observational studies, involving 298 subjects, with 9 subjects from case reports. After the first vaccine dose, 27 of 248 subjects experienced adverse effects, with 1 case report advising a temporary halt and dose reduction of clozapine. The subject in this case was admitted in a delirious state 4 days after vaccination with repeated falls and urinary incontinence; active infectious and neurologic etiologies were ruled out. Second dose data were available for 261 subjects, with 31 reporting adverse effects. Adverse effects included hematological changes, delirious state, seizures, and fever. CONCLUSIONS: The review suggests that individuals on clozapine receiving COVID-19 vaccines may experience adverse effects. Clozapine levels and immune system interactions should be monitored in these cases.

Enhancing Immunological Memory: Unveiling Booster Doses to Bolster Vaccine Efficacy Against Evolving SARS-CoV-2 Mutant Variants.

A growing number of re-infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in previously immunized individuals has sparked discussions about the potential need for a booster vaccine dosage to counteract declining antibody levels and new strains. The protective immunity produced by vaccinations, and past illnesses relies on immunological memory. CD4 + T cells, CD8 + T cells, B cells, and long-lasting antibody responses are all components of the adaptive immune system that can generate and maintain this immunological memory. Since novel mutant variants have emerged one after the other, the world has been hit by repeated waves. Various vaccine formulations against SARS-CoV-2 have been administered across the globe. Thus, estimating the efficacy of those vaccines against gradually developed mutant stains is the essential parameter regarding the fate of those vaccine formulations and the necessity of booster doses and their frequency. In this review, focus has also been given to how vaccination stacks up against moderate and severe acute infections in terms of the longevity of the immune cells, neutralizing antibody responses, etc. However, hybrid immunity shows a greater accuracy of re-infection of variants of concern (VOCs) of SARS-CoV-2 than infection and immunization. The review conveys knowledge of detailed information about several marketed vaccines and the status of their efficacy against specific mutant strains of SARS-CoV-2. Furthermore, this review discusses the status of immunological memory after infection, mixed infection, and vaccination.

Internal drainage of retropharyngeal abscess secondary to esophageal foreign bodies: a case series.

INTRODUCTION AND OBJECTIVES: Foreign body oesophagus is a commonly seen emergency in ENT. It is seen both in children and adults. When sharp bony foreign bodies such as chicken, fish, and mutton bone gets impacted in the oesophagus, it predisposes the patient to various complications. The foreign body can migrate extraluminally with time and cause retropharyngeal abscess. MATERIALS AND METHODS: Retrospective study over a period of 6 months from November 2019 to April 2020 of patients with foreign body oesophagus. We came across 20 patients with oesophageal foreign bodies and five of them had associated retropharyngeal abscess. Rigid esophagoscopy with foreign body removal and internal drainage of pus through the oesophageal rent followed by conservative management with intravenous antibiotics based on culture and sensitivity was done. RESULTS: Patients improved drastically as the pus drained into the oesophagus via the rent in the posterior oesophageal wall and did not require an external incision and drainage. They were discharged in a week. CONCLUSION: Removal of partial extraluminally migrated foreign body oesophagus and internal drainage of the abscess followed by nasogastric feeds till the rent resolves and intravenous pus culture-sensitive antibiotics fastens patient recovery and reduces the morbidity associated with external incision and drainage and oesophageal rent repair.

Beat the stress: breeding for climate resilience in maize for the tropical rainfed environments.

KEY MESSAGE: Intensive public sector breeding efforts and public-private partnerships have led to the increase in genetic gains, and deployment of elite climate-resilient maize cultivars for the stress-prone environments in the tropics. Maize (Zea mays L.) plays a critical role in ensuring food and nutritional security, and livelihoods of millions of resource-constrained smallholders. However, maize yields in the tropical rainfed environments are now increasingly vulnerable to various climate-induced stresses, especially drought, heat, waterlogging, salinity, cold, diseases, and insect pests, which often come in combinations to severely impact maize crops. The International Maize and Wheat Improvement Center (CIMMYT), in partnership with several public and private sector institutions, has been intensively engaged over the last four decades in breeding elite tropical maize germplasm with tolerance to key abiotic and biotic stresses, using an extensive managed stress screening network and on-farm testing system. This has led to the successful development and deployment of an array of elite stress-tolerant maize cultivars across sub-Saharan Africa, Asia, and Latin America. Further increasing genetic gains in the tropical maize breeding programs demands judicious integration of doubled haploidy, high-throughput and precise phenotyping, genomics-assisted breeding, breeding data management, and more effective decision support tools. Multi-institutional efforts, especially public-private alliances, are key to ensure that the improved maize varieties effectively reach the climate-vulnerable farming communities in the tropics, including accelerated replacement of old/obsolete varieties.

Delirium on clozapine: A tale of friend turned foe-A case report.

Treatment resistant schizophrenia (TRS) is often encountered in clinical practice. Clozapine remains the drug of choice in the management of TRS. Several studies have shown that clozapine is the most effective antipsychotic medication to date for TRS. But it is also well known that it has multiple side effects. Some side effects are transient and relatively benign, while other adverse effects are menacing, serious and life-threatening. Delirium may occur with clozapine and is a therapeutic challenge as there is always a risk of precipitating delirium on clozapine rechallenge. Limited management strategies are available as alternatives for the management of psychiatric illness stabilized on clozapine. In this case report, we describe an older adult patient who developed delirium on clozapine. The aims of this case report are to discuss the mechanism by which clozapine leads to delirium, revisit various factors which could possibly lead to delirium, and discuss the different management strategies available for management of psychiatric illness for a patient previously stabilized on clozapine.

Choreoathetoid movements associated with methamphetamine: A case report and review of literature.

BACKGROUND AND OBJECTIVES: Physicians and psychiatrists often encounter patients in the emergency department presenting after methamphetamine use. While physical and psychiatric manifestations associated with methamphetamine use are well known, movement disorders are relatively less common. The aim of this case report is to add to existing literature awareness about the possibility of movement disorders occurring after methamphetamine use, discuss the possible mechanism by which such use leads to dyskinesia, and describe possible management strategies. METHODS AND RESULTS: In this case report, we describe choreoathetoid movements occurring in a young female after relatively short-term methamphetamine use. DISCUSSION AND CONCLUSIONS: Evidence for treatment of methamphetamine induced choreoathetosis is limited. Expectant management of such symptoms is a viable option if there are no additional comorbidities that require therapy. SCIENTIFIC SIGNIFICANCE: Clinicians should be alert to the possibility of movement disorders in methamphetamine users and familiar with treatment options. (Am J Addict 2018;XX:1-4).

Reducing the number of unnecessary routine laboratory tests through education of internal medicine residents.

INTRODUCTION: The Choosing Wisely guidelines advise against ordering routine blood tests for hospitalised patients unless they change management. Unnecessary testing can lead to adverse effects (eg, iatrogenic anaemia, poor sleep quality, risk for infections and increased cost of care). METHODS: An 8-week quality initiative aimed at reducing unnecessary blood tests was implemented in three internal medicine resident inpatient services. The initiative included a 30 min educational session, reminders prior to rotation and midrotation and posters in work areas that displayed lab pricing and urged judicious testing. Residents were encouraged to justify the purpose of ordering tests in their daily progress notes. Attending physicians were made aware of the initiative. Preintervention and postintervention time points were used to compare key metrics. A >10% decrease between time periods was used as an evaluation criterion. RESULTS: There were 293 patient records reviewed in the preintervention period and 419 in the postintervention period. The two groups were similar in terms of age and gender. Median blood test count (complete blood count/basic metabolic profile/comprehensive metabolic profile) decreased from 4 to 2 tests per patient per day (50 % decrease) after the intervention. The median length of hospital stay decreased from 4.9 to 3.9 days (21% decrease). A decreased percentage of people requiring transfusions was also noted (2016: 6.1%, 2017: 2.9%). CONCLUSION: The frequency of unnecessary routine blood tests ordered in the hospital can be decreased by educating resident physicians, making them cost conscious and aware of the indications for ordering routine labs. Frequent reminders are needed to sustain the educational benefit.

Carrier Localization in GaN/AlN Quantum Dots As Revealed by Three-Dimensional Multimicroscopy.

The localization of carrier states in GaN/AlN self-assembled quantum dots (QDs) is studied by correlative multimicroscopy relying on microphotoluminescence, electron tomography, and atom probe tomography (APT). Optically active field emission tip specimens were prepared by focused ion beam from an epitaxial film containing a stack of quantum dot layers and analyzed with different techniques applied subsequently on the same tip. The transition energies of single QDs were calculated in the framework of a 6-bands k.p model on the basis of APT and scanning transmission electron microscopy characterization showing that a good agreement between experimental and calculated energies can be obtained, overcoming the limitations of both techniques. The results indicate that holes effectively localize at interface fluctuations at the bottom of the QD, decreasing the extent of the wave function and the band-to-band transition energy. They also represent an important step toward the correlation of the three-dimensional atomic scale structural information with the optical properties of single light emitters based on quantum confinement.

Hydrogeochemical controls on mobilization of arsenic and associated health risk in Nagaon district of the central Brahmaputra Plain, India.

In recent years, elevated concentration of arsenic (As) in groundwater in the northeastern states of India has become a major cause of concern. Since many regions of the Brahmaputra plains are reported with groundwater As contamination, an attempt was made to study the As contamination and factors governing its release in the Nagaon district in Brahmaputra floodplain, based on various water types, relation of As with other major ions and with various depth profiles. The origin of groundwater mineralization and the processes responsible for As enrichment in groundwater was determined by calculating saturation index using PHREEQC code. Multivariate statistical analysis was carried out for identification of As-releasing mechanism based on rock-water interaction. Principle component analysis of physicochemical parameters revealed the association of As with SiO2 and Cl- in pre-monsoon and the fact that alkaline condition favors release of As. The relation between As and Fe shows that reductive dissolution of solid Fe oxide and hydroxide phases could be the source of As in Nagaon district. The result of hierarchical cluster analysis indicates that As release could also be associated with the agrochemicals application. Health risk assessment revealed that children are more susceptible to carcinogenic as well as non-carcinogenic health impact with consumption of As-contaminated drinking water. The male population is more susceptible to cancer as compared to females as the average water consumption is higher in case of male. Overall, the study highlights the health risk assessment is a matter of chief concern in this study as the younger generation are at higher risk.

Comparative study of photoluminescence from In0.3Ga0.7As/GaAs surface and buried quantum dots.

The optical properties of In0.3Ga0.7As/GaAs surface quantum dots (SQDs) and buried QDs (BQDs) are investigated by photoluminescence (PL) measurements. The integrated PL intensity, linewidth, and lifetime of SQDs are significantly different from the BQDs both at room temperature and at low temperature. The differences in PL response, measured at both steady state and in transient, are attributed to carrier transfer between the surface states and the SQDs.

Water-hydroxide trapping in cobalt tungstate for proton exchange membrane water electrolysis.

The oxygen evolution reaction is the bottleneck to energy-efficient water-based electrolysis for the production of hydrogen and other solar fuels. In proton exchange membrane water electrolysis (PEMWE), precious metals have generally been necessary for the stable catalysis of this reaction. In this work, we report that delamination of cobalt tungstate enables high activity and durability through the stabilization of oxide and water-hydroxide networks of the lattice defects in acid. The resulting catalysts achieve lower overpotentials, a current density of 1.8 amperes per square centimeter at 2 volts, and stable operation up to 1 ampere per square centimeter in a PEMWE system at industrial conditions (80°C) at 1.77 volts; a threefold improvement in activity; and stable operation at 1 ampere per square centimeter over the course of 600 hours.

A Virtual Inpatient Psychiatry Unit in a Multicampus Health Care System During the COVID-19 Pandemic.

A virtual, telehealth-based inpatient psychiatric unit was implemented in a multicampus health care system to care for patients involuntarily admitted under emergency hold laws who tested positive for COVID-19. Through a multidisciplinary approach, these patients received proper general medical and psychiatric treatments. This column describes the development and operationalization of the unit in terms of team structure, patient referral and admission, patient and staff safety, general medical and psychiatric treatments, and discharge planning. The results of this virtual approach to caring for patients with both COVID-19 and acute mental illness illustrate the potential of a multidimensional approach for improving care efficiency during public health emergencies.

Renal Crisis as the Initial Manifestation of Scleroderma.

We report the case of a young Hispanic woman who was originally admitted to the emergency department following hypertensive urgency and right-sided blurry vision. The patient did not carry a diagnosis of scleroderma at the time of the visit. However, upon further evaluation, the patient was found to have a scleroderma renal crisis. An angiotensin-converting enzyme (ACE) inhibitor was initiated promptly with subsequent normalization of the blood pressure and creatinine level. Scleroderma renal crisis is a rare, highly feared complication of scleroderma that if left untreated can be life-threatening. Therefore, it is important to identify this condition early and initiate therapy without delay.

Paediatric submental epidermoid cyst.

A young girl presented with an insidious onset, gradually increasing midline submental swelling of 1-year duration and pain on swallowing for 6 months. Ultrasonography of the neck suggested a hypoechoic cystic swelling of the submental region between the muscles of the floor of the mouth, with no increased vascularity. An extraoral surgical enucleation was done and a postoperative biopsy suggested an epidermoid cyst. Epidermoid cysts of the submental region are extremely rare and any midline head and neck lesion in children requires critical examination and evaluation to avoid complications. Here, we present a rare case of a paediatric submental epidermoid cyst and its clinical features and management.

Isotopic and hydrogeochemical tracking of dissolved nutrient dynamics in the Brahmaputra River System: A source delineation perspective.

The Brahmaputra river system (BRS) produces the largest discharge in India, supplying water to more than 62 million inhabitants. The present study aims to quantify the environmental elements that affect the spatio-temporal variation of nutrients in the Brahmaputra river system (BRS). The association of physico-chemical characteristics of floodplain sediments with the distribution pattern of P during wet and dry periods in different depths were also studied. The seasonal variation suggest that the average dissolved inorganic nitrogen and dissolve inorganic phosphorus are found higher in monsoon while the average dissolve silica were higher in post-monsoon. The spatial variation of dissolve inorganic phosphate and nitrate concentration suggests both the nutrient are higher in upstream sites. The DiS concentrations tended to be higher in downstream. In 70% of the sampled tributaries, the average molar ratio for dissolved inorganic nitrogen/dissolved inorganic phosphorous (DIN/DIP) was greater than 16:1, which indicates phosphate limited biological productivity. In contrast, an average molar ratio of dissolved inorganic silica/DIN (DSi/DIN) of 3.8 ± 3.0 favoured diatom growth in those tributaries where DSi/DIN molar ratio was lower than 1, indicating eutrophication. The BRS transported 24.7, 5.93, and 312 × 104 tons/year-1 of DIN, PO4-P and SiO2-Si, respectively. The depth-wise variation of P-fraction during monsoon suggests that the authigenic phosphorus was most abundant followed by Fe-bound, exchangeable, detrital and organic. In the post-monsoon, Fe-bound P was found at a higher concentration followed by authigenic phosphorus. High nutrient concentrations with more δ18O depleted water implied precipitation being the major source of nutrients in the BRS.

Surgical & medical management of ROCM (Rhino-orbito-cerebral mucormycosis) epidemic in COVID-19 era and its outcomes - a tertiary care center experience.

OBJECTIVE: To evaluate the outcome of patients with ROCM (Rhino-orbito-cerebral mucormycosis) following their medical and surgical management. MATERIALS AND METHODS: It is a prognostic study based in a tertiary care center in North-Western India. Patients who developed ROCM post COVID-19 infection from 1st September 2020 to 30th June 2021 were included in this study. Surgical debridement and administration of antifungal therapy was done for the post-COVID-19 ROCM patients. Disease progression and survival was studied up to 5 months of follow-up in the second wave. RESULTS: A total of 145 ROCM patients were included. The mean age at presentation, male: female ratio was 48.2 years and 2:1 respectively. As per our proposed new staging system and treatment strategy, the majority of patients belonged to stage II (31.72%) and stage III (31.03%). On a follow-up period of 5 months, 26 (18%) patients have lost their life and rest of the patients are on strict follow-up. CONCLUSION: ROCM is an extremely aggressive fungal infection which rapidly became an epidemic following the COVID-19 pandemic. The diverse and unique presentation led us to evolve a new strategy to classify and manage these patients.

Improvement in Memory Deficits With Memantine in Mania Secondary to Traumatic Brain Injury and Preexisting Perinatal Birth Injury.

Cognitive deficits are known to occur after brain injury, be it perinatal injury, traumatic brain injury (TBI), or any other type of insult to the brain. The problem may be compounded if psychiatric illness is present in addition to the brain injury because the illness itself or the psychotropic medications used in its management may lead to worsening of cognitive functioning. We present the case of a patient who presented to the hospital with symptoms suggestive of mania with psychotic features that had started after a recent TBI, with the brain scan also revealing the presence of a preexisting perinatal birth injury. When the patient recovered from the psychiatric symptoms, he still appeared to have memory problems that improved with the use of add-on memantine, an N-methyl-D-aspartate receptor antagonist. To date, there is some literature supporting the off-label use of memantine as a cognitive enhancer in patients with TBIs and other psychiatric illnesses, such as bipolar disorder.

Hypoglossal schwannoma in the submandibular region.

Hypoglossal nerve schwannomas originating extracranially and mimicking a submandibular salivary gland tumour are extremely rare. A 55-year-old woman presented with a painless, gradually increasing swelling in the right submandibular region for the past 1 year. Fine-needle aspiration cytology and contrast-enhanced CT of the swelling showed features of submandibular gland malignant lesion. Intraoperatively, the right submandibular gland with a hypoglossal nerve swelling was noticed. Right submandibular gland along with the hypoglossal swelling were excised with adequate margins. However, the postoperative histopathology was reported as hypoglossal nerve schwannoma and a normal salivary gland. Accurate preoperative diagnosis of hypoglossal schwannomas may be challenging. A high level of suspicion must be sought for in cases with unusual clinical presentations and imaging characteristics. Herein, we report a rare presentation of submandibular hypoglossal schwannoma along with its clinical features and its management.