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BACKGROUND: Emerging evidence shows an impact of the COVID-19 pandemic on people living with dementia and informal carers, without any evidence-based global comparison to date. The aim of this international study was to explore and compare the perceived impact of COVID-19 and associated public health restrictions on the lives of people living with dementia and informal carers and access to dementia care across five countries. METHODS: Informal carers and people living with dementia who were residing in the community in the UK, Australia, Italy, India, and Poland were interviewed remotely between April and December 2020. Participants were asked about their experiences of the pandemic and how restrictions have impacted on their lives and care. Transcripts were analysed by researchers in each country using inductive thematic analysis. RESULTS: Fifteen people living with dementia and 111 informal carers participated across the five countries. Four themes emerged: (1) Limited access and support; (2) Technology and issues accessing remote support; (3) Emotional impact; and (4) Decline of cognitive and physical health reported by carers. Whilst variations were noted, the pandemic has indirectly affected people with dementia and carers across all five countries. The pandemic removed access to social support services and thus increased carer burden. Remote services were not always provided and were very limited in benefit and usability for those with dementia. As a result, carers appeared to notice reduced cognitive and physical health in people with dementia. Particular differences were noted between India and Poland vs. the UK, Italy, and Australia, with less impact on care provision in the former due to limited uptake of support services pre-pandemic based on cultural settings. CONCLUSIONS: The pandemic has amplified dementia as a global public health problem, and people affected by the condition need support to better access vital support services to live well.
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COVID-19 , Demência , Cuidadores , Demência/diagnóstico , Demência/epidemiologia , Demência/terapia , Humanos , Pandemias , SARS-CoV-2RESUMO
PURPOSE: Risk management in the healthcare sector is a highly relevant sub-domain and a crucial research area from the humanitarian perspective. The purpose of this paper is to focus on the managerial/supply chain risk factors experienced by the government hospitals in an Indian state. The present paper analyzes the inter-relationships among the significant risk factors and ranks those risk factors based on their criticality. DESIGN/METHODOLOGY/APPROACH: The current research focuses on 125 public hospitals in an Indian state. Questionnaire-based survey and personal interviews were conducted in the healthcare sector among the inpatients and hospital staff to identify the significant risk factors. An integrated DEMATEL-ISM-PROMETHEE method is adopted to analyze the impact potential and dependence behavior of the risk factors. FINDINGS: The analysis asserts the absence of critical risk factors that have a direct impact on patient safety in the present healthcare system under investigation. However, the results illustrate the remarkable impact potential attributed to the risk factor, namely, staff shortage in inducing other risk factors such as employee attitudinal issues, employee health issues and absenteeism altogether resulting in community mistrust/misbeliefs. Maintenance mismanagement, monsoon time epidemics, physical infrastructure limitations are also found to be significant risk factors that compromise patient satisfaction levels. PRACTICAL IMPLICATIONS: Multiple options are illustrated to mitigate significant risk factors and operational constraints experienced by public hospitals in the state. The study warrants urgent attention from government officials to fill staff vacancies and to improve the infrastructural facilities to match with the increasing demand from the society. Furthermore, this research recommends the hospital authorities to start conducting induction and training programs for the hospital employees to instill the fundamental code of conduct while working in hectic, challenging and even in conditions with limited resources. ORIGINALITY/VALUE: Only limited papers are visible that address the identification and mitigation of risk factors associated with hospitals. The present paper proposes a novel DEMATEL-ISM-PROMETHEE integrated approach to map the inter-relationships among the significant risk factors and to rank those risk factors based on their criticality. Furthermore, the present study discloses the unique setting of the public healthcare system in a developing nation.
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Administração Hospitalar/normas , Hospitais Públicos/organização & administração , Recursos Humanos em Hospital/provisão & distribuição , Recursos Humanos em Hospital/normas , Humanos , Índia , Modelos Estatísticos , Segurança do Paciente , Satisfação do Paciente , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Intestinal and multivisceral transplantation can be complicated by cytomegalovirus (CMV)-related viremia and disease. Intravenous ganciclovir (GCV) and oral valganciclovir remain the treatment of choice in this setting. Limited data are available on GCV-resistant (GCV-R) CMV infection in small intestine and multivisceral transplant recipients. METHOD: A retrospective review was performed on all patients who underwent small intestine or multivisceral transplantation from November 8, 2003 through November 30, 2008. Those with CMV viremia and invasive disease were identified. GCV resistance was suspected in patients who continued to have viremic episodes or invasive disease despite appropriate GCV treatment. Genotypic analyses were performed to detect the presence of GCV resistance genes UL97 and UL54. RESULTS: During the study period, 88 small intestine or multivisceral transplants were performed on 85 patients. Of the 88 transplantations, 16 patients developed CMV viremia with or without end-organ disease (18.2%) and 5.7% developed GCV-R CMV infection. In patients diagnosed with CMV infection, 31.3% (5/16) had GCV-R CMV infection. Of patients with GCV-R CMV infection, 80% (4/5) developed CMV allograft enteritis, resulting in allograft explantation in 3 patients. All patients with GCV-R CMV infection were CMV donor positive/recipient negative. Patients with tissue-invasive CMV disease were 18 times more likely to be infected with GCV-R CMV (95% confidence interval 1.24-260.93; P-value 0.0341). CONCLUSION: Small intestinal and multivisceral transplant recipients have a higher rate of GCV-R CMV infection compared with other solid organ transplant recipients, which is often associated with tissue-invasive disease and allograft loss.
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Antivirais/farmacologia , Infecções por Citomegalovirus/virologia , Citomegalovirus/efeitos dos fármacos , Ganciclovir/farmacologia , Intestinos/transplante , Transplante de Órgãos/efeitos adversos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Imunossupressores , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
Sugars Will Eventually be Exported Transporters (SWEETs) are the novel sugar transporters widely distributed among living systems. SWEETs play a crucial role in various bio-physiological processes, viz., plant developmental, nectar secretion, pollen development, and regulation of biotic and abiotic stresses, in addition to their prime sugar-transporting activity. Thus, in-depth structural, evolutionary, and functional characterization of maize SWEET transporters was performed for their utility in maize improvement. The mining of SWEET genes in the latest maize genome release (v.5) showed an uneven distribution of 20 ZmSWEETs. The comprehensive structural analyses and docking of ZmSWEETs with four sugars, viz., fructose, galactose, glucose, and sucrose, revealed frequent amino acid residues forming hydrogen (asparagine, valine, serine) and hydrophobic (tryptophan, glycine, and phenylalanine) interactions. Evolutionary analyses of SWEETs showed a mixed lineage with 50-100 % commonality of ortho-groups and -sequences evolved under strong purifying selection (Ka/Ks < 0.5). The duplication analysis showed non-functionalization (ZmSWEET18 in B73) and neo- and sub-functionalization (ZmSWEET3, ZmSWEET6, ZmSWEET9, ZmSWEET19, and ZmSWEET20) events in maize. Functional analyses of ZmSWEET genes through co-expression, in silico expression and qRT-PCR assays showed the relevance of ZmSWEETs expression in regulating drought, heat, and waterlogging stress tolerances in maize. The first ever ZmSWEET-regulatory network revealed 286 direct (ZmSWEET-TF: 140 ZmSWEET-miRNA: 146) and 1226 indirect (TF-TF: 597; TF-miRNA: 629) edges. The present investigation has given new insights into the complex transcriptional and post-transcriptional regulation and the regulatory and functional relevance of ZmSWEETs in assigning stress tolerance in maize.
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Proteínas de Plantas , Zea mays , Proteínas de Plantas/química , Zea mays/genética , Zea mays/metabolismo , Proteínas de Membrana Transportadoras/genética , Glucose , Filogenia , Estresse Fisiológico/genética , Regulação da Expressão Gênica de PlantasRESUMO
BACKGROUND: Randomized controlled trials (RCTs) of vitamin D (VitD) supplementation for depression have yielded inconsistent results. We conducted the first RCT of VitD supplementation with multipoint serum 25(OH)D assessments in major depressive disorder (MDD) patients with concurrent severe VitD deficiency. METHODS: We randomized antidepressant-free depressed adults with mean baseline 25(OH)D of 11.5 ng/ml to VitD (60,000 IU every 5 days; n = 31) or placebo (n = 28) for 12 weeks. All patients also received escitalopram (10-20 mg/day). Patients were rated at baseline and at the end of weeks 4, 8, and 12. Serum 25(OH)D was estimated at baseline, week 8, and week 12. RESULTS: In an intent-to-treat analysis, mean Hamilton Depression Scale scores dropped from 25.7 to 5.7 and from 25.8 to 5.0 in VitD and placebo groups, respectively (primary outcome; P = 0.92). VitD and placebo groups did not differ on other objective and subjective ratings of depression, or on global ratings. Similar findings characterized completer analyses. No significant correlations were observed between 25(OH)D levels and depression ratings across the course of the study. Importantly, endpoint escitalopram doses were 4 mg/day higher in placebo than in VitD patients, and 4 mg/day higher in VitD deficient than in VitD sufficient patients. LIMITATIONS: A ceiling effect with escitalopram may have prevented the discovery of benefits with VitD supplementation. CONCLUSIONS: VitD supplementation does not improve antidepressant outcomes with flexibly dosed escitalopram. VitD deficient depressed patients may require higher antidepressant doses to experience benefits similar to those whose deficiency is corrected by VitD supplementation.
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Transtorno Depressivo Maior , Deficiência de Vitamina D , Adulto , Colecalciferol/efeitos adversos , Colecalciferol/uso terapêutico , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Suplementos Nutricionais , Método Duplo-Cego , Humanos , Vitamina D , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/tratamento farmacológico , VitaminasRESUMO
The term "la chorιe fibrillare" was used by the French physician Augustine Marie Morvan to describe a syndrome showing hyperactivity features involving the central, autonomic, and peripheral nervous system. The central hyperactivity symptoms are confusion, behavioral problems, hallucinations, myoclonus, and insomnia; the autonomic hyperactivity symptoms are hyperhidrosis and variations in blood pressure; and peripheral hyperexcitability is characterized by painful cramps, myokymia, and neuromyotonia. Here, we present a case that has typical features of Morvan's syndrome and provides a brief description based on available literature.
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Doenças do Sistema Nervoso Autônomo , Síndrome de Isaacs , Mioquimia , Siringomielia , Alucinações , Humanos , Síndrome de Isaacs/complicações , Síndrome de Isaacs/diagnóstico , Mioquimia/complicações , Mioquimia/diagnóstico , Siringomielia/diagnósticoRESUMO
Objective: To determine the prevalence of sexual dysfunction in female patients with schizophrenia receiving olanzapine or risperidone and to understand its relationship with other psychosocial variables.Methods: This cross-sectional descriptive study evaluated 57 female stabilized schizophrenia outpatients receiving risperidone (n = 28) or olanzapine (n = 29) in the psychiatric departments of a tertiary care hospital in South India from January to May 2019. Sexual dysfunction was assessed with the Changes in Sexual Functioning Questionnaire, severity of psychosis with the Brief Psychiatric Rating Scale, and level of improvement with the Clinical Global Impressions-Improvement and Severity scales.Results: Among the subjects, 93% of women receiving risperidone experienced sexual dysfunction compared to 83% in the olanzapine group. Sexual responses such as pleasure, frequency of sexual contacts, desire, arousal, and orgasm were significantly low in both drug groups (P < .05). Logistic regression of sexual dysfunction as dependent variable with other important variables found no significant relationship.Conclusions: This study suggests that sexual dysfunction is an important undetected problem in the majority of female schizophrenia patients. Risperidone was associated with more sexual dysfunction. Sexual dysfunction is an understudied yet important consideration in the treatment of schizophrenia.
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Antipsicóticos , Esquizofrenia , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Estudos Transversais , Feminino , Humanos , Olanzapina/efeitos adversos , Risperidona/efeitos adversos , Esquizofrenia/tratamento farmacológico , Psicologia do EsquizofrênicoRESUMO
INTRODUCTION: Glucosamine hydrochloride normalizes GABA antagonist- and social defeat-induced behavioral alterations and upregulation of immune response genes in Drosophila and mice, respectively, increases hippocampal neurogenesis in mice, and demonstrates efficacy in murine behavioral models of depression. This suggests that it may have antidepressant potential in humans. METHODS: In an open label, 4-week pilot study, patients (n = 20) diagnosed with mild to moderate, nonpsychotic (unipolar) major depressive episode (DSM-IV) were treated with glucosamine in monotherapy at 1 g/day for 1 week and 2 g/day for 3 more weeks. Patients were assessed at baseline, and at 2- and 4-week follow up using the 21-item Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impression-Improvement (CGI-I) scale, and other measures. An intent-to-treat analysis with last-observation-carried-forward was conducted on the whole sample. RESULTS: Three patients dropped out before the first follow up; the rest completed the study. HAM-D scores dropped by a third in the sample as a whole; however, only 4 patients (20 %) were considered HAM-D responders (improvement by >50 %) and only 2 patients (10 %) were CGI-I responders (endpoint score of 1 or 2). There were only 2 (10 %) HAM-D remitters (endpoint score <8). There were no serious adverse events and the treatment was well tolerated. CONCLUSIONS: Encouraging preclinical results notwithstanding, glucosamine monotherapy does not appear to be effective against major depression. A more authoritative conclusion would require a randomized controlled trial.
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Transtorno Depressivo Maior , Animais , Antidepressivos/uso terapêutico , Depressão , Transtorno Depressivo Maior/tratamento farmacológico , Método Duplo-Cego , Glucosamina/uso terapêutico , Humanos , Camundongos , Projetos Piloto , Escalas de Graduação Psiquiátrica , Resultado do TratamentoAssuntos
Antipsicóticos/uso terapêutico , Depressores do Sistema Nervoso Central/uso terapêutico , Isoxazóis/uso terapêutico , Melatonina/uso terapêutico , Pirimidinas/uso terapêutico , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Humanos , Palmitato de PaliperidonaRESUMO
Syndromes of delusional misidentification and reduplication are among the many neuropsychiatric conditions that affect both brain and behaviour and pose great challenges to mental health professionals. Fregoli syndrome belongs to the group of delusional misidentification syndromes with the belief that a familiar person is disguised as a strange person by taking different physical appearance but remains the same person psychologically. Though this he syndrome has been associated with organic cerebral dysfunction particularly of the right hemisphere, most cases occur in the setting of schizophrenia. Here we report a schizophrenic patient who developed Frégoli syndrome.
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Esquizofrenia/fisiopatologia , Adulto , Reconhecimento Facial/fisiologia , Feminino , Humanos , Esquizofrenia Paranoide/fisiopatologiaRESUMO
The present paper investigates the effect of a mathematical model describing the aforementioned process in which the ambient nanofluid in the presence of suction/injection and magnetic field are taken into consideration. The flow is induced by an infinite elastic sheet which is stretched along its own plane. The stretching/shrinking of the sheet is assumed to be proportional to the distance from the slit. The governing equations are reduced to a nonlinear ordinary differential equation by means of similarity transformation. The consequential nonlinear equation is solved analytically. Consequences show that the flow field can be divided into a near-field region and a far-field region. Suction on the surface plays an important role in the flow development in the near-field whereas the far-field is responsible mainly by stretching. The electromagnetic effect plays exactly the same role as the MHD, which is to reduce the horizontal flow resulting from stretching. It is shown that the behavior of the fluid flow changes with the change of the nanoparticles type. The present study throws light on the analytical solution of a class of laminar boundary layer equations arising in the stretching/shrinking sheet problem.
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OBJECTIVE: The safety and efficacy profile of risperidone and olanzapine were compared in a double-blind trial that used doses widely accepted in clinical practice. METHODS: Subjects (n = 71) who met Diagnostic and Statistical Manual of Mental Disorders-IV criteria for schizophrenia were randomly assigned to receive 2-8 mg/day of risperidone (mean modal dose = 5.5 mg/day) or 5-20 mg/day of olanzapine (mean modal dose = 14.4 mg/day) for 1 year. RESULTS: The two study groups were similar at baseline in all aspects. Seventy-four percent of the participants completed the trial, with no between-differences in the proportion of dropouts. Olanzapine group showed significantly greater improvement in negative symptoms in assessments at 3rd, 6th, 9th, and 12th months (P = 0.05, 0.00, 0.00, and 0.00, respectively). Clinical global impression of severity (CGI-S) scores were consistently lower in the olanzapine group at 3rd, 6th, and 9th months (P = 0.01, 0.03, and 0.05, respectively) as measured by positive and negative symptom scale (PANSS). Total scores on PANSS, positive symptoms, general psychopathology, and CGI improvement showed comparable improvement at 3rd, 6th, 9th, and 12th months of follow-up (all subjects, including dropouts). Severity of extrapyramidal symptoms was low in both groups, with no between-group differences. Mean change in body weight, fasting blood sugar, and fasting cholesterol was comparable in both groups. Risperidone group had significant hyperprolactinemia after one year (P = 0.03). CONCLUSIONS: Both treatments were well-tolerated and efficacious. Greater reductions in severity of the illness and negative symptoms were seen with olanzapine consistently through 1 year. The frequency and severity of extrapyramidal symptoms were negligible and similar in the two treatment groups. Weight gain, hyperlipidemia, and hyperglycemia were comparable in both groups. Risperidone produced significant hyperprolactinemia.
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BACKGROUND: The elderly population has a significant risk of suicide when compared to any other age group. Despite this, suicide among the aged receives scant attention. Hence, identification of suicide risk factors specific to this population will help in the development of suitable prevention strategies for this group. AIMS: Comparison of risk factors for attempting the suicide in the elderly versus younger suicide attempters. MATERIALS AND METHODS: A total 1159 suicide attempters attended the suicide prevention clinic of IQRAA International Hospital and Research Centre. They were evaluated using a specially designed psycho-sociodemographic proforma. The group was divided into those above 65 years (elderly) and those below 65 years (younger) and all the risk factors were compared between these two groups. RESULTS: Most suicide attempters in the elderly category were found to be married, less educated, unemployed and hailed from a rural background and joint families. They had a higher rate of family history of psychiatric illness, past psychiatric illness, concurrent medical illness and history of medical contact in the three months prior to the attempt. A significant number in the elderly group had attempted suicide more than a week after a stressor. CONCLUSION: The results from this study suggests that in suicide attempters from Indian geriatric population, co-morbid physical illness, mental illness (particularly depression) and family burden of psychiatric illness are important predictors in comparison to younger populations. Also, these attempters had contact with a medical professional in the three months prior to the attempt. Specific preventive interventions need to be tailored for this population to reduce the risk of suicide rather than adopting generalized suicide prevention strategies.
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Cu(II) complexes [Cu(mqt)(B)H2O]ClO4(1-3) of 2-thiol 4-methylquinoline and phenanthroline bases (B), viz 1,10-phenanthroline (phen in 1), Dipyrido[3,2-d:2',3'-f]quinoxaline (dpq in 2) and Dipyrido[3,2-a:2',3'-c]phenazine (dppz in 3) have been prepared and characterized by elemental analysis, IR, UV-Vis, magnetic moment values, EPR spectra and conductivity measurements. The spectral data reveal that all the complexes exhibit square-pyramidal geometry. The DNA-binding behaviors of the three complexes were investigated by absorption spectra, viscosity measurements and thermal denaturation studies. The DNA binding constants for complexes (1), (2) and (3) were determined to 2.2×10(3), 1.3×10(4) and 8.6×10(4)M(-1) respectively. The experimental results suggest that these complexes interact with DNA through groove-binding mode. The photo induced cleavage studies shows that the complexes possess photonuclease property against pUC19 DNA under UV-Visible irradiation via a mechanistic pathway involving formation of singlet oxygen as the reactive species. Antimicrobial photodynamic therapy was studied using photodynamic antimicrobial chemotherapy (PACT) assay against Escherichiacoli and all complexes exhibited significant reduction in bacterial growth on photoirradiation.
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Antibacterianos/farmacologia , Complexos de Coordenação/síntese química , Cobre/farmacologia , Fenantrolinas/farmacologia , Fotoquimioterapia , Fármacos Fotossensibilizantes/síntese química , Fármacos Fotossensibilizantes/farmacologia , Oxigênio Singlete/metabolismo , Animais , Antibacterianos/síntese química , Bovinos , Contagem de Colônia Microbiana , Complexos de Coordenação/química , Complexos de Coordenação/farmacologia , DNA/metabolismo , Clivagem do DNA/efeitos dos fármacos , Eletroforese em Gel de Ágar , Escherichia coli/efeitos dos fármacos , Escherichia coli/crescimento & desenvolvimento , Testes de Sensibilidade Microbiana , Desnaturação de Ácido Nucleico , Fenantrolinas/síntese química , ViscosidadeRESUMO
Lipopolysaccharide (LPS) in the cell wall of the P. aeruginosa is a major factor in the pathogenicity and virulence of this organism. Immunotype-specific serum antibodies to this LPS antigen (ALPS) are usually elevated with the onset of the bacteremia, act as opsonins, are protective in high levels, and are significantly associated with improved survival. In the present study, the ability of 11 patients with AIDS to mount a specific ALPS response with the onset of P. aeruginosa bacteria was evaluated prospectively. Of the 11 patients with AIDS only one had a substantial ALPS response, six mounted only a marginal ALPS response, and four had no ALPS response to the infecting strain of the P. aeruginosa. These data suggest most patients with AIDS do not exhibit a marked antigen-specific humoral response at the onset of P. aeruginosa bacteremia; this has important prognostic and therapeutic significance, as high ALPS titers are associated with survival.
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Síndrome da Imunodeficiência Adquirida/imunologia , Bacteriemia/imunologia , Lipopolissacarídeos/imunologia , Infecções por Pseudomonas/imunologia , Pseudomonas aeruginosa/imunologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/mortalidade , Adulto , Anticorpos Antibacterianos/sangue , Bacteriemia/complicações , Feminino , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Proteínas Opsonizantes/imunologia , Prognóstico , Estudos Prospectivos , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/mortalidade , Fatores de Risco , Taxa de SobrevidaRESUMO
The tetrapeptide Pro-Glu-Leu-Leu forms the 94-97 fragment of C globin in sea cucumber. 2% Butanediol dimethacrylate-cross linked polystyrene (2% BDDMA-PS), which had been optimized, was used for the synthesis of the tetrapeptide Pro-Glu-Leu-Leu. The peptide was synthesized by using Boc-amino acid strategy. The peptide purity was checked by RP-HPLC and the peptide was characterized by (1)H NMR spectroscopy and amino acid analysis. Conformation of the peptide was studied by 1D- and 2D- homonuclear (1)H NMR, in DMSO-d6 at 300K. The conformation of the synthetic tetrapeptide (extended backbone conformation) is not in agreement with that in C globin.