Meditation-A Slippery Slope for Psychosis: A Case Series With Review of Evidence.

ABSTRACT: The practice of meditation has been traditionally viewed as a self-regulatory approach that aids in psychological well-being. Over the last decade, mindfulness-based meditation has gained a separate therapeutic significance in various mental health conditions. There has also been considerable understanding of the adverse effects of meditation over the years. Despite this, there is still underreporting of the altered behavioral presentations arising possibly because of intensive and unguided meditation practices. We present two cases of meditation-related psychosis with different clinical presentations. The write-up highlights the need for tailoring the meditation practices after evaluation of mental state of the individuals and early detection of "at-risk" mental states. There should be regular screening of emergence of any unwanted effects during the course of meditation and the guides should be able to detect the early warning signs of psychosis.

Public knowledge, attitudes, and practices toward COVID-19: An online cross-sectional study in the Union territory of Jammu and Kashmir.

BACKGROUND: COVID-19, since its emergence, has become a global health problem with countries adopting unprecedented measures to control the spread of this pandemic. Adherence of the populations to control measures is affected by their knowledge, attitude, and practices (KAP) towards the disease. It was with this aim that the present study was conducted among the residents of UT of J&K to assess their KAP toward COVID-19. METHODOLOGY: A cross-sectional online survey of 464 J&K residents was conducted between 1st May and 10th May 2020. Survey Monkey tool was used to develop a link and KAP questionnaire was used for data collection. The survey instrument consisted of demographic characteristics, 11 items on knowledge, 5 items on attitudes, and 7 items on practices. Data collected was represented in descriptive statistics, and one-way analysis of variance was the test of significance. RESULTS: Mean knowledge, attitude, and practice scores were 7.69 ± 0.74, 4.70 ± 0.57, and 4.32 ± 0.68, respectively, among the respondents. Majority (99%) knew the sign and symptoms, mode of transmission of the disease and avoided attending large gatherings. Use of mask was almost universal and about 38% were taking supplements like vitamins or herbal medicines. Good knowledge, positive attitude, and appropriate practices among the respondents about COVID-19 suggest that community based health education programs play a key role in containment and mitigation of this disease. CONCLUSION: Sustained messaging and updates from the national and local health authorities on COVID-19 to the public are likely to help control the transmission of the disease.

Effect of Transcranial Low-Level Light Therapy vs Sham Therapy Among Patients With Moderate Traumatic Brain Injury: A Randomized Clinical Trial.

Importance: Preclinical studies have shown that transcranial near-infrared low-level light therapy (LLLT) administered after traumatic brain injury (TBI) confers a neuroprotective response. Objectives: To assess the feasibility and safety of LLLT administered acutely after a moderate TBI and the neuroreactivity to LLLT through quantitative magnetic resonance imaging metrics and neurocognitive assessment. Design, Setting, and Participants: A randomized, single-center, prospective, double-blind, placebo-controlled parallel-group trial was conducted from November 27, 2015, through July 11, 2019. Participants included 68 men and women with acute, nonpenetrating, moderate TBI who were randomized to LLLT or sham treatment. Analysis of the response-evaluable population was conducted. Interventions: Transcranial LLLT was administered using a custom-built helmet starting within 72 hours after the trauma. Magnetic resonance imaging was performed in the acute (within 72 hours), early subacute (2-3 weeks), and late subacute (approximately 3 months) stages of recovery. Clinical assessments were performed concomitantly and at 6 months via the Rivermead Post-Concussion Questionnaire (RPQ), a 16-item questionnaire with each item assessed on a 5-point scale ranging from 0 (no problem) to 4 (severe problem). Main Outcomes and Measures: The number of participants to successfully and safely complete LLLT without any adverse events within the first 7 days after the therapy was the primary outcome measure. Secondary outcomes were the differential effect of LLLT on MR brain diffusion parameters and RPQ scores compared with the sham group. Results: Of the 68 patients who were randomized (33 to LLLT and 35 to sham therapy), 28 completed at least 1 LLLT session. No adverse events referable to LLLT were reported. Forty-three patients (22 men [51.2%]; mean [SD] age, 50.49 [17.44] years]) completed the study with at least 1 magnetic resonance imaging scan: 19 individuals in the LLLT group and 24 in the sham treatment group. Radial diffusivity (RD), mean diffusivity (MD), and fractional anisotropy (FA) showed significant time and treatment interaction at 3-month time point (RD: 0.013; 95% CI, 0.006 to 0.019; P < .001; MD: 0.008; 95% CI, 0.001 to 0.015; P = .03; FA: -0.018; 95% CI, -0.026 to -0.010; P < .001).The LLLT group had lower RPQ scores, but this effect did not reach statistical significance (time effect P = .39, treatment effect P = .61, and time × treatment effect P = .91). Conclusions and Relevance: In this randomized clinical trial, LLLT was feasible in all patients and did not exhibit any adverse events. Light therapy altered multiple diffusion tensor parameters in a statistically significant manner in the late subacute stage. This study provides the first human evidence to date that light therapy engages neural substrates that play a role in the pathophysiologic factors of moderate TBI and also suggests diffusion imaging as the biomarker of therapeutic response. Trial Registration: ClinicalTrials.gov Identifier: NCT02233413.

Spot and Diffuse Signs: Quantitative Markers of Intracranial Hematoma Expansion at Dual-Energy CT.

Purpose To compare dual-energy CT with iodine quantification to single-energy CT for evaluation of the spot sign for intracranial hematoma expansion. Materials and Methods In this retrospective study, 42 patients (mean age, 66 years ± 15 [standard deviation]; 19 women) were referred for dual-energy CT assessment of intracranial hemorrhage from October 2014 to January 2017. A machine learning approach (naive Bayes classifier) was used to identify iodine markers of extravasation for risk of hematoma expansion. Specificity and sensitivity of these markers were then independently validated in 65 new patients from February 2017 to February 2018. Results Analysis of dual-energy CT images identified two features of iodine extravasation: total iodine concentration within the hematoma (Ih) and focal iodine concentration in the brightest spot in the hematoma (Ibs) as predictors of expansion. The I2 score derived from these features provided a measure of expansion probability. Optimal classification threshold was an I2 score of 20 (95% confidence interval [CI]: 18, 23), leading to correct identification of 39 of 46 (85%; 95% CI: 71%, 94%) of the hematomas on the training set (sensitivity of 79% [11 of 14; 95% CI: 57%, 100%] and specificity of 88% [28 of 32; 95% CI: 76%, 99%]), and 62 of 70 (89%; 95% CI: 79%, 95%) of the hematomas on the validation set (sensitivity of 71% [10 of 14; 95% CI: 48%, 95%] and specificity of 93% [52 of 56; 95% CI: 86%, 100%]). Sensitivity, specificity, and accuracy of conventional spot sign were, respectively, 57% (eight of 14), 90% (29 of 32), and 80% (37 of 46) on the training set and 57% (eight of 14), 83% (47 of 56), and 75% (53 of 70) on the validation set. Conclusion This study identified two quantitative markers of intracranial hemorrhage expansion at dual-energy CT of the brain. The I2 score derived from these markers highlights the utility of dual-energy CT measurements of iodine content for high sensitivity risk assessment. © RSNA, 2018 Online supplemental material is available for this article.

Epidemiological Profile and Antimicrobial Resistance Pattern of Enteric Fever in a Tertiary Care Hospital of North India - a Seven Year Ambispective Study.

INTRODUCTION: Enteric-fever is a major public-health problem in developing countries emerging as multidrug-resistant, Nalidixic-acid resistant and extremely drug-resistant Salmonella (Pakistan, 2016), has intensified the use of WHO watch/reserve group antimicrobials such as azithromycin and meropenem. METHODS: This ambispective-study was conducted on 782 non-repeat blood-culture isolates of S. Typhi, S. Paratyphi A and S. Paratyphi B obtained from 29,184 blood cultures received at a 1000-bedded tertiary-care hospital of North-India from 2011-2017. Identification and antibiograms were obtained by Vitek-2 compact and Kirby-Bauer's disc diffusion with resistance to ampicillin, chloramphenicol and cotrimoxazole being labeled as multidrug-resistant. Decreased ciprofloxacin-susceptibility and ciprofloxacin-resistance were defined as MIC 0.125-0.5 and >1 µg/ml. RESULTS: S. Typhi and S. Paratyphi A in a ratio of 3.9:1 were seen between July-September predominantly distributed between 6-45 year age group. Resistance to co-trimoxazole, chloramphenicol, ceftriaxone and azithromycin was 6.1%, 13.8%, 16.1 and 5.78% respectively. Multidrug-resistant S. typhi and S. paratyphi A were 2.73% and 1.91% respectively. CONCLUSION: Enteric-fever is a major public-health problem in India. Emergence of multidrug-resistant, Nalidixic-acid resistant and extremely-drug resistant Salmonella mandates ongoing surveillance for targeted empirical therapy and containment of spread. Repeated epidemics call for water, sanitation, hygiene and vaccination strategies to sustain herd-immunity.

Ethnobotanical and phytopharmacological review of Scindapsus officinalis (“Gajapippali”)

Scindapsus officinalis (S. officinalis) holds a reputed position in Ayurvedic system of medicine. It has been ethanobotanically used to treat diarrhea (“atisara”), worm infes-tation (“krmiroga”), and as antipyretic. Literature survey on S. officinalis was carried out via electronic search in PubMed, SciFinder, Scirus, Google Scholar, Agricola and Web of Science and a library search. Results revealed that a very specific botanical description of the plant is still not available. The plant is mistaken within the hybrids and other plants of genus Scindapsus and family Araceae. Since ethnobotanically the plant is of much importance, chemistry of the plant yet needs to be fully explored. Thus the need of the hour is to comprehend the fragmented information available on the botany, traditional uses, phytochemistry and pharmacology of S. officinalis which could help in the correct identification of the sample and avoid adulteration due to mistaken identity.

Dual-Energy Head CT Enables Accurate Distinction of Intraparenchymal Hemorrhage from Calcification in Emergency Department Patients.

Purpose To evaluate the ability of dual-energy (DE) computed tomography (CT) to differentiate calcification from acute hemorrhage in the emergency department setting. Materials and Methods In this institutional review board-approved study, all unenhanced DE head CT examinations that were performed in the emergency department in November and December 2014 were retrospectively reviewed. Simulated 120-kVp single-energy CT images were derived from the DE CT acquisition via postprocessing. Patients with at least one focus of intraparenchymal hyperattenuation on single-energy CT images were included, and DE material decomposition postprocessing was performed. Each focal hyperattenuation was analyzed on the basis of the virtual noncalcium and calcium overlay images and classified as calcification or hemorrhage. Sensitivity, specificity, and accuracy were calculated for single-energy and DE CT by using a common reference standard established by relevant prior and follow-up imaging and clinical information. Results Sixty-two cases with 68 distinct intraparenchymal hyperattenuating lesions in which the reference standards were available were included in the study, of which 41 (60%) were confirmed as calcification and 27 (40%) were confirmed as hemorrhage. Sensitivity, specificity, and accuracy of DE CT for the detection of hemorrhage were 96% (95% confidence interval [CI]: 81%, 100%), 100% (95% CI: 91%, 100%), and 99% (95% CI: 92%, 100%) and those of single-energy CT were 74% (95% CI: 54%, 89%), 95% (95% CI: 83%, 99%), and 87% (95% CI: 76%, 94%), respectively. Six of 68 (9%) lesions were classified as indeterminate and three (4%) were misinterpreted with single-energy CT alone and were correctly classified with DE CT. Conclusion DE CT by using material decomposition enables accurate differentiation between calcification and hemorrhage in patients presenting for emergency head imaging and can be especially useful in problem-solving complex cases that are difficult to determine based on conventional CT appearance alone. (©) RSNA, 2016 Online supplemental material is available for this article.

In Vitro Validation of an Artefact Suppression Algorithm in X-Ray Phase-Contrast Computed Tomography.

X-ray phase-contrast tomography can significantly increase the contrast-resolution of conventional attenuation-contrast imaging, especially for soft-tissue structures that have very similar attenuation. Just as in attenuation-based tomography, phase contrast tomography requires a linear dependence of aggregate beam direction on the incremental direction alteration caused by individual voxels along the path of the X-ray beam. Dense objects such as calcifications in biological specimens violate this condition. There are extensive beam deflection artefacts in the vicinity of such structures because they result in large distortion of wave front due to the large difference of refractive index; for such large changes in beam direction, the transmittance of the silicon analyzer crystal saturates and is no longer linearly dependent on the angle of refraction. This paper describes a method by which these effects can be overcome and excellent soft-tissue contrast of phase tomography can be preserved in the vicinity of such artefact-producing structures.

Pharmacognostical and high performance thin layer chromatography studies on leaves of Clerodendrum infortunatum L.

BACKGROUND: Clerodendrum infortunatum L. commonly known as Bhant plays a significant role in Indian System of Medicine, that is, Ayurveda, due to its medicinal properties. It grows easily in waste places of all areas of India, Bangladesh, and Myanmar. AIM: The present study was carried out with a view to lay down its pharmacognostic standards along with high-performance thin layer chromatography (HPTLC) studies in order to document/validate its therapeutic benefits. MATERIALS AND METHODS: In this research, leaves of C. infortunatum were subjected to pharmacognostic evaluation parameters such as macroscopy, quantitative microscopy, physicochemical studies, phytochemical screening. HPTLC has been developed for detection and quantification of gallic acid and tyrosine in C. infortunatum. Increasing serial dilutions of reference standard gallic acid (20-100 µg/mL) and tyrosine (20-100 µg/mL) were scanned at 254 nm and 280 nm, respectively. RESULTS: Microscopy of leaf revealed the presence of anisocytic stomata, sclereids, glandular and covering trichome, and prisms of calcium oxalate crystal. The total ash, water-soluble, and acid insoluble ash values of leaves were 9.95%, 2.15%, and 0.70%, respectively. The maximum extractive value of crude powder was in the water. HPTLC studies revealed that the amount of gallic acid in the crude powder of test sample were high (0.244 mg/g) in comparison to tyrosine (0.081 mg/g). CONCLUSION: The data generated would be of significant use for the authentication of drug and would also serve as a reference for the standardization and quality control of C. infortunatum.

Bioavailability enhancers of herbal origin: an overview.

Recently, the use of herbal medicines has been increased all over the world due to their therapeutic effects and fewer adverse effects as compared to the modern medicines. However, many herbal drugs and herbal extracts despite of their impressive in-vitro findings demonstrates less or negligible in-vivo activity due to their poor lipid solubility or improper molecular size, resulting in poor absorption and hence poor bioavailability. Nowadays with the advancement in the technology, novel drug delivery systems open the door towards the development of enhancing bioavailability of herbal drug delivery systems. For last one decade many novel carriers such as liposomes, microspheres, nanoparticles, transferosomes, ethosomes, lipid based systems etc. have been reported for successful modified delivery of various herbal drugs. Many herbal compounds including quercetin, genistein, naringin, sinomenine, piperine, glycyrrhizin and nitrile glycoside have demonstrated capability to enhance the bioavailability. The objective of this review is to summarize various available novel drug delivery technologies which have been developed for delivery of drugs (herbal), and to achieve better therapeutic response. An attempt has also been made to compile a profile on bioavailability enhancers of herbal origin with the mechanism of action (wherever reported) and studies on improvement in drug bioavailability, exhibited particularly by natural compounds.

Mimosa pudica L. (Laajvanti): An overview.

Mimosa pudica L. (Mimosaceae) also referred to as touch me not, live and die, shame plant and humble plant is a prostrate or semi-erect subshrub of tropical America and Australia, also found in India heavily armed with recurved thorns and having sensitive soft grey green leaflets that fold and droop at night or when touched and cooled. These unique bending movements have earned it a status of 'curiosity plant'. It appears to be a promising herbal candidate to undergo further exploration as evident from its pharmacological profile. It majorly possesses antibacterial, antivenom, antifertility, anticonvulsant, antidepressant, aphrodisiac, and various other pharmacological activities. The herb has been used traditionally for ages, in the treatment of urogenital disorders, piles, dysentery, sinus, and also applied on wounds. This work is an attempt to explore and compile the different pharmacognostic aspects of the action plant M. pudica reported till date.

Herbs-are they safe enough? an overview.

Drugs based on herbs have become a common form of therapy as well as for prophylaxis because they are often perceived as being natural and therefore harmless. Today they are one of the hottest trends and most sought after in the field of nutrition or herbal therapeutics. As the use of complementary medicine grows, so does the knowledge that many compounds in common use not only have a significant effect on the body but may also interact with pharmaceuticals and also with other alternative products. Concurrent use of herbs with drugs may mimic, magnify, or oppose the effect of drugs leading to herb-drug interactions. Currently, there is very little information published on herb-herb or herb-drug interactions as compared to the use of herbs which is progressively growing across the world. Many reports of herb-drug interactions are sketchy and lack laboratory analysis of suspect preparations. Health-care practitioners should caution patients against mixing herbs and pharmaceutical drugs. The article reviews the recent literature on the adverse effects of herbal remedies including the most widely sold herbal medicinal products, like liquorice, garlic, ginger, green tea, and turmeric, etc., and reinforce the safety aspect of herbal products, which are considered to be relatively safe by common people.

Hypoglycemic effects of Citrullus colocynthis roots.

The aim of this study was to examine the effect of root of C. colocynthis on the biochemical parameters of normal and alloxan-induced diabetic rats. Diabetes mellitus was induced by intraperitoneal (120 mg/kg b.w.) injection of alloxan monohydrate for three days and the animals showing blood glucose level in the range of 175-300 mg/dL were selected for study. The blood glucose concentrations of the animals were measured at the beginning of the study and the measurements were repeated on 3rd, 5th and 7th day after the start of the experiment. On day 7, blood was collected by cardiac puncture under mild ether anesthesia. Aqueous extract of roots of Citrullus colocynthis showed significant reduction in blood sugar level (58.70%) when compared with chloroform (34.72%) and ethanol extracts (36.60%) (p < 0.01). The aqueous extracts showed improvement in parameters like body weight, serum creatinine, serum urea and serum protein as well as lipid profile and also restored the serum level of bilirubin total, conjugated bilirubin, serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transminase (SGPT) and alkaline phosphatase (ALP).

Pharmacological studies on seeds of Alangium salvifolium Linn.

The seeds of Alangium salvifolium Linn. have been traditionally reported to exhibit a variety of biological activities, including antidiabetic, anticancer, diuretic, anti-inflammatory, antimicrobial, laxative, and antiepileptic activities. The objective of this study was to verify the traditional claims and to evaluate the seeds of Alangium salvifolium in various organic extracts to screen the antidiabetic, antiepileptic, analgesic and antiinflammatory activities. The chloroform, ethanol, and water extracts of Alangium salvifolium seeds were obtained and subjected for phytochemical screening and evaluated for their pharmacological activities. From the acute toxicity study it was observed that chloroform, ethanol, and aqueous extracts of Alangium salvifolium seeds are non-toxic at a fixed dose of 2000 mg/kg. Among all three extracts ethanol extracts exhibited significant (p < 0.01) antidiabetic, antiepileptic, analgesic and anti-inflammatory activities. The phytochemical analysis revealed the presence of alkaloids, glycosides, terpenoids, steroids and tannins. The results of present study verified the traditional claims made by ayurvedic practitioner. However, the chemical constituents responsible for the pharmacological activities remain to be investigated.

Phytochemical investigation characterisation and anticonvulsant activity of Ricinus communis seeds in mice.

The ethanol extract of the dried, powdered hull portion of Ricinus communis seeds indicated the presence of alkaloids, steroids, flavonoids, glycosides and phenolics, amongst others. Ricinine was isolated as an active constituent and characterised by various chemical and spectroscopic techniques. The anticonvulsant activity of the isolated compound was evaluated in mice using the maximal electroshock (MES) model. The isolated compound at a dose of 60 mg kg⁻¹ body weight, orally, significantly (p < 0.05) reduced the extensor tonus phase of convulsion by MES-induced seizures in albino mice when compared with the standard drug diazepam (30 mg kg⁻¹ body weight, orally). The results of this study support the folkloric use of the plant in epileptic remedies.

Problems associated with clinical trials of Ayurvedic medicines / Problemas associados com ensaios clínicos de medicamentos Ayurvédicos

Herbal drugs have been used since ancient times as medicines for the treatment of various diseases. Especially in countries like India many of herbal drugs and formulations are used in different practices of treatment like Ayurveda, Siddha and Unani. It is estimated that about 25 percent of all modern medicines are directly or indirectly derived from plants sources. The contribution of developing countries in global herbal business is very poor due to lack of quality control and standardization measures. There is lack of common standards and appropriate methods for evaluating Traditional Medicine to ensure the safety, efficacy and quality control. This indicates the importance and necessity to develop a standard operational procedure for the standardization of herbal drugs and formulations. Benchmarking the evaluation protocols including both quality control and quality assurance of herbal drugs would play a major role in providing highly reliable and effective herbals drugs and to attract international trade, thus generating revenue. The article highlights various problems being faced by developing countries and suggests a unique approach for the preparation of SOP/guidelines for the standardization of all herbal based formulations, also there is a need for systematic clinical trials of traditional plant based medicines to enhance global acceptance

CNS activity of aqueous extract of root of Cissus quadrangularis Linn. (Vitaceae).

In Ayurveda, Cissus quadrangularis Linn. is used to treat anorexia, asthma, sickle cell, colds, pain, and malaria. Aqueous C. quadrangularis extract was evaluated in vivo for its antiepileptic activity by using the maximal electroshock and isonicotinic hydrazide acid models, for its analgesic activity by using the hot plate method, and for its smooth muscle relaxant activity by using the rotarod method. Adult male Swiss mice were used for this study and animals were divided into 6 animals per group. Doses of 250 mg/kg body weight and 500 mg/kg body weight protected the mice against maximal electroshock seizure, and delayed the onset time of seizures induced by isonicotinic hydrazide acid. Prominent analgesic activity was observed using the hot plate method. The paw licking time was delayed significantly. The extract also displayed prominent smooth muscle relaxant activity. The results suggest that the aqueous extracts of C. quadrangularis roots possess anticonvulsant, analgesic, and smooth muscle relaxant properties.

Distal radius in adolescent girls with anorexia nervosa: trabecular structure analysis with high-resolution flat-panel volume CT.

PURPOSE: To examine trabecular microarchitecture with high-resolution flat-panel volume computed tomography (CT) and bone mineral density (BMD) with dual-energy x-ray absorptiometry (DXA) in adolescent girls with anorexia nervosa (AN) and to compare these results with those in normal-weight control subjects. MATERIALS AND METHODS: The study was approved by the institutional review board and complied with HIPAA guidelines. Informed consent was obtained. Twenty adolescent girls, 10 with mild AN (mean age, 15.9 years; range, 13-18 years) and 10 age- and sex-matched normal-weight control subjects (mean age, 15.9 years; range, 12-18 years) underwent flat-panel volume CT of distal radius to determine apparent trabecular bone volume fraction (BV/TV), apparent trabecular number (TbN), apparent trabecular thickness (TbTh), and apparent trabecular separation (TbSp). All subjects underwent DXA of spine, hip, and whole body to determine BMD and body composition. The means and standard deviations (SDs) of structure parameters were calculated for AN and control groups. Groups were compared (Student t test). Linear regression analysis was performed. RESULTS: AN subjects compared with control subjects, respectively, showed significantly lower mean values for BV/TV (0.37% +/- 0.05 [SD] vs 0.46% +/- 0.03, P = .0002) and TbTh (0.31 mm +/- 0.03 vs 0.39 mm +/- 0.03, P < .0001) and higher mean values for TbSp (0.54 mm +/- 0.13 vs 0.44 mm +/- 0.04, P = .02). TbN was lower in AN subjects than in control subjects, but the difference was not significant (1.17 mm(-3) +/- 0.15 vs 1.22 mm(-3) +/- 0.07, P = .43). There was no significant difference in BMD between AN and control subjects. BMD parameters showed positive correlation with BV/TV and TbTh in the control group (r = 0.55-0.84, P = .05-.01) but not in AN patients. CONCLUSION: Flat-panel volume CT is effective in evaluation of trabecular structure in adolescent girls with AN and demonstrates that bone structure is abnormal in these patients compared with that in normal-weight control subjects despite normal BMD. SUPPLEMENTAL MATERIAL: http://radiology.rsnajnls.org/cgi/content/full/249/3/938/DC1.