Correlation of pre-operative and post-operative retinal nerve fibre layer thickness with visual outcome following decompression of pituitary macroadenoma.

OBJECTIVE: To (i) correlate preoperative retinal nerve fibre layer (RNFL) thickness with visual parameters in patients with pituitary macroadenomas. (ii) study the predictive role of preoperative RNFL in visual outcome following surgery for pituitary macroadenomas (iii) correlate change in postoperative RNFL thickness (RNFLT) with visual outcome. METHODS: Preoperative and post-operative RNFL thickness of thirty-three consecutive patients operated for pituitary macro adenoma between June 2022 and May 2023 were measured using Optical Coherence Tomography (OCT) and compared with standard visual examination findings and Magnetic Resonance Imaging (MRI) measurements. RESULTS: A total of 66 eyes of 33 patients who underwent surgical excision of pituitary macro adenoma between June 2022 and May 2023 were studied. The mean age in years of the study group was 44.36 ± 13.77 and both sexes were equally represented (Male: Female = 16:17). RNFL thinning predominantly involved the temporal (51.21+/-15.19 µm) followed by nasal quadrants (62.67+/- 17.03 µm) and correlated well with the visual field (VF) deficit (p <0.001). Patients with severe disc pallor had extremely thin RNFL (less than 67 +/- 8.68 µm). Patients with moderate to severe visual acuity (VA) deficits had significantly thinner RNFLs (65.08±7.09) compared to patients with normal to mild impairment in vision. (83.185±1.2) (p<0.05). RNFL values were significantly thinner for patients with Wilson Grade C, D and E tumours (66.13 ±12.19 µm) compared to those in Grade A and B (77.67±22.12 µm). The mean preop RNFL of patients who showed post-operative improvement in vision was 87.025± 15.02 µm, of patients in whom vision remained static was 74.58 ±18.31 µm. The mean VA (Decimal) increased from a minimum of 0.60 at the pre-operative timepoint to a maximum of 0.68 at the post-operative timepoint. (Wilcoxon Test: V = 42.5, p = <0.001). The mean RNFLT (µm) increased from 77.14 µm at the pre-operative timepoint to 83.77 µm at the post-operative timepoint. (Wilcoxon Test: V = 218.0, p = <0.001). The mean change of RNFL in patients in whom vision improved was 3.6 µm and the mean change of RNFL in patients in whom vision remained static was 9.51 µm. Absence of postoperative visual improvement was noted despite postoperative RNFL thickness improvement in eyes which showed significant preoperative thinning of the nasal (<65 µm) and temporal (<52µm) quadrants. CONCLUSION: RNFL thinning corelates directly with visual acuity, visual field, and optic disc pallor. Patients with pituitary adenoma have preferential thinning of temporal and nasal quadrants. Visual outcome is better in patients with preserved RNFLT of values more than 82 +/- 5 µm. Reversal of RNFL thinning postoperatively need not necessarily correlate with visual improvement especially in patients who showed significant preoperative thinning of nasal and temporal quadrants.

Biosubstitutes for dural closure: Unveiling research, application, and future prospects of dura mater alternatives.

The dura mater, as the crucial outermost protective layer of the meninges, plays a vital role in safeguarding the underlying brain tissue. Neurosurgeons face significant challenges in dealing with trauma or large defects in the dura mater, as they must address the potential complications, such as wound infections, pseudomeningocele formation, cerebrospinal fluid leakage, and cerebral herniation. Therefore, the development of dural substitutes for repairing or reconstructing the damaged dura mater holds clinical significance. In this review we highlight the progress in the development of dural substitutes, encompassing autologous, allogeneic, and xenogeneic replacements, as well as the polymeric-based dural substitutes fabricated through various scaffolding techniques. In particular, we explore the development of composite materials that exhibit improved physical and biological properties for advanced dural substitutes. Furthermore, we address the challenges and prospects associated with developing clinically relevant alternatives to the dura mater.

Retinal nerve fiber layer thickness and its correlation with visual symptoms and radiological features in pituitary macroadenoma.

Objective: The aim of the study was to evaluate the association of the thickness of retinal nerve fiber layer (RNFL) with (i) visual symptoms and (ii) suprasellar extension defined by magnetic resonance imaging (MRI) in patients with pituitary macroadenoma. Materials and Methods: RNFL thickness of 50 consecutive patients operated for pituitary macroadenoma between July 2019 and April 2021 were compared with standard visual examination findings and MRI measurements such as optic chiasm height, distance between the optic chiasm and adenoma, suprasellar extension, and chiasmal lift. Results: The study group included 100 eyes of 50 patients operated for pituitary adenomas with suprasellar extension. RNFL thinning predominantly involved the nasal (84.26 ± 16.43 µm) and temporal quadrants (70.72 ± 14.80 µm) and correlated well with the visual field deficit (P < 0.001). Patients with moderate-to-severe deficit in visual acuity had a mean RNFL thickness <85 µm and patients with severe disc pallor had extremely thin RNFLs (<70 µm). Suprasellar extension defined as Wilsons Grade C, D, and E and Fujimotos Grades 3 and 4 were significantly associated with thin RNFLs <85 µm (P < 0.01). Chiasmal lift more than 1 cm and tumor chiasm distance of <0.5 mm were associated with thin RNFL (P < 0.002). Conclusion: RNFL thinning correlates directly with the severity of visual deficits in patients with pituitary adenoma. Wilsons Grade D and E, Fujimoto Grade 3 and 4, chiasmal lift more than 1 cm, and chiasm tumor distance <0.5 mm are strong predictors of RNFL thinning and poor vision. Pituitary macro adenoma and other suprasellar tumors need to be excluded in patients with preserved vision but having obvious RNFL thinning.

Impact of nurse-led medication adherence therapy on bipolar affective disorder: A randomized controlled trial.

PURPOSE: This study evaluated the impact of nurse-led medication adherence therapy (MAT) on medication adherence behavior and symptom severity of inpatients with bipolar disorder. METHOD: Two arms, single-blind, randomized controlled trial on individuals with bipolar disorder was conducted at inpatient department of mental healthcare setting, India. Eighty-five participants were randomly allocated to MAT group and Treatment as usual group. Standard measures were used to assess medication adherence and symptom severity of both groups at baseline and follow-up time points. CONCLUSION: MAT improved medication adherence behavior resulting in marked decrease in symptom severity of participants with bipolar disorders. IMPLICATIONS FOR NURSING PRACTICE: Psychiatric nurses can effectively implement MAT for bipolar inpatients, which improves better clinical outcomes, prevent relapse, and readmissions.

Activity monitoring of stroke patients by physiotherapist and caregivers in a hospital setting: A pilot study.

Background: Activity monitoring is a necessary technique to ensure stroke survivors' activity levels in the hospital are within optimal levels as this is important for enhanced motor recovery. However, this could be time-consuming for healthcare professionals like physiotherapists. Activity monitoring by caregivers could be an alternate option. Therefore, our aim was to compare the activity monitoring of stroke survivors by caregivers and physiotherapists during early phase in a hospital setting. Methods: An observation study was carried out in the neuroscience ward in a tertiary care hospital among 17 stroke survivors. Physiotherapist and caregivers were instructed to use an activity log chart that was developed during previous research conducted by the same authors for observing the activities performed by the patients every 15 minutes from 8 AM to 5 PM across one day. Data collected were analysed using Stata 15. Kappa statistics were carried out to determine the agreement of the observations between the two raters. Results: A total of 10 male and seven female caregivers of stroke survivors with a mean age of 40.11 ± 9.2 years and a trained physiotherapist participated in the study. A total of 272 observations of caregivers were in agreement with that of the physiotherapist. Inter-rater Kappa statistics showed 60% agreement between the physiotherapist and the caregivers (p<0.05). Conclusions: There was moderate agreement between the physiotherapist and caregiver for activity monitoring of stroke survivors. This suggests behavioural mapping by caregivers may be a potential alternative solution in healthcare settings.

Effect of holistic relapse prevention intervention among individuals with alcohol dependence: a prospective study at a mental health care setting in India.

Present study examined effectiveness of Integrative Body Mind Spirit (I-BMS) intervention among individuals with alcohol dependence. A 2-group single blind RCT design was used, comparing I-BMS to treatment as usual (TAU) on drinking and psychological outcomes. One hundred participants diagnosed with alcohol dependent syndrome were randomly assigned to receive 7 sessions of I-BMS or TAU. Measurements done by a registered nurse who was blinded to the experimental design used standardized questionnaire on wellbeing, readiness to change, craving, quantity and frequency of drinking before and up to 6 months after the intervention. With respect to the within group effects, the I-BMS group demonstrated significant improvement in all outcome measures with large effect size. Compared to TAU, I-BMS participants showed lesser relapse rates and quantity of drinking at 3-month follow-up, reduction in craving and drinking days at 2-month follow-up. At 6 months follow-up, participants in I-BMS group reported significant improvement in wellbeing and motivation compared to TAU. Results of binary logistic regression showed that number of previous attempts and living in urban area positively predicted participant's relapse possibility at 6-month follow-up. Results suggest that I-BMS is worthy of further efficacy testing. In conclusion, it is feasible to implement I-BMS intervention for individuals with alcohol dependence.

Neutrophil to lymphocyte ratio - A novel prognostic marker following spontaneous intracerebral haemorrhage.

BACKGROUND: Inflammation plays a role in secondary brain injury after intracerebral haemorrhage (ICH). Peripheral biomarkers of inflammation especially the neutrophil-to-lymphocyte ratio (NLR) have been shown to influence outcome following ischemic stroke and traumatic brain injury. Role of NLR in outcome prognostication following haemorrhagic stroke has not yet been conclusively established. This study analyses the prognostic significance of admission neutrophil to lymphocyte ratio on mortality and 90-day outcome in patients admitted with acute SICH. MATERIAL AND METHODS: A total of 851 patients with spontaneous ICH were retrospectively investigated. Admission haematological parameters were retrieved from our hospital laboratory systems and NLR was then calculated using the formula ANC/ALC. (Absolute neutrophil count/Absolute lymphocyte count) Clinical outcome was assessed by modified Rankin Scale at 90 days. Logistic regression was performed to identify independent risk factors of mortality and 90-day outcome. Receiver operator curve (ROC) test was used to determine the predictive value of NLR for 30-day death. RESULTS: A total of 851 patients enrolled in the study. Our 30 day and 90 day mortality were 125 (17.7 %) and 244 (28.7 %) respectively. The mean NLR in the entire cohort was 9.03 ±â€¯7.6. NLR was significantly higher in the mortality group compared to the survivors (11.98 ±â€¯9.91 vs 8.52 ±â€¯7.05) P < 0.001. NLR in patients with a good outcome at 90 days (7.21 ±â€¯6.06) was a lower in comparison to patients with poor outcome(10.66 ±â€¯8.48).(p=<0.001). NLR was dichotomised at 8.2 which was computed based on ROC curve. Mortality and poor outcome were higher in the NLR > 8.2 group at 140 (40.1 %) and 23 (67.8 %) respectively (p < 0.001). Age, GCS < 8, Volume of Hematoma, Intra ventricular extension of hematoma and NLR > 8.2 were found to be independent predictors of outcome. GCS < 8 had a greater predictive value (5.236) compared to NLR.8.2 (1.78). CONCLUSION: Elevated levels of admission NLR were independently related to poor mortality and 90-day outcome after ICH. NLR is a novel, easily available and cost effective prognostic biomarker following ICH.

Nurse-Led Body-Mind-Spirit Based Relapse Prevention Intervention for People With Diagnosis of Alcohol Use Disorder at a Mental Health Care Setting, India: A Pilot Study.

BACKGROUND: Alcohol dependence is associated with alcohol-related problems and persistent vulnerability to relapse. Despite newer medications, frequent relapses continue to occur. Hence, there is a need to look at holistic approaches to deal with this problem. OBJECTIVE: Evaluate the effectiveness of nurse-led body-mind-spirit (BMS)-based relapse prevention intervention on craving and quantity and frequency of alcohol consumption among alcohol-dependent individuals. METHODS: Randomized control trial was adopted, and the study was conducted at a mental health care setting in India. Sixty individuals with alcohol use disorder were randomly assigned to a BMS group (n = 30) and a treatment-as-usual (TAU) group (n = 30) between June 2017 and March 2018. Subjects of both groups were initially assessed for craving and quantity and frequency of alcohol consumption. BMS subjects received seven sessions of BMS intervention and routine treatment at de-addiction wards. The interventions comprise of body, mind, and spirit strategies that aid in handling triggers, accept responsibility for their own well-being and take charge of self health. TAU group subjects received only routine treatment. All the participants were followed up over 3 months postdischarge. RESULTS: Over 3 months of follow-up, BMS group subjects (vs. TAU group) reported significantly lesser quantity of alcohol consumption (F = 9.74, p < .001, η = .144), fewer drinking days (F = 14.04, p < .001, η = .195), lower relapse rates (14 vs. 28), and lesser craving (F = 14.01, p < .001, η = .195). Regression analysis showed that number of previous attempts (>1) and increased baseline drinking were associated with relapse. CONCLUSION: Findings provide evidence of BMS intervention in reducing craving and drinking outcomes among alcohol-dependent individuals in India.

Clinical Profile and Predictors of Outcome in Spontaneous Intracerebral Hemorrhage from a Tertiary Care Centre in South India.

Background. This article attempts to evaluate the clinical profile and outcome determinants following hypertensive SICH in a South Indian population. The study represents the largest series of SICH reported from a single centre in India. Materials and Methods. Prospective data collection and analysis of patients with SICH admitted to our centre between 1st January 2015 and 31st December 2018. The variables analysed include: age, sex, comorbidities, Glasgow coma score (GCS) on admission, radiological features, treatment modality, and outcome at three months. Modified Rankin score (mRS) was used to assess the outcome at discharge and three months. Results. Our study group of 905 patients included 638 males and 267 females and the mean age at presentation was 58.10 ± 12.76 years. The study group included 523 patients (57.8%) previously diagnosed hypertensive, of whom 36.3% (n = 190) were on irregular medication. The most frequent locations of hematoma were basal ganglia (478), thalamus (202), lobar (106), cerebellar (61), brainstem (31), and primary intraventricular haemorrhage (27). Secondary intraventricular extension was seen in 425 (47%) patients on admission. The mean volume of the clot on admission was 23.45 ± 19.79 ml, and clot progression was seen in only 46 (5.08%) cases. Surgical evacuation through craniotomy was done in 147 (16.8%) patients, and external ventricular drainage (EVD) was placed in 56 (6.2%) patients. Overall 3-month mortality was 30.1% (266 patients). On the last follow up a favorable outcome (mRS 0-3) was observed in 412 (45.53%) patients and a poor outcome (mRS 4-5) in 207 patients (22.87%). Independent predictors of mortality are Age >70 (p = <0.001, OR 4.806, 95% CI 3.064-7.54), admission GCS <8 (p = <0.001, OR7.684, 95% CI 5.055#x2013;11.68), and Hematoma volume >30 ml (p = <0.001, OR 2.45, 95% CI 1.626-3.691). Intraventricular haemorrhage was an additional poor outcome predictor (p < 0.015, CI 1.105-2.585). Surgical evacuation reduced mortality in the group, but morbidity rates remained the same. Conclusions. SICH predominantly affects a younger population in India in comparison to the Western society. Elderly age, poor GCS on admission, clot volume above 30 ml and intraventricular extension remain the most consistent predictors of death and poor outcome. Further studies are needed to assess the risk of SICH among hypertensive patients and to prognosticate the outcome after SICH using novel predictors, including biomarkers.

Neurocognitive Profile in Indian Individuals Genetically at Risk of Schizophrenia.

BACKGROUND: Cognitive deficits have been noted in patients of schizophrenia in remission, as well as in first-degree relatives. This study aims to evaluate the neurocognitive performance in unaffected first-degree relatives of patients of schizophrenia in comparison with healthy controls, as well as patients of schizophrenia in remission. METHODS: It was a 1-year case-control study by purposive sampling. Patients with a diagnosis of schizophrenia, first-degree relatives of patients of schizophrenia, and controls from nongenetic relatives of patients were recruited as per inclusion and exclusion criteria. Samples were matched for age and educational status. The General Health Questionnaire 28 (GHQ-28) screened them and they were checked for remission by Positive and Negative Syndrome Scale (PANSS) and then subjected to various instruments for assessment of neurocognition, standardized for the Indian population. To remove the effect of symptoms as confounding factors, PANSS score of <3 for each individual item was set as the criterion for remission. Intelligence quotient (IQ) was screened in all participants to exclude mental retardation. Statistical analysis used was the analysis of variance (ANOVA) with post hoc Fisher's least significant difference (LSD). RESULTS: Significant neurocognitive impairments were detected in the patients and first-degree relatives when compared with the control subjects. The most common impairment in the patient group was in speed of processing, and among unaffected first-degree relatives, it was in the working memory. CONCLUSION: Indian individuals genetically at risk of schizophrenia showed significant neurocognitive impairments in all domains compared with controls.

Effectiveness of Psychological Intervention by Videoconference for Family Members with Depression of Farmers Who Have Committed Suicide.

BACKGROUND: In India two thirds of the population is directly or indirectly dependent on agriculture. The suicide rate for farmers throughout the world is higher than the non-farming population with India being no exception. Family members of the household where a member has committed suicide are at an increased risk for depression, anxiety and suicide. There is a paucity of trained counsellors in India, while there is sufficient research showing counselling and therapy through videoconferencing is just as effective as in-person therapy. It is however, not commonly practiced in India, especially in rural settings. We propose to evaluate psychiatric morbidity and assess feasibility and effectiveness of videoconferencing for family members of farmers who had committed suicide. OBJECTIVES: The objective is to evaluate family members of farmers who have committed suicide for psychiatric morbidity and psychosocial risk factors. We aim to identify depression, anxiety and suicidal risk in family members and then administer psychological intervention through video-conferencing for depression to study its effectiveness in the cohort. METHODOLOGY: The data on completed farmer suicide would be collected from district authorities and police departments. Home visit would be made by research staff to assess the risk factors for the farmers who completed suicide. Family members would be screened for anxiety and depression and severity of depression and suicidal ideas would be rated. The family members having mild to moderate depression would be randomised and CBT based psychological intervention (5 sessions) over three months would be given by trained psychologist through videoconferencing. The outcome would be measured at the end of six months. CONCLUSIONS: Psychological interventions through video-conference might be beneficial in the treatment of mild to moderate depression in family members of the farmers who have committed suicide.

Academic stress among Indian adolescent girls.

CONTEXT: Academic learning is the main source of stress among adolescents and is associated with mental health problems; finding its determinants helps to know the risk factors that influence stress. AIM: The main aim of the study was to assess the educational stress and their predictors among adolescent girls. SETTINGS AND DESIGN: A cross-sectional study was conducted in ten colleges involving adolescent girls pursuing preuniversity and university studies at Dharwad city, India. SUBJECTS AND METHODS: The study included 314 randomly selected adolescent girls aged between 16 and 19 years. The study was approved by the institutional ethics committee. Data were collected by employing random sampling technique. Self-administered questionnaires were administered which included sociodemographic data sheet, personality inventory, intelligence quotient (IQ) assessment, and educational stress scale for adolescents. RESULTS: Mean educational stress was 50.04 ± 10.82 (range 16-80). There was a significant association between educational stress and religion, father education, number of siblings, combination of subjects, type of personality, and IQ. Regression analysis revealed that number of siblings and extrovert neuroticism personality negatively predicted stress (beta = -0.115, P = 0.037; beta = -0.242, P = 0.001) and considered as protective factors. Introvert neuroticism, Hindu religion, illiterate father, and commerce combination of subjects positively predicted stress among adolescent girls (beta = 0.160, P = 0.026; beta = 0.119, P = 0.028; beta = 0.125, P = 0.017; and beta = 0.278, P < 0.001) and considered as risk factors. CONCLUSIONS: Findings help in better understanding of educational stress factors among adolescent girls and consider them while developing stress prevention programs.

Impact of holistic stress management program on academic stress and well-being of Indian adolescent girls: A randomized controlled trial.

CONTEXT: Academic stress among adolescents is a significant contributor to a variety of mental and behavioral disorders. Holistic stress management interventions equip adolescents with good mental health and improve academic performance. AIM: The aim of the study is to evaluate the effectiveness of holistic group-based stress management program in reducing academic stress, depression, anxiety, and improving well-being among adolescent girls. SETTINGS AND DESIGN: Randomized control trial was adopted and the study was conducted at selected colleges of Dharwad city, Karnataka, India. MATERIALS AND METHODS: Two hundred and thirty adolescent girls were randomly selected and assigned to either experimental (n = 115) or control group (n = 115). Both group participants were initially assessed for academic stress, depression, anxiety, general stress, and well-being. The experimental group participants participated in eight sessions of holistic group-based stress management program over a period of 1 month. The intervention comprises of body-mind-spirit strategies focusing on techniques to handle stressful situations, accept responsibility for their own well-being, and take charge of self-health. Control group participants did not receive any intervention. Postintervention assessments were conducted for all the participants on monthly intervals for 6 months. RESULTS: Over 6 months follow-up compared to control group, the experimental group participants showed statistically significant decrease in academic stress (F = 131.60, P < 0.01, n2 G = 0.14), depression (F = 156.70, P < 0.01, n2 G = 0.13), anxiety (F = 190.50, P < 0.01, n2 G = 0.16), general stress (F = 166.10, P < 0.01, n2 G = 0.16), and improvement in well-being (F = 156.40, P < 0.01, n2 G = 0.13). CONCLUSIONS: These findings indicate that holistic stress management program has a positive effect on reducing stress, anxiety, depression, and improving well-being.

Serum Magnesium as a Marker of Neurological Outcome in Severe Traumatic Brain Injury Patients.

Hypomagnesemia is postulated as one of the important determinants of outcome following traumatic brain injury (TBI) through its effect on secondary injuries to neurons. AIMS AND OBJECTIVE: The aim of this study was to determine the relationship between serum magnesium level and neurological outcome in patients admitted with severe head injury. MATERIALS AND METHODS: In this prospective study, patients admitted with severe TBI were recruited and dichotomized into low serum magnesium group and normal serum magnesium group based on the initial serum magnesium level. Data were collected regarding age, sex, and Glasgow Coma Scale at admission. Neurological outcome of the patients in these groups was assessed using Glasgow Outcome Scale at 6 months. RESULTS: Seventy-two patients (male = 50, female = 22) with a mean (±standard deviation) age of 42.5 (±12.7) years were studied. Forty-two (58%) patients had low serum magnesium level (<1.3 mEq/L) at admissions. At 6-month follow-up, 81% of patients with poor neurological outcome had low serum magnesium as compared to 19% of patients with good outcome (P = 0.01). Hypomagnesemia was associated with poor neurological outcome (odds ratio = 2.1, P = 0.04, 95% confidence interval = 1.0-8.8) on regression analysis. CONCLUSION: Hypomagnesemia appears to be an independent prognostic marker in patients with severe TBI.

Current Innovations in Peripheral Nerve Stimulation.

Peripheral nerve stimulation has been used in the treatment of several chronic pain conditions including pain due to peripheral nerve dysfunctions, complex regional pain syndrome, and cranial neuralgias. It has been shown to be effective for chronic, intractable pain that is refractory to conventional therapies such as physical therapy, medications, transcutaneous electrical stimulations, and nerve blocks. Recently, a new generation of peripheral nerve stimulation devices has been developed; these allow external pulse generators to transmit impulses wirelessly to the implanted electrode, and their implantation is significantly less invasive. In this review, we discuss the history, pathophysiology, indications, implantation process, and outcomes of employing peripheral nerve stimulation to treat chronic pain conditions.