Change of symptoms of schizophrenia across phases of menstrual cycle.

The relation between schizophrenia and the menstrual cycle has always been found attractive by researchers. It is still a question of debate whether the clinical picture changes during the menstrual cycle. Our study aimed to see whether there is any change of symptoms during different phases of menstrual cycle (premenstrual, menstrual, and postmenstrual) in patients suffering from schizophrenia. Over a period of 15 months, 40 female inpatients of a tertiary care psychiatric hospital with the diagnosis of schizophrenia were assessed by applying PANSS. Rating was done up to two menstrual cycles. Total scores, positive and negative subscale scores, and general psychopathology scores of PANSS in premenstrual, menstrual, and postmenstrual phases of those patients were compared with one another by applying paired t test. Symptoms in women suffering from schizophrenia frequently vary with the different phases of menstrual cycle. The positive symptoms improved significantly only during progesterone phase. Negative symptoms and general psychopathology subscale showed improvement on estrogen phases of menstrual cycle. So optimal treatment needs to be adjusted to the individual women suffering from schizophrenia.

Ninety-Day Morbidity and Mortality in Risk-Screened and Optimized Patients Undergoing Two-Team Fast-Track Simultaneous Bilateral TKA Compared With Unilateral TKA-A Prospective Study.

BACKGROUND: Simultaneous bilateral total knee arthroplasty (SBTKA) offers significant socioeconomic benefits. However, retrospective studies and public health data show increased mortality and morbidity rates in patients undergoing SBTKA compared with those undergoing unilateral TKA (UTKA), and there have been recommendations against the use of SBTKA. High-volume centers, which feature careful patient selection and fast-tracked surgery, continue to perform SBTKA and have published their results in favor of the procedure. However, the quality of evidence remains poor. METHODS: We prospectively examined 90-day morbidity and mortality of SBTKA compared with UTKA in risk-screened and optimized patients in our high-volume joint replacement facility. A total of 1200 consecutive patients were recruited in each arm. RESULTS: Ninety-day mortality was higher in SBTKA patients than in UTKA patients (0.58% vs 0.42%, respectively; P = .5646). Overall procedure-related complications were significantly higher in the SBTKA group (7.25% vs 4.42%, respectively; P = .0034). The relative risk of cardiovascular complications in SBTKA patients was 6.5 times higher than that in UTKA patients (1.08% vs 0.17%, respectively; P = .0136). Neurological complications were 9.5 times more common in the SBTKA group (1.58% vs 0.17%, respectively; P = .0024). All other complications were comparable in the 2 groups. CONCLUSION: Risk screening and preoperative optimization reduce mortality and overall complication rates in SBTKA patients; however, overall procedure-related complications, specifically cardiovascular and neurological, remain significantly high in SBTKA patients, for which a guarded approach is recommended.

Extremity and Orthopaedic Injuries.

The extremities remain the most common sites of wounding in combat, and are often a combination of injures to soft tissues, bones, vessels and nerves. While these injuries are managed only after life threatening injuries are tackled first, precise evaluation and prompt management strategies to attain optimal outcome remain the goals of treatment. With advancements in tourniquet science, broader spectrum antibiotics, use of negative pressure wound therapy, easier options for fracture stabilization and continuously evolving reconstructive procedures have all increased the tools available to the surgeon to salvage severely damaged limbs.

Canine Monocytic Ehrlichiosis among working dogs of organised kennels in India: A comprehensive analyses of clinico-pathology, serological and molecular epidemiological approach.

Canine Monocytic Ehrlichiosis (CME) is a serious tick-borne rickettsial disease affecting canine populations globally. Besides few reports from stray and pet dogs from localised geographical regions (cities/towns/small states), a comprehensive study on prevalence of Ehrlichia canis (E. canis) among working dogs from different geo-climatic zones of India was pertinently lacking. Study of CME among these dog populations was thus carried out, encompassing clinical aspects and different diagnostic methodologies viz., microscopy, serology and molecular biology. During the two-year study period, clinical specimens from 225 cases suspected of canine ehrlichiosis were examined for clinical pathology and presence of the haemoparasites. Overall prevalence of ehrlichiosis by microscopic examination, commercial dot-ELISA kit and nested PCR assay was estimated to be 1.3%, 19.1% and 5.8%, respectively, which were found to be statistically significant by McNemar Chi squared test (p<0.05). It was also observed that possibly due to widespread use of doxycycline therapy in field, CME presently does not remain a potential threat which it uses to pose earlier. However, concurrent infections of E. canis and Babesia gibsoni were found to be mostly fatal. Keeping in view of high number of apparently healthy dogs (24) out of total positive cases (46) observed during the study, it is recommended that prevalence studies on CME should also involve screening of apparently healthy dogs. Phylogenetic analysis carried on partial sequencing of 16S rRNA of E. canis strains revealed that all of the Indian strains clustered in a single clade with other E. canis species from India and rest of the world. Molecular divergence was observed among the sequences of Brazilian and American isolates which were also included in the present study. These findings have thus opened a new paradigm for planning of pragmatic control strategies against CME.

Co-morbidity of Obsessive-compulsive Disorder and Other Anxiety Disorders with Child and Adolescent Mood Disorders.

OBJECTIVE: To assess the co-morbidity of obsessive-compulsive disorder (OCD) and other anxiety disorders in child and adolescent mood disorders. METHODS: A total of 100 patients aged < 18 years with mood disorders according to the DSM-IV-TR were screened for OCD and other anxiety disorders using Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version. RESULTS: The prevalence of co-morbid anxiety disorders was 22%; OCD was present in 4%, and subthreshold obsessive-compulsive symptoms were present in 2%. Among others, 8% had panic disorder, 7% had generalised anxiety disorder, 3% had separation anxiety disorder, and 1% had social phobia; multiple anxiety disorders were present in 3% of patients. CONCLUSION: Co-morbid anxiety disorder was found in one-fifth of children and adolescents with mood disorder.

Recurrence of hallucinations in consecutive episodes of schizophrenia and affective disorder.

48 patients with episodic psychosis (18 schizophrenia, 30 MDP) were studied to examine whether they had similar hallucinations in consecutive episodes. 34 cases reported hallucinations, 23 of whom had hallucinations in consecutive episodes. In 22 of these 23 cases, the same type of hallucination (in the same sense organ modality) recurred. A recurrence of similar content was found in nearly half of the cases. In cases in whom the hallucinatory content persisted, however, there was no persistence of delusional content. Similar neurophysiological disturbances in similar neuroanatomical regions may result in the persistence of the same hallucinations.

Consistency of delusions in schizophrenia and affective disorder.

The content of delusions were studied in a group of schizophrenics and affective disorder patients who had an episodic course to ascertain if the content of delusions remained similar or became dissimilar during different episodes. There were 18 schizophrenics and 30 affective disorder cases in this study. Consistency of delusional content was noted in one third of the cases in each group. Delusional content was consistent over episodes more often in Hindus (P less than 0.04), those married (P less than 0.03), and those from a rural background in the schizophrenic group. These differences were not observed in the affective disorder cases. Possible reasons for the consistence or non-consistence of delusional content are discussed.

A comparison of stapled vs handsewn anastomosis in anterior resection for carcinoma rectum.

The merits of stapled versus hand sewn anastomosis were evaluated in a prospective randomized study of 60 patients undergoing resection for rectal cancer. The analysed factors included the time required for construction of anastomosis, post operative complications, local recurrence, disease free state and survival. Hand sewn anastomosis was performed in two layers with 3/0 silk in 30 cases and the stapled anastomosis with EEA staplers in 30 cases. The anastomosis time averaged 24 minutes in the suture group and 16 minutes in the stapling group. Five post-operative complications occurred in each group. Six patients of the hand sewn group developed local recurrence as a first sign of treatment failure compared to four patients in the stapled group. The average time of study was 41 months. No significant difference was found in the overall survival pattern of the two groups.

Psycho-social dysfunctions in patients after recovery from mania and depression.

Contrary to popular opinion, complete functional recovery does not occur in approximately 25% of patients with a diagnosis of mood disorders. The current study aimed at finding the recovery status in major mood disorders. A sample group of 122 patients (77 bipolar and 45 major depression) was selected from the outpatient department, fulfilling the DSM-IV diagnostic criteria. All patients had their index episodes at least one year prior to their date of inclusion and were either asymptomatic or mildly symptomatic during that time. Manics and depressives were rated with the Bech Raefelson Mania Scale (BRMS) and Hamilton Depression Rating Scale (HDRS) respectively. All the patients were also rated on the Brief Psychiatric Rating Scale (BPRS), Dysfunction Analysis Questionnaire (DAQ) and Global Evaluation Scale of Disability Assessment Schedule by WHO (GES/DAS). They were compared with 40 age and sex matched normal controls. It was found that the symptomatic recovery was better than the functional recovery in both manics and depressives and patients with major depression were marginally more dysfunctional compared to those with mania. It is concluded that a majority of patients of both mania and depression do not achieve complete functional recovery and are in need of on-going psychosocial rehabilitation.

Post-encephalitic Kluver-Bucy syndrome.

Kluver-Bucy syndrome is a rare amalgamation of neurobehavioural signs and symptoms seen infrequently in humans following insult to bilateral temporal lobes. This report presents a case which along with emerging symptoms of Kluver-Bucy syndrome, developed Attention-Deficit/Hyperactivity Disorder (ADHD) consequent to viral encephalitis. The case highlights the presentation and management of this syndrome in a six-year-old girl with primary focus on the implications of Kluver-Bucy symptoms in current clinical practice involving neurobehavioural syndromes in children.

Event-related potential: An overview.

Electroencephalography (EEG) provides an excellent medium to understand neurobiological dysregulation, with the potential to evaluate neurotransmission. Time-locked EEG activity or event-related potential (ERP) helps capture neural activity related to both sensory and cognitive processes. In this article, we attempt to present an overview of the different waveforms of ERP and the major findings in various psychiatric conditions.