Role of ferroptosis inhibitors in the management of diabetes.

Ferroptosis, the iron-dependent, lipid peroxide-mediated cell death, has garnered attention due to its critical involvement in crucial physiological and pathological cellular processes. Indeed, several studies have attributed its role in developing a range of disorders, including diabetes. As accumulating evidence further the understanding of ferroptotic mechanisms, the impact this specialized mode of cell death has on diabetic pathogenesis is still unclear. Several in vivo and in vitro studies have highlighted the association of ferroptosis with beta-cell death and insulin resistance, supported by observations of marked alterations in ferroptotic markers in experimental diabetes models. The constant improvement in understanding ferroptosis in diabetes has demonstrated it as a potential therapeutic target in diabetic management. In this regard, ferroptosis inhibitors promise to rescue pancreatic beta-cell function and alleviate diabetes and its complications. This review article elucidates the key ferroptotic pathways that mediate beta-cell death in diabetes, and its complications. In particular, we share our insight into the cross talk between ferroptosis and other hallmark pathogenic mediators such as oxidative and endoplasmic reticulum stress regulators relevant to diabetes progression. Further, we extensively summarize the recent developments on the role of ferroptosis inhibitors and their therapeutic action in alleviating diabetes and its complications.

Comparison of the effect of in vitro and in vivo exposure on cadaveric anxiety among first year medical and nursing students.

BACKGROUND: Human anatomy instruction is mostly focused on cadaver dissection and prosected specimen examination. Exposure to cadaver dissection can be a stressful experience that may cause a wide variety of symptoms among students of health sciences. To compare and evaluate the effect of in-vitro and in-vivo exposure on cadaveric anxiety, disgust propensity and sensitivity, and attitude toward death and dying among 1st-year medical and nursing students. MATERIALS AND METHODS: An open-label randomized trial (matched-control experimental design) was conducted among 127 1st-year Medical and Nursing students from a selected Institute of National Importance, Bhopal, India during 2015. The participants were divided into an experimental and control group based on matched trait anxiety scores using the Trait Anxiety Inventory. Followed by preassessment, video demonstration with cadaver dissection (in vitro exposure) was then administered to the experimental group, while the control group had direct exposure to cadaver dissection (in vivo exposure). RESULTS: The study showed that there was a statistically significant difference in state anxiety related to cadaver dissection in the experimental group (P = 0.01). However, video-demonstration of cadaver dissection did not have any effect on disgust propensity and sensitivity and attitude toward death and dying. CONCLUSION: The findings provided evidence that video-demonstration of cadaver dissection reduced anxiety, although it did not have any effect on disgust and attitudes of death. The dissection hall experience may evoke feelings of anxiety and disgust that need to be addressed through advanced preparedness and coping strategies, especially among medical and nursing students.

Role of ER stress inhibitors in the management of diabetes.

Endoplasmic Reticulum (ER) stress has been established to play a key pathophysiological role in developing metabolic diseases such as Diabetes Mellitus (DM). The complications of DM have been closely associated with deregulation of the unfolded protein response (UPR) signaling pathways, which are critically responsible for restoring homeostasis following ER stress. Chronic ER stress in the background of persistent hyperglycemia, as observed in DM, overwhelms the UPR signaling and commits the cells to apoptosis. The factors such as hyperglycemia, increased reactive oxygen species (ROS), disrupted calcium homeostasis, and overt inflammation serve as major UPR signal transduction pathways, including PKR like ER kinase (PERK), Activating transcription factor 6α/ß (ATF6), and Inositol requiring enzyme1α/ß (IRE1). The constantly developing understanding of these ER stress mediators has also unraveled their potential as therapeutic targets of small molecules termed ER stress inhibitors. A wide range of both naturally occurring and synthetic compounds have been screened and studied for their properties to inhibit ER stress in various experimental models. This review article elucidates the critical signaling pathways associated with response to ER stress. We shed light on the crosstalk between ER stress mediators with oxidative and inflammatory stress mediators in the background of DM. We extensively summarize the pieces of evidence sourced from preclinical and clinical research about the role of ER stress inhibitors and their pharmacological mechanism of action in alleviating ER stress in diabetes.

Use of Technology to Facilitate Performance of Activities of Daily Living in Persons Availing Psychiatric Rehabilitation Services During Covid-19 Pandemic.

The global health crisis caused by the coronavirus pandemic (COVID-19) has brought about previously unimaginable changes to all of health care, including the field of psychiatric rehabilitation. During the pandemic, many issues pertaining to the people with SMI(Severe Mental Illness) was addressed, however, we have not found any studies exploring the impact of pandemic on Activities of daily living. Here we discuss two case reports to furnish the first -hand experience on how online sessions have helped patients to improve their Instrumental Activities of Daily Living (IADL), a component of Activities of Daily Living (ADL). Though the pandemic had an impact on IADL initially in both the patients, with technology facilitated psychiatric rehabilitation both patients improved in areas of managing household chores, cooking, concentration and memory as reported by their caregivers. Family involvement in care and bonding also increased. Online sessions facilitated persons with mental illness to engage in daily activities, created an interest in them to attend the sessions and to translate them in real-time world and increased the involvement of caregivers in training them.

How Healthy Is State Mental Health System in Madhya Pradesh, India? An Assessment of Today to Plan for a Better Tomorrow.

BACKGROUND: Mental illness affects over one-third of the Indian population, and only a little is known about the exact situation of health systems in Madhya Pradesh, India. Therefore, the present research work provides an assessment of state mental health systems in Madhya Pradesh. METHODS: The present cross-sectional study was conducted as a part of National Mental Health Survey 2015-16 in 48 districts of Madhya Pradesh, to provide an overview of the status of mental health systems. Secondary data was also retrieved from the state office so as to present the situational analysis in a more comprehensive and inferential way. The proforma for the study was developed based on the experience gained from studies conducted earlier with World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS) and with WHO's Mental Health Atlas as the base for thematic analysis. RESULTS: Out of 51 districts, 13.7% of the districts of the state have been covered under District Mental Health Program (DMHP) in 2015-16. Around 11.8% of district/general hospitals were involved in providing mental health services. The availability of psychiatrist was 0.05 per Lakh population. Around 0.2% of the total health budget was allocated by the state for the last financial year for mental health. The overall average score of Madhya Pradesh in the assessment of qualitative indicators was 31 out of 100 in the year 2015-16. CONCLUSION: There is huge scope and an urgent need to increase mental healthcare facilities (with upgradation of existing one) along the availability of mental healthcare staff.

Profile of recipients of holistic health counselling in a psychiatric OPD in South India.

BACKGROUND OF THE STUDY: Persons with mental illness (PwMI) are prone to weight gain as a side effect of antipsychotics. Health counselling on diet, physical activity, medication adherence, expressed emotions and technology use, by health professionals, can help in managing these side-effects. AIM: The aim of this study was to identify the pre-counselling profile of the subjects such as body mass index (BMI), diet, physical activity, medication adherence, expressed emotions and technology use among PwMI; to attend the Holistic Health Clinic as part of follow-up services in the psychiatry Outpatient Department (OPD) as well as to find correlation and association between the study variables. METHODS: The study involved a cross-sectional descriptive design based on convenience sampling. The sample consists of 56 patients who are receiving antipsychotics under symptom control (self-reported) and were overweight. Data were collected with a patient assessment proforma and analysed using SPSS-22. RESULTS: The patients referred to the holistic health counselling (HHC) had abnormal weight and BMI. The mean and SD of weight was 74.48 ± 14.07 and BMI 29.51 ± 5.15. All the participants received counselling on diet, 87.5% on physical activity, 62.5% on sleep hygiene, 55.4% on medication adherence, 8.9% on family emotional climate and only 5.4% on healthy use of technology. Weight has shown significant relation with gender (male = 80.84 ± 17.71, female = 71.09 ± 10.52, t = -2.52, p = .015) and near to significant relationship (χ2 = 7.685, p = .053) with educational status. CONCLUSION: Patients receiving second-generation antipsychotics (SGA) have lesser extra pyramidal side-effects; however, they are more prone to gain weight. Proper screening and counselling during the follow-up visit in the outpatient setting can help in identification, prevention and management of the obesity-related metabolic syndrome and cardiovascular disease (CVD), and motivate them to adopt healthy behaviours.

Supported employment programme for persons with severe mental disorders in India: A feasibility study.

BACKGROUND: A number of persons with severe mental illnesses are unable to prepare for, find or keep a job due to factors linked to their illness as well as psychosocial issues. AIM: To test the feasibility of a supported employment programme to help persons with severe mental disorders obtain and sustain employment. METHODS: A supported employment programme was developed for persons with severe mental disorders with components of (a) assessment of vocational potential, (b) vocational counselling, (c) networking and liaison with prospective employers, (d) job-related training and placement and (e) continued support for 6 months. Job placement status, social occupational functioning and disability (quantitative data) and benefits of enrolling in the employment programme (qualitative data) were assessed. RESULTS: A total of 40 employers were liaised with for providing job placement and reasonable accommodation. Out of 63 participants recruited into the study, 32 (50.8%) participants were placed in competitive jobs, placement was actively attempted for 17 (27.0%) participants, 7 (11.1%) were referred for skill training and 7 (11.1%) dropped out from the study. The disability score significantly reduced and socio-occupational functioning significantly improved in those who were placed over a period of 6 months. CONCLUSION: The supported employment programme was found to be feasible as it showed good placement rates and improvement in socio-occupational functioning and disability scores.

Homelessness in mental illness: Opportunities & prospects in the Indian context.

Homelessness is considered a serious public health concern. Bidirectional relationship has been established between homelessness and mental illness by research studies and its association with compromised well-being, poor quality of life and low productivity. Recent legislative enactments in India have necessitated on the part of the state to address issues related to the rights of persons with mental illness including shelter and housing. Therefore, it becomes imperative to discuss opportunities and prospects in India towards rehabilitating homeless mentally ill in context of existing programs, policies and legislations.

The impact of depressive symptoms on the clinical presentation of Persistent Delusional Disorder.

BACKGROUND: Our aim was to investigate the influence of depressive symptoms on the clinical presentation of Persistent Delusional Disorder (PDD). METHODS: We have previously conducted a retrospective review of patients diagnosed with PDD (n = 455). We divided this sample into two groups according to the presence or absence of co-morbid depressive symptoms - a subsample of PDD with depressive co-morbidity (PDD + D; n = 187) and a subsample of PDD without depressive co-morbidity (PDD only; n = 268). RESULTS: PDD + D group had a significantly younger age at onset of PDD. The PDD + D group received significantly more antidepressants but had similar response and adherence rates. CONCLUSIONS: The presence of depressive symptoms in 41% of the study population did not appear to influence the clinical presentation or response to treatment.

Risperidone versus olanzapine in the acute treatment of Persistent Delusional Disorder: A retrospective analysis.

There is a dearth of prospective trials studying treatment response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available retrospective data indicate good response to second-generation antipsychotics (SGAs). We selected the data of patients prescribed either olanzapine or risperidone from a retrospective chart review of PDD (n=455) at our centre. We compared the two groups olanzapine (n =86) versus risperidone (n =280) on dose, drug adherence, response and adverse effects. The two groups were comparable on socio-demographic and clinical characteristics of PDD. There was no statistically significant difference between the two groups on adherence (>80%) and response to treatment (>52% good response). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone. Logistic regression analysis identified shorter mean duration of illness, good adherence and absence of substance dependence as predictors of good response to both drugs. Our study indicates that acute PDD responds well to treatment with both risperidone and olanzapine, provided adherence can be ensured. In the absence of specific treatment guidelines and randomized controlled trials for PDD, our analysis reaffirms the efficacy of SGAs.

Potential use of Caulerpa fastigiata biomass for removal of lead: kinetics, isotherms, thermodynamic, and characterization studies.

The present study attempts to analyze the biosorption trend of biosorbent Caulerpa fastigiata (macroalgae) biomass for removal of toxic heavy metal ion Pb (II) from solution as a function of initial metal ion concentration, pH, temperature, sorbent dosage, and biomass particle size. The sorption data fitted with various isotherm models and Freundlich model was the best one with correlation coefficient of 0.999. Kinetic study results revealed that the sorption data on Pb (II) with correlation coefficient of 0.999 can best be represented by pseudo-second-order. The biosorption capacity (q e ) of Pb (II) is 16.11 ± 0.32 mg g(-1) on C. fastigiata biomass. Thermodynamic studies showed that the process is exothermic (ΔH° negative). Free energy change (ΔG°) with negative sign reflected the feasibility and spontaneous nature of the process. The SEM studies showed Pb (II) biosorption on selective grains of the biosorbent. The FTIR spectra indicated bands corresponding to -OH, COO(-), -CH, C = C, C = S, and -C-C- groups were involved in the biosorption process. The XRD pattern of the C. fastigiata was found to be mostly amorphous in nature.

Potential use of leaf biomass, Araucaria heterophylla for removal of Pb+2.

The present investigation attempt to analyze the biosorption behavior of novel biosorbent, Araucaria heterophylla (green plant) biomass, for removal of Pb(+2) from solution as the function of initial metal ion concentration, pH, temperature, sorbent dosage and biomass particle size. The maximum biosorption was found to be 95.12% at pH 5 and biosorption capacity (q(e)) of Cd(+2) is 9.643 mg/g. The Langmuir and Freundlich equilibrium adsorption isotherms were studied and observed that Freundlich model is best fit than the Langmuir model with correlation coefficient of 0.9927. Kinetic studies indicated that the biosorption process of Cd(+2) followed well pseudo second order model with R2 0.999. The process is exothermic and, spontaneous. The chemical functional groups -OH, CH2 stretching vibrations, C=O of alcohol, C=O of amide, P=O stretching vibrations, -CH, were involved in the process. The XRD pattern of the A. heterophylla was found to be mostly amorphous in nature. The SEM studies showed Pb(+2) biosorption on selective grains of the biosorbent. It was concluded that A. heterophylla leaf powder can be used as an effective, low cost, and environmentally friendly biosorbent for the removal of Pb(+2) from aqueous solution.

Electroconvulsive therapy (ECT) in bipolar disorder: A narrative review of literature.

In many countries including India electroconvulsive therapy (ECT) is frequently used to treat different phases of bipolar disorder. The response to ECT is impressive in mania, depression and in mixed affective states. Preliminary evidence also suggests benefit from maintenance ECT in bipolar disorder. However, most of the literature on efficacy and adverse effects comes from case series, retrospective reports and open trials - controlled trials have been few and far between. Official guidelines recommend the use of ECT only when there is a dire emergency or when all other options have been exhausted. Concurrent use of lithium and antiepileptic drugs along with ECT is common in clinical practice. While such practice appears to be largely safe, one should be mindful about dose of lithium and possible interference of antiepileptic drugs with efficacy of ECT. The use of suprathreshold bilateral ECT and bifrontal placement of electrodes may confer some advantage over other methods.

Inter-rater reliability of Hamilton depression rating scale using video- recorded interviews - Focus on rater-blinding.

BACKGROUND: Hamilton depression rating scale (Ham-D) is the most widely used clinician rating scale for depression. There has been no Indian study that has examined the inter-rater reliability (IRR) of video-recorded interviews of the 21-item Ham-D. AIM: To study the IRR of scoring video-recorded interviews for 21-item Ham-D. MATERIALS AND METHODS: Eighteen subjects with major depressive disorder involved in a larger study were interviewed using the semi-structured clinical interview of the 21-item Ham-D by a primary rater after informed consent. These interviews were video-recorded and portions edited to ensure rater blinding. Subsequently, the video-recorded interviews were rated by a "blind" rater. Both rated the different sub-domains of Ham-D according to Rhoades and Overall (1983). IRR was evaluated using intra-class correlation coefficient. RESULTS: Excellent IRR was observed (0.9891) between the two raters. This was true for each of the primary factors and super-factors. CONCLUSION: Video recorded 21-item Ham-D has excellentIRR. Video-recorded interviews of Ham-D can be reliably used to blind raters in research.