Clinical Pattern of Pediatric Hydatid Disease.

Context: Literature regarding hydatid disease in children is sparse. Aims: To highlight the peculiarities in the clinical pattern of pediatric hydatid disease (PHD). Settings and Design/Materials and Methods: Data were collected retrospectively from all children aged <18 years who presented to our tertiary care institute from July 2021 to June 2023 with hydatid disease involving any organ. Statistical Analysis Used: Simple statistical analysis involving sums, means, averages, and percentages. Results: Four of the 10 cases (40%) involved the lung, while only 2 (20%) involved the liver. There were five females and four males with an age range of 2-17 years. Four of the cases had primary extrahepatic extrapulmonary hydatid disease (40%), two involving the pancreas, one in the rectouterine pouch, and one intracranial. Conclusions: The clinical pattern of PHD is different from that of adults. Pulmonary echinococcosis is more common than hepatic involvement. Primary extrahepatic extrapulmonary hydatid disease is also more common in children than previously thought. A cystic lesion anywhere in a child warrants a differential of hydatid disease.

Oral versus long-acting injectable antipsychotic in first episode schizophrenia: A 12 weeks interventional study.

Background: There is underutilization of long-acting injectable (LAI) antipsychotics for first-episode schizophrenia (FES) despite having convenient dosing and treatment retention. LAIs are predominantly used for patients with poor compliance, chronic course, and multiple relapses. Materials and Methods: Seventy-two treatment naïve patients with the first episode of Schizophrenia (DSM-5) were assessed for baseline severity of psychopathology using the positive and negative syndrome scale (PANSS) and quality of life (QOL) using the WHOQOL-BREF scale. Patients were randomized to receive either oral haloperidol or LAI haloperidol for a period of 12 weeks. Results: Both the groups had a significant reduction in PANSS scores and improvement in QoL over 12 weeks period (P = 0.0001). The LAI group showed greater adherence and significantly better quality of life than the oral group (P = 0.023). The mean numbers of side effects were less in the LAI group at week 2 as compared to the oral group. Conclusion: LAI haloperidol is similar to oral haloperidol in patients with FES with respect to treatment response and offers benefits in form of a lesser number of side effects during early treatment, overall better adherence rates, and better QOL.

Expectations of caregivers of persons with severe mental illness from mental health rehabilitation services: A qualitative study.

BACKGROUND: Mental health rehabilitation services (MHRS) play an essential role in addressing the diverse and often complex needs of persons with severe mental illness (SMI). The rehabilitation services are of utmost importance in training these patients to lead an independent and meaningful life. In India, caregivers of persons with SMI play a significant role in the decision-making process concerning treatment and rehabilitation. AIM: The main objective of the present study was to understand and analyze the expectations of caregivers of persons with severe mental illness from mental health rehabilitation services in the Indian context. METHOD: The present study is qualitative in nature. A semi-structured interview schedule was used to capture the caregivers' expectations. Fifteen caregivers who met inclusion and exclusion criteria were interviewed for the study. The data obtained was analyzed using Braun and Clarke's six-phase data analysis framework. RESULTS: Thematic analysis of the data emerged into five themes, namely (1) 'proximity', (2) 'professionalism of staff', (3) 'treatment related expectations', (4) 'welfare benefits', and (5) 'infrastructure'. These themes and their sub-themes were subsequently discussed in the light of existing literature. CONCLUSION: Caregivers of persons with SMI identified the most relevant as well as generic expectations from MHRS. Understanding these expectations can help improvise the existing services delivery system and help institutes, non-government organizations (NGOs) and other concerned entities working in mental health rehabilitation to develop service user friendly rehabilitation models.

Prevalence of mental health disorders among health-care providers of COVID-19 positive and suspected cases.

Background: Health-care providers (HCP) engaged in demanding work like being involved in the care of COVID-19 positive and suspected cases are likely to have a lot of stress, anxiety, depression, and other mental health issues. It will be noteworthy to have an idea about the magnitude of the mental health problems in them to formulate effective intervention strategies for their well-being. Aims and Objectives: The aim of this study is to determine whether frontline HCP engaged in the treatment and care of COVID-19 positive and suspect cases experienced increased mental health problems. Methodology: Two hundred and fifty-one frontline HCPs engaged in COVID-19 duty and 97 nonfrontline (controls) HCP were assessed and compared using tools like General Health Questionnaire 12, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale. Appropriate statistical tools such as analysis of variance and Chi-square were used. Results: Frontline HCP who were directly involved in COVID-19 duty had a higher proportion (28.3%) of psychological morbidities as compared to 19.6% among controls; HCP-frontline had significantly 2.17 times chances of having psychological distress compared to HCP controls. Among, HCP-frontline 13.1% had clinical depression, whereas in the HCP control, this was 6.2%. Further, 20.3% of HCP frontline and 10.3% of HCP control had clinical anxiety, and the difference between the two groups was statistically significant (P = 0.0011). Conclusion: Frontline HCPs working in demanding work such as COVID-19 patient care are susceptible to psychological distress, anxiety, and depression which warrant urgent attention.

Stress, Coping, and Resilience Among Home-Quarantined Persons During the COVID-19 Pandemic: Findings From a Community Study.

Objective: To assess stress, coping, and resilience among home-quarantined individuals via a community survey during the coronavirus disease 2019 (COVID-19) pandemic.Methods: In this cross-sectional study, a combined list was generated of all contacts of positive COVID-19 cases, traced by a contact tracing team, and international travelers who had entered the country after March 8, 2020 (2 weeks before the air travel shutdown on March 22, 2020 in India). This community-based study was conducted among people who were quarantined in their homes and international travelers who arrived in the country after declaration of lockdown. Stress and coping were assessed via the 12-item General Health Questionnaire, 10-item Perceived Stress Scale, and Brief Resilient Coping Scale. The participants with higher perceived stress scores (≥ 14) were asked to seek help from telemedicine services. Study data were collected from April 8, 2020, to May 20, 2020.Results: The mean age of the 153 study participants was 40.10 years, and 41.8% were women. Poor coping was identified in 25.5% of the sample, and moderate/high stress was present in 49.7%. Significantly higher stress was noted in women (P = .007). Higher age, joint family structure, and contacts of COVID cases were significant predictors of moderate/severe perceived stress in the logistic regression.Conclusions: Adequate psychological supportive services should be provided to home-quarantined persons through provision of information, rapid communication, and timely supplies of general and medical items.

Homeologs of Brassica SOC1, a central regulator of flowering time, are differentially regulated due to partitioning of evolutionarily conserved transcription factor binding sites in promoters.

Evolution of Brassica genome post-polyploidization reveals asymmetrical genome fractionation and copy number variation. Herein, we describe the impact of promoter divergence among SUPPRESSOR OF OVEREXPRESSION OF CONSTANS1 (SOC1) homeologs on expression and function in Brassica spp. SOC1, a regulated floral pathway integrator, is conserved as 3 redundant homeologs in diploid Brassicas. Even with high sequence identity within coding regions (92.8-100%), the spatio-temporal expression patterns of 9 SOC1 homologs in B. juncea and B. nigra indicates regulatory divergence. While LF and MF2 SOC1 homeologs are upregulated during floral transition, MF1 is barely expressed. Also, MF2 homeolog levels do not decline post-flowering, unlike LF. To investigate the underlying source of divergence, we analyzed the sequence and phylogeny of all reported (22) and isolated (21) upstream regions of Brassica SOC1. Full length upstream regions (4712-19189 bp) reveal 5 ubiquitously conserved ancestral Blocks, harboring binding sites of 18 TFs (TFBSs) characterized in Arabidopsis thaliana. The orthologs of these TFBSs are differentially conserved among Brassica SOC1 homeologs, imparting expression divergence. No crucial TFBSs are exclusively lost from LF_SOC1 promoter, while MF1_SOC1 has lost NF-Y binding site crucial for SOC1 activation by CONSTANS. MF2_SOC1 homeologs have lost important TFBSs (SEP3, AP1 and SMZ), responsible for SOC1 repression post-flowering. BjuAALF_SOC1 promoter (proximal 2 kb) shows ubiquitous reporter expression in B. juncea cv. Varuna transgenics, while BjuAAMF1_SOC1 promoter shows absence of reporter expression, validating the impact of TFBS divergence. Conservation of the original primary protein sequence is discovered in B. rapa homeologs (46) of 18 TFs. Co-regulation pattern of these TFs appeared similar for B. rapa LF and MF2 SOC1 homeologs; MF1 shows significant variation. Strong regulatory association is recorded for AP1, AP2, SEP3, FLC and CONSTANS/NF-Y, highlighting their importance in homeolog-specific SOC1 regulation. Correlation of B. juncea AP1, AP2 and FLC expression with SOC1 homeologs also complies with the TFBS differences. We thus conclude that redundant SOC1 loci contribute differentially to cumulative expression of SOC1 due to divergent selection of ancestral TFBSs.

SUPPRESSOR OF OVEREXPRESSION OF CONSTANS1 influences flowering time, lateral branching, oil quality, and seed yield in Brassica juncea cv. Varuna.

SOC1, a MADS-box type II transcription factor, integrates environmental and endogenous cues to promote flowering in angiosperms. Recent reports implicating SOC1 in roles beyond floral transition prompted functional characterization of SOC1 in polyploid rapeseed mustard genomes. Gene characterization in Brassicas necessitates analysis of composite homeolog function. While insertional mutagenesis is untenable in Brassicas owing to gene redundancy, gain-of-function approach entails serial characterization of individual homeologs. Herein, we demonstrate modulated floral promotive effects in natural variants of Brassica SOC1 and provide lateral branching as a probable outcome of polyploidy-induced gene diversification. Ectopic expression of two B genome specific SOC1 variants in Arabidopsis thaliana resulted in differential floral acceleration and manifestation of multiple vegetative rosettes. Characterization of composite homeolog function in B. juncea via introgression of Brassica SOC1 specific artificial miRNA, designed to target homeologs, also exhibited modifications in floral transition and lateral branching. Comprehensive analysis of field performance of B. juncea transgenics displayed altered fitness across 11 agronomic traits. Crucially, reduced SOC1 levels directly impacted two developmental traits, namely, flowering time and number of lateral branches which in turn influenced several dependent agronomic traits. While delayed flowering and crop maturity resulted in altered fatty acid composition with higher SFA and lower PUFA in transgenics relative to controls, reduction in overall count of lateral branches caused a concomitant decrease in silique count which ultimately impacted total seed yield in transgenics. Statistical analysis revealed number of secondary branches as the most critical trait influencing seed yield. Based on our findings, we propose enhancing levels Brassica SOC1, a key target, for achieving earliness in flowering, improved seed yield and oil quality, and studying trait trade-offs.

Natural variation in Brassica FT homeologs influences multiple agronomic traits including flowering time, silique shape, oil profile, stomatal morphology and plant height in B. juncea.

Natural structural variants of regulatory proteins causing quantitative phenotypic consequences have not been reported in plants. Herein, we show that 28 natural structural variants of FT homeologs, isolated from 6 species of Brassica, differ with respect to amino-acid substitutions in regions critical for interactions with FD and represent two evolutionarily distinct categories. Analysis of structural models of selected candidates from Brassica juncea (BjuFT_AAMF1) and Brassica napus (BnaFT_CCLF) predicted stronger binding between BjuFT and Arabidopsis thaliana FD. Over-expression of BjuFT and BnaFT in wild type and ft-10 mutant backgrounds of Arabidopsis validated higher potency of BjuFT in triggering floral transition. Analysis of gain-of-function and artificial miRNA mediated silenced lines of B. juncea implicated Brassica FT in multiple agronomic traits beyond flowering, consistent with a pleiotropic effect. Several dependent and independent traits such as lateral branching, silique shape, seed size, oil-profile, stomatal morphology and plant height were found altered in mutant lines. Enhanced FT levels caused early flowering, which in turn was positively correlated to a higher proportion of desirable fatty acids (PUFA). However, higher FT levels also resulted in altered silique shape and reduced seed size, suggesting trait trade-offs. Modulation of FT levels for achieving optimal balance of trait values and parsing pair-wise interactions among a reportoire of regulatory protein homeologs in polyploid genomes are indeed future areas of crop research.

Functional characterization of a novel Brassica LEAFY homolog from Indian mustard: Expression pattern and gain-of-function studies.

LEAFY plays a central role in regulation of flowering time and floral meristem identity in plants. Unfortunately, LFY function remains uncharacterized in agronomicaly important Brassicas. Herein, we illustrate fine-mapping of expression domains of LFY in 15 cultivars of 6 Brassica species and describe gain-of-function phenotypes in Arabidopsis and Brassica. We depict early flowering and altered fatty-acid composition in transgenic seed. The cDNA encoding BjuLFY (417aa) shared only 85% identity with reported homolog of B.juncea implying distinctness. Quantitative RT-PCR based coarse expression mapping of BjuLFY in tissue samples representing 3 time points at specific days after sowing (DAS), pre-flowering (30 DAS), flowering (75 DAS) and post-flowering (110 DAS), depicted an intense pulse of BjuLFY expression restricted to primary floral buds (75 DAS) which subsided in secondary floral buds (110 DAS); expression in root samples was also recorded implying neo-functionalization. Fine-mapping of expression during flowering confirmed tightly regulated LFY expression during early stages of bud development in 15 cultivars of 6 Brassica species implying functional conservation. Ectopic expression of BjuLFY in A. thaliana and B. juncea caused floral meristem defects and precocious flowering. B. juncea transgenics (T1) over-expressing BjuLFY flowered 20days earlier produced normal flowers. GC-MS analysis of mature seed from Brassica transgenics showed an altered fatty-acid profile suggestive of seed maturation occurring at lower temperatures vis-à-vis control. Our findings implicate BjuLFY as a regulator of flowering in B. juncea and suggest its application in developing climate resilient crops.

Attitudes toward psychotropic medications among patients with chronic psychiatric disorders and their family caregivers.

AIM: To examine attitudes towards psychotropic medications among patients with chronic psychiatric disorders as well as their family caregivers by using factor analysis. MATERIALS AND METHODS: The study included 200 patients and their family caregivers with chronic psychiatric disorders who are attending the psychiatry outpatient services. A self-designed 18-item self-rated questionnaire was used to evaluate the attitude toward psychotropics and factor analysis was done to study the different models of attitudes. RESULTS: In general both patients and caregivers had positive attitude toward the psychotropic medications and there was no significant difference between the patients and caregivers on the various items of the questionnaire assessing the attitude. Factor analysis of the questionnaire indicated that either two-factor or four-factor models explained the attitude of the patients and caregivers. In the two-factor model there was one positive and one negative attitude factor, whereas the four-factor model comprised of two positive and two negative attitude factors. The four-factor model of attitudes provided a more comprehensive solution to how attitudes might be formed among patients and their family caregivers. Factors one and four in the four-factor solution still reflected positive attitudes, but appeared to portray a risk-benefit approach, in which benefits such as the efficacy of psychotropic medications in treating mental illnesses and preventing relapse, and medications being better than other options were being contrasted with the risks of side effects and permanent damage or harm. CONCLUSION: Attitudes of patients with chronic psychiatric disorders and their caregivers toward psychotropic medications appear to be shaped by factors such as perceived efficacy or benefit from medicines, the necessity for taking treatment and concerns such as side effects, harm or expense.

Development of novel carrier(s) mediated tuberculosis vaccine: more than a tour de force.

Despite worldwide availability of the vaccines against most of the infectious diseases, BCG and various programs such as Directly Observed Treatment Short course (DOTS) to prevent tuberculosis still remains one of the most deadly forms of the disease affecting millions of people globally. The evolution of multi drug resistant strains (MDR) has increased the complexity further. Although currently available marketed BCG vaccine has shown sufficient protection against childhood tuberculosis, it has failed to prevent the most common form of disease i.e., pulmonary tuberculosis in adults. However, various vaccine candidates have already entered phase I clinical trials and have shown promising outcomes. The most prominent amongst them is the heterologous prime-boost approach, which shows a great promise towards designing and development of a new efficacious tuberculosis vaccine. It has also been shown that the use of various viral and non-viral vectors as carriers for the potential vaccine candidates will further boost their effect on subsequent immunization. In this review, we briefly summarize the potential of a few novel nano-carriers for developing effective vaccination strategies against tuberculosis.

Explanatory models in patients with first episode depression: a study from north India.

The purpose of this work was to study the explanatory models of patients with first episode depression presenting to a tertiary care hospital located in North-western India. One hundred sixty four consecutive patients with diagnosis of first episode depression (except severe depression with psychotic symptoms) according to the International Classification of Diseases-10th Revision (ICD-10) and ≥18 years of age were evaluated for their explanatory models using the causal models section of Explanatory Model Interview Catalogue (EMIC). The most common explanations given were categorized into Karma-deed-heredity category (77.4%), followed by psychological explanations (62.2%), weakness (50%) and social causes (40.2%). Among the various specific causes the commonly reported explanations by at least one-fourth of the sample in decreasing order were: will of god (51.2%), fate/chance (40.9%), weakness of nerves (37.8%), general weakness (34.7%), bad deeds (26.2%), evil eye (24.4%) and family problems (21.9%). There was some influence of sociodemographic features on the explanations given by the patients. From the study, it can be concluded that patients with first episode depression have multiple explanatory models for their symptoms of depression which are slightly different than those reported in previous studies done from other parts of India. Understanding the multiple explanatory models for their symptoms of depression can have important treatment implications.

Contribution of spirituality to quality of life in patients with residual schizophrenia.

There is increasing recognition that a person's spiritual or religious experiences contribute to quality of life (QOL). However, research exploring the relation between spirituality and QOL has mainly been in the context of chronic and life-threatening illnesses, and studies examining this important correlate of QOL in chronically mentally ill subjects are sparse. This study aimed to explore the relationship between spirituality and QOL, and to investigate if spirituality contributes to other domains of QOL (both physical and psycho-social) in subjects with residual schizophrenia. In a study with a cross-sectional design, 103 patients with residual schizophrenia were assessed with the Positive and Negative Syndrome scale, and their quality of life, spirituality and religiousness were assessed with the WHO Quality of Life-Spirituality, Religiousness and Personal Beliefs (WHOQOL-SRPB) scale. The SRPB domain and all its facets other than spiritual connection correlated significantly with all other domains of QOL and overall QOL. On regression analysis, the inner peace domain of spirituality explained 21.6 to 37.6% of variance of all QOL domains except the domain of level of independence. The spirituality domain explained 33.8% of the variance of the 'level of independence domain of QOL. Taken together, inner peace and spirituality facets explained 23 to 40% of the variance of the social relationships domain, the psychological domain and the level of independence domain of QOL. This study suggests that spirituality and religiosity have an important influence on overall QOL of patients with schizophrenia. Hence, besides pharmacological and non-pharmacological management for schizophrenia, clinicians should focus on this aspect and encourage their patients to follow their religious practices and spiritual beliefs.

Relationship between spirituality/religiousness and coping in patients with residual schizophrenia.

PURPOSE: To measure spirituality/religiousness and its relation to coping skills in patients with residual schizophrenia. METHODS: Using a cross-sectional design, 103 persons with residual schizophrenia were assessed on Positive and Negative Syndrome Scale [PANSS] and Ways of Coping Checklist [WCC] to assess the repertoire of coping skills and WHO Quality of Life-Spirituality, Religiousness and Personal Belief scale [WHOQOL-SRPB] to assess religiousness and spirituality. RESULTS: Positive reappraisal as a coping strategy had significant positive correlation with all the facets of WHOQOL-SRPB and SRPB total domain scores. The coping subscales of accepting responsibility, planful problem solving, distancing, confrontive coping, and self-controlling also had significant positive correlations with different facets of WHOQOL-SRPB and total SRPB domain score. Seeking social support and escape-avoidance as coping mechanisms had no correlations with any of the WHOQOL-SRPB facets. CONCLUSIONS: A sound spiritual, religious, or personal belief system is associated with active and adaptive coping skills in subjects with residual schizophrenia. Understanding and assessing the spirituality and religiousness of subjects with schizophrenia can help in better management of the disorder.