Age at first drink and severity of alcohol dependence.

BACKGROUND: Early age at first drink (AFD) has been linked to early onset and increased severity of alcohol dependence in various studies. Few Indian studies on AFD have shown a negative correlation between AFD and severity of alcohol dependence. Our study aimed to explore this relationship in patients with alcohol dependence syndrome (ADS) diagnosed using ICD-10 criteria. METHODS: One hundred fifty-one consecutive patients freshly diagnosed with ADS were included in the study, which was conducted at the psychiatry unit of a tertiary care, multispecialty hospital. The Addiction Severity Index (ASI) was used to assess severity of alcohol dependence. RESULTS: Mean AFD was 24.85 years (range = 13-40 years). Median ASI score was 36 (range = 21 to 57). The study yielded a weak negative correlation (ρ = -.105) between AFD and ASI, which was statistically not significant. CONCLUSIONS: We found no correlation between AFD and severity of alcohol dependence at detection in Indian Armed Forces personnel, which is contrary to what has been reported worldwide and in previous Indian studies. Delayed initiation of alcohol use among those enrolling in the Indian Armed Forces and early detection of alcohol dependence within the military environment are possible explanations.

Is four-dimensional CT angiography as effective as digital subtraction angiography in the detection of the underlying causes of intracerebral haemorrhage: a systematic review.

PURPOSE: To determine whether the sensitivity and specificity of four-dimensional CTA (4D-CTA) are equivalent to digital subtraction angiography (DSA) in the detection of underlying vascular abnormalities in patients with intracerebral haemorrhage (ICH). METHODS: A systematic review of studies comparing 4D-CTA with DSA in the detection of the underlying structural causes of ICH was performed on the literature published between 1998 and 2019. RESULTS: We identified a total of 237 articles from PubMed, SCOPUS and Web of Science using the following Medical Subject Headings (MeSH) terms: primary intracerebral haemorrhage, 4D-CTA, DSA, cerebral haemorrhage, angiography, digital subtraction, arteriovenous malformations, 4D, CTA, dynamic-CTA and time-resolved CTA. Following the removal of duplicate publications and articles failing to meet our inclusion criteria, there were four articles potentially viable for analysis. Therefore, there were not sufficient studies to provide a statistically meaningful meta-analysis. CONCLUSION: The review of current literature has demonstrated that there are few published studies comparing 4D-CTA with DSA in spontaneous ICH, with only four suitable studies identified for potential analysis. However, due to the restricted number of patients and high sensitivity and specificity of 3 studies (100%), performing a meta-analysis was not meaningful. Qualitative analysis of the data concluded that 4D-CTA has the diagnostic potential to replace invasive DSA in certain cases with vascular abnormalities. However, further research studies directly comparing 4D-CTA with DSA using larger prospective patient cohorts are required to strengthen the evidence base.

Gender differential and implications in the epidemiology of stress fractures among cadets of Indian Armed Forces.

BACKGROUND: Most studies on stress fractures in India have been carried out among recruits as against officer trainees and limited to males. With the continuous induction of women in the Armed Forces, it was decided to carry out a study among officer trainees of the three services and compare the epidemiology among genders. METHODS: A prospective study was carried out in 2011-2012 at Training Institutes of the three services where male and female cadets train together. Baseline data was collected for all trainees who joined the academy during the study period. All cadets were followed up for development of stress fractures for which details were taken. Additional information was taken from the Training Institute. RESULTS: A total of 3220 cadets (2612 male and 608 female cadets) were included in the study. Overall 276 cadets were observed to have stress fractures during training - making an incidence of 6.9% for male cadets and 15.8% for female cadets. Females were found to have a significantly higher incidence of stress fractures. Further the distribution and onset of stress fractures in females was observed to be distinct from males. CONCLUSION: The significant gender differential observed in the study indicates differential role of intrinsic and extrinsic risk factors in the causation of stress fractures among male and female. Special consideration needs to be given to these while planning and implementing measures for prevention. Further studies may be carried out on subject and on the effect of interventions in stress fracture prevention.

General route to synthesize of metal (Ni, Co, Mn, Fe) oxide nanostructure and their optical and magnetic behaviour.

Here we report a generalised way to prepare transitional metal (Ni, Co, Mn, Fe) oxide nanostructures via solvothermal route followed by controlled heat treatment. The method has been successfully involved to produce structurally uniform and well crystalline phase of the different metal (Ni, Co, Mn) oxide faceted nanoparticles and porous nanorods (Fe2O3) with highly anisotropic surfaces. The product materials were characterized by the X-ray powder diffraction and electron microscope (SEM, TEM) to investigate the structural and morphological details. Optical absorption study was carried out by UV-VIS spectrophotometer and the results are analysed on the basis of their electronic transitions of 3d shell and band energies. The details magnetic investigation was carried out by the measurement of magnetization with varying magnetic field and temperature. The observed magnetic behaviour is explained on the basis of uncompensated spins lying on the surface which is extremely anisotropic in the present systems of the synthesized materials.

Bioefficacy of hydromethanolic extract of tuber of Chlorophytum borivilianum (Safed Musli) for the management of male infertility in cyproterone acetate-treated albino rats.

Increase in male sexual dysfunction, and its treatment with conventional aphrodisiac drugs with side effects lead to investigate the spermatogenesis and androgenesis augmentative efficacy of hydromethanolic (40 : 60) extract of root of Chlorophytum borivilianum (family - Liliaceae) against cyproterone acetate-induced subfertility in Wistar strain male albino rat. For this purpose, experimental rats were divided into three treatment groups: vehicle (received distilled water), cyproterone acetate (gastric intubation at 250 mg kg(-1) twice daily for 35 days) and cyproterone acetate plus root extract of C. borivilianum (gastric intubation at 250 mg kg(-1) plus 400 mg kg(-1) with an interval of 20 min twice daily for 35 days). After 35-day treatment, all rats were euthanised. Reproductive deviations towards negative side were investigated by screening the spermatogenic and steroidogenic biosensors. Oxidative stress profile in reproductive organs and sperm pellet was evaluated by biochemical assessment of antioxidative enzyme activities and level of end products of the lipid peroxidation. Apoptosis profile was evaluated by Western blot study, TUNEL assay and DNA fragmentation study of testicular tissues. Evaluation of toxicity profile was included for experimental investigation. After cyproterone acetate treatment, the pituitary-testicular axis was deviated towards the negative side and its tuning system was affected by oxidative stress and apoptosis-mediated process, which reduced the quality of semen and finally led to subfertility. Co-administration of C. borivilianum root extract enhanced male reproductive potentiality and prevented the negative deviations after the treatment with cyproterone acetate by means of increasing oxidative defence and maintaining homeostasis in testicular apoptosis process.

Corrective role of Eugenia jambolana on testicular impairment in streptozotocin-induced diabetic male albino rat: an approach through genomic and proteomic study.

The present study was conducted to explore the effect of ethyl acetate fraction of hydro-methanolic (40 : 60) extract of seed of Eugenia jambolana on testicular impairment in diabetic rats. In this respect, biomarkers of oxidative stress, genomics and proteomics in testicular tissue were assessed. Side by side, glycated haemoglobin, serum testosterone, activities of glutamate oxaloacetate transaminase and glutamate pyruvate transaminase in serum, epididymal sperm count including reproductive organosomatic indices were evaluated. Results indicate that a significant recovery (P < 0.05) in the levels of these parameters in fraction-treated diabetic group in comparison with diabetic control. A significant recovery was noted (P < 0.05) in the expression of Bax and Bcl-2 gene towards the control after the treatment of said fraction. Histological study also focused a significant recovery (P < 0.05) in the number of different generation of germ cells at stage VII of spermatogenesis in fraction-treated diabetic group. The said fraction treatment to diabetic rat can recover the activities of serum glutamate oxaloacetate transaminase and glutamate pyruvate transaminase significantly towards the control (P < 0.05). Finally, it may be concluded that ethyl acetate fraction of seed of E. jambolana has a promiseable remedial effect on diabetes-induced testicular dysfunctions in male rat without inducing any metabolic toxicity.

Genetic variation modulates susceptibility to aberrant DNA hypomethylation and imprint deregulation in naïve pluripotent stem cells.

Naïve pluripotent stem cells (nPSC) frequently undergo pathological and not readily reversible loss of DNA methylation marks at imprinted gene loci. This abnormality poses a hurdle for using pluripotent cell lines in biomedical applications and underscores the need to identify the causes of imprint instability in these cells. We show that nPSCs from inbred mouse strains exhibit pronounced strain-specific susceptibility to locus-specific deregulation of imprinting marks during reprogramming to pluripotency and upon culture with MAP kinase inhibitors, a common approach to maintain naïve pluripotency. Analysis of genetically highly diverse nPSCs from the Diversity Outbred (DO) stock confirms that genetic variation is a major determinant of epigenome stability in pluripotent cells. We leverage the variable DNA hypomethylation in DO lines to identify several trans-acting quantitative trait loci (QTLs) that determine epigenome stability at either specific target loci or genome-wide. Candidate factors encoded by two multi-target QTLs on chromosomes 4 and 17 suggest specific transcriptional regulators that contribute to DNA methylation maintenance in nPSCs. We propose that genetic variants represent candidate biomarkers to identify pluripotent cell lines with desirable properties and might serve as entry points for the targeted engineering of nPSCs with stable epigenomes. Highlights: Naïve pluripotent stem cells from distinct inbred mouse strains exhibit variable DNA methylation levels at imprinted gene loci.The vulnerability of pluripotent stem cells to loss of genomic imprinting caused by MAP kinase inhibition strongly differs between inbred mouse strains.Genetically diverse pluripotent stem cell lines from Diversity Outbred mouse stock allow the identification of quantitative trait loci controlling DNA methylation stability.Genetic variants may serve as biomarkers to identify naïve pluripotent stem cell lines that are epigenetically stable in specific culture conditions.

Nucleic acid testing for blood banks: an experience from a tertiary care centre in New Delhi, India.

INTRODUCTION: Blood safety is a challenging task in India; with a population of around 1.23 billion and a high prevalence rate of HIV (0.29%), HBV (2-8%) and HCV (≈ 2%) in general population. Nucleic acid testing (NAT) in blood donor screening has been implemented in many developed countries to reduce the risk of transfusion-transmitted viral infections (TTIs). NAT shortens this window period, thereby offering blood centers a much higher sensitivity for detecting viral infections. MATERIALS AND METHODS: Routine ID-NAT for HIV-1, HCV and HBV was started from June 2010 at AIIMS blood bank by the Procleix® Ultrio® Assay (Novartis Diagnostics, USA) a multiplex NAT, which allows the simultaneous detection of HIV-1, HCV, and HBV in a single tube. During the period of 27 months from June 2010 to August 2012, around 73,898 samples were tested for all the three viruses using both ELISA (by Genscreen Ultra HIV Ag-Ab(BIO-RAD), Hepanostika HCV Ultra & HBsAg Ultra(Biomerieux) and Nucleic acid testing. The comparative results of both the assays are being presented here in this study. RESULTS: Out of 73,898 samples, 1104 samples (1.49%) were reactive by NAT. out of these 1104 samples, 73 were reactive for HIV-1 (0.09%), 186 were reactive for HCV only (0.25%), 779 (1.05%) were reactive for HBV only, and around 66 (0.08%) were HBV-HCV co-infections. There was one HIV, 37 HCV, 73 HBV and 10 HBV-HCV co-infection cases that were not detected by serology but reactive on NAT testing, with a combined yield of 1 in 610 donations (total 121 NAT yields). CONCLUSION: NAT could detect HIV, HBV and HCV cases in blood donor samples that were undetected by serological tests. NAT can interdict a large number of infected unit transfusions and thus help in providing safe blood to the patients.

Individual donor nucleic acid testing for blood safety against HIV-1 and hepatitis B and C viruses in a tertiary care hospital.

BACKGROUND: In July 2010, we started universal individual donor nucleic acid testing (ID-NAT) at our blood bank. This test simultaneously detects human immunodeficiency virus-1 (HIV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) in samples of donor blood. We continued to do the enzymelinked immunosorbent assay (ELISA) test for these agents, as per the guidelines of the Drug Controller General of India. We assessed the impact of ID-NAT in preventing transfusionassociated transmission of viruses. METHODS: We used fourth generation ELISA to screen blood samples of all voluntary and replacement blood donors. ID-NAT was done by transcription-mediated amplification (TMA). RESULTS: Of the 18 356 donors, ID-NAT could not be performed on 2 samples which were inadequate. Of the 18 354 donors tested by both ID-NAT and fourth generation ELISA, 7 were found to be NAT-positive but ELISA-negative (NAT yield) for HBV and HCV. The prevalence of NAT yield cases among routine donors was 1 in 2622 donations tested (0.038%). Since we supply blood as components (packed red cells, fresh frozen plasma and platelet concentrate), these 7 units of blood would have yielded 21 components and hence 21 patients could have been infected with HBV and HCV viruses. CONCLUSION: In the vast majority of blood units tested, the results of ELISA and ID-NAT for HIV-1, HBV and HCV were concordant. ID-NAT did detect the presence of viruses missed by ELISA in some blood units. It widespread use in blood banks would ensure safer blood transfusion.

Does application of complexity theory simplify concepts of psychiatry: Analogies and insights.

Scientific curiosity has not been able to explain the cause of psychiatric illness based on primarily biological or social paradigm. Available literatures were explored to understand causality of psychiatric illness from perspective of physics. Theory of complexity and other relevant theories were extrapolated to address these questions. Mental illness appeared to be a complex interplay of reductionism and emergentism, genetic and epigenetics, stress and the vulnerability or the core and the periphery. Mental illness displayed complex interaction between biological trait and environmental state.

Adult attention-deficit Hyperactivity disorder: From clinical reality toward conceptual clarity.

There is ambiguity about the clinical picture and concept of attention-deficit hyperactivity disorder (ADHD) in adults. Relevant literature was extracted from various search engines, analyzed, and interpreted. Available literature suggests a significant prevalence of ADHD in the adult population affecting the quality of socio-occupational functioning. Inattentiveness was more commonly present than hyperactivity-impulsivity. Frequent comorbidities with other psychiatric disorders like anxiety disorders and substance use disorders were noted. Pharmacological management and psychotherapy have been found effective in its management. ADHD is a disorder across the lifespan and fairly prevalent among adults. Greater awareness and more research are required for a better understanding of Adult ADHD and its effective management.

First-episode psychosis: How long does it last? A review of evolution and trajectory.

Study of first-episode psychosis (FEP), an episode of psychotic nature which manifests for the first time in an individual in the longitudinal continuum of his/her illness, has been study matter of research interest in recent years. A comprehensive review of the literature will help us understand the evolution and trajectory of this concept better. A literature review of available articles addressing the concept, phenomenology, evolution, identification, course, and outcome of FEP was done; the same was subsequently divided into broad topics for better clarity and analyzed. FEP constituted a clinical psychotic phenomenon with underlying significant heterogeneity in diagnosis, stability, course, and outcome. The study has attempted to view FEP both as horizontal spectrum across various diagnoses and longitudinally ranging from asymptomatic individual with unknown risk status to attenuated psychosis to multiple relapses/unremitting illness. Many risk and protective factors have been brought out with varying certainty ranging bio-psycho-social spectrum. Efforts have been made to calculate polygenic risk score based on genes involvement/sharing between various psychotic spectrum disorders; as well as biomarker panels to identify people at risk. FEP may prove to be an important concept to understand psychosis in general; without putting things into the diagnostic rubric. It may help understand multiple risk and protective factors for the course and outcome of psychotic illness and may clear the cloud to sharpen the evidence toward commonality and distinctiveness between various psychotic diagnoses in vogue for more comprehensive concept.

Wild-type but not mutant huntingtin modulates the transcriptional activity of liver X receptors.

BACKGROUND: Huntington's disease is caused by expansion of a polyglutamine tract found in the amino-terminal of the ubiquitously expressed protein huntingtin. Well studied in its mutant form, huntingtin has a wide variety of normal functions, loss of which may also contribute to disease progression. Widespread transcriptional dysfunction occurs in brains of Huntington's disease patients and in transgenic mouse and cell models of Huntington's disease. METHODS: To identify new transcriptional pathways altered by the normal and/or abnormal function of huntingtin, we probed several nuclear receptors, normally expressed in the brain, for binding to huntingtin in its mutant and wild-type forms. RESULTS: Wild-type huntingtin could bind to a number of nuclear receptors; LXRalpha, PPARgamma, VDR and TRalpha1. Over-expression of huntingtin activated, while knockout of huntingtin decreased, LXR mediated transcription of a reporter gene. Loss of huntingtin also decreased expression of the LXR target gene, ABCA1. In vivo, huntingtin deficient zebrafish had a severe phenotype and reduced expression of LXR regulated genes. An LXR agonist was able to partially rescue the phenotype and the expression of LXR target genes in huntingtin deficient zebrafish during early development. CONCLUSION: Our data suggest a novel function for wild-type huntingtin as a co-factor of LXR. However, this activity is lost by mutant huntingtin that only interacts weakly with LXR.

Sero-Epidemiological and Behavioural Survey of HIV, HBV and HCV amongst Indian Armed Forces Trainees.

BACKGROUND: Information on the emerging epidemics of Human immunodeficiency virus (HIV), Hepatitis B (HBV) and C (HCV) viruses in younger age groups in India is scanty due to paucity of representative, population based surveys and varied estimation methodology. This study was done to assess the point prevalence of HIV, HBV and HCV infections alongwith the epidemiological factors associated with these infections. Attitudes, beliefs and behaviour related to sexual and injecting drug practices, with a view to assess the need for introduction of screening program for the new entrants of the armed forces was also studied. METHODS: A multi-centric cross sectional serological and behavioural survey was carried out amongst newly enrolled trainees of the Armed Forces in 2004. The group was selected by multistage random sampling giving equal representation to all regions of India. Study subjects were interviewed using a pretested, validated questionnaire and screened for HIV, HBV and HCV infections by rapid tests. Standard confirmatory tests were carried out for trainees testing positive. Quality assurance measures were integral part of each activity. A database was created in MS Access and SPSS ver 11.0.1 was used for analysis. RESULT: Out of the 23,000 trainees included in the study, 22666 (98.55%) were included in the analysis. The age, formal education and age at first sexual intercourse of participants ranged from 16-25 years (median 20), 8-17 years (median 10) and 12-25 years, respectively. Partial knowledge about routes of spread of HIV was highly prevalent but complete knowledge was extremely low. Per thousand point prevalence of HIV, HBV and HCV was 0.61 (95% CI, 0.34-10.3, poisson), 9.31 (8.1-10.65) and 4.44 (3.61-5.39), respectively. Clustering of HIV (4.56 per 1000, 2.19-8.38) and HCV (30.54 per 1000, 23.67-38.78) and a higher number of HCV as compared to HBV was found amongst trainees from northeast. A statistically significant association was found between history of injecting drug use (other than medical) and HCV (p<0.05). CONCLUSION: Self-exclusion for recruitment as military trainees might have resulted in underestimation of general population figures but results provide region wise estimates unavailable till now. Concerted efforts are required in the current HIV/AIDS program activities to bring about knowledge and behaviour change amongst teenagers and young adults.

Role of various lifestyle and behavioral strategies in positive mental health across a preventive to therapeutic continuum.

There is growing interest in lifestyle and behavioral strategies not only in prevention but also in the management of psychiatric morbidity. Available literature in this direction was accessed, and the role of various lifestyle and behavioral factors was explored. There is strong evidence of the role of good sleep, nutritious diet, exercise, social connectedness, enhanced self-esteem, sense of purpose in life, resilience, mindfulness, and environmental mastery in the promotion of mental well-being and prevention and management of psychiatric disorders. There is a significant scope of lifestyle and behavioral intervention in ensuring positive mental health spanning from preventive to therapeutic dimension.

Workplace based assessment: A review of available tools and their relevance.

Workplace-based assessment (WPBA) appears to be a promising tool for more comprehensive assessment of the learners. Relevant literature in this direction was collated and analyzed for its relevance, salience, and merit. Many WPBA tools are being used by various educational institutions which spans across multiple domains and over the entire duration of the workplace learning. It caters to holistic assessment with structured measures, real-time feedback, and continuous professional development. It is being used more for formative assessment and has limited utility in summative assessment as on date. WPBA tools have promising prospect in bringing novelty, objectivity, and holistic approach in assessment.

Recurrent thunderclap headaches and multilobar intracerebral haemorrhages: two cases of reversible cerebral vasoconstriction syndrome (RCVS).

We describe two patients with thunderclap headaches due to reversible cerebral vasoconstriction syndrome (RCVS). The first patient illustrates multilobar intracerebral haemorrhages as an under-appreciated feature of RCVS, and the second illustrates recurrent thunderclap headache (presumed recurrent RCVS) after a long interval of 4 years. These cases demonstrate the spectrum of presentation of RCVS, a clinically under-recognized condition.

Effect of a pathway bundle on length of stay.

BACKGROUND: Pathways to guide clinical care are well accepted and used in many emergency departments. We wanted to introduce a number ("bundle") over a short space of time and involve the whole patient stay in the pathway. It was hypothesised that a more efficient process would result with an overall reduction in length of stay (LoS). METHODS: A "bundle" of 14 evidence-based pathways of care was introduced into a medium-sized district general hospital (DGH) in late 2006/early 2007. These pathways covered emergency department care and acute medical care for a period of up to 48 h. A total of 8184 acute emergency admission episodes were audited, 3852 in the 8 months before introduction of the new pathways and 4332 in the 8 months after their introduction. RESULTS: The overall effect of introducing the pathway bundle had a trend towards reduction in LoS by 0.2 days (95% CI -0.2 to 0.5), but this was not statistically significant (p>0.1). However, in those patients with