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Jayakrishnan K, Baruah A, Kumar P, Javeth A. Scales and Interventions for Resilience among Treatment-Seeking Patients with Depression: A Systematic Review. J Caring Sci 2023; 12:84-93. [PMID: 37469753 PMCID: PMC10352640 DOI: 10.34172/jcs.2023.31964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/07/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Resilience is an ability of an individual to effectively adjust and thrive in adverse stressful conditions. Resilience has protective and compensatory effects against depression. Evaluating resilience clinically and modifying it among patients with depression hugely impacts their prognosis. We aimed to explore different clinical scales for measuring resilience as well as interventions used with an intent to improve resilience among patients with depression. Methods A systematic literature review was conducted by searching PubMed central, Biomed central, and google scholar, using relevant MeSH keywords. The population of interest were the patients who were clinically diagnosed with Bipolar or Unipolar Depression and the population were not restricted to any country. Clinical scales for evaluation and interventions for resilience among patients with depression were set as an outcome of the study. Randomized controlled trials (RCTs), Quasi-experimental studies, observational studies, and narrative reviews were considered relevant research designs for extraction. Results A total of 8689 articles were identified and 13 articles were included in the final review, which yielded five scales that have been identified and have been used to evaluate resilience among the patients who are clinically diagnosed with depression and six different interventions for building resilience among patients with depression. Conclusion Resilience-building interventions will not only act as a preventive measure against depression but also help in promoting recovery and sustaining remission after a depressive episode. Clinical evaluation of resilience and management will significantly support boosting emotional experience.
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Affiliation(s)
| | - Arunjyoti Baruah
- Department of Psychiatric Nursing, LGBRIMH, Tezpur, Assam, India
| | - Pankaj Kumar
- Department of Psychiatry, AIIMS Patna, Patna, Bihar, India
| | - Athar Javeth
- College of Nursing, AIIMS Kalyani, West Bengal, India
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Padmanabhan RA, Johnson BS, Dhyani AK, Pillai SM, Jayakrishnan K, Laloraya M. Autoimmune regulator (AIRE): Takes a hypoxia-inducing factor 1A (HIF1A) route to regulate FOXP3 expression in PCOS. Am J Reprod Immunol 2023; 89:e13637. [PMID: 36305192 DOI: 10.1111/aji.13637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 09/05/2022] [Accepted: 10/03/2022] [Indexed: 02/03/2023] Open
Abstract
PROBLEM Autoimmune polyendocrinopathy-candidiasis- ectodermal dystrophy (APECED) pathology due to autoimmune regulator (AIRE) gene mutations leads to loss of central tolerance triggering immune attack, a factor causing infertility. One of the targets of autoimmune attack is ovary and its repercussion results in polycystic ovarian syndrome (PCOS). Although reduced Tregs have been reported in PCOS, a lacunae exists on the status of AIRE gene expression and its role in treg insufficiency via HIF1A-FOXP3 axis in PCOS. METHOD OF STUDY This is a case-control cohort study recruiting 40 normal and 40 PCOS volunteers for peripheral blood sample collection and PCOS diagnoses were based on Rotterdam Consensus criteria. AIRE and HIF1A expression status was analysed by qRT PCR and western blot. FACS analyses was conducted on AIRE silenced peripheral blood mononuclear cells (PBMCs) after Treg induction. RESULTS Our results indicate a reduced AIRE (fold change log2 (RQ) = -2.6, P < .01) and increased HIF1A (fold change log2 (RQ) = 3.6, P < .02) in PBMCs of PCOS subjects compared to age-matched controls. Western blot of AIRE and HIF1A corroborates with qRT PCR data. Our CHIP data demonstrate AIRE mediated HIF1A promoter regulation. Silencing of AIRE in PBMCs contributes to the upregulation of HIF1A transcripts by two-fold (P < .0015) and downregulation in FOXP3 expression by three-fold (P < .0017). FACS analyses revealed that silencing of AIRE reduces Tcell to Treg conversion. CONCLUSIONS Our consolidated results derive a new connection among AIRE-HIF1A-FOXP3 with AIRE reduction enabling increased HIF1A resulting in reduced FOXP3 in PBMCs of PCOS patients leading to Treg insufficiency.
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Affiliation(s)
- Renjini Ambika Padmanabhan
- Female Reproduction and Metabolic Syndromes Laboratory, Division of Molecular Reproduction, Rajiv Gandhi Centre for Biotechnology, Thycaud PO, Poojappura, Thiruvananthapuram, Kerala, India
| | - Betcy Susan Johnson
- Female Reproduction and Metabolic Syndromes Laboratory, Division of Molecular Reproduction, Rajiv Gandhi Centre for Biotechnology, Thycaud PO, Poojappura, Thiruvananthapuram, Kerala, India
| | - Ajay Kumar Dhyani
- Female Reproduction and Metabolic Syndromes Laboratory, Division of Molecular Reproduction, Rajiv Gandhi Centre for Biotechnology, Thycaud PO, Poojappura, Thiruvananthapuram, Kerala, India
| | - Sathy M Pillai
- SAMAD IVF Hospitals, V. V. Road, Pattoor, Thiruvananthapuram, Kerala, India
| | - K Jayakrishnan
- KJK Hospital and Fertility Research Centre, Mar Ivanios College Road, Nalanchira, Thiruvananthapuram, Kerala, India
| | - Malini Laloraya
- Female Reproduction and Metabolic Syndromes Laboratory, Division of Molecular Reproduction, Rajiv Gandhi Centre for Biotechnology, Thycaud PO, Poojappura, Thiruvananthapuram, Kerala, India
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Nair R, Mohan K, Jayakrishnan K, Srinivasan P, Javeth A, Sharma S, Kumari B. Lived Experience of Nurses in COVID-19 Units - A Phenomenological Study from Eastern India. J Caring Sci 2022; 11:197-209. [PMID: 36483693 PMCID: PMC9720498 DOI: 10.34172/jcs.2022.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/04/2022] [Indexed: 04/05/2024] Open
Abstract
Introduction: Nurses are the frontline workers who had to play multiple functions like in acute care, community, etc. but, it was stated that COVID-19 has caused immense trauma to nurses globally. Methods: A descriptive phenomenological study to explore the lived experience of nurses working in COVID-19 units was conducted among nine senior nursing officers recruited by purposive homogenous sampling and interviewed with an open-ended interview guide by ensuring data saturation. COREQ guideline were adopted for this qualitative study. Results: Qualitative data were analysed using Giorgi's framework, and themes and sub-themes were derived. The major themes that emerged in the present study were "Reactions and preparation", "Feelings and satisfaction in active duty", "Role of a helping hand", "Working experience in PPE", and "Pandemic and socialization". Each theme had further sub-themes to classify the verbatims. Conclusion: Most of the nurses had anxiety and prepared themselves to play with fire, had unrealistic hope, and mixed emotions, kept their family away and intentionally concealed information to reduce family's fear, were satisfied with training and preparation, and had unpleasant experiences with PPE, had to restrict their social activities and felt social stigma. It also concludes with the recommendation that warrants the need to improve their professional quality of life and working conditions by safeguarding nurses' physical and mental health.
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Affiliation(s)
- Rathish Nair
- College of Nursing, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Keerthi Mohan
- College of Nursing, All India Institute of Medical Sciences, Patna, Bihar, India
| | - K Jayakrishnan
- College of Nursing, All India Institute of Medical Sciences, Patna, Bihar, India
| | - P Srinivasan
- College of Nursing, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Athar Javeth
- College of Nursing, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Sadhana Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Bandana Kumari
- Department of Biochemistry, All India Institute of Medical Sciences, Patna, Bihar, India
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Johnson BS, Krishna MB, Padmanabhan RA, Pillai SM, Jayakrishnan K, Laloraya M. Derailed peripheral circadian genes in polycystic ovary syndrome patients alters peripheral conversion of androgens synthesis. Hum Reprod 2022; 37:1835-1855. [PMID: 35728080 DOI: 10.1093/humrep/deac139] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do circadian genes exhibit an altered profile in peripheral blood mononuclear cells (PBMCs) of polycystic ovary syndrome (PCOS) patients and do they have a potential role in androgen excess? SUMMARY ANSWER Our findings revealed that an impaired circadian clock could hamper the regulation of peripheral steroid metabolism in PCOS women. WHAT IS KNOWN ALREADY PCOS patients exhibit features of metabolic syndrome. Circadian rhythm disruption is involved in the development of metabolic diseases and subfertility. An association between shift work and the incidence of PCOS in females was recently reported. STUDY DESIGN, SIZE, DURATION This is a retrospective case-referent study in which peripheral blood samples were obtained from 101 control and 101 PCOS subjects. PCOS diagnoses were based on Rotterdam Consensus criteria. PARTICIPANTS/MATERIALS, SETTING, METHODS This study comprised 101 women with PCOS and 101 control volunteers, as well as Swiss albino mice treated with dehydroepiandrosterone (DHEA) to induce PCOS development. Gene expression analyses of circadian and steroidogenesis genes in human PBMC and mice ovaries and blood were executed by quantitative real-time PCR. MAIN RESULTS AND THE ROLE OF CHANCE We observed aberrant expression of peripheral circadian clock genes in PCOS, with a significant reduction in the core clock genes, circadian locomotor output cycles kaput (CLOCK) (P ≤ 0.00001), brain and muscle ARNT-like 1 (BMAL1) (P ≤ 0.00001) and NPAS2 (P ≤ 0.001), and upregulation of their negative feedback loop genes, CRY1 (P ≤ 0.00003), CRY2 (P ≤ 0.00006), PER1 (P ≤ 0.003), PER2 (P ≤ 0.002), DEC1 (P ≤ 0.0001) and DEC2 (P ≤ 0.00005). Transcript levels of an additional feedback loop regulating BMAL1 showed varied expression, with reduced RORA (P ≤ 0.008) and increased NR1D1 (P ≤ 0.02) in PCOS patients in comparison with the control group. We also demonstrated the expression pattern of clock genes in PBMCs of PCOS women at three different time points. PCOS patients also exhibited increased mRNA levels of steroidogenic enzymes like StAR (P ≤ 0.0005), CYP17A1 (P ≤ 0.005), SRD5A1 (P ≤ 0.00006) and SRD5A2 (P ≤ 0.009). Knockdown of CLOCK/BMAL1 in PBMCs resulted in a significant reduction in estradiol production, by reducing CYP19A1 and a significant increase in dihydrotestosterone production, by upregulating SRD5A1 and SRD5A2 in PBMCs. Our data also showed that CYP17A1 as a direct CLOCK-BMAL1 target in PBMCs. Phenotypic classification of PCOS subgroups showed a higher variation in expression of clock genes and steroidogenesis genes with phenotype A of PCOS. In alignment with the above results, altered expression of ovarian core clock genes (Clock, Bmal1 and Per2) was found in DHEA-treated PCOS mice. The expression of peripheral blood core clock genes in DHEA-induced PCOS mice was less robust and showed a loss of periodicity in comparison with that of control mice. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION We could not evaluate the circadian oscillation of clock genes and clock-controlled genes over a 24-h period in the peripheral blood of control versus PCOS subjects. Additionally, circadian genes in the ovaries of PCOS women could not be evaluated due to limitations in sample availability, hence we employed the androgen excess mouse model of PCOS for ovarian circadian assessment. Clock genes were assessed in the whole ovary of the androgen excess mouse model of PCOS rather than in granulosa cells, which is another limitation of the present work. WIDER IMPLICATIONS OF THE FINDINGS Our observations suggest that the biological clock is one of the contributing factors in androgen excess in PCOS, owing to its potential role in modulating peripheral androgen metabolism. Considering the increasing prevalence of PCOS and the rising frequency of delayed circadian rhythms and insufficient sleep among women, our study emphasizes the potential in modulating circadian rhythm as an important strategy in PCOS management, and further research on this aspect is highly warranted. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the RGCB-DBT Core Funds and a grant (#BT/PR29996/MED/97/472/2020) from the Department of Biotechnology (DBT), India, to M.L. B.S.J. was supported by a DST/INSPIRE Fellowship/2015/IF150361 and M.B.K. was supported by the Research Fellowship from Council of Scientific & Industrial Research (CSIR) (10.2(5)/2007(ii).E.U.II). The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Betcy Susan Johnson
- Female Reproduction and Metabolic Syndromes Laboratory, Division of Molecular Reproduction, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India.,Research Scholar, Research Centre, University of Kerala, Thiruvananthapuram, Kerala, India
| | - Meera B Krishna
- Female Reproduction and Metabolic Syndromes Laboratory, Division of Molecular Reproduction, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
| | - Renjini A Padmanabhan
- Female Reproduction and Metabolic Syndromes Laboratory, Division of Molecular Reproduction, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
| | | | - K Jayakrishnan
- KJK Hospital and Fertility Research Centre, Thiruvananthapuram, Kerala, India
| | - Malini Laloraya
- Female Reproduction and Metabolic Syndromes Laboratory, Division of Molecular Reproduction, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
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Dinesh KS, Nazeema PK, Archana M, Jayakrishnan K, Santhi Krishna AS, Swapna CS, Sujitha VK, Anju S, Girish BM, Geethu B, Krishnendu C. Application Of A Non-Linear Multi-Model Ayurveda Intervention In Elderly COVID-19 Patients- A Retrospective Case Series. J Ayurveda Integr Med 2021; 13:100476. [PMID: 34230788 PMCID: PMC8249719 DOI: 10.1016/j.jaim.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 10/30/2022] Open
Abstract
Background and Aim With over 155 million infections, nearly 32 lakh deaths, and an economic toll accounting to trillions, the COVID-19 pandemic is ravaging the world. The mainstream medical system is being handicapped with the challenge of patient management with no proven treatment at one end and the use of vaccine at the other with prevailing ambiguity in developing herd immunity and safety concerns of mass vaccinations amidst pandemic. Though vaccination is the only hope, fool proof evidences are absent on its efficacy. Also, adults of above 65 are of greater risk in terms of complications and death. China has already documented the use of traditional Chinese medicine against the pandemic with national participation rate of 90%. In this regard, the use of complementary and alternative medicine (CAM) against COVID-19 is relevant, especially in a country like India where it is widely practised as Ayurveda. Experimental procedure The current report is a retrospective case series of 64 Non-Resident Indians (NRIs) above the age of 60 years tested positive through Reverse Transcription-Polymerase Chain Reaction (RT-PCR) through a Non-Linear multi-modal Ayurveda Intervention (NLMAI) for 21 days consulted through online media. The NLMAI is a combination of herbal and herbo-mineral drug interventions, lifestyle modifications, and psychological support done in 2 phases. Results and conclusions The management revealed a mean duration of symptoms assessed through survival function of 11 symptoms of COVID-19 as 0.577 days [SE=0.39] with a CI 95% [lower bound=0.500, upper bound 0.653] which was considerably low when compared to global statistics. Moreover, none of the cases advanced to complications or death. The holistic, non-linear, multi-modal approach of Ayurveda may be used to counter the gravity of the COVID-19 pandemic through easy symptomatic recovery, co-morbidity managements and deaths.
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Key Words
- AYUSH, Ayurveda, yoga and naturopathy, Unani, Siddha and homoeopathy
- Alternative medicine
- Ayurveda
- CAM, Complementary and alternative medicine
- COVID-19
- COVID-19, Corona Virus Disease- 2019
- Co-morbidity
- NLMAI, Non-Linear multi-modal Ayurveda Intervention
- NRIs, Non-Resident Indians
- RT-PCR, Reverse Transcription-Polymerase Chain Reaction
- SARS-CoV-2, Severe Acute Respiratory Syndrome Corona Virus-2
- Traditional medicine
- elderly patients
- survival function
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Affiliation(s)
- K S Dinesh
- Department of Kaumarabhritya, Vaidyaratnam P S Varier Ayurveda College, Kottakkal. Edarikode (P.O), Pincode:676501, Malappuram district, Kerala, India, Contact No: 9447698085
| | - P K Nazeema
- Department of Kaumarabhritya, Vaidyaratnam P S Varier Ayurveda College, Kottakkal. Edarikode (P.O), Pincode:676501, Malappuram district, Kerala, India, Contact No: 9495511081
| | - Madhavi Archana
- AYUSH Public Health Initiative, Department of Kaumarabhritya, Vaidyaratnam P S Varier Ayurveda College, Kottakkal Edarikode (P.O), Pincode:676501, Malappuram district, Kerala, India, Contact No.7022928745
| | - K Jayakrishnan
- Department of Swasthavritha, All India Institute of Ayurveda, Mathura Rd, Gautampuri Awas, Sarita Vihar, New Delhi, Pincode:110076, India, Contact No: 9496349829
| | - A S Santhi Krishna
- Surya, katampazhipuram, Palakkad, Pincode: 678633 Kerala, India, Contact No: 9447785271
| | - Chitra S Swapna
- Department of Kaumarabhritya, Santhigiri Ayurveda Medical college, Olassery, Kodumba, Palakkad, Pincode: 67855, Kerala, India, Contact No: 9495608309
| | - V K Sujitha
- Department of Kaumarabhritya, Vaidyaratnam P S Varier Ayurveda College, Kottakkal, Edarikode (P.O), Pincode:676501, Malappuram district, Kerala, India, Contact No: 9744872345
| | - Sathian Anju
- AYUSH Public Health Initiative, Department of Kaumarabhritya, Vaidyaratnam P S Varier Ayurveda College, Kottakkal, Edarikode (P.O), Pincode:676501, Malappuram district, Kerala, India, Contact No: 9946424009
| | - Babu M Girish
- Department of Statistics, CHMKM Government Arts and Science College, Koduvally, pin code: 673572 Kozhikode, Contact No: 9447395825
| | - Balakrishnan Geethu
- AYUSH Extra Mural Research, Department of Kaumarabhritya, Vaidyaratnam P S Varier Ayurveda College, Kottakkal, Edarikode (P.O), Pincode:676501, Malappuram district, Kerala, India
| | - C Krishnendu
- AYUSH Extra Mural Research, Department of Kaumarabhritya, Vaidyaratnam P S Varier Ayurveda College, Kottakkal, Edarikode (P.O), Pincode:676501, Malappuram district, Kerala, India
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Goyal N, Jayakrishnan K. Successful Pregnancy after Frozen Embryo Transfer after Recurrent Endometrial Collection in a Patient with Mosaic Turner Syndrome. J Hum Reprod Sci 2021; 14:91-93. [PMID: 34083999 PMCID: PMC8057145 DOI: 10.4103/jhrs.jhrs_83_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/10/2020] [Accepted: 12/23/2020] [Indexed: 11/21/2022] Open
Abstract
A 36-year-old female with Mosaic Turner Syndrome presented for oocyte donation program. She developed endometrial collection each time she was started on estradiol valerate for endometrial preparation. All causes of the endometrial collection were ruled out and empirical antibiotics given. Finally, the patient developed a satisfactory endometrium of 5.7 mm with no endometrial collection after being given low dose estradiol-estrogel (Transdermal application) and five doses of subcutaneous injections on granulocyte-colony-stimulating factor. The patient conceived after embryo transfer and is in follow-up.
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Affiliation(s)
- Nidhi Goyal
- Fertility Research Centre, KJK Hospital, Thiruvananthapuram, Kerala, India
| | - K Jayakrishnan
- Fertility Research Centre, KJK Hospital, Thiruvananthapuram, Kerala, India
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Devi AN, Anil Kumar TR, Pillai SM, Jayakrishnan K, Kumar PG. Expression profiles of NPHP1 in the germ cells in the semen of men with male factor infertility. Andrology 2015. [DOI: 10.1111/andr.12062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A. N. Devi
- Rajiv Gandhi Centre for Biotechnology; Thiruvananthapuram Kerala India
| | - T. R. Anil Kumar
- Rajiv Gandhi Centre for Biotechnology; Thiruvananthapuram Kerala India
| | - S. M. Pillai
- Samad IVF Hospital; Thiruvananthapuram Kerala India
| | | | - P. G. Kumar
- Rajiv Gandhi Centre for Biotechnology; Thiruvananthapuram Kerala India
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Jayakrishnan K. A CORRELATIVE STUDY TO ASSESS THE PSYCHOLOGICAL WELLBEING AND SELF-ESTEEM AMONG ADULT CHILDREN OF MENTALLY ILL PARENT/S IN SELECTED HOSPITAL OF UDUPI DISTRICT. Journal of Health and Allied Sciences NU 2014. [DOI: 10.1055/s-0040-1703801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Introduction: Caregivers across the world, who are often unrecognised and under supported, are deeply and personally impacted by the care they provide. The recognition of high levels of caregiver morbidity demands a holistic approach and nurses need to be more responsive to the needs of carers and care-recipients rather than focussing on the patient alone. Aims and Objectives: to determine the psychological wellbeing of adult children with mentally ill parent/s, to assess the level of self-esteem of adult children of their mentally ill parent/s, and to find the relationship between psychological wellbeing and self-esteem.
Study design: descriptive correlational study design.
Methods and materials: study was conducted among 63 adult children of mentally ill parents by using convenient sampling technique. A survey approach was used for the study. Tools used for the study were Demographic Proforma, Psychological wellbeing scale, and Rosenberg's self-esteem scale.
Results: Majority, 35 (55.6%) of the samples were found to be having high psychological wellbeing. 27 (42.9%) of the samples were intermediate psychological wellbeing and only 1 (1.6%) participant was having low psychological wellbeing. Majority (68.3%) of the samples were found to be having normal self-esteem. (30.2%) of the samples were with low self-esteem and only (1.6%) participant was having high self-esteem. There is no significant correlation was found between psychological wellbeing and self-esteem (r = 0.044, p= 0.730).
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Affiliation(s)
- K. Jayakrishnan
- Student MSc. (N), Department of Psychiatric/ Mental Health Nursing, Manipal College of Nursing Manipal, Manipal University, Manipal - 576 104, Karnataka, India
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Kumar P, Nawani N, Malhotra N, Malhotra J, Patil M, Jayakrishnan K, Kar S, Jirge PR, Mahajan N. Assisted reproduction in polycystic ovarian disease: A multicentric trial in India. J Hum Reprod Sci 2013; 6:49-53. [PMID: 23869152 PMCID: PMC3713578 DOI: 10.4103/0974-1208.112382] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 06/02/2012] [Accepted: 02/07/2013] [Indexed: 11/29/2022] Open
Abstract
AIM: The aim of this study is to compare ovarian response, oocyte, embryo quality, ovarian hyperstimulation syndrome incidence, and pregnancy rates in polycystic ovary syndrome (PCOS) and non-PCOS group. MATERIALS AND METHODS: This was a prospective observational study on PCOS carried out in seven assisted reproduction centers in India between August 2008 and July 2010, as part of trial under the Indian Society of Assisted Reproduction. A total of 192 women (77 in the PCOS group and 115 in the non- PCOS group) undergoing in vitro fertilization/intracytoplasmic sperm injection were included. All women had long protocol and recombinant follicle-stimulating hormone stimulation. ANALYSIS: The mean number of follicles and oocytes was higher in PCOS group compared with non-PCOS, being 27.2 (±8.8) and 13.6 (±5.3); 15.9 (±6.3) and 10.9 (±6.2), respectively. The recovery rates of oocytes and mature oocytes per follicle were less in the PCOS group which was 64% and 61.1%, respectively as opposed to 80.3% and 74.5%, respectively in non-PCOS group. The total numbers of top-quality embryos were less in the PCOS group. CONCLUSION: In PCOS women though the number of follicles was more, recovery of mature oocytes, top-quality embryos was less. Pregnancy rates were comparable in both groups.
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Affiliation(s)
- Pratap Kumar
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Karnataka, India
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Jayakrishnan K, Menon V, Nambiar D. Submucous fibroids and infertility: Effect of hysteroscopic myomectomy and factors influencing outcome. J Hum Reprod Sci 2013; 6:35-9. [PMID: 23869149 PMCID: PMC3713575 DOI: 10.4103/0974-1208.112379] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 09/14/2012] [Accepted: 02/07/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Submucosal myomas are associated with infertility and may be treated by hysteroscopic resection. OBJECTIVE The aim of this retrospective study was to analyze 37 subfertile patients who unnderwent hysteroscopic myomectomy in a tertiary care center with particular regard to their postprocedure reproductive outcome. MATERIALS AND METHODS The entire patient group (n = 37) underwent the procedure between March 2004 and March 2010. The submucosal myomas were type 0 (n = 27), type 1 (n = 8), and type 2 (n = 2). The mean myoma size was 2.1 cm; mean duration of the procedure was 54 mins and mean follow-up was 26 ± 10 months. 22 patients had one or more associated infertility factors. RESULTS The complication rate was 5.4%. 11 patients (29.7%) conceived after the procedure. The pregnancy rate was better when myoma was the exclusive etiology of infertility (40%), when the myoma was completely intracavitary (33.3%), when the lesion was ≥ 30 mm in size (50%), and there were no associated intramural fibroids. CONCLUSION Hysteroscopic myomectomy is a safe procedure to enhance fertility especially in cases with unexplained infertility.
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Affiliation(s)
- K Jayakrishnan
- Department of Minimally Invasive Surgery, KJK Hospital, Nalanchira, Chackai, Trivandrum, Kerala, India
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Jayakrishnan K, Baheti SN. Laparoscopic tubal sterilization reversal and fertility outcomes. J Hum Reprod Sci 2012; 4:125-9. [PMID: 22346079 PMCID: PMC3276946 DOI: 10.4103/0974-1208.92286] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Revised: 03/08/2011] [Accepted: 09/21/2011] [Indexed: 11/25/2022] Open
Abstract
PURPOSE: The purpose of the study was two-fold. Firstly it was to assess the suitability for tubal recanalization and factors predicting successful laparoscopic recanalization. Secondly, it was to analyze the fertility outcomes and factors affecting the pregnancy rate following laparoscopic tubal recanalization. MATERIALS AND METHODS: A retrospective chart review of prospectively followed-up 29 women at a tertiary care center seeking tubal sterilization reversal between May 2005 and February 2010 were included. RESULTS: In 14 (48.3%) women unilateral tubes were suitable and in only 3 women (10.3%) bilateral tubes were suitable. All cases with laparoscopic tubal sterilization were suitable, whereas all cases with fimbriectomy were unsuitable for recanalization. In 6 (20.7%) cases salphingostomy was performed as an alternative procedure to tubal reanastomosis. The overall pregnancy rate was 58.8%. In cases with sterilization by Pomeroy's method, 4 out of 10 (40%) conceived, whereas for laparoscopic tubal ligation cases 6 out of 7 (85.7%) conceived (P=0.32). None of the patients with final tubal length <5 cm conceived (P=0.03). Comparing the age at recanalization, in women ≤30 years, 71.4% conceived, as compared with 50% when age of women was more than 30 years (P=0.37). CONCLUSIONS: The important factors determining the success of recanalization are technique of sterilization and the remaining length of the tube after recanalization. The gynecologist must use an effective technique of sterilization to minimize the failure rates, but at the same time, which causes minimal trauma, and aim at preserving the length of the tube so that reversal is more likely to be successful, should the patient's circumstances change.
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Affiliation(s)
- K Jayakrishnan
- Department of Minimally Invasive Surgery, KJK Hospital and Fertility Research Centre, Trivandrum, Kerala, India
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Jayakrishnan K, Koshy AK, Raju R. Role of laparohysteroscopy in women with normal pelvic imaging and failed ovulation stimulation with intrauterine insemination. J Hum Reprod Sci 2011; 3:20-4. [PMID: 20607004 PMCID: PMC2890905 DOI: 10.4103/0974-1208.63117] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 12/28/2009] [Accepted: 01/02/2010] [Indexed: 11/23/2022] Open
Abstract
CONTEXT: Women with primary infertility and no obvious pelvic pathology on clinical evaluation and imaging are either treated empirically or further investigated by laparoscopy. AIMS: The role of diagnostic laparoscopy in women who fail to conceive after empirical treatment with ovulation induction and intrauterine insemination was evaluated. SETTINGS AND DESIGN: Retrospective study at a private infertility center. MATERIALS AND METHODS: A study of patients who underwent diagnostic laparoscopy between 1st January 2001 and 31st December 2008 was performed. Those patients who had no detectable pathology based on history, physical examination, and ultrasound and had treatment for three or more cycles in the form of ovulation induction and IUI were included in the study. Moderate and severe male factor infertility and history of any previous surgery were exclusion criteria. STATISTICAL ANALYSIS USED: Data were statistically analyzed using Statistics Package for Social Sciences (ver. 16.0; SPSS Inc., Chicago). RESULTS: Of the 127 women who underwent diagnostic laparoscopy and hysteroscopy, 87.4% (n = 111) of patients had positive findings. Significant pelvic pathology (moderate endometriosis, pelvic inflammatory disease, and tubal pathology) was seen in 26.8% of cases. CONCLUSION: One in four women had significant pelvic pathology where treatment could possibly improve future fertility. Diagnostic laparoscopy has a role in infertile women with no obvious abnormality before they proceed to more aggressive treatments.
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Affiliation(s)
- K Jayakrishnan
- Fertility Research and Gynecology Centre, KJK Hospital, Trivandrum - 695 015, Kerala, India
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Jayakrishnan K, Anupama R, Koshy A, Raju R. Endometrial carcinoma in a young subfertile woman with polycystic ovarian syndrome. J Hum Reprod Sci 2011; 3:38-41. [PMID: 20607008 PMCID: PMC2890909 DOI: 10.4103/0974-1208.63122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 07/27/2009] [Accepted: 10/15/2009] [Indexed: 11/08/2022] Open
Abstract
Adenocarcinoma of the endometrium is a morbid condition in women under 40 years of age with an incidence of 25%. However, patients with anovulatory polycystic ovarian syndrome are at risk of developing endometrial carcinoma. The disease is often advanced when diagnosed, thereby depriving the woman of the option for fertility sparing conservative approach. In young women with menstrual abnormalities and polycystic ovarian disease and/or infertility, an endometrial evaluation should be performed. Carcinoma endometrium should be kept in mind while evaluating young women with polycystic ovary syndrome for abnormal uterine bleeding. Only strictly selected patients should, therefore, be indicated for long-term progestogen treatment and careful evaluation before and after treatment should be performed.
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Affiliation(s)
- K Jayakrishnan
- Department of Reproductive Medicine, Fertility Research and Gynaec Centre, KJK Hospital, Trivandrum, Kerala 695 015, India
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Jayakrishnan K, Anupama R. Outcome of Septal Resection in Patients with Primary Infertility. J Minim Invasive Gynecol 2009. [DOI: 10.1016/j.jmig.2009.08.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jayakrishnan K, Koshy AK, Manjula P, Nair AM, Ramachandran A, Kattoor J. Endometrial stromal sarcoma mimicking a myoma. Fertil Steril 2008; 92:1744-6. [PMID: 18937947 DOI: 10.1016/j.fertnstert.2008.08.124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 05/18/2008] [Accepted: 08/26/2008] [Indexed: 11/28/2022]
Abstract
Uterine malignancies are not uncommonly misdiagnosed for the more ubiquitous leiomyoma. A case of endometrial stromal sarcoma with ultrasound and color Doppler imaging is described.
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Affiliation(s)
- K Jayakrishnan
- KJK Hospital, Fertility Research and Gynaec Centre, Trivandrum, Kerala, India
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Abraham MA, Korula A, Jayakrishnan K, John GT, Thomas PP, Jacob CK. Prognostic factors in diffuse proliferative lupus nephritis. J Assoc Physicians India 1999; 47:862-5. [PMID: 10778652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Patients with diffuse proliferative lupus nephritis (DPLN) can have variable clinical course. Identification of the predictors of outcome would help to improve the management. We have studied the prognostic significance of clinical, laboratory and histological parameters in patients with DPLN. METHODS Twenty nine patients diagnosed to be having DPLN seen between 1987 and 1991 were followed up for over 57 months. Parameters assessed for prognostic significance included serum creatinine, urine protein at the time of biopsy, blood pressure, type of immunosuppression, composite scores and individual components of activity index (AI) and chronicity index (CI). Kaplan-Meier survival curves were plotted and the results were compared using log rank test. Fishers' exact test was used to study the risk factors. RESULTS End stage renal failure developed in 7/29 (24.1%) patients; 7/19 (36.8%) who had hypertension and 7/16 (43.8%) who had nephrotic proteinuria developed renal failure, while none who had normal blood pressure or nonnephrotic proteinuria, developed renal failure (p < 0.01). Three patients had high activity index (> 12) and all three developed renal failure. Other parameters such as age, gender, serum creatinine, type of immunosuppression, CI and individual components of AI failed to predict the outcome (p > 0.05). CONCLUSION Hypertension, nephrotic proteinuria and high AI were predictive of progression to end stage renal failure in patients with diffuse proliferative lupus nephritis.
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Affiliation(s)
- M A Abraham
- Christian Medical College and Hospital, Vellore, India
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Peedicayil A, Jasper P, Francis S, Jayakrishnan K, Mathai M, Regi A. A randomized trial of extra-amniotic foley catheter and intra-cervical prostaglandin E2 for cervical ripening. J Clin Epidemiol 1998. [DOI: 10.1016/s0895-4356(98)90065-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abraham MA, Korula A, Arun KN, Jayakrishnan K, John GT, Thomas PP, Jacob CK. Treatment of diffuse proliferative lupus nephritis: an Indian experience. Natl Med J India 1997; 10:273-5. [PMID: 9481097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Immunosuppressive therapy has improved the prognosis in lupus nephritis. However, infectious complications may contribute to morbidity. There is also debate on the best form of therapy. We, therefore, compared the results of two different forms of therapy. METHOD Twenty-nine patients diagnosed to have diffuse proliferative lupus nephritis were followed up over 54 months. The treatment consisted of azathioprine (1.5 mg/kg/day) or pulse intravenous cyclophosphamide (500 mg/m2 body surface area monthly) along with prednisolone (2 mg/kg on alternate days). RESULTS Seventeen patients received azathioprine (group A) and 12 received cyclophosphamide (group B). The mean (SD) follow up in groups A and B were 54.35 (33.6) and 52 (35.8) months, respectively. Apart from the higher number of males in group B, both groups were comparable for age, presence of hypertension, renal function, 24-hour urinary protein excretion and composite scores for histological activity and chronicity indices (p > 0.05). The renal survival estimated by the Kaplan-Meier method was similar in both groups (p > 0.05). Four patients had renal failure requiring replacement therapy in group A and 3 in group B. Major infective episodes were more common in group B than in group A (p = 0.03). CONCLUSION Azathioprine was as effective as pulse intravenous cyclophosphamide in preserving renal functions up to 54 months. Major infective episodes were more common with pulse intravenous cyclophosphamide.
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Affiliation(s)
- M A Abraham
- Department of Nephrology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Rajacic N, Darweesh M, Jayakrishnan K, Gang RK, Jojic S. The distally based superficial sural flap for reconstruction of the lower leg and foot. Br J Plast Surg 1996; 49:383-9. [PMID: 8881785 DOI: 10.1016/s0007-1226(96)90007-7] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe our experience with the use of distally based superficial sural flaps for coverage of defects in the lower leg and foot in 21 patients. In 18 patients the flap was successfully transferred, in 2 cases partial necrosis of the flap occurred and 1 flap failed completely. In 18 cases the flap was used as a fasciocutaneous flap and in 3 cases as a fascial flap only. The advantages of this flap are: easy and quick dissection, hence saving operating time, minimal morbidity of donor site and preservation of major arteries of the leg. Although the flap was described as reliable for covering defects around the ankle joint, we have been able to cover defects of the dorsum of the foot distally and up to the mid-third of the tibia proximally.
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Affiliation(s)
- N Rajacic
- Al-Babtain Center for Plastic, Reconstructive Surgery and Burns, Kuwait University
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