Minocycline in depression not responding to first-line therapy: A systematic review and meta-analysis

BACKGROUND

Major depressive disorder is often resistant to first-line treatment, with around 30% failing to respond to traditional therapy. Treatment-resistant depression results in prolonged hospitalization and healthcare costs. Anti-inflammatory drugs have shown promising results in depression not responding to initial therapy. Minocycline has anti-inflammatory properties and crosses the blood-brain barrier. It has demonstrated varied results in several randomized controlled trials (RCTs).

METHODS

We assessed the efficacy of minocycline compared to placebo in depression not responding to one first-line antidepressant via a systematic review and meta-analysis. We performed a comprehensive literature search across PubMed, Cochrane, and Scopus for RCTs. We visualized the results using forest plots and drapery plots. We assessed and explored heterogeneity using I2, prediction interval, and meta-regression. Then, we rated the certainty of the evidence.

RESULTS

Four RCTs revealed a non-significant difference in depression severity [-3.93; 95% CI: -16.14 to 8.28], rate of response [1.15; 0.33-4.01], and rate of remission [0.94; 0.44-2.01]. However, the reduction in depression severity is significant at a trend of P < .1. The high between-study heterogeneity (I2 = 78%) for depression severity could be answered by meta-regression (P = .02) for the duration of therapy.

CONCLUSION

There is no significant difference with minocycline compared to placebo for depression not responding to first-line antidepressant therapy. However, the treatment response varies with treatment duration and patients' neuroinflammatory state. Thus, larger and longer RCTs, especially in diverse disease subgroups, are needed for further insight. This is needed to allow greater precision medicine in depression and avoid elevated healthcare expenditure associated with hit-and-trial regimens.

REGISTRATION

CRD42023398476 (PROSPERO).

Impact of COVID-19 lockdown on substance availability, accessibility, pricing, and quality: A multicenter study from India

BACKGROUND AND AIM

Pandemic and consequent lockdowns are likely to affect the drug market by the sudden disruption of the supply chain. We explored the change in the availability, access, purity, and pricing during lockdown from respondents seeking treatment for drugs, alcohol, and tobacco dependence.

MATERIALS AND METHODS

A cross-sectional survey was conducted among 404 respondents from seven treatment centers across India. A structured questionnaire assessed the change in availability, access, quality, and price of substances used during the first phase (March 24-April 14) and the second phase (April 15-May 3) of lockdown.

RESULTS

A majority of the respondents in treatment used tobacco (63%) and alcohol (52%). Relatively few respondents used opioids (45%) or cannabis (5%). Heroin (44%) was the most common opioid the respondents were treated for. Seventy-five percent, 65%, and 60% of respondents treated for alcohol, tobacco, and opioid problems, respectively, reported a reduction in the availability and access during the first phase of the lockdown. In the second phase, respondents with alcohol and tobacco dependence reported greater availability than those with opioid and cannabis dependence. The reported price of all substances increased more than 50% during the first phase of lockdown and remained higher throughout the second phase. Deterioration in purity was reported by more than half of the people who used opioid.

CONCLUSION

Lockdown could have affected both licit and illicit drug markets, albeit to a varying degree. The observed changes seemed short-lasting, as suggested by the recovering trends during the second phase of lockdown.

Emotional distress among health professionals involved in care of inpatients with COVID-19: a survey based cross-sectional study

INTRODUCTION

Health care workers (HCWs) are directly involved in processes linked with diagnosis, management, and assistance of coronavirus disease-19 (COVID-19) patients which could have direct implications on their physical and emotional health. Emotional aspects of working in an infectious pandemic situation is often neglected in favour of the more obvious physical ramifications. This single point assessment study aimed to explore the factors related to stress, anxiety and depression among HCWs consequent to working in a pandemic.

MATERIAL AND METHODS

This was a cross-sectional study involving healthcare workers who were working in COVID-19 inpatient ward, COVID-19 screening area, suspect ward, suspect intensive care unit (ICU) and COVID-19 ICU across four hospitals in India. A web-based survey questionnaire was designed to elicit responses to daily challenges faced by HCWs. The questionnaire was regressed using machine-learning algorithm (Cat Boost) against the standardized Depression, Anxiety and Stress Scale - 21 (DASS 21) which was used to quantify emotional distress experienced by them.

RESULTS

A total of 156 participants were included in this study. As per DASS-21 scoring, severe stress was seen in ∼17% of respondents. We could achieve an R² of 0.28 using our machine-learning model. The major factors responsible for stress were decreased time available for personal needs, increasing age, being posted out of core area of expertise, setting of COVID-19 care, increasing duty hours, increasing duty days, marital status and being a resident physician.

CONCLUSIONS

Factors elicited in this study that are associated with stress in HCWs need to be addressed to provide wholesome emotional support to HCWs battling the pandemic. Targeted interventions may result in increased emotional resilience of the health-care system.

A multicentric survey among patients with substance use disorders during the COVID-19 lockdown in India

BACKGROUND

The unprecedented first wave of the COVID-19 pandemic severely impacted mental health services globally. However, the negative impact of such disruptions on people with substance use disorders (SUD) seeking treatment remains unclear. We aim to explore the behaviors adopted by these individuals to overcome the service disruptions.

MATERIALS AND METHODS

We explored the changes related to substance use behavior (quit attempts, withdrawal experienced, treatment-seeking, and risky behaviors), and behavioral changes in response to COVID-19 lockdown. A cross-sectional survey was conducted among 404 people with SUD seeking treatment from seven centers across India. They were assessed by a specially designed structured questionnaire during the first wave (June-September) of the pandemic.

RESULTS

An overwhelming majority experienced withdrawal symptoms, with close to half making quit attempts and seeking treatment during the lockdown. Three-fourth of the sample reported difficulty in accessing treatment services and medications. Patients with opioid use were significantly more likely to think about quitting (χ² = 20.408, P = 0.000), make attempts (χ² = 12.436, P = 0.000), seek treatment (χ ² = 7.536, P = 0.006), and self-medicate for withdrawal symptoms (χ² = 5.885, P = 0.015). In turn, those with alcohol use were more likely to use telepsychiatry services (χ² = 35.143, P = 0.000) and experience stigma by family members (χ² = 29.951, P = 0.000) and neighbors (χ² = 17.725, P = 0.000). Among COVID-19 safety precautions, majority practised wearing masks and social distancing but not others.

CONCLUSION

COVID-19 lockdown led a significant proportion of substance users, especially opioid users, to make quit attempts and seek help. However, these could not be sustained due to difficulty in accessing treatment services. Further, significant proportion failed to adhere to COVID-19 safety precautions.

BL-02: a versatile X-ray scattering and diffraction beamline for engineering applications at Indus-2 synchrotron source

A hard X-ray engineering applications beamline (BL-02) was commissioned recently and started operation in March 2019 at the Indian synchrotron source, Indus-2. This bending-magnet-based beamline is capable of operating in various beam modes, viz. white, pink and monochromatic beam. The beamline utilizes the X-ray diffraction technique in energy-dispersive and angle-dispersive modes to carry out experiments mainly focused on engineering problems, viz. stress measurement, texture measurement and determination of elastic constants in a variety of bulk as well as thin-film samples. An open-cradle six-circle diffractometer with ∼12 kg load capacity allows accommodation of a wide variety of engineering samples and qualifies the beamline as a unique facility at Indus-2. The high-resolution mode of this beamline is suitably designed so as to carry out line profile analysis for characterization of micro- and nano-structures. In the present article the beamline is described starting from the beamline design, layout, optics involved, various operational modes and experimental stations. Experiments executed to validate the beamline design parameters and to demonstrate the capabilities of the beamline are also described. The future facilities to be incorporated to enhance the capabilities of the beamline are also discussed.

Children and COVID19: Understanding impact on the growth trajectory of an evolving generation

The COVID19 pandemic has forced the world to be closed in a shell. It has affected large population worldwide, but studies regarding its effect on children very limited. The majority of the children, who may not be able to grasp the entire emergency, are at a bigger risk with other problems lurking behind the attack of SARS-CoV-2 virus. The risk of infection in children was 1.3%, 1.5%, and 1.7% of total confirmed COVID-19 cases in China, Italy and United States respectively which is less compared to 2003 epidemic of severe acute respiratory syndrome (SARS), when 5-7% of the positive cases were children, with no deaths reported while another recent multinational multicentric study from Europe which included 582 PCR (polymerase chain reaction) confirmed children of 0-18 year of age, provide deeper and generalize incite about clinical effects of COVID19 infection in children. According to this study 25% children have some pre-existing illness and 8% required ICU (intensive care unit) admission with 0.69% case fatality among all infected children. Common risk factor for serious illness as per this study are younger age, male sex and pre-existing underlying chronic medical condition. However, we need to be more concerned about possible implications of indirect and parallel psychosocial and mental health damage due to closure of schools, being in confinement and lack of peer interaction due to COVID19 related lockdown and other containment measures. The effects can range from mood swings, depression, anxiety symptoms to Post Traumatic Stress Disorder, while no meaningful impact on COVID19 related mortality reduction is evident with school closure measures. The objective of this paper is to look at both the positive & negative effects in children due to COVID19 related indirect effects following lockdown and other containment measures. There is a need to gear up in advance with psychological strategies to deal with it post the pandemic by involving all stakeholders (parents, teachers, paediatricians, psychologists, psychiatrists, psychiatric social workers, counsellors), proposing an integrated approach to help the children to overcome the pandemic aftermath.

Psychological adaptive difficulties and their management during COVID-19 pandemic in people with diabetes mellitus

BACKGROUND AND AIMS

People with diabetes have multiple psychosocial issues related to diabetes and its complications and this may be exacerbated during the COVID-19 pandemic.

METHODS

We reviewed the psychological adaptative difficulties in people with diabetes especially during natural disasters including the prevailing COVID-19 pandemic.

RESULTS

There are significant concerns regarding worsening of glycemic control, unavailability of appropriate medicines, inaccessibility to health care or acquiring SARS- CoV-2 infection and subsequent poorer outcomes during the COVID-19 pandemic. Although there are some guidance documents for managing diabetes and associated complications during COVID-19 pandemic but very few address the psychological issues in people with diabetes. We discuss the psychological adaptive difficulties and an approach to address the psychosocial concerns in people with diabetes during the COVID-19 pandemic.

CONCLUSIONS

People with diabetes have significant diabetes distress and psychological adaptive difficulties that is aggravated by the COVID-19 pandemic. An integrated multidisciplinary approach is needed to manage the prevailing psychological issues amongst people with diabetes during the COVID-19 pandemic.

Noninvasive assessment of cutaneous alterations in mice exposed to whole body gamma irradiation using optical imaging techniques

We report the results of a study carried out to investigate the potential of optical techniques such as optical coherence tomography, Mueller matrix spectroscopy, and cross-polarization imaging for noninvasive monitoring of the ionizing radiation exposure-induced alterations in cutaneous tissue of mice. Radiation dose-dependent changes were observed in tissue microvasculature and tissue optical parameters like retardance and depolarization as early as 1 h post radiation exposure. Results suggest that these optical techniques may allow early detection of radiation dose-dependent alterations which could help in screening of population exposed to radiation.

Structural variation in a synchrotron-induced contamination layer (a-C:H) deposited on a toroidal Au mirror surface

A carbon layer deposited on an optical component is the result of complex interactions between the optical surface, adsorbed hydrocarbons, photons and secondary electrons (photoelectrons generated on the surface of optical elements). In the present study a synchrotron-induced contamination layer on a 340 mm × 60 mm Au-coated toroidal mirror has been characterized. The contamination layer showed a strong variation in structural properties from the centre of the mirror to the edge region (along the long dimension of the mirror) due to the Gaussian distribution of the incident photon beam intensity/power on the mirror surface. Raman scattering measurements were carried out at 12 equidistant (25 mm) locations along the length of the mirror. The surface contamination layer that formed on the Au surface was observed to be hydrogenated amorphous carbon film in nature. The effects of the synchrotron beam intensity/power distribution on the structural properties of the contamination layer are discussed. The I(D)/I(G) ratio, cluster size and disordering were found to increase whereas the sp²:sp³ ratio, G peak position and H content decreased with photon dose. The structural parameters of the contamination layer in the central region were estimated (thickness ≃ 400 Å, roughness ≃ 60 Å, density ≃ 72% of bulk graphitic carbon density) by soft X-ray reflectivity measurements. The amorphous nature of the layer in the central region was observed by grazing-incidence X-ray diffraction.

A cross-sectional study of factors affecting seasonality in bipolar disorder

<p><strong>Background.</strong> Researchers have evinced interest in the effect of seasonal variations on mood and behavioural patterns in affective disorders. </p><p><strong>Objective. </strong>To study seasonality in bipolar disorder (BD) patients and also the factors affecting this seasonality. </p><p><strong>Method. </strong>Forty-nine patients with BD in euthymic phase were recruited and analysed using<strong> </strong>the<strong> </strong>Seasonal Pattern Assessment Questionnaire and Morningness-Eveningness Questionnaire. </p><p><strong>Results. </strong>Most of the patients were morning types but chronotype had no influence on seasonality. Age of patient and number of episodes were the most important factors affecting seasonality in BD. </p><p><strong>Conclusion. </strong>Seasonality and its influencing factors must be considered while managing bipolar disorder.</p>

Onset of acute and transient psychotic disorder in India: a study of socio-demographics and factors affecting its outcomes

OBJECTIVE

Acute and transient psychotic disorder has been accepted as a distinct diagnostic entity in the ICD-10. However, there are few studies delineating its demographics and factors affecting its outcome. This study aimed to examine the socio-demographic profile of patients with acute and transient psychotic disorder and the variables associated with the onset of illness and their effect on illness outcome in an Indian setting.

METHODS

This was a retrospective study in which case notes of patients admitted from 1 January to 31 December 2012 and diagnosed with acute and transient psychotic disorder (according to the ICD-10 diagnostic criteria) were analysed. Socio-demographic variables and variables associated with the onset of illness were noted. Duration of hospital stay was used as a proxy measure for clinical outcome.

RESULTS

A total of 185 patient records were analysed. Overall, 49% of the patients were males and 51% were females. Most of the cases (60%) were aged between 20 and 39 years. The majority was married, unemployed, educated up to middle school, living in a nuclear family, and had a rural background. Age (p = 0.05) and marital status (p = 0.03) significantly affected the outcome. Overall, 46% of the patients had stress as a precipitating factor, 27% reported substance use, and 23% had a family history of psychiatric illness prior to the onset of their illness. The onset of illness was from May to October in 54% of the patients, with the duration of untreated illness ranging from 7 to 15 days in 38% of the patients. The clinical outcome was significantly affected by duration of untreated illness (p = 0.05).

CONCLUSIONS

Acute and transient psychotic disorders show slight female preponderance and occur in early adulthood. There is no precipitating stress in most cases and shorter duration of untreated illness predicts favourable clinical outcome.

Effect of gold nanoparticles on depolarization characteristics of Intralipid tissue phantom

We report results of studies on the effect of different shapes and sizes of gold nanoparticles (GNPs) on the depolarization characteristics of Intralipid tissue phantoms. For a given extinction coefficient, the absorption characteristics of the GNPs contributed more to the depolarization of the turbid medium, and the contribution of scattering was significant only for the larger-sized particles. For rod-shaped GNPs, their depolarization plays an important role in the low scattering regime in which the depolarization properties of the nanoparticles (NPs) dominate in the turbid medium even if the contribution of the scattering from the NPs is about an order of magnitude less. For highly scattering samples, GNP absorption significantly modulates the depolarization spectra of the turbid medium.

Emotional intelligence, perceived stress and burnout among resident doctors: an assessment of the relationship

BACKGROUND

Burnout is an increasing problem among the medical fraternity, especially resident doctors. We assessed the relationship between burnout, emotional intelligence and perceived stress in an attempt to explore a probable solution.

METHODS

Residents in the departments of medicine (n=29) and surgery (n=27) were assessed with a specially designed proforma consisting of participant's profile sheet, Shirom-Melamed Burnout Measure (SMBM), Trait Emotional Intelligence Questionnaire and Perceived Stress Scale (PSS). Correlation and mediational analysis were used to analyse the data.

RESULTS

The findings showed a positive correlation of burnout with perceived stress and a negative correlation with trait emotional intelligence (EI). Perceived stress also showed a negative correlation with trait EI. Mediation analysis showed that perceived stress mediates the effect of trait EI on burnout.

CONCLUSION

Enhancing EI through training may be an important intervention for targeting burnout.

Identification of vulnerability among first-degree relatives of patients with schizophrenia

OBJECTIVES

To evaluate the status of schizotypy, neurological soft signs, and cognitive functions as vulnerability markers for schizophrenia and to investigate the potential value of their combination for early identification of people at high risk for schizophrenia.

METHODS

A cross-sectional study was conducted. Subjects were drawn from first-degree relatives of inpatients and outpatients with schizophrenia (n = 50). Controls (n = 30) were recruited by word-of-mouth from hospital staff and attendants of hospitalised patients. Subjects who met inclusion criteria on screening were subjected to selected measures for assessment, including Schizotypal Personality Questionnaire-Brief Version, the Cambridge Neurological Inventory, digit span test, paired associate learning test, and visuospatial working memory matrix. Statistical analysis was completed using the independent t test and significance (p value), as well as calculation of effect size (Cohen's d). Discriminant function analysis was used to determine the effect of combining assessment measures.

RESULTS

First-degree relatives showed higher schizotypy scores (Cohen's d = 0.88) and neurological soft signs (Cohen's d = 1.55). They scored significantly worse on all neurocognitive measures (Cohen's d = -1.27). Discriminant function analysis showed that Schizotypal Personality Questionnaire-Brief Version, neurological soft signs, and total cognitive index (the sum of weighted scores on individual cognitive scales) in combination better discriminated between the first-degree relative and control groups (Wilks' λ = 0.54).

CONCLUSION

Use of multiple vulnerability markers could enhance the specificity of measures used to determine risk for schizophrenia.

Disability and quality of life in schizophrenia and obsessive compulsive disorder: a cross-sectional comparative study

OBJECTIVE

To assess and compare the quality of life and disability in patients with schizophrenia and obsessive compulsive disorder.

METHODS

A cross-sectional study was carried out in the outpatient psychiatry clinics at Jaipur of India. Fifty patients with obsessive compulsive disorder and 47 with schizophrenia (diagnosed as per criteria of the 10th revision of the International Classification of Diseases), and with a minimum duration of 2 years on maintenance treatments, were evaluated. Evaluation was based on the World Health Organization Quality of Life Instrument, the Global Assessment of Functioning scale, and the Indian Disability Evaluation Assessment Scale. The collected data were analysed using descriptive and inferential statistics.

RESULTS

Regarding quality of life domains, there was no statistically significant difference between the 2 groups. Obsessive compulsive disorder patients had lower scores on all domains of disability, all such differences being statistically significant.

CONCLUSIONS

The deleterious effect of illness on quality of life and functioning occur not only in schizophrenic but also in obsessive compulsive disorder patients. Thus management should be planned with this consideration to yield better outcomes in both conditions.

Polar decomposition of 3 x 3 Mueller matrix: a tool for quantitative tissue polarimetry

The polarization properties of any medium are completely described by the sixteen element Mueller matrix that relates the polarization parameters of the light incident on the medium to that emerging from it. Measurement of all the elements of the matrix requires a minimum of sixteen measurements involving both linear and circularly polarized light. However, for many diagnostic applications, it would be useful if the polarization parameters can be quantified with linear polarization measurements alone. In this paper, we present a method based on polar decomposition of Mueller matrix for quantification of the polarization parameters of a scattering medium using the nine element (3 x 3) Mueller matrix that requires linear polarization measurements only. The methodology for decomposition of the 3 x 3 Mueller matrix is based on the previously developed decomposition process for sixteen element (4 x 4) Mueller matrix but with an assumption that the depolarization of linearly polarized light due to scattering is independent of the orientation angle of the incident linear polarization vector. Studies conducted on various scattering samples demonstrated that this assumption is valid for a turbid medium like biological tissue where the depolarization of linearly polarized light primarily arises due to the randomization of the field vector's direction as a result of multiple scattering. For such medium, polar decomposition of 3 x 3 Mueller matrix can be used to quantify the four independent polarization parameters namely, the linear retardance (delta ), the circular retardance (psi), the linear depolarization coefficient (Delta) and the linear diattenuation (d) with reasonable accuracy. Since this approach requires measurements using linear polarizers only, it considerably simplifies measurement procedure and might find useful applications in tissue diagnosis using the retrieved polarization parameters.

Mueller matrix approach for determination of optical rotation in chiral turbid media in backscattering geometry

For in vivo determination of optically active (chiral) substances in turbid media, like for example glucose in human tissue, the backscattering geometry is particularly convenient. However, recent polarimetric measurements performed in the backscattering geometry have shown that, in this geometry, the relatively small rotation of the polarization vector arising due to the optical activity of the medium is totally swamped by the much larger changes in the orientation angle of the polarization vector due to scattering. We show that the change in the orientation angle of the polarization vector arises due to the combined effect of linear diattenuation and linear retardance of light scattered at large angles and can be decoupled from the pure optical rotation component using polar decomposition of Mueller matrix. For this purpose, the method developed earlier for polar decomposition of Mueller matrix was extended to incorporate optical rotation in the medium. The validity of this approach for accurate determination of the degree of optical rotation using the Mueller matrix measured from the medium in both forward and backscattering geometry was tested by conducting studies on chiral turbid samples prepared using known concentration of scatterers and glucose molecules.