Radiologists' Rating for Comparative Qualitative Assessment of Intravoxel Incoherent Motion Using Novel Analysis Methods

OBJECTIVE

The objective was to assess qualitative interpretability and quantitative precision and reproducibility of intravoxel incoherent motion ( IVIM) parametric images evaluated using novel IVIM analysis methods for diagnostic accuracy.

METHODS

Intravoxel incoherent motion datasets of 55 patients (male/female = 41:14; age = 17.8 ± 5.5 years) with histopathology-proven osteosarcoma were analyzed. Intravoxel incoherent motion parameters-diffusion coefficient ( D ), perfusion fraction ( f ), and perfusion coefficient ( D* )-were estimated using 5 IVIM analysis methods-(i) biexponential (BE) model, (ii) BE-segmented fitting 2-parameter (BESeg-2), (iii) BE-segmented fitting 1-parameter (BESeg-1), (iv) BE model with total variation penalty function (BE + TV), and (v) BE model with Huber penalty function (BE + HPF). Qualitative scoring in a 5-point Likert scale (uninterpretable: 1; poor: 2; fair: 3; good: 4; excellent: 5) was performed by 2 radiologists for 4 criteria: (a) tumor shape and margin, (b) morphologic correlation, (c) noise suppression, and (d) overall interpretability. Interobserver agreement was evaluated using Spearman rank-order correlation ( rs ). Precision and reproducibility were evaluated using within-subject coefficient of variation (wCV) and between-subject coefficient of variation (bCV).

RESULTS

BE + TV and BE + HPF produced significantly ( P < 10 -3 ) higher qualitative scores for D (fair-good [3.3-3.8]) than BE (poor [2.3]) and for D* (poor-fair [2.2-2.7]) and f (fair-good [3.2-3.8]) than BE, BESeg-2, and BESeg-1 ( D* : uninterpretable-poor [1.3-1.9] and f : poor-fair [1.5-3]). Interobserver agreement for qualitative scoring was rs = 0.48-0.59, P < 0.009. BE + TV and BE + HPF showed significantly ( P < 0.05) improved reproducibility in estimating D (wCV: 24%-31%, bCV: 21%-31% improvement) than the BE method and D* (wCV: 4%-19%, bCV: 5%-19% improvement) and f (wCV: 25%-49%, bCV: 25%-47% improvement) than BE, BESeg-2, and BESeg-1 methods.

CONCLUSIONS

BE + TV and BE + HPF demonstrated qualitatively and quantitatively improved IVIM parameter estimation and may be considered for clinical use further.

Teaching NeuroImage: Glutaredoxin-5-Associated Variant Nonketotic Hyperglycinemia

A 5-year-old boy presented with subacute motor regression since age 2.5 years. Examination revealed spasticity of bilateral lower extremities, generalized dystonia, and pseudobulbar palsy. Investigations revealed raised plasma lactate (2.5 mmol/L, normal range 0.8-1.5 mmol/L) and no evidence of sideroblastic anemia. Neuroimaging showed cavitating leukoencephalopathy with involvement of long tracts (corticospinal, spinothalamic tracts) and dorsolateral columns of cervicothoracic cord (Figures 1 and 2). A next-generation sequencing test identified a novel homozygous missense variant (c.171C > A, p.Phe57Leu) in exon 1 of the Glutaredoxin-5 (GLRX5) gene.

Designing of bis-organosilanes as dual chemosensor for Sn(II) and Al(III) ions: Antibacterial activity and in silico molecular docking study

Here, in this article, we present the design and synthesis of 1,2,3-triazole allied Schiff base functionalized organosilanes 6(a-e) utilising single step approach. These compounds were further characterised using NMR (1H, 13C) and mass spectrometry. Furthermore, UV-Visible and fluorescence spectroscopy showed that compound 6a had a high selectivityto Sn(II) and Al(III) metal ions compared to other relevant metal ions with lowlimit of detection (LOD) values. Suppression of -C=N isomerization, constrained intramolecular charge transfer (ICT), and complexation with Sn(II)/Al(III) ions (Chelation Enhanced Fluorescence (CHEF)) results in probe 6a's enhanced turn on fluorescence toward the detection of Sn(II) and Al(III) ions. Probe 6a was a strong candidate for the detection of Sn(II) and Al(III) ions due to its selectivity, reversibility, and competitiveness. Since the detecting phenomenon can be reversed, the sensor 6a perfectly mimics the INHIBIT molecular logic gate. Also, computational study utilising DFT technique was used to shed light on the complexation mode of 6a with Sn(II) and Al(III) metal ions. The compound 6a's antibacterial activity has also been successfully tested against Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria. Additionally, the compound 6a was docked to the E. coli and S. aureus proteins, which exhibited excellent results with binding energies of -7.18 Kcal mol-1 and -7.05 Kcal mol-1, respectively. As both in-vitro and docking studies demonstrated anti-bacterial activity of the probe 6a, it may be anticipated that the probe has potential to serve as anti-bacterial drug in nearly future.

DENTAL CAVITIES IN PEOPLE WITH TYPE 2 DIABETES MELLITUS: AN ANALYSIS OF RISK INDICATORS

Diabetes is associated with a greater number of dental cavities. It is unclear, therefore, how potential risk factors such as salivary glucose, glycemic control and blood sugar could impact the onset of dental caries between people that have type 2 diabetes (T2D). Aim of the study - analyzing the risk factors for oral cavity disease in T2D patients. We analyzed the patient data including their dietary habits, dental hygiene practices, age and control of glycemic. The Indian dataset was used. Individual patient observations include the patient's diabetes classification as a range of medical attributes such as age, pregnancy, pedigree, glucose, body mass index, skin, blood pressure and insulin. The research discovered a significant correlation between poorly managed glycemic levels and dental caries are more prevalent in people with T2DM. High sugar consumption and poor oral hygiene habits have been identified as risk factors. These results highlight the need for integrating diabetes treatment measures with dental care to reduce dental caries in this susceptible group. Utilizing dental cavities into account improves oral health and has a positive impact on health outcomes for those with type 2 diabetes.

Short-term exposure to air pollution and emergency room visits for acute respiratory symptoms among adults

OBJECTIVE: To examine the short-term effect of ambient air pollution on daily acute respiratory emergency room visits among adults.METHODS: A time-series study (June 2017-February 2019) was carried out among adults (≥18 years) visiting a multi-specialty hospital in Delhi. We evaluated the association between the daily levels of particulate matter (PM) <2.5 μm in diameter (PM2.5) and PM <10 μm in diameter (PM10), ozone (O₃), nitrogen dioxide (NO₂), carbon monoxide (CO) and sulphur dioxide and daily count of emergency room (ER) visits for acute respiratory symptoms. Generalised additive model (GAM) was used with the Poisson link function to analyse the associations for 0-1 to 0-7 lag days.RESULTS: A total of 69,400 ER visits were recorded, of which 2,669 were by adults due to acute respiratory symptoms. At 0-7 lag days, an increment of 1 standard deviation in NO₂ and PM2.5 concentration was associated with a percentage increase in acute respiratory ER visits of respectively 53.0% (95% CI 30.84-78.97) and 19.5% (95% CI 4.53-36.65). During 0-7 lag days, a positive trend was observed at higher concentrations of CO (>1.86-3.28 mg/m³), while a negative significant association was observed at low concentrations of CO (<1.171 mg/m³).CONCLUSION: Short-term exposure to ambient NO2 and PM2.5 was associated with acute respiratory emergency visits of adults at lag 0-7 days.

Phthalate induced hormetic effect reveals susceptibility of gill compared to muscle tissue after depuration in commercially important fish (Etroplus suratensis)

Effect of Bis-2ethylhexyl phthalate (DEHP) on commercially important tropical fish pearl spot has not been demonstrated at environmental concentrations along with depuration. The species is estuarine, juvenile and difficult to maintain but widely consumed and well distributed in tropical estuaries. Antioxidant activity of SOD, CAT and GPx was enhanced on all exposure days for gill and muscle suggesting high oxidative stress, except on day 5. Detoxifying enzyme-GST behaved differentially in gill and muscle tissue after depuration, depicting inhibited activity of GST in gill leading to lipid peroxidation. However, the muscle tissue was able to recover from stress after 7 days of depuration with the help of detoxifying enzymes. Overcompensation of antioxidant activity was observed over disruption of homeostasis defining hormesis effect. Integrated biomarker (IBR) index depicted high toxicity during entire exposure time, but after depuration, gill could not mediate LPO at lowest concentration (10 μg/l) while muscle tissue recovered, suggesting persistence of stress in gill.

Limb salvage of an infant with infantile fibrosarcoma using TRK inhibitor larotrectinib

Infantile fibrosarcoma (IFS) is an extremely rare locally aggressive soft tissue tumour of childhood. Primary therapy involves complete surgical resection with or without chemotherapy. However complete surgical resection might not be feasible in all cases and so requires other modalities for further management. We report the case of a male infant from Bangladesh with a locally advanced IFS of the leg which was partially resected. The patient received adjuvant chemotherapy which was complicated by the development of chemotherapy-related veno-occlusive disease and had to be discontinued. Thereafter he was referred to our dedicated sarcoma oncology clinic in India for further management. The parents of the child refused amputation of the limb. The tumour tested positive for NTRK3-ETV6 gene fusion and after discussion in multidisciplinary clinic, targeted therapy using oral NTRK inhibitor larotrectinib was started. The patient had complete response at the end of 8 months of treatment with larotrectinib. This is the first report from the Indian subcontinent and we encourage that these children should be referred to specialist clinics for appropriate multidisciplinary management for best outcomes.

Click derived organosilane assembled with nano platform for the detection of Cu2+ ions: Biological evaluation and molecular docking approach

Metal ions have active roles in biochemical, industrial, and environmental processes. The design and development of new rapid sensing materials with advanced reasonable, compelling, and convenient, techniques are urgent. Here in this work, we design and develop sensor with the facile amalgamation of the pyrene-based organosilane (5) through a click silylation approach silicon composite for selective detection of Cu²⁺ ions. Physicochemical and keen methods are employed to perceive the resultant hybrid nanoparticles (H-NPs), and these nanocomposites similarly displayed a strong affection for Cu²⁺ ions. In addition, the identification restrictions while utilizing 5 and H-NP's towards Cu²⁺ found in this study are far lower than the WHO rules for drinking water. Further, organosilane (5) shows good antibacterial and antioxidant activity. The antibacterial effects of triazole-based organosilane (5), are evaluated with a molecular docking study with Escherichia coli (IJZQ) was conducted. The selected ligand was revealed to have a reasonable docking score with a binding energy of -8.40 kcal mol^-1.

Functional β-mannooligosaccharides: Sources, enzymatic production and application as prebiotics

One of the emerging non-digestible oligosaccharide prebiotics is β-mannooligosaccharides (β-MOS). β-MOS are β-mannan derived oligosaccharides, they are selectively fermented by gut microbiota, promoting the growth of beneficial microorganisms (probiotics), whereas the growth of enteric pathogens remains unaffected or gets inhibited in their presence, along with production of metabolites such as short-chain fatty acids. β-MOS also exhibit several other bioactive properties and health-promoting effects. Production of β-MOS using the enzymes such as β-mannanases is the most effective and eco-friendly approach. For the application of β-MOS on a large scale, their production needs to be standardized using low-cost substrates, efficient enzymes and optimization of the production conditions. Moreover, for their application, detailed in-vivo and clinical studies are required. For this, a thorough information of various studies in this regard is needed. The current review provides a comprehensive account of the enzymatic production of β-MOS along with an evaluation of their prebiotic and other bioactive properties. Their characterization, structural-functional relationship and in-vivo studies have also been summarized. Research gaps and future prospects have also been discussed, which will help in conducting further research for the commercialization of β-MOS as prebiotics, functional food ingredients and therapeutic agents.

Mesenteric lipoblastomatosis: an uncommon fat-containing childhood tumour diagnosed on imaging

Lipoblastomatosis of mesentery is an extremely rare benign fat-containing mesenchymal tumour in infants and young children. On imaging, it appears as a solid infiltrating mass interspersed with macroscopic fat. We describe the distinctive imaging features of a large mesenteric Lipoblastomatosis, corroborated with intraoperative and histopathological features. We hope the case report and short review about this rare entity will increase the diagnostic confidence of reading radiologists while formulating differentials for lesions of similar appearance in the paediatric age group.

Development of piperazine conjoined 1,2,3-triazolyl-γ-propyltriethoxysilanes: Fluorometric detection of Cr3+ ions and computational study

Chromium is essential for some biochemical processes, and excess is a big concern that shows adverse effects on human health and the environment. Therefore, it is urgent to design new sensors to detect chromium ions rapidly. The present study discusses the synthesis of piperazine conjoined 1,2,3-triazolyl-γ-propyltriethoxysilanes (4a-4b) and development of 4a as fluorescence turn-on sensor for the detection of Cr³⁺ ions. The mechanistic insights reveal to the restricted CN rotation and inhibited intramolecular charge transfer (ICT) process. In addition, Job's plot and Benesi-Hildebrand plot justify the 1:1 binding affinity with a binding constant of 9.96 × 10⁵ M^-1 for [ligand 4a + Cr³⁺] complex and the limit of detection for Cr³⁺ ions is observed as 6.06 × 10^-8 M. The fluorescence spectral changes, ¹H NMR spectra and DFT studies provide evidences for ligand 4a and Cr³⁺ ions interactions. Further, the reversibility of the ligand 4a from [ligand 4a + Cr³⁺] complex on the addition of EDTA can be used in the construction of molecular logic gate where Cr³⁺ and EDTA are considered as inputs and the fluorescence intensity at 398 nm as output. Further, compounds 4a-4b were then evaluated for their antibacterial activity against bacterial strains (Escherichia coliand Staphylococcus aureus), revealing a modest activity. The binding mode of ligand 4a to Staphylococcus aureus (PDB ID - 3U2K) and Escherichia coli (PDB ID - 5Z4O) was investigated using an in-silico molecular docking technique, which revealed that the triazole ring and silanyl group are involved in hydrogen bonding with proteins and may be the cause of the ligand's antibacterial activity. The ligand 4a demonstrated a high affinity for binding within the active sites of proteins with binding energies of -7.97 kcal/mol (3U2K) and -8.68 kcal/mol (5Z4O).

Attitude towards patients with psychiatric illness among undergraduate medical students at Government Medical College: A cross-sectional study

Background

People with mental illnesses commonly experience stigma, discrimination, and prejudice from the general public and medical professionals around the world. Numerous research has looked into the unfavourable perceptions that medical students have of those who suffer from mental illness.

Objective

The objective was to study the attitude of undergraduate medical students towards patients with psychiatric illnesses.

Materials and Methods

A cross-sectional study was carried out among undergraduate medical students who were exposed (n = 69) to 2-week psychiatry posting and attended lectures and those who were not exposed (n = 163) to psychiatry training using self-reported Attitude Scale for Mental Illness (ASMI) questionnaire via Google form distributed among medical students.

Results

The findings indicate there is no change in attitude toward the patient with psychiatric illness after exposure to psychiatry training among medical students. However, urban residence and female gender were the factors found to be influencing students' attitudes towards patients with psychiatric illnesses.

Conclusions

There was no change in attitude towards patients with psychiatric illness after psychiatry exposure. Students belonging to urban domicile and female students showed more sympathetic attitudes toward those with mental illnesses.

Windsock or Cobra Head Sign: A Distinctive Imaging Sign to Differentiate Type 1 Colonic Atresia From Hirschsprung's Disease

Colonic atresia is a rare cause of congenital low-type intestinal obstruction in the neonatal age group and may present as a surgical emergency if not diagnosed early. Clinically, it can pose a diagnostic dilemma for Hirschsprung disease, which involves a different treatment strategy. Therefore, an early and accurate diagnosis is paramount from a management and prognosis perspective. The contrast enema plays a crucial role in the diagnosis of the disease. The "Windsock or Cobra head sign" on the contrast enema, typically seen only in type 1 colonic atresia, can help radiologists and surgeons identify this disease. We report a case of a two-day-old neonate, including a clinical feature of low-grade intestinal obstruction with distinctive imaging signs of type 1 colonic atresia, which can help make a definitive diagnosis.

Tuberculous meningitis in the elderly

OBJECTIVE

Although the elderly population remains at high risk for tuberculosis, studies addressing tuberculous meningitis (TBM) in this age group are scarce. The present study aimed to evaluate the spectrum and outcome of geriatric TBM and document differences between older and young patients.

METHODS

A prospective cohort study was conducted in the adult TBM patients admitted at PGIMER, Chandigarh (India). Consecutive older patients aged 60 years and above were enrolled from January 2019 to December 2020, and young adults aged 18-59 years were enrolled from July 2019 to December 2019.

RESULTS

Fifty-five older patients with a mean age of 66.6 years and 73 young patients with a mean age of 35.1 years were enrolled. At admission, older patients were more likely to have altered mental status (96.4% vs. 78.1%, P = 0.003) and advanced disease with British medical research council staging 2 or 3 (98.2% vs. 89.0%, P = 0.043); however, headache (38.2% vs. 67.1%, P = 0.001), vomiting (18.2% vs. 35.6%, P = 0.030) and fever (80.0% vs. 91.8%, P = 0.052) were less common. Cerebrospinal fluid (CSF) abnormalities were less marked in older patients, with a significant difference in median total cells (70 vs. 110/µl, P = 0.013). Hydrocephalous and infarct were common neuroimaging abnormalities in both groups; however, tuberculomas were significantly less in the elderly (15.1% vs. 35.2%, P = 0.012). Older patients had a significantly low survival rate (56.4% vs. 76.7%, P = 0.021).

CONCLUSION

Significant differences in clinical, CSF and radiological characteristics exist between elderly and young TBM patients, with survival remains dismal in the elderly.

Role of Imaging in Childhood Arthritis

ABSTRACT

Imaging plays a pivotal role in the management of various childhood arthritis. Conventional radiography is the most commonly ordered imaging modality for the evaluation of arthritis. Owing to their higher sensitivity for detecting synovitis, magnetic resonance imaging and ultrasonography are increasingly being used to guide clinical management of various forms of arthritis, especially juvenile idiopathic arthritis. Magnetic resonance imaging is a preferred modality for evaluating more complex sites such as the sacroiliac joint. In this review, we have discussed the rational use and the characteristic imaging features of common childhood arthritis.

Triplication of ureter: A rare case

Anatomical fusion abnormalities of the urinary system and ureters are not uncommon. However, triplication of the ureter is very rare. A boy with this abnormality is being presented in view of its rarity. The importance of a thorough preoperative evaluation is being projected that may help us to choose the best management avenue.

TB free India: Reaching the unreached tribal population under National Tuberculosis Elimination Programme

India is the highest TB burden country in the world. The burden however is not uniform in different strata including tribal population - one of the key affected populations in the country. As the evidences from tribal population are hardly available, most of the policies and strategies implemented under National Tuberculosis Elimination Programme (NTEP) are usually based on the evidences from general populations. NTEP is continuously taking steps to strengthen TB services in tribal areas. The Social Action Plan including Tribal Action Plan is in place and the appropriate strategies are incorporated in the National Strategic Plan (NSP) to ensure universal access to quality TB services to vulnerable population groups. However, its implementation becomes challenging especially in tribal areas as different tribal groups have their own unique ways of dealing with health issues. These issues are therefore required to be addressed holistically involving all the stakeholders. In view of this a symposium was jointly organized by the Central TB Division (CTD), Govt. of India and ICMR - National Institute of Research in Tribal Health (NIRTH), Jabalpur on 17th and 18th December, 2019 at ICMR - NIRTH, Jabalpur. It provided an excellent platform for all the stakeholders from different parts of the country to share their experiences in tuberculosis particularly among marginalized populations. The recommendations emerged out of this interactive symposium highlight the sincere effort of NTEP to tackle TB situation in tribal population and show the way forward towards India's TB elimination goal by 2025 especially in hard to reach tribal areas.

Psychosocial aspects of suicide in largest industry of farmers in Vidarbha Region of Maharashtra

India consists of 16% of the world's population, but sustains only 2.4% of land resources. The agriculture sector is the only livelihood to two-third of its population, which gives employment to 57% of the workforce and is a raw material source to a large number of industries. Farmer suicides account for approximately 10% of all suicides in India. The national suicide rate is 10.6/lac, whereas in Maharashtra it is 14.2/lac, in Andhra Pradesh 12.1/lac, in Telangana 27.7/lac, and in Chhattisgarh 27.7/lac. The National Crime Records Bureau data from 1995 to 2006 show that 200,000 farmers had committed suicide, with an average rate of 16,000/year. Every 7^th suicide in the country is a farmers' suicide. The first state where suicides were reported was Maharashtra with particularly in the Vidarbha region. In Maharashtra, farmers' suicide rate is 60% higher than the general suicide rate. Every 5^th farmers' suicide committed in the country had occurred in Maharashtra, Vidarbha being a particularly sensitive region but also in Punjab, Uttar Pradesh, Kerala, and Karnataka. In a country of 70 million farmers, 10 in every 100,000 farmers commit suicide. Many inquiry commissions were formed and recommendations were implemented, especially in Punjab. The problem of suicide is not only reported in India but also reported in different parts of the world like England and Wales. We adopted the psychological autopsy approach to offer some insight into the reason why these individuals resorted to such a drastic step.

Suicidal Ideation and Pesticide Exposure in Rural Communities of Central India

Background  This study aims to evaluate association between suicidal ideation and pesticide exposure in rural communities of Wardha district of Central rural India compared with villagers who are not exposed to it. Method  It was a cross-sectional study done in rural community of Wardha district in Central India. About 100 farmers who were exposed to pesticides and 100 controls who were not exposed to pesticides were included. A Semistructured proforma to record sociodemographic variables and Indian version of the Self Reporting Questionnaire-20 was used. Results  Of these 200 subjects, data were available for 85 farmers in study group and 74 in control group. In the farmers group, 31% of farmers had suicidal ideas, while 8% of controls felt like ending their life. Conclusion  Measures must be taken to store pesticides at a safer place thus reducing long-term exposure. Organic farming is a better choice to avoid suicidal ideas.

Extensively drug-resistant tuberculosis treated with bedaquiline: A case report in the particularly vulnerable tribal group of Madhya Pradesh, India

The management of drug-resistant (DR) tuberculosis (TB) remains a challenge particularly in remote rural areas of the country. Although the treatment with wholly oral drug regimens, including bedaquiline (BDQ) and delamanid, is rolled out under the National TB Elimination Program, little is known about its coverage and the effectiveness in hard-to-reach tribal areas. The present report describes the early identification and successful management, through team effort, of a case of extensively DR TB belonging to the Saharia tribe - a Particularly Vulnerable Tribal Groups (PVTGs) of Madhya Pradesh, which has a very high prevalence of TB. The BDQ-containing regimen was well tolerated and found effective with minimal side effects and contributed to the reduced time to culture conversion and radiological improvements. The concerted efforts and strategies need to be adopted for effective implementation of Programmatic management of DR TB (PMDT) guidelines in remote tribal areas of the country.

Diseased Body and Diseased Mind: Mind Your Psychological Health during Lockdown

The novel Corona virus also known as 2019-nCoV that originated in China in December 2019 has quickly spread all over the world. In absence of specific treatment or vaccine, with no natural immunity, we are forced to rely on old public health measures like Quarantine, Social distancing and Isolation for prevention of spread among community. Although isolated incidents of epidemics have required isolation and quarantine in the past, no pandemic has required social distancing to a national and international scale before. Despite the obvious physical health and economic concerns of this situation, all the above measures bring forth challenges of emotional and psychological nature which can be especially severe in special populations like elderly, young children and adolescents, health care workers, persons with mental illness. Also, certain aspects like death, role of mass media, and ethics also arise during isolation and quarantine. With mass media playing a significant role in drumming up the perceived threat, people may resort to panic behaviours like hoarding essential day to day use items and masks and other medical supplies leading to shortage. Problem of fake news related to COVID 19 lead to Govt. of India launching of AAROGYA SETU app as well as websites to centralise all COVID 19 related information to people of India. Death in isolation deprives family members and friends of opportunity to grieve for near and dear ones lost due infection or due to natural causes. The requirement of isolation and quarantine during this distressing pandemic has paved way for recognising the importance and advantages of telemedicine as a whole which has led to various government bodies including the Government of India to draw primary guidelines for medical practitioners to follow and ensure ethical concerns are addressed.

Medical Students Attitude & Knowledge of Psychiatry an Impact of Psychiatry Posting

India being a signatory to Alma-Ata declaration, envisaged ‘Health for all by the year 2000” and hence should look into training undergraduates in psychiatry. Medical students’ attitude towards psychiatry are determined by complex inter lacing variables. Low recruitment is a serious challenge for psychiatry worldwide. Moreover, psychiatry is poorly represented in medical education and undergraduate training in psychiatry and behavioral sciences in most medical colleges in India is unsatisfactory. Keeping these facts in mind, this study was carried out to assess the influence of psychiatry training, including direct patient contact on attitude of medical students towards mental illness. This study was conducted at Department of Psychiatry, Mahatma Gandhi Institute of Medical Science, Sevagram, Wardha, Maharashtra. Second year MBBS students were evaluated with a pre and posttest during their 2 weeks posting in the Psychiatry department. There was some improvement in attitude & knowledge of undergraduate medical students about mental health after two weeks of psychiatry posting. The improvement in male medical students is more than three times of that seen in female medical students, after two weeks of training. The existing M.C.I. recommendations need serious considerations for implementation in each & every Medical College of India. As per the current curriculum, the introduction to psychiatry is in the 1st term during lectures on behavioral sciences following which they not exposed again until the 5th semester when the undergraduate students are required to attend 40 hours lectures parallel to 4 weeks clinical posting culminating with compulsory short note questions worth 20 marks included in paper II of the General Medicine exam. Finally, another two weeks of psychiatry posting is mandatory during internship. Female medical students have shown deterioration in their attitudes & knowledge over more questions than male counterparts. Hence it can be deduced that, males tend to learn better by experience.

Long-term survival of patients treated for tuberculosis: a population-based longitudinal study in a resource-poor setting

OBJECTIVE

We assessed the long-term survival of TB patients belonging to the Saharia tribe, a high TB burden community in Shivpuri district, Madhya Pradesh, central India.

METHODS

Population-based, longitudinal study conducted among 9756 Saharia population in 2013, and a resurvey done 2 years later in 2015 using the same methods. The status of the individuals during resurvey was recorded as non-TB, relapse and death. The deaths recorded in this period were used to measure the mortality among TB-affected population and the non-TB population in this cohort.

RESULTS

The standardised mortality ratio for the study cohort was 122.9 per 1000 population; males had higher mortality than females (129.9 vs. 96.8). The expected mortality among the non-TB population was 30.2, and the observed mortality among TB-affected population was 122.9 per 1000 population.

CONCLUSION

In the Saharia tribe, post-treatment mortality in the TB-affected population is significantly higher than in the general population. This highlights an urgent need for implementation of effective public health strategies to prevent disproportionate deaths among TB-affected individuals in resource-poor settings, and the importance of periodic follow-up of patients after cure/completion of treatment, especially in vulnerable populations.

Woman Mental Health - Midlife

Woman’s mental health, is an important issue and easily one of the most neglected domains, especially so for a woman in her middle age full of physiological and psychological turmoil. Mental health problems occur in higher frequency in women in general. Depression is more common in women as compared to men, women are twice as likely to experience anxiety as men and about 60 % of persons suffering from an OCD or a phobia are women. The greater gender predisposition necessitates an in-depth analysis of the biological and environmental factors of women which cause them to be more predisposed to mental illnesses. A recent report on Women of Tomorrow, reported women in India to be the most stressed female population of the world. Overall, the women of the developing nations were found to be more stressed than their sisters in the developed world. This led us to think about the cultural and environmental influences on the disorders, along with attitudes and perceptions of the society in the mental make-up of a woman. The contributing factors discussed in this article need extensive research to help modulate the implicated factors and in turn amount to primordial prevention. This article emphasizes the priorities to be studied in the context of a woman’s mental health, explores deeper issues and interrelationship of multi factorial determinants.

Schizophrenia with Co-morbid Obsessive-Compulsive Disorder: A Case Series

The frequency of co-morbidities like Obsessive Compulsive Disorder (OCD) is common in schizophrenia. Some studies have reported earlier age of onset, more positive and negative symptoms, more depressive symptoms, and worse prognosis in such patients. The phenomenology and management of OCD in schizophrenia is understudied. Evidence claims that the course of illness of both schizophrenia and bipolar disorders may be affected by obsessive-compulsive disorder whereas in other cases antipsychotic induced obsessive-compulsive symptoms have been observed. A meta-analysis of of schizophrenia and its co-morbid psychiatric conditions, found a prevalence of 12.1% for obsessive compulsive disorder, 9.8% for panic disorders, 12.4% for post-traumatic stress disorder and 14.9% for social phobia. SGAs like amisulpride and aripiprazole are found to be useful in the treatment of comorbid OCD in schizophrenia due to their negligible serotonergic properties. A combination of selective serotonin reuptake inhibitors (SSRI) with antipsychotics has been recommended by the American Psychiatric Association (APA) for treatment of comorbid OCD in schizophrenia. Escitalopram at a dose of 20 mg/day has been found to be beneficial in such cases while psychosis worsened with the use of fluvoxamine and clomipramine. Below is a series of seven cases of schizophrenia with co-morbid obsessive-compulsive symptoms who are on treatment for their illness from the psychiatric outpatient department of a rural hospital in central India.

Association of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Ureaplasma species infection and organism load with cervicitis in north Indian population

Cervicitis is predominantly caused by Neisseria gonorrhoeae and Chlamydia trachomatis, which accounts for almost half of all the cases of cervicitis. The role of newer organisms like Mycoplasma genitalium and Ureaplasma sp. and association of bacterial load with cervicitis are also not well established. So the study aimed to determine the relative frequency of these organisms and their load in association with cervicitis cases from north India. A case-control study involving 300 women was conducted using quantitative real-time PCR from endocervical swabs for identification of organisms and quantification of bacterial load. Among 150 cervicitis cases, C. trachomatis, N. gonorrhoeae, M. genitalium and Ureaplasma parvum were detected in 5 (3·3%), 10 (6·6%), 37(24·6%) and 47 (31·3%) respectively. Old age (<0·001, chi-squared test) and irregular menstrual cycles (<0·001, chi-squared test) were significantly associated with cervicitis. M genitalium was the only organism to be associated significantly with cervicitis with regard to age (<0·031) and symptoms like discharge (P < 0·033, chi-squared test) and dysuria (P < 0·044, chi-squared test) in multivariate analysis. Our finding suggests that the bacterial load of these organisms is not significantly associated with cervicitis. However, we found significant association of M. genitalium infection with clinical characteristics of cervicitis cases.

Spine radiograph in dysplasias: A pictorial essay

Spine radiograph is an essential component of a skeletal survey. It provides important diagnostic clues to various types of skeletal dysplasia. In some conditions, a spine radiograph alone may be diagnostic and characteristic; but mostly, it yields more value as a part of the complete skeletal survey. In this article we will discuss about a few common lethal and non-lethal skeletal dysplasias and their characteristic imaging findings; primarily focusing on the spine radiograph.

A novel approach for optimal design of digital FIR filter using grasshopper optimization algorithm

The idea behind designing digital filters is to compute the optimal filter coefficients such that the magnitude response of the designed matches the ideal frequency response using optimization algorithms. The proposed work employed a recently proposed swarm-based optimization technique, namely, a grasshopper optimization algorithm (GOA) to design a linear phase finite impulse response (FIR) low pass, high pass, band pass , and band stop filters. This proposed algorithm models the behaviour of grasshoppers while seeking food sources to solve optimization problems. For the designing of the FIR filter, an absolute error difference fitness function is used, which is minimized using GOA to obtain optimal filter coefficients. The performance comparison of the proposed work is done with already existing algorithms such as cuckoo search, particle swarm optimization, artificial bee colony to prove its superiority and consistency. It is found that GOA based filter meets the objective efficiently with reduced ripples in pass band and higher attenuation in stop band with least execution time.

Percutaneous Management of Persistent Urine Leak After Partial Nephrectomy: Sealing the Leak Site with Glue

Background: Localized urinary extravasation is a known complication after partial nephrectomy; however, rarely it forms a nephrocutaneous fistula. Nephrocutaneous fistula after partial nephrectomy is a management challenge for the treating surgeon. It is typically managed with indwelling ureteral stent placement. Persistent fistula after indwelling ureteral stent can be managed with percutaneous nephrostomy drainage. However, persistence after all these measures is a real therapeutic dilemma. Few reports are available on effective management of persistent urine leak by percutaneous obliteration of leak site using glue. Case Presentation: We report one such rare case of persistent nephrocutaneous fistula in a 41-year-old man of Indo-Aryan ethnicity. He was managed effectively with percutaneous cyanoacrylate glue application, when all the conservative methods failed. At 6 months follow-up he is doing well clinically and radiologically. Conclusion: Persistent nephrocutaneous fistula after partial nephrectomy is a rare and highly morbid condition, which leads to multiple intervention and prolonged hospital stay. Percutaneous glue application is a potential therapeutic approach to tackle such cases with good results.

Bacillus subtilis CP4, isolated from native soil in combination with arbuscular mycorrhizal fungi promotes biofortification, yield and metabolite production in wheat under field conditions

AIMS

The aim of this study was to identify the best combination of plant growth promoting bacteria (PGPB) and arbuscular mycorrhizal fungi (AMF) for biofortification and enhancing yield in wheat as well as improve soil health under field conditions. Another aim was to get insights into metabolite dynamics in plants treated with PGPB and AMF.

METHODS AND RESULTS

Different combinations of PGPB and AMF that gave good results in greenhouse study were used in a field study. The combined application of Bacillus subtilis CP4 (native PGPB) and AMF gave the best results with a significant increase in biomass, macronutrient and micronutrient content in wheat grains and improvement in yield-related parameters relative to the untreated control. PGPB and AMF treatment increased antioxidant enzymes and compounds and decreased the level of an oxidation marker. Metabolite profiling performed using Gas Chromatography-Mass Spectrometry (GC-MS) showed significant upregulation of specific organic acids, amino acids, sugars and sugar alcohols in plants treated with CP4 and AMF. The altered pathways due to CP4 and AMF inoculation mainly belong to carbohydrate and amino acid metabolism. A positive correlation was observed between some organic acids, sugars and amino acids with wheat growth and yield parameters. The activities of soil enzymes increased significantly with the best results shown by native PGPB and AMF combination.

CONCLUSIONS

A native bacterial isolate Bacillus subtilis CP4 in combination with AMF showed exceptional ability for biofortification and yield enhancement under field conditions. The upregulation of a number of metabolites showed correlation plant growth promotion and nutrients.

SIGNIFICANCE AND IMPACT OF THE STUDY

The combined application of native B. subtilis CP4 and AMF could offer a more sustainable approach for the development of a biofertilizer to enhance wheat nutrient content and production and soil health thereby advancing agriculture.

Diagnostic accuracy of TB-LAMP assay in patients with pulmonary tuberculosis-a case-control study in northern India

SETTING

A tertiary care hospital in North India.

OBJECTIVE

Tuberculosis (TB) remains a major public health problem in developing countries. The diagnosis of tuberculosis is still challenging in primary care settings in endemic countries like India. WHO has endorsed loop mediated isothermal amplification assay (LAMP) for TB as a replacement for smear microscopy for peripheral settings, however, more data is required to establish the specificity of this modality for the diagnosis of TB. In this study we aim to determine the diagnostic accuracy of the TB-LAMP assay in pulmonary tuberculosis.

DESIGN

A total of 236 patients (117 cases suspected of TB and 119 patients with non-TB pulmonary disease) were enrolled between February to July, 2018. Microbiological workups consisting of mycobacterial smear microscopy, culture, Xpert MTB/Rif and TB-LAMP were performed.

RESULTS

From 236 samples, 18 (7.6%) were excluded from the study. TB-LAMP and Xpert MTB/RIF were positive in 46 (21.1%) and 49 (22.5%) of the samples, respectively. The sensitivity of Xpert MTB/RIF and TB-LAMP, when culture was taken as a reference standard, was 90% (95%CI: 78.2-96.7) and 82% (95%CI: 68.6-91.4), respectively. The specificity, positive predictive value (PPV), and negative predictive value (NPV) of TB-LAMP assay were 96.8% (95%CI: 92.8-98.9), 89.1% (95%CI: 77.4-95.2), and 94.4% (95%CI: 90.4-96.5), respectively.

CONCLUSION

The TB-LAMP assay showed a good specificity and sensitivity for detection ofM. tuberculosis in adults, however, for programmatic implementation, more studies are required to be conducted at peripheral level healthcare settings.

COVID-19 and environmental -weather markers: Unfolding baseline levels and veracity of linkages in tropical India

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly spreading across the globe due to its contagion nature. We hereby report the baseline permanent levels of two most toxic air pollutants in top ranked mega cities of India. This could be made possible for the first time due to the unprecedented COVID-19 lockdown emission scenario. The study also unfolds the association of COVID-19 with different environmental and weather markers. Although there are numerous confounding factors for the pandemic, we find a strong association of COVID-19 mortality with baseline PM_2.5 levels (80% correlation) to which the population is chronically exposed and may be considered as one of the critical factors. The COVID-19 morbidity is found to be moderately anti-correlated with maximum temperature during the pandemic period (-56%). Findings although preliminary but provide a first line of information for epidemiologists and may be useful for the development of effective health risk management policies.

Diagnostic accuracy of Xpert MTB/RIF ultra for detection of Mycobacterium tuberculosis in children: a prospective cohort study

The Xpert MTB/RIF Ultra is a recent advancement in molecular diagnostics of tuberculosis (TB) with higher sensitivity compared to its predecessor, the Xpert MTB/RIF assay. Prospective studies evaluating the performance of Xpert MTB/RIF Ultra in children with suspected TB are lacking. In this study, we evaluated the Xpert MTB/RIF Ultra for detection of Mycobacterium tuberculosis in samples from 156 children, of which one was excluded from the analysis. Of the remaining 155 samples, 6·5% (10/155), 21·3% (33/155), 20% (31/155) and 21·9% (34/155) were positive by smear examination, MGIT culture, Xpert MTB/RIF and Xpert MTB/RIF Ultra, respectively. The Xpert MTB/RIF and Xpert MTB/RIF Ultra had a similar overall sensitivity of 81·8% (95% CI: 64·5-93) and 84·8% (95% CI: 68·1-94·9), respectively. In suspected pediatric TB patients, the Xpert MTB/RIF Ultra had higher sensitivity compared to the Xpert MTB/RIF (72·7 vs 63·6). The AUC (area under the curve) of 0·905 for the Xpert MTB/RIF and 0·893 for the Xpert MTB/RIF Ultra indicate similar and good overall performance. Both Xpert assays were found to be equally efficient, however Xpert MTB/RIF Ultra showed better detection rate in suspected TB cases.