Indian Psychiatric Society multicentre study: Diagnostic patterns, comorbidity and prescription practices for patients with Dementia

BACKGROUND

There are more than 5 million people with dementia in India. Multicentre studies looking at details of treatment for people with dementia In India are lacking. Clinical audit is a quality improvement process which aims to systematically assess, evaluate, and improve patient care. Evaluating current practice is the key to a clinical audit cycle.

AIM

This study aimed to assess the diagnostic patterns and prescribing practices of psychiatrists for patients with dementia in India.

METHOD

A retrospective case file study was conducted across several centers in India.

RESULTS

Information from the case records of 586 patients with dementia was obtained. Mean age of the patients was 71.14 years (standard deviation = 9.42). Three hundred twenty one (54.8%) were men. Alzheimer's disease (349; 59.6%) was the most frequent diagnosis followed by vascular dementia (117; 20%). Three hundred fifty five (60.6%) patients had medical disorders and 47.4% patients were taking medications for their medical conditions. Eighty one (69.2%) patients with vascular dementia had cardiovascular problems. Majority of the patients (524; 89.4%) were on medications for dementia. Most frequently prescribed treatment was Donepezil (230; 39.2%) followed by Donepezil-Memantine combination (225; 38.4%). Overall, 380 (64.8%) patients were on antipsychotics. Quetiapine (213, 36.3%) was the most frequently used antipsychotic. Overall, 113 (19.3%) patients were on antidepressants, 80 (13.7%) patients were on sedatives/hypnotics, and 16 (2.7%) patients were on mood stabilizers. Three hundred nineteen (55.4%) patients and caregivers of 374 (65%) patients were receiving psychosocial interventions.

CONCLUSIONS

Diagnostic and prescription patterns in dementia which emerged from this study are comparable to other studies both nationally and internationally. Comparing current practices at individual and national levels against accepted guidelines, obtaining feedback, identifying gaps and instituting remedial measures help to improve the standard of care provided.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Perioperative NSAIDs and Long-Term Outcomes After cancer Surgery: a Systematic Review and Meta-analysis

Purpose of Review

This review investigated the use of perioperative non-steroidal anti-inflammatory drugs (NSAIDs) and long-term outcomes in cancer surgery patients, and whether this is dependent on cancer type, type of NSAID and timing of administration.

Findings

Perioperative NSAID use was found to be associated with longer disease-free survival (hazard ration, HR = 0.84 (95% CI, 0.73–0.97)) and overall survival (HR = 0.78 (95% CI, 0.64–0.94)). No difference was found between different types of NSAID for disease-free survival, although in overall survival ketorolac use was significant (HR = 0.63 (95% CI, 0.42–0.95)). Analysis on the timing of NSAID administration found no subgroup to be associated with cancer outcomes. The cancer-type analysis found an association with outcomes in breast and ovarian cancers. However, the level of certainty remains very low, mostly due to the heterogeneity and the retrospective nature of most studies.

Summary

Perioperative NSAID use may be associated with increased disease-free and overall survival after cancer surgery. This may be dependent on the type of cancer and type of NSAID, and further research is needed to support this. These data may inform future prospective trials, which are needed to determine the clinical impact, as well as optimal NSAID regimen.

Copper antimony sulfide thin films for visible to near infrared photodetector applications

Ternary chalcostibite copper antimony sulfide (CuSbS₂) is an emerging semiconductor material having applications in photovoltaics, energy storage and optoelectronics due to its high absorption coefficient, suitable bandgap, and it consists of non-toxic and earth abundant elements. CuSbS₂ thin films are prepared by combining chemical bath deposition (antimony sulfide (Sb₂S₃)) and thermal evaporation (copper (Cu)) followed by a heat treatment and their application as visible to near infrared photodetectors is reported. Crystalline structure, elemental composition, chemical state, morphology and optoelectronic properties of the films were characterized by various techniques. The effect of three different Cu thicknesses (CAS 20, CAS 30 and CAS 40 nm) on the photodetection properties are evaluated under illumination using light emitting diodes (LEDs) and a laser. The photodetectors fabricated are successfully tested under different wavelengths, power densities and applied voltage and their photoresponse cyclic stability for each wavelength of illumination was recorded. From the sensitivity calculations, the sample with 20 nm Cu thickness (CAS 20) showed higher detection sensitivity for visible to near infrared wavelengths. Better responsivity results were obtained for CAS 40 because of its improved crystallinity and phase purity. Photodetector properties such as sensitivity and responsivity are evaluated for all the samples. These results are beneficial for cost effective and environment friendly photodetectors and optoelectronic devices based on CuSbS₂ thin films.

Copper antimony sulfide (CuSbS₂) thin films for visible to near infrared photodetection

Synthesis of surfactant free stable nanofluids based on barium hexaferrite by pulsed laser ablation in liquid

Barium hexaferrite nanofluids based on five different solvents have been prepared by employing Pulsed Laser Ablation in Liquid (PLAL) at two different wavelengths of 532 nm and 1064 nm. They were then characterized using Transmission Electron Microscopy (TEM), Scanning Electron Microscopy (SEM), X-ray Photoelectron Spectroscopy (XPS), UV-Vis spectroscopy, and Vibrating Sample Magnetometry (VSM). The chemical states of the ablated nanoparticles were identified from XPS analysis and found to be matching with that of the target. The crystallinity of the nanoparticles were confirmed from high resolution TEM (HRTEM) images and SAED patterns. It is found that different liquid environments lead to the formation of barium ferrite nanoparticles with different particle diameters. The plausible mechanism involved in this process is discussed. This study can pave way for the synthesis of stable magnetic nanofluids of permanent magnets. Further, this technique could be utilized for tailoring the morphology of nanoparticles with a judicious choice of the solvents and other ablation parameters.

Barium hexaferrite nanofluids based on five different solvents are prepared using pulsed laser ablation in liquid, the different solvents resulting in different particle diameters. This study paves the way for the synthesis of stable magnetic nanofluids of permanent magnets.

Behavioral and psychological symptoms of dementia: A study of symptomatology

BACKGROUND

Behavioral disturbances are integral to the dementing process and contribute adversely to the quality of life of the patients and caregivers. Information regarding the nature of symptoms in Alzheimer's disease is limited in the Indian context.

AIM

To study the nature of symptoms in Alzheimer's disease using the Malayalam adaptation of Behavioral Pathology in Alzheimer's disease Rating Scale (BEHAVE-AD).

MATERIALS AND METHODS

Forty patients diagnosed as having Alzheimer's disease as per DSM-IV criteria were studied using the Malayalam version of BEHAVE-AD.

RESULTS

Delusions and paranoid ideations were present in 53% of the sample studied and 33% had hallucinations. Activity disturbances were seen in 65%, aggressive symptoms in 75% and diurnal rhythm disturbances in 55%. Affective disturbances and anxiety symptoms were present in 37% and 43% respectively.

CONCLUSION

The prevalence of behavioral and psychological symptoms of dementia was found to be high.

The 4051-Angstroms band of C3 (A 1Piu-X 1Sigmag +, 000-000): perturbed low-J lines and lifetime measurements

Rotational analyses have been carried out at high resolution for the 000-000 and 000-100 bands of the A (1)Pi(u)-X (1)Sigma(g) (+) transition of supersonic jet-cooled C(3). Two different spectra have been recorded for each band, using time gatings of 20-150 and 800-2300 ns. At the shorter time delay the spectra show only the lines observed by many previous workers. At the longer time delay many extra lines appear, some of which have been observed previously by [McCall et al.Chem. Phys. Lett. 374, 583 (2003)] in cavity ring-down spectra of jet-cooled C(3). Detailed analysis of these extra lines shows that at least two long-lived states perturb the A (1)Pi(u), 000 state. One of these appears to be a (3)Sigma(u) (-) vibronic state, which may possibly be a high vibrational level of the b (3)Pi(g) state, and the other appears to be a P = 1 state with a low rotational constant B. Our spectra also confirm the reassignment by McCall et al. of the R(0) line of the 000-000 band, which is consistent with the spectra recorded towards a number of stars that indicate the presence of C(3) in the interstellar medium. Fluorescence lifetimes have been measured for a number of upper-state rotational levels. The rotational levels of the A (1)Pi(u) state have lifetimes in the range of 230-190 ns, decreasing slightly with J; the levels of the perturbing states have much longer lifetimes, with some of them showing biexponential decays. An improved value has been obtained for the nu(1) vibrational frequency of the ground state, nu(1) = 1224.4933 +/- 0.0029 cm(-1).

Prevalence of dementia in an urban population in Kerala, India

BACKGROUND

Dementia is emerging as an important health problem of elderly people in India.

AIMS

To investigate the prevalence, psychosocial correlates and risk factors of various dementing disorders in an urban population in Kerala, southern India.

METHOD

A door-to-door survey was conducted in the city of Kochi (Cochin) to identify residents aged > or =65 years using cluster sampling. Of 1934 people screened with a vernacular adaptation of the Mini-Mental State Examination, all those scoring at or below the cut-off of 23 were evaluated further and those with confirmed cognitive and functional impairment were assigned diagnoses according to DSM-IV criteria. Identified cases were categorised by ICD-10 criteria. Ten per cent of those screened as negative were evaluated at each stage.

RESULTS

Prevalence of dementia was 33.6 per 1000 (95% CI 27.3-40.7). Alzheimer's disease was the most common type (54%) followed by vascular dementia (39%), and 7% of cases were due to causes such as infection, tumour and trauma. Family history of dementia was a risk factor for Alzheimer's disease and history of hypertension was a risk factor for vascular dementia.

CONCLUSIONS

Dementia is an important health problem of the elderly population. Identification of risk factors points towards the possibility of prevention.

NIR vibrational overtone spectra of toluidines-evidence for steric and electronic effects in o-toluidine

The near infrared vibrational overtone absorption spectra of liquid phase toluidines are reported. The analysis of the observed CH and NH local mode mechanical frequency values shows that there exists steric and electronic interaction between the amino and methyl groups in o-toluidine. This observation supports the conclusions drawn from structural studies of toluidines by resonance two-photon ionization (R2PI) spectroscopy, ab initio calculations and laser induced fluorescence studies reported earlier.

CH overtone spectrum of nitromethane: a C3V coupled oscillator analysis using local mode parameters

The near infrared overtone absorption spectrum of liquid phase nitromethane in the spectral region deltaV = 2-5 is reported. The observed spectrum is analysed using local mode model. It is shown that the observed CH local mode overtones and local-local combinations are well predicted by a C(3V) coupled oscillator Hamiltonian.

NIR vibrational overtone spectra of N-methylaniline, N,N-dimethylaniline and N,N-diethylaniline--a conformational structural analysis using local mode model

In aniline, the lone pair electrons on the nitrogen atom in the amino group interact with the pi electrons of the ring and the mechanical frequency of the ring CH oscillator shows a red shift from that of benzene. This happens because of the parallel orientation of the pi electrons in the two molecules. This effect is observed in N-methylaniline also. But in N,N-dimethylaniline, the addition of two alkyl group to the amino group changes the parallel orientation of pi electrons of the nitrogen. This changes the electron donating nature of the amino substituent and as a result, a blue shift is observed in the mechanical frequency of the ring CH oscillator from that of benzene. The same effect is observed in the ring CH oscillator frequency of N,N-diethylaniline also.

Vibrational overtone spectra of chloroanilines--evidence for intramolecular hydrogen bonding in o-chloroaniline

The near infrared vibrational overtone absorption spectra of liquid phase aniline and chloroanilines are reported. The analysis of the observed CH and NH local mode mechanical frequency values shows that intramolecular hydrogen bonding occurs between NH2 group and chlorine atom in o-chloroaniline. This observation supports the conclusion drawn from microwave spectroscopic studies reported earlier.

An epidemiological study of dementia in a rural community in Kerala, India

BACKGROUND

This community-based epidemiologic study of dementia in a rural population in India investigated the prevalence of various dementing disorders in the community, psychosocial correlates of the morbidity, and assessment of the risk factors associated with dementia.

METHOD

A door to door survey was conducted to identify elderly people aged 60 and above. A total of 2067 elderly persons were then screened with a vernacular adaptation of the MMSE. All those who scored 23 and below had a detailed neuropsychological evaluation by CAMDEX-Section B, and the care-givers of the people with confirmed cognitive impairment were interviewed using CAMDEX-Section H to confirm the history of deterioration or impairment in social or personal functioning. In the third phase the subjects with confirmed cognitive impairment were evaluated at home as to whether they satisfied the DSM-III-R criteria for dementia. Subcategorisation of dementia was done based on ICD-10 diagnostic criteria. Five percent of those whose screening was negative were randomly selected and evaluated during each stage.

RESULTS

Sixty-six cases of dementia were identified from 2067 persons aged 60 and above, a prevalence rate of 31.9 per thousand. After correction this rate was 33.9 per thousand. Fifty-eight percent of the dementia cases were diagnosed as vascular dementia and 41% satisfied the criteria for ICD-10 dementia in Alzheimer's disease. There were more women in the Alzheimer's disease group; smoking and hypertension were associated with vascular dementia while a family history of dementia was more likely in the Alzheimer's group.

CONCLUSION

Dementia is an important cause of morbidity in the geriatric population in this community, where families take responsibility for the care of relatives with dementia.

Prevalence of priority psychiatric disorders in a rural area in kerala

The objective of the study was to determine the prevalence rate of priority psychiatric disorders in a rural area in Kerala and to find out the sociodemographic correlates of the morbidity. A door to door survey had been conducted by trained surveyors to identify individuals with priority psychiatric disorders. The detected cases were examined by a psychiatrist at their houses in the village itself, to confirm as to whether they were having any psychiatric disorder. Out of the 1094 households surveyed (having a population of five thousand two hundred and eighty four), seventy seven individuals were found to have priority psychiatric disorders giving a prevalence rate of 14.57 per thousand. Females in general showed increased mental morbidity. An increased prevalence rate has been observed among Scheduled Castes/Scheduled Tribes. An increased morbidity is noticed among the people belonging to the lower socioeconomic status.