Multiple Complement Pathway-related Proteins Might Regulate Immunopathogenesis of Major Depressive Disorder

Objective@#Exacerbated inflammatory pathway has emerged as a predominant etiological construct of major depressive disorder (MDD). Innate immune molecules like complement proteins induce inflammatory responses and also regulate key neurobiological processes. However, there is a dearth of literature on the impact of critical complement proteins in MDD. Herein, plasma profiling of seven complement proteins was carried out to obtain a better insight into the role of the complement pathway in MDD. @*Methods@#Plasma levels of C1q, C3, C3b/iC3b, C4, Factor B, Factor H, and properdin were assayed in 22 patients with MDD and 27 healthy controls by multiplex suspension assay. The patients with MDD were diagnosed as per DSM IV-TR. Hamilton Depression Rating Scale (HAM-D), Montgomery Depression Rating Scale and Clinical Global Improvement were used for clinical assessments of the patients. The plasma levels of these complement proteins were also correlated with various clinical scores and phenotypes of MDD. @*Results@#The patients with MDD and healthy controls did not differ in terms of age and gender (p ＞ 0.1). The patients with MDD had a mean duration of illness of around 3 years, with average number of depressive episodes being 6 and the mean HAM-D score was 19. Of the seven complement components, the plasma levels of C1q, Factor B, and Factor H (p ≤ 0.05) were significantly elevated in MDD patients compared to healthy controls. However, the plasma levels of these complement proteins were not found to correlate with the clinical profile of MDD patients. @*Conclusion@#Both Factor B and Factor H are crucial in the induction and regulation of the alternative pathway of complement activation. The alternative pathway also plays a critical role in inflammation. These findings suggest an important role of the alternative complement pathway in immuno-inflammation in MDD.

SEMICONDUCTOR SHORTAGE AND INDIAN AUTOMOBILE SECTOR: EMPIRICAL ANALYSIS

The semiconductor shortage has had a signi?cant impact on the automobile sector in India. Semiconductors are a vital component in the production of vehicles, and the shortage has resulted in production delays and reduced output for many automobile manufacturers in India. This research paper examines the impact of the current semiconductor shortage on the automotive industry. The research paper begins by exploring the causes of the shortage, including the global shift towards digitalization, the pandemic-induced surge in demand for technology products, and the limited production capacity of semiconductor manufacturers. The paper then examines the economic effects of the shortage, including reduced revenues, increased costs, and reduced supply. It further explores the strategies adopted by automotive manufacturers to mitigate the impact of the shortage, such as increasing production and increasing their investments in semiconductor manufacturers. Finally, the paper discusses the implications of the shortage and suggests effective solutions to address the crisis. A simulation is carried out to forecast the strength of manufacturing in India. The ?ndings of this research indicate that the current semiconductor shortage is having a signi?cant impact on the automotive industry, and that appropriate strategies should be adopted to address the crisis.

Thrombotic thrombocytopenic purpura as an acute complication of COVID-19

Introduction: While disseminated intravascular coagulation (DIC) is a serious complication of COVID-19, a close differential in critically ill patients with thrombocytopenia is Thrombotic thrombocytopenic purpura (TTP). Case Report: We describe the case of a middle-aged lady admitted with COVID-19 pneumonia who developed progressive thrombocytopenia, altered sensorium and renal failure. The absence of coagulation abnormalities alerted to the possibility of TTP, strengthened by presence of schistocytes in peripheral smear. Conclusions: This case highlights the need for high index of suspicion and to pay attention to normal tests as well that might give clues to the diagnosis. New onset thrombocytopenia in COVID-19 need not always indicate DIC. A careful examination of peripheral smear may help diagnosing TTP especially if coagulation profile is normal.

Surveillance for Developmental Dysplasia of the Hip in India: Consensus Guidelines From the Pediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association

Justification: When developmental dysplasia of the hip (DDH) is diagnosed during infancy, conservative management is often successful, with good long-term outcomes. In India, DDH is often not diagnosed until walking age and there are limited guidelines for its screening. Process: A multidisciplinary Expert Group consisting of members of the Paediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association worked collaboratively to develop surveillance guidelines for DDH. Objectives: To enhance the early detection rate of DDH in India through development and implementation of a standardized surveillance care pathway, thus reducing the burden of late-presenting DDH. Recommendations: Routine clinical hip examinations must be performed on all infants at birth and during immunization visits at these approximate time points: 6, 10, and 14 weeks; 6, 9, 12, 15, and 18 months of age. Assessments include Ortolani and Barlow tests for infants <14 weeks; limited hip abduction and leg length discrepancy for infants >14 weeks; and evaluation of limp in walking children. If clinical examination is abnormal or inconclusive, referral to orthopedics for further evaluation and management is recommended. In infants younger than 6 weeks with positive Barlow test but negative Ortolani test, hip ultrasound is recommended at 6 weeks of age. Infants must also be screened for DDH risk factors: breech presentation, family history of DDH, unsafe hip swaddling, and hip instability at any previous clinical examination. In infants with risk factors but normal clinical examination, further evaluation should include ultrasound taken no earlier than 6 weeks of age for infants younger than 14 weeks, ultrasound or X-ray for infants 14 weeks to 6 months of age, and X-ray for infants older than 6 months. Referral to an orthopedic surgeon is recommended if radiological tests are abnormal.

Evaluation of analgesic properties of petroleum ether extract of Zingiber officinale

Background: Herbal remedies and alternative therapies have been employed in the treatment of pain from time immemorial. Ginger is a widely used spice with a lot of medicinal properties, and it is especially soothing to the gastro-intestinal system. Most of the analgesics used in modern medicine have side effects to either gastro-intestinal tract or nervous system. Ginger has neither. Scientific evaluation of the analgesic properties of Zingiber officinale is needed. Aim and Objective: The aim of the study was to evaluate the analgesic effect of three doses of orally administered petroleum ether extract of Z. officinale and to compare with morphine. When tested for analgesic activity, to find out the difference in reaction time at various time intervals for each dose of the extract, and their significance. Materials and Methods: Petroleum ether extract of Z. officinale rhizomes was used. Wistar strain albino rats (150-200 g) and Swiss albino mice (20-25 g) housed under standard laboratory conditions were used. The central analgesic activities of the extract were evaluated by the tail clip method and hot plate method. Statistical analysis was done by one-way analysis of variance to compare the means in the experimental groups. Results: In tail clip method, pain was mechanically induced pain and the pain threshold was measured in terms of mice’ reaction time in seconds. All doses of the extract of Z. officinale were capable of increasing the reaction time in mice during the various time periods. Maximum analgesic activity was shown by 800 mg/kg of the extract at 90 minutes. In hot plate test, maximum analgesic activity was shown by 800 mg/kg of the extract at 180 min. At 30 and 60 min, 800 mg/kg of the extract was as effective as the standard drug, morphine. Conclusions: The study revealed that Z. officinale has significant analgesic properties especially in higher doses.

Beyond diabetes mellitus: role of metformin in non-muscle-invasive bladder cancer

INTRODUCTION@#Usage of metformin is associated with improved survival in lung, breast and prostate cancer, and metformin has been shown to inhibit cancer cell growth and proliferation in in vitro studies. Given the lack of clinical data on metformin use in patients with bladder cancer, we aimed to evaluate the role of metformin in their oncological outcomes.@*METHODS@#Medication use data from a prospectively maintained database of 122 patients with non-muscle-invasive bladder cancer treated with intravesical Bacille Calmette-Guerin (BCG), who were recruited under a randomised, double-blinded, controlled clinical trial, was collected and analysed. Kaplan-Meier curves were used to assess overall survival (OS) and disease-specific survival (DSS).@*RESULTS@#At a median follow-up duration of 102 (range 3-357) months, 53 (43.4%) patients experienced disease recurrence and 21 (17.2%) experienced disease progression. There was no significant difference in mortality between patients with and without diabetes mellitus. There was significant difference in OS between patients without diabetes mellitus, patients with diabetes mellitus on metformin and patients with diabetes mellitus but not on metformin (p = 0.033); patients with diabetes mellitus on metformin had the best prognosis. Metformin use was associated with significantly lower DSS (p = 0.042). Other oral hypoglycaemic agents, insulin or statins were not associated with disease recurrence or progression.@*CONCLUSION@#Metformin use was associated with improved oncological outcomes in patients with non-muscle-invasive bladder cancer treated with intravesical BCG. Prospective studies with larger patient populations are needed to validate the role of metformin as potential therapy for bladder cancer.

Workplace Violence against Healthcare Professionals - A Cross-Sectional Study to Assess the Current Scenario in Chennai City, India

Workplace violence against health workers is offensive and harms the psychological and physical well-being of health-care staff. It affects their job motivation leading to compromise in the quality of care provided. The present study was conducted to assess the prevalence and potential risk factors associated with workplace violence against medical and dental healthcare professionals in Chennai city. MethodsA descriptive cross-sectional survey was done among 440 healthcare professionals from medical and dental settings. A specially designed validated questionnaire consisted of 15 questions divided into 3 sections was used to collect the demographic details, experience and factors associated with workplace violence. ResultsThe overall prevalence of workplace violence in the current study was 38 %, with male participants reporting a higher prevalence than females. 51.4 % of the respondents believe that the lack of proper communication and negligence of the doctor also plays a crucial role in violence against them. More than half of the participants (61.4 %) recommended doctors to carry weapons for self-defence against violence and these values rise to 71 % among individuals with more than 10 years of clinical experience. Around 70.5 % believed that media publicity plays a crucial role in the increasing trend of violence against healthcare professionals. ConclusionsWorkplace violence against doctors in Chennai is frequent although in most of the situations it is psychological. Healthcare staff should be trained to identify, manage and prevent violent situations adequately. A nationwide law for the prevention of violence against healthcare professionals and institutions should be developed.

Molecular characteristics of Acinetobacter baumannii and the changes of efflux pump expression under tigecycline pressure / 医学研究生学报

Objective　Acinetobacter baumannii (A. baumannii) is a commonly infective bacterium in the hospital. This study aims to analyze its molecular epidemiological characteristics, detect the carrying rate of efflux pump and regulatory protein genes, and investigate the effects of tigecycline on the efflux pump and expression of regulatory protein genes.　Methods　A total of 183 A. baumannii strains were collected from inpatients of the affiliated hospital of Jiangsu University from May 2017 to March 2019. They were divided into an antimicrobial-resistant group (one or more antimicrobial-resistant strains, 139 strains) and a sensitive group (the drugs in the drug sensitivity test were all non-resistant strains, 44 strains). Repeated sequence PCR was used for homology analysis of the strains, and pulse-field gel electrophoresis (PFGE) was used as the gold standard for homology analysis to verify and compare some strains. PCR was used to detect the occurrence of drug resistance-related genes. Based on homology analysis, efflux pump carrying rate detection and antibiotics sensitivity test results, 6 clinical strains carrying all efflux pump genes but different resistance phenotypes were selected as experimental strains, including sensitive strains (SAB), the multidrug resistance strain (MDRAB) and the extensively drug-resistant strain (XDRAB). All strains were induced in vitro with the minimum inhibitory concentration (MIC) of tigecycline. The induced strains were categorized as induction group, and the same strains cultured in LB agar without tigecycline was used as a control group. MIC was used to analyze the tigecycline susceptibility, and RT-qPCR was used to detect the gene expression of efflux pumps, such as TetB, AbaQ and regulatory proteins (AdeS and BaeS), in drug-resistant strains.　Results　Homology analysis showed that there were 45 clonal groups in the detected clinical isolates, with no obvious outbreak of epidemic clonal groups. Efflux pumps and regulatory proteins were widely distributed in the clinical isolates, and the expression of AdeB, TetB, AbeS, AdeS in MDRAB and XDRAB is significantly higher than that insensitive group SAB. Continuous in vitro induction with tigecycline could increase the antimicrobial resistance of some clinical strains and even significantly increase the expression levels of efflux pumps and regulatory proteins.　Conclusion　A. baumannii is widely distributed in the clinic, and efflux pumps and regulatory proteins might play an important role in drug resistance process. The unreasonable use of tigecycline could enhance the tolerance of A. baumannii by up-regulating the expression of some bacterial efflux pumps.

Health workforce in India: opportunities and challenges

Health system reforms in India during the past decade yielded an impressive growth of medical, dental and nursing education opportunities, but health workforce density remains low in comparison to the World Health Organization (WHO) norms. Apart from shortage, retaining qualified health workforce in the rural and underserved areas remains a huge challenge. This crisis is likely to persist until and unless health system addresses the fundamental requirements of health workers as envisaged in health policies. Concerted attention and long term political commitments are required to overcome health system barriers to achieve rural recruitment and retention across various cadres in states. As the major share of health workforce belongs to the private sector, their resources need to be harnessed to meet health system goals through partnerships and collaborations. There is an urgent need for better regulation and enforcement of standards in medical education and delivery of health services across the public and private sectors.

Evolution of dietary preferences and the innate urge to heal: Drug discovery lessons from Ayurveda

Highly specialized and functionally integrated cognitive systems facilitate hedonistic and healthy foodpreferences. Guided by survival needs, flavor preferences not only select safe, nutritious dietarycomponents, but also those with negligible calorific value but significant health benefits, for example,spices. Feeding behavior, both innate and acquired, is guided not only by taste receptors on the tonguebut also visceral organs. The gustatory cortex receives information from all senses, not just taste, suggesting multiple checkpoints in predicting and evaluating healthy foods. Ayurvedic interpretation of‘rasa’ as chemistry is compatible with medicinal value of diets because, taste and odor are chemosensoryperceptions. As flavor and taste are linked to the chemical structure of compounds, taste might offerclues about pharmacological activity. Ayurvedic idea of vipaka, or post digestive perception of taste,recognizes the extended role of taste receptors beyond the tongue and stretching into the viscera.Ayurvedic wisdom is consistent with evolutionary guideposts that suggest three successive stages ofnutritional appraisal: before, during, and after ingesting food. While olfaction induces affinity orrevulsion even before ingestion, gustatory receptors on the tongue evaluates nutritional value uponcontact, and the chemoreceptors in the deeper metabolic systems probably pronounce the final verdicton the nutritive and health benefits of ingested substances. Alliesthesia, neophobia, and the extremevariation in human T2R genes (coding for bitterness receptors) illustrate the importance of adaptivelearning of dietary preferences. These evolutionary clues are compatible with the Ayurvedic principle of‘rasa’, in facilitating the process of drug discovery.© 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

A comparative study between APACHE II and Ranson scoring systems in predicting the severity of acute pancreatitis

Background: Acute pancreatitis is a common disease with wide clinical variation and its incidence is increasing. Acute pancreatitis may vary in severity, from mild self-limiting pancreatic inflammation to pancreatic necrosis with life-threatening sequelae. The severity of acute pancreatitis is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis. Aim of the study: To compare the efficacy of Ranson scoring with APACHE II scoring system in predicting the severity of acute pancreatitis. Materials and methods: The present study was a prospective study of 33 cases of Acute pancreatitis admitted in Rajiv Gandhi Government General Hospital, Chennai, during the study period of July 2014 to September 2014. 33 cases for the purpose of the study were selected on the basis of the nonprobability (purposive) sampling method. multiple clinical and laboratory variables of both Ranson and APACHE II scoring system and the final score of the patient from both the scoring systems are assessed to know their efficacy in predicting the severity of the disease (higher the score more severe the disease). Results: Overall, 8(24.2%) patients suffered from severe pancreatitis and 25(75.7%) had mild acute pancreatitis of which all 8 had severe attack as per APACHE II score (>8) and only 3 of these were considered severe by Ranson score (>3). The systemic complications were a multiorgan failure in 2(6.06%), respiratory 1(3.03%) and renal 1(3.03%) all seen in patients with the severe score as per APACHE II. Umarani Subramaniam, Ahila Muthuselvi, Kesavan. A comparative study between APACHE II and Ranson scoring systems in predicting the severity of acute pancreatitis. IAIM, 2019; 6(4): 55-59. Page 56 Conclusion: The early diagnosis and precise scoring of disease severity are important goals in the initial evaluation and management of pancreatitis. Pancreatitis not only must be differentiated from a myriad of other potential diagnoses, but patients must also be stratified to identify those with severe disease and to guide appropriate therapy.

Evaluation of amputation risk in diabetic foot ulcer patients infected with Acinetobacter baumannii from a Tertiary Care Centre in South India

Background: Foot complications are found to be a significant frequent, complication of Diabetes mellitus. Carbapenem-resistant Acinetobacter baumannii is gradually becoming dominant among Diabetes patients in urban population. The purpose of this study was to evaluate the clinical relationship of these gram negative bacteria and their resistance mechanisms in patients with diabetic foot and infected ulcer in India. Methods: An observational study of 532 patients with infected ulcers in diabetic feet was conducted in Hycare for Wounds a tertiary care centre exclusively dedicated for Wound care and Management between May, 2017 and April, 2018. Processing and identification was done as per standard guidelines. The bacteriological assessment was performed in deep tissue cultures and amputation was considered major when performed above the foot’s middle tarsus. Results: Out of 532 patients studied 350 were positive for bacterial growth. Commonest   isolate was Pseudomonas aeruginosa followed by Staphylococcus aureus (MSSA) species, Klebsiella and E. coli. We observed that 14 patients were infected with Acinetobacter baumannii and 50 % were carbapenamase producers. Clinical Outcomes: Out of 14 patients 6 were major amputees and 5 were minor amputees and the rest 3 patients are under medical management. Conclusion: Carbapenem-resistant Acinetobacter baumannii is a serious threat to Diabetic patients and can be considered as a risk factor for major amputation.

Lupus Nephritis in Indian Children: Flares and Refractory Illness

Objective: To evaluate the incidence of flares and treatment resistance in children with lupusnephritis and their association with renal outcomes. Methods: We retrospectively reviewedthe case records of 34 children treated for lupus nephritis (Class II-IV) at a single center.Patients were followed for a minimum of five years to evaluate treatment response, onset offlares, and renal survival. Regression analyses were performed to identify the factorsassociated with treatment refractoriness, incidence of flares and renal survival. Results: Theincidence of flares was 0.16 episodes/person/year. Eight patients (23.5%) were refractory totreatment. The five-year renal survival was 79%. Multiple episodes of flares (P=0.028) andtherapy refractoriness (P=0.003) were associated with poor renal survival. Conclusions:Prevention and aggressive management of renal flares is expected to prevent progression toend stage renal disease in lupus nephritis.

Minocycline-Induced Autoimmune Hepatitis: A Rare But Important Cause of Drug-Induced Autoimmune Hepatitis / 대한소아소화기영양학회지

Drug-induced autoimmune hepatitis (DIAIH) is an increasingly recognized form of drug-induced liver injury that leads to a condition similar to idiopathic autoimmune hepatitis. A number of drugs have been associated with DIAIH, minocycline is one of the most well characterized. Minocycline is a semisynthetic tetracycline antibiotic used in the treatment of acne vulgaris. Minocycline-induced autoimmune hepatitis presents with serologic and histologic features similar to idiopathic autoimmune hepatitis. However, the natural history and outcomes of these two conditions differ significantly. The majority of patients with minocycline-induced autoimmune hepatitis experience complete resolution of symptoms after withdrawal of the medication. Some patients may require a short course of steroids and rarely use of an immunomodulator to achieve resolution of disease. Recurrence of symptoms is rare and typically only occurs with reintroduction of minocycline. It is important for primary care providers to consider minocycline-induced autoimmune hepatitis when liver injury develops during minocycline therapy.

Proximal ulna: a rare location for solitary intraosseous hemangioma

Intraosseous hemangiomas are rare, benign bone tumors usually affecting the bones of the axial skeleton. Its incidence in the long bones is extremely rare. We report a 19-year-old boy with solitary intraosseous hemangioma of the proximal ulna. Radiographs and computed tomography images showed a well-defined osteolytic lesion involving the right proximal ulna. Magnetic resonance imaging showed intermediate signal intensity on T1-weighted images and increased signal intensity on T2-weighted images with internal trabeculae and peripheral post-contrast enhancement. Postcurettage histologic diagnosis of intraosseous hemangioma was made

Protective effect of metformin against tuberculosis infections in diabetic patients: an observational study of south Indian tertiary healthcare facility

ABSTRACT Background: World Health Organization estimated that people with diabetes (DM) are at 2-3 times higher risk for tuberculosis (TB). Studies have shown that DM not only increases the risk of active TB, but also puts co-affected persons at increased risk of poor outcomes. Objectives: To determine the protective effect of metformin against TB in DM patients and also, to investigate the relationship between poor glycemic control and TB. Methods: A case-control study was conducted over 8 months, where cases and controls were selected based on the inclusion and exclusion criteria of the study. The diabetics diagnosed with TB were selected as study group (SG = 152) and without TB were as control group (CG = 299). Exposure status of metformin in both groups were analyzed. Results: The mean (SD) age of both CG and SG were 55.54 ± 11.82 and 52.80 ± 11.75, respectively. Majority of the subjects in the study were males. The mean hospital stay of SG and CG were 7 days and 6 days, respectively. Poor glycemic control (HbA1c > 8) observed in SG (51.7%) vs CG (31.4%). HbA1c value <7 is associated protective factor for TB occurrence [OR = 0.52 (95% CI 0.29-0.93)]. The protective effect of metformin against TB was 3.9-fold in diabetics (OR = 0.256, 0.16-0.40). Conclusion: Poor glycemic control among diabetics is a risk factor for TB occurrence. The result shows metformin use is a protective agent against TB infection in diabetics. Hence, incorporation of metformin into standard clinical care would offer a therapeutic option for the prevention of TB.

Pseudomyogenic (epithelioid sarcoma-like) hemangioendothelioma - a rare vascular neoplasm with deceptive morphology and distinctive immunophenotype

Pseudomyogenic (epithelioid sarcoma-like) hemangioendothelioma is a rare, low grade vascular(endothelial) neoplasm typically presenting as multicentric, superficial to deep nodules in extremitieswith a slight tendency of affecting young adult males. We report a case of pseudomyogenichemangioendothelioma in a 15-year-old boy presenting initially with a 1 cm right thigh painlesscutaneous lump. The lump was excised with the clinical impression of a sebaceous cyst. On microscopy,a poorly circumscribed, mild to moderately atypical spindle cell lesion in fascicular and storiformpatterns with strikingly myoid-like eosinophilic cytoplasm was identified. The spindle cells werehighlighted by pancytokeratin AE1/AE3, CD31, and ERG with retained INI-1, while being negativefor MNF116, S100, CD34, EMA, desmin, SMA, caldesmon, myogenin, MyoD1, HHV-8 and CD163.Following the first diagnostic report, a positron emission tomography–computed tomography(PET-CT) scan revealed another 4 cm ill-defined nodule accompanied by a smaller adjacent 0.7cm ipsilateral satellite nodule within the right psoas muscle that displayed similar morphologyand immunophenotype as the cutaneous lump, supporting the multicentric feature of this uniqueentity. It is an uncommon yet increasingly recognised neoplasm of endothelial origin possessing amisleading myoid morphology and distinctive immunophenotype worth notifying.

Ictal EEG Non-linear And High Order Spectral Analysis Methods In Electroconvulsive Therapy And Its Clinical Utility.

Introduction: Analysis of ictal electroencephalogram (EEG) during electroconvulsive therapy (ECT) early in the course provides information to predict clinical outcome. Previous studies used visual, power spectral and non linear methods to analyze EEG. EEG signals are non stationary, non linear, non Gaussian and chaotic in nature. Such signals can be better characterized by non linear and higher order spectrum analysis. However there is scarcity of data assessing such measurers in predicting clinical outcome. We conducted nonlinear and high order spectrum analyses of ictal EEG recorded during ECT and correlated the measures with clinical outcome. Methods: Schizophrenia patients receiving ECT were assessed using the brief psychiatric rating scale (BPRS) before and 2 weeks after the start of ECT. EEG was recorded during seizure from left frontal-pole (FP1) channel. In 26 patients, completely artifact-free EEG was available. Approximate entropy (ApEn), Sample entropy (SamEn), Hurst exponent (H), Bispectrum entropy (HOS.En), correlation dimension (CD) and Largest Lyapunov exponent (LLE) were computed for EEG from the earliest ECT session (2nd or 3rd). Results: HOS.En emerged as a significant measure which predicted outcome at two weeks (HOS En1: r = - 0.434; p = 0.027 & En2: r = -0.414; 0.036) other measures, viz., ApEn (r = -0.001; p = 0.995), SampEn (r = - 0.152; p = 0.458), H (r = 0.123; p = 0.549), CD (r = 0.119; p = 0.563) and LLE (r = -0.293; p = 0.146) did not predict the outcome. Conclusion: In patients with schizophrenia receiving ECT higher bispectrum entropy of ictal EEG early in the ECT course predicts better clinical outcome at the end of two weeks. None of the other non linear measures evaluated in the study predicted clinical outcome.