A study to assess perceived stress, life events and prevalence of dissociative experiences in patients with anxiety disorders

Background: Anxiety disorders are characterized by a central theme of intense subjective distress and apprehension of impending danger. Dissociation has been frequently associated in such patients, where it acts as a defense mechanism that allows temporary relief. Previous studies have also shown that more number of life events and higher perceived stress are seen in patients of anxiety disorder, which may even act as predictors of developing the disease. Addressing these factors may contribute to improved understanding of underlying psychopathology and better treatment outcomes. Methods: This was a cross-sectional, 1 year time bound study. As per calculation from prevalence, 161 participants were selected as sample population with specific inclusion and exclusion criteria. Socio-demographic data was collected, appropriate scales were administered to assess the required parameters and statistical analysis was carried out thereafter. Results: We found that 21.74% patients had dissociative experience, 40.37% patients had perceived stress during last month, 53.4% had less/moderate stress and 39.1% patients had severe stress. Most frequently occurring life event was financial loss or problem. Statistically significant association was found between total life events score and socio-demographic variables. Mean dissociative experience scale score was positively correlated with total perceived stress scale score and total life event score. Total perceived stress scale score was also positively correlated with total life event score. Conclusions: Anxiety disorder patients had high levels of dissociation, perceived stress and life events, and these three parameters were also correlated with each other.

Beyond the ‘tic’ king clock: a case report on adult onset tic disorder

Tic is rapid recurrent non-rhythmic motor movement or vocalization; movement of limbs or other body parts is known as motor tic and involuntary repetitive sound like grunting sniffing throat clearing is known as a vocal tic. Tic is a neurodevelopmental disorder and has its onset in the developmental period. According to diagnostic and statistical manual of mental illnesses (DSM) 5, tic should have its onset before 18 years of age and can resolve with proper treatment. In this case, a 23-year-old female presented with recurrent abnormal throat clearing and excessive loud sounds which started for the last 1 year. Initially, she was diagnosed with psychogenic hiccup in another department and was treated with Baclofen 30 mg for 1 month but as no improvement was observed later she was referred to psychiatry outpatient department (OPD) for further treatment where she was diagnosed with adult onset vocal tic with a premonitory urge for tics scale (PUTS) score of 27 on admission and she was treated with tablet Risperidone 2 mg and after 4 weeks of treatment all symptoms subside and PUTS score came to be 6 at the time of discharge.

Association of vitamin D3 with psoriasis and psoriatic arthritis-an observational study

Background: The objective of this study is to investigate the association between 25 (OH) vit D3 level and psoriasis, in our city with long sunny weather, in an attempt to clarify the controversies. Methods: The 100 patients with psoriasis including 29 with psoriatic arthritis were taken randomly as cases from medicine outpatient department of KPCMCH. Psoriasis area and severity index (PASI) was calculated for all patients with psoriasis and disease activity score (DAS28-CRP) in all arthritis patients. The control group had 150 age and sex-matched participants without any symptoms related to psoriasis or psoriatic arthritis. The 25 (OH) vit D3 serum level was estimated for both groups. This is an observational, cross-sectional study. Results: Out of total 100 patients, 55% were male and 45% female, with mean age and disease duration 49.7±6.7 years and 11.4±3.5 years, respectively. The control group had 150 subjects (86 males, 64 females). The 25 (OH) vit D3 levels of both patients and controls were 19.2±8.5 ng/ml and 29.9±6.7 ng/ml, respectively and the difference was statistically significant (p<0.05). The 25(OH) vit D3 levels were 21.9±4.1 ng/ml in patients with disease duration <10 years, and 15.9±4.2 ng/ml in patients with disease duration ? 10 years and difference was statistically significant (p<0.05). It was 18.9±7.8 ng/ml and 20.1±8.4 ng/ml respectively in psoriasis patients with and without arthritis but the difference was statistically not significant (p>0.05). The 25(OH) vit D3 level was lower in psoriasis with high PASI compared to psoriasis with low-moderate PASI and lower in psoriatic arthritis with high disease activity compared to arthritis with low-moderate disease activity. Conclusions: Both psoriasis and psoriatic arthritis patients had lower 25 (OH) vit D3 levels. The disease durations were directly related to 25 (OH) vit D3 insufficiency. Lower levels were associated with higher active diseases.

Association of vitamin D3 with psoriasis and psoriatic arthritis-an observational study

Background: The objective of this study is to investigate the association between 25 (OH) vit D3 level and psoriasis, in our city with long sunny weather, in an attempt to clarify the controversies. Methods: The 100 patients with psoriasis including 29 with psoriatic arthritis were taken randomly as cases from medicine outpatient department of KPCMCH. Psoriasis area and severity index (PASI) was calculated for all patients with psoriasis and disease activity score (DAS28-CRP) in all arthritis patients. The control group had 150 age and sex-matched participants without any symptoms related to psoriasis or psoriatic arthritis. The 25 (OH) vit D3 serum level was estimated for both groups. This is an observational, cross-sectional study. Results: Out of total 100 patients, 55% were male and 45% female, with mean age and disease duration 49.7±6.7 years and 11.4±3.5 years, respectively. The control group had 150 subjects (86 males, 64 females). The 25 (OH) vit D3 levels of both patients and controls were 19.2±8.5 ng/ml and 29.9±6.7 ng/ml, respectively and the difference was statistically significant (p<0.05). The 25(OH) vit D3 levels were 21.9±4.1 ng/ml in patients with disease duration <10 years, and 15.9±4.2 ng/ml in patients with disease duration ? 10 years and difference was statistically significant (p<0.05). It was 18.9±7.8 ng/ml and 20.1±8.4 ng/ml respectively in psoriasis patients with and without arthritis but the difference was statistically not significant (p>0.05). The 25(OH) vit D3 level was lower in psoriasis with high PASI compared to psoriasis with low-moderate PASI and lower in psoriatic arthritis with high disease activity compared to arthritis with low-moderate disease activity. Conclusions: Both psoriasis and psoriatic arthritis patients had lower 25 (OH) vit D3 levels. The disease durations were directly related to 25 (OH) vit D3 insufficiency. Lower levels were associated with higher active diseases.

A rare case of primary adenoid cystic carcinoma of lung.

A 33-year-old male presented with repeated episodes of blood-streaked sputum for last one-and half-year. Chest radiograph showed consolidation in the right lower zone. Fibreoptic bronchoscopy revealed an endoluminal growth in the right lower lobe bronchus. Histopathological examination of bronchoscopic biopsy specimen confirmed adenoid cystic carcinoma.

Orthopaedic applications of bone graft & graft substitutes: a review.

Treatment of delayed union, malunion, and nonunion is a challenge to the orthopaedic surgeons in veterinary and human fields. Apart from restoration of alignment and stable fixation, in many cases adjunctive measures such as bone-grafting or use of bone-graft substitutes are of paramount importance. Bone-graft materials usually have one or more components: an osteoconductive matrix, which acts as scaffold to new bone growth; osteoinductive proteins, which support mitogenesis of undifferentiated cells; and osteogenic cells, which are capable of forming bone in the appropriate environment. Autologous bone remains the “gold standard” for stimulating bone repair and regeneration, but its availability may be limited and the procedure to harvest the material is associated with complications. Bone-graft substitutes can either substitute autologous bone graft or expand an existing amount of autologous bone graft. We review the currently available bone graft and graft substitutes for the novel therapeutic approaches in clinical setting of orthopaedic surgery.

Effect of ovine follicular fluid peptide on ovarian responses and other organ weights in rats, Rattus norvegicus Berkenhout 1769.

The present study was aimed to study the effect of an ovine follicular fluid peptide on ovarian follicle and good oocyte numbers and weights of ovary, uterus, liver, pancreas and kidney in rats, R. norvegicus. A 30.1 kDa peptide was isolated from ovine follicular fluid by ammonium sulphate precipitation and then gel filtration. The peptide was tested at various levels in normal (22 and 36 day-old), superovulated (29 day-old) immature and 121-day old mature rats on the ovarian responses and other organ weights. The isolated peptide inhibited the growth of antral follicles in normal and superovulated rats. Ovarian, uterine weight and recovery of good oocytes were reduced when the peptide was administered at 100 microg dose. The peptide had no effect on kidney, liver, pancreas weight and recovery of preantral follicles.

Portal hypertensive gastropathy and gastric varices before esophageal variceal sclerotherapy and after obliteration.

OBJECTIVES: To evaluate the frequency and clinical importance of portal hypertensive gastropathy (PHG) and gastric varices (GV) before endoscopic sclerotherapy (EST) and after esophageal variceal obliteration. METHODS: Patients with portal hypertension (PHT) with variceal bleed were prospectively evaluated for PHG and GV before EST with intravariceal injection of absolute alcohol and after esophageal variceal obliteration. Gastric varices and PHG were characterized and graded according to previously established criteria. Patients were followed up for 12-48 (mean 37) months after variceal obliteration. RESULTS: Of 70 patients with PHT 26 had PHG before (severe in two) [18/37 in cirrhosis, 6/20 in non-cirrhotic portal fibrosis (NCPF), and 2/13 in extrahepatic portal vein obstruction (EHPVO)] and 50 had PHG after variceal obliteration (severe in 22) (27/37 in cirrhosis, p = 0.03 before versus after esophageal variceal obliteration; 16/20 in NCPF, p < 0.01; and 7/13 in EHPVO, p = ns). Type I GV (continuation of esophageal varix into the stomach) was found in 25/70 before and 5/70 after esophageal variceal obliteration (p < 0.001); in contrast, other types of GV were seen in 14/70 before and 29/70 after (p < 0.01). Overt bleeding from GV and PHG during follow-up after variceal obliteration occurred in 6 and 4 patients, respectively. CONCLUSIONS: Esophageal variceal obliteration by EST increases the frequency of PHG and GV (except type I GV which get obliterated); both PHG and GV have potential to cause rebleeding.

Emerging facets of diastolic heart failure.

One hundred patients with congestive cardiac failure (52 males and 48 females) with age ranging from 16 to 56 yrs (mean age 42 +/- 6) were studied to determine the relative prevalence of systolic and diastolic failures, their clinical profiles and common aetiologies. Age matched 25 control subjects were also studied to established a normal range of echocardiographic values for LV diastolic function. Thirty eight patients (38%) were found to have pure diastolic heart failure and another 5 (5%) and 57 (57%) were detected to have mixed and systolic failures respectively. An attempt to correlate the clinical assessment of diastolic failure with echo doppler study showed the sensitivity and specificity of the clinical criteria for diagnosis of diastolic heart failure to be 100% and 91.94% respectively. Of the 38 cases of diastolic failure detected 39.5% had hypertension, 31.6% ischaemic heart disease and 13.16% hypertrophic cardiomyopathy.

Neurological complications due to Semple-type antirabies vaccine. Clinical and therapeutic aspects.

Thirty nine patients with neuroparalytic accidents due to the use of Semple-type antirabies vaccine were studied. The mean age of the patients was 25.8 +/- 13.2 years. The suspected source of infection was the bite of a dog in 36 (92.3%) cases. The mean interval between the first dose of ARV and the onset of neurological deficits was 14.4 +/- 8.7 days. The number of doses was 7 or less in 28 (71.8%) and more than 7 in 11 (28.2%) cases. With regard to neurological deficits, 5 (12.8%) had encephalopathy, 1 (2.6%) had encephalomyeloradiculopathy, 12 (30.7%) had cervical myeloradiculopathy, 4 (10.3%) had dorsolumbar myeloradiculopathy and 17 (43.6%) had polyradiculopathy. Lumbar cerebrospinal fluid analysis was done in 31 (79.5%) cases and was abnormal in 15 (48.4%), in the form of pleocytosis or raised protein or both. Electroencephalogram was done in 24 (61.5) cases and was abnormal in 7 (29.2%); in 6 (85.7%) of theme the abnormalities were subclinical. Electroneuromyography was done in 15 (38.5%) patients and was abnormal in 13 (72.2%). Visual evoked potentials were studied in 11 (28.2%) cases and were abnormal in 2 (18.2%). Thirty six (92.3%) cases received steroids and 25 (64.1%) received cyclophosphamide in addition. The therapeutic results were better in those who received cyclophosphamide. Three patients died; One died due to respiratory failure and two due to unrelated causes while on respirator. The latter two were autopsied, and findings in the brain were unremarkable.