Multi-view graph-based interview representation to improve depression level estimation.

Depression is a serious mental illness that affects millions worldwide and consequently has attracted considerable research interest in recent years. Within the field of automated depression estimation, most researchers focus on neural network architectures while ignoring other research directions. Within this paper, we explore an alternate approach and study the impact of input representations on the learning ability of the models. In particular, we work with graph-based representations to highlight different aspects of input transcripts, both at the interview and corpus levels. We use sentence similarity graphs and keyword correlation graphs to exemplify the advantages of graphical representations over sequential models for binary classification problems within depression estimation. Additionally, we design multi-view architectures that split interview transcripts into question and answer views in order to take into account dialogue structure. Our experiments show the benefits of multi-view based graphical input encodings over sequential models and provide new state-of-the-art results for binary classification on the gold standard DAIC-WOZ dataset. Further analysis establishes our method as a means for generating meaningful insights and visual summaries of interview transcripts that can be used by medical professionals.

Repercussions of Smokeless Tobacco on Buccal Mucosa: A Community Based Observational Study at a Tertiary Care Centre in Western Rajasthan.

Background: Tobacco is consumed mainly as smoking or smokeless tobacco [SLT]. "Smokeless tobacco" (SLT) term is used for the consumption of tobacco mixed with other constituents in form of chewing, spitting and dipping. Consumers of smokeless tobacco chew the products and spit out the juice that builds up in oral cavity which leads to various malignant and pre malignant lesions of oral cavity. Methods: Descriptive observational study was conducted in the city of Jodhpur through department of ENT, Head & Neck Surgery, Dr. SN medical college, Jodhpur. Results: Male to female ratio of smokeless tobacco usage was almost same. Increasing age was associated with occurrence of oral lesions and 43% patients developed oral lesions in the group > 64 yrs of age. Duration was another associating factor and 66% developed symptoms within < 10 years of usage. Oral submucous fibrosis is the most common lesion. Malignant lesions were seen in 0.3% cases. Around 78% cases developed dependency. Diabetic patients were seen more prone to development of oral lesions. Conclusions: Development of lesions in the oral cavity by smokeless tobacco depends on various factors such as quantity of tobacco usage per day, place of putting tobacco and duration. Awareness regarding its fatal effects and timely diagnosis and management can save many lives.

Fluid Imbalance in Geriatrics: The Need for Optimal Hydration.

In the elderly, increased morbidity and mortality are often linked to fluid and electrolyte imbalances due to age-related physiological changes, hence monitoring and maintaining healthy hydration levels is important for the geriatric patient population. Patients recuperating from an illness at home maybe likely to neglect proper fluid intake and energy management, which hampers their timely recovery. In elderly patients with concurrent illnesses and therapies, dehydration is a common condition that often remains unnoticed despite persistent disease symptoms. Oral nutritional supplements such as scientifically formulated oral rehydration therapies (ORTs) have been recommended in such cases. These supplements can be further suggested by nutritional counseling, diet modification, nursing interventions, and educating the patients. The main aim of this review is to generate a greater understanding of the fluid intake requirements for the elderly, thus contributing to the prevention of the negative effects of dehydration. This review comprehensively highlights the need for treatment, recovery from illness to supportive care to address a patient's needs. Maintaining an optimal hydration level aids the efficacy of therapy in elderly patients. Hospitalized patients are considered to be at risk of dehydration, whereas patients at home completely ignore the need for fluid and energy management, leading to hospital readmissions and delayed recovery. Guidelines are available for treating, managing, and maintaining ideal hydration levels, these are considered to be imperative in managing elderly patients with chronic illnesses.

Subcutaneous Randomized Nasolabial Flap: Our Experience.

Nasolabial flaps are one of the oldest methods of reconstruction. This study aims to observe the viability of a random-pattern subcutaneous nasolabial flap. Inpatients of carcinoma of oral cavity and nose undergoing excision with primary reconstruction from January 2014 to December 2019 were observed and followed-up. Their data including site of primary and post-operative complication was recorded. A total of 38 patients underwent reconstruction using nasolabial flap. Most cases were of buccal mucosa carcinoma (68.4%). Facial vessels were ligated in all except 7 cases and, only 1 (2.6%) showed total, and 3 (7.9%) showed partial flap necrosis. A subcutaneous nasolabial flap is simple, viable and easy to harvest. It is a random-pattern flap therefore; facial vessel preservation may not be a compulsion. Flap raised subcutaneously is thinner and thus inset is easy and bulk associated discomfort is avoided.

Subclinical Kwashiorkor in Adults: A New Age Paradigm.

Childhood protein-energy undernutrition (PEU) is a well-recognized problem and therefore a lot of work has been done to identify and manage paediatric PEU. Though there have been several reports of low protein consumption in adults from developing countries, PEU and its subtle forms (subclinical PEU) are not yet recognized as adult disorders. Physicians and public perception do not favour easy recognition and action. In this review, the authors provide a scoping review of the existing literature on this entity providing insights into its recognition, pathogenesis and management. Adult subclinical PEU is an enormous under-recognized challenge that can have detrimental consequences if not recognized and corrected in time. PEU has grave health and economic impact on the patient and society. Therefore, it is important to recognize subclinical PEU and prevent its progression to full-blown form.

Incidence of arrhythmias in COVID-19 patients with double mutant strain of SARS-CoV-2 virus: A tertiary care experience.

Background: Our understanding of arrhythmias is minimal with SARS-CoV-2 virus and with the emergence of its double mutant, virtually nonexistent. Patients with the double mutant (B.1.617) SARS-CoV infection had more cardiac manifestations, including arrhythmias and sudden death, than with the traditional variant. Objective: To determine the incidence of arrhythmias in COVID-19 patients with double mutant strain of SARS-CoV-2 virus (B.1.617). Materials and methods: We describe a prospective observational study conducted in the Department of Medicine, United Institute of Medical Sciences, Prayagraj, Uttar Pradesh on patients admitted to the hospital during the period March 2021 to May 2021. Different type of arrhythmias were studied in the admitted patients. Results: Sinus bradycardia is the most common arrhythmia, followed by atrial fibrillation. Malignant arrhythmias, such as ventricular tachycardia/ventricular fibrillation and Torsades de pointes due to QT prolongation, were present in small number of patients with high mortality outcomes. Sinus tachycardia and high-grade AV blocks were also present in some of the patients. Conclusions: Current literature lacks studies on arrhythmias secondary to COVID-19 (double mutant) strain and its possible mechanisms. This makes it difficult to distinguish between arrhythmias secondary to COVID-19 (double mutant) infection due to hypoxemia, dyselectrolytemia, SIRS, comorbidities, and medications or direct viral effects on the cardiomyocytes.

Intracranial Hemorrhage in a Young Woman: An Unusual Initial Presentation of Undiagnosed Choriocarcinoma.

Choriocarcinoma is an uncommon tumor. Undiagnosed choriocarcinoma initially presenting with intracranial hemorrhage in an apparently healthy female is rare and presents a diagnostic difficulty. The authors report a case presenting as intracranial hemorrhage of unsuspected choriocarcinoma. As the measurement of beta-human chorionic gonadotropin (ß-hCG) would have helped in the preoperative diagnosis, estimation of serum ß-hCG levels is suggested in the diagnostic workup of a female of reproductive age group when radiological investigations are inconclusive. Craniotomy and excision of tumor followed by chemotherapy and radiotherapy may improve the outcome.

Diagnosis and Management of Hypothyroidism: Addressing the Knowledge-Action Gaps.

Hypothyroidism presents a large epidemiological burden in India. As a result of subtle and nonspecific clinical symptoms and signs, the condition often goes undiagnosed and is not adequately treated when it is detected. There is heterogeneity in the diagnostic and treatment approaches to hypothyroidism. As a result of the physiological changes in thyroid hormones with age and illness, it is important to tailor the diagnosis and management of this condition in specific populations including pregnant women, infants, children, geriatric patients, and those with comorbid conditions. Enhanced understanding and education of physicians and patients can help to improve the outcomes of treatment in hypothyroidism which should be focused on patient-centered care. Policies and reforms should be crafted and implemented at the national level to curb public health challenges of hypothyroidism. This publication summarizes the recommendations of a national advisory board meeting to identify and bridge the gaps in understanding of the diagnosis and treatment of hypothyroidism in India. As a complement to clinical judgment, these recommendations will foster the diagnosis and management of hypothyroidism in the community and clinics for the benefit of the patients. FUNDING: Merck Ltd, India.

Medication Counseling for Thyroxine.

This communication from the National Indian Patient-centered Thyroid Management group provides a useful tool to help in medication counseling during hypothyroidism management. The authors classify and list aspects of thyroxine use which must be discussed with patients on thyroxine supplementation or replacement. Issues related to concomitant food and medications intake, preconception and pregnancy management, as well as sick day care, are also discussed.

Patient-centered Management of Hypothyroidism.

This communication from the National Indian Patient-centered Thyroid management group (InPACT) deals with a novel, yet essential, aspect of hypothyroidism management. The authors describe the role and scope of patient-centered care in this condition. They focus on the relevance of a patient-centered clinical approach, which will help decide appropriate targets, as well as techniques to achieve those targets. Means of helping persons with hypothyroidism live a healthy life, such as education about precaution in concomitant food and medications intake, as well as sick day management, are discussed.

Distraction osteogenesis for correction of mandibular abnormalities.

INTRODUCTION: Management of mandibular deformities is challenging. Distraction osteogenesis is a relatively new technique with promising results. MATERIALS AND METHODS: We selected 12 patients. The osteotomy site decided was proximal to the antegonial notch. Latency time was five to seven days. Consolidation period was eight weeks in eleven cases and six weeks in one case. RESULTS: In all the patients, appreciable lengthening of mandible was achieved. DISCUSSION: The greatest advantage of distraction osteogenesis is growth of soft tissue along with the growth of hard tissue. This increases post operative stability.

A prospective clinical study of myocarditis in cases of acute ingestion of paraphenylene diamine (hair dye) poisoning in northern India.

BACKGROUND: Myocarditis is a unheard and unreported dangerous complication of hair dye ingestion which contains paraphenylene diamine. So a prospective study was planned to assess myocardial damage in regard to clinical profile and outcome with different treatment approaches in patients with oral ingestion of Hair dye. METHODS AND RESULTS: The material comprised of 1595 cases admitted in Medicine Department of Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh-INDIA, from July 2004 to Jan 2011. Out of 1595 cases 1060 cases were of stone hair dye poisoning and 535 cases were of other branded hair dyes (powdered form containing less amount of Paraphenylene diamine). Diagnosis of myocarditis was made solely on the basis of the clinical signs/symptoms suggestive of myocardial damage, electrocardiography changes, elevated cardiac biomarkers and abnormalities on trans thoracic echocardiography. The cases were thoroughly studied for cardiac complications. Myocarditis was reported in 15% of total cases with mortality rate of 29%. Occurrence of myocarditis was directly related to amount of Hair dye ingested. In patients affected from myocarditis 9% develop life threatening Ventricular tachycardia/ventricular fibrillation. CONCLUSION: Hair dye (Paraphenylene di amine) is highly toxic. In cases who consumed more than 10 gram of Paraphenylene diamine, myocarditis is a dangerous complication. Proper management includes continuous cardiac monitoring to prevent sudden cardiac death.

Efficacy of single dose epidural morphine versus intermittent low-dose epidural morphine along with bupivacaine for postcaesarean section analgesia.

BACKGROUND: Obstetric anesthesia presents a challenge to the anesthesiologist. The effective pain management allows the partu-rient adequate degree of comfort and promotes physical reco-very and a sense of well being. MATERIALS AND METHODS: This randomized controlled study was designed to assess the analgesic efficacy and side effects of 1.20 mg single-dose epidural morphine (Group 1) versus intermittent 12 hourly epidural morphine (0.5 mg) with bupivacaine (Group2) for postoperative analgesia in lower segment caesarean section cases. RESULTS: Each group consisted of 36 patients. Demographic characteristics of two groups were comparable and differences among them were not statistically significant. Mean duration of analgesia was significantly longer in group one patients (16.5±2.5h) in comparison to group two patients (11.5±1.5h). Mean highest visual analog scales (VAS scale) was significantly lower (3.2±0.9) in group one patients in comparison of group two (6.7±0.8) patients. Only 43% patient in group one required supplementary perenteral analgesic (Paracetamole/Diclofenac) and 71% required epidural morphine/bupivacaine in group two. Mean number of supplementary perenteral analgesic required in group one was 0.7 and it was 1.8 in group two. There was no significant difference in nausea, vomiting, itching, and pruritis in two groups of patients. CONCLUSION: Our study showed that the use of single dose epidural morphine is associated with lower pain scores at rest and movement when compared to intermittent epidural morphine with bupivacaine in postcaesarean section analgesia.

Nephropathy in newly diagnosed type 2 diabetics with special stress on the role of hypertension.

OBJECTIVE: Nephropathy is a common complication in diabetes mellitus (DM), with significant morbidity and mortality. The aim of the present study is to study the incidence of nephropathy in newly diagnosed type 2 diabetics and to study the relationship of development of nephropathy with various risk factors associated with DM, like age, sex, blood pressure, blood sugar, body mass index (BMI). MATERIAL AND METHODS: We analysed 300 newly diagnosed type 2 diabetics (diagnosed within 6 months), between Jan 2008 to August 2009. Presence of urinary microalbuminuria in two samples in a period of six months was taken as criteria for detecting nephropathy. RESULTS: Incidence of nephropathy in newly diagnosed type 2 diabetics was 17.34% (52/300). It increased significantly with increase in age and was 30% in age group >60 years. It also has significant correlation with male sex and blood pressure with incidence of nephropathy being as high as 66.67% at BP> 160/100 mmHg. The incidence also increased with increase in BMI as well as HbA1C. Dyslipidemia also has significant effect. All results were statistically proven. Family history of DM has only little effect. CONCLUSION: Incidence of nephropathy in newly diagnosed type 2 diabetics is as high as 17.34%. Hypertension is the most important associated factor contributing to development of nephropathy in these patients. Poor glycemic control (high HbA1C), high BMI, dyslipidemia, age, male sex also play significant role. Family history of DM seems to have little effect.

Fractured tracheostomy tube migrating into the tracheobronchial tree: a rare complication.

Tracheostomy is a life saving procedure and many patients are discharged with permanent tracheostomy tubes. We report the rare occurrence of a fractured tracheostomy tube migrating into the tracheobronchial tree and highlight the clinical manifestations of this uncommon complication that carries the potential risk of fatal respiratory obstruction.

Cutaneous horn following injury to pinna.

Cutaneous Horn of the pinna is a relatively uncommon entity. Most of the cases reported in literature have been caused due to prolonged exposure to sunlight but in this case the cutaneous horn has been caused due to injury to the pinna with wheat sheaf.

Leiomyoma arising from septum of nose.

Leiomyomas are benign tumours which are presumed to arise from vascular smooth muscle in the nasal cavity. They are rare in nasal cavity but are commonly encountered in GIT, female genital tract (uterus). The rarity of these tumours in nasal cavity is evident from the fact that less than 45 cases have been reported till date. We report a 45 years old male with Leiomyoma of the nasal cavity with brief review of literature.

Comparative analgesic efficacy of buprenorphine or clonidine with bupivacaine in the caesarean section.

The need for early ambulation for caring of the neonate by mothers makes postoperative pain management after cesarean delivery unique. Favorable results have been observed with buprenorphine, clonidine and bupivacaine as epidural analgesics. This prospective, randomised triple blind control study was carried out among 112 lower segment caesarean segment (LSCS) patients, divided into three groups, to assess the analgesic efficacy and side effects of epidural analgesia, with an intermittent top up of (i) bupivacaine (0.125%) and buprenorphine (0.075 mg) (ii) bupivacaine (0.125%) and clonidine (37.5 microgram) and (iii) bupivacaine (0.125%) alone, in LSCS cases. The demographic characteristics (age, weight and height) of the three groups were comparable and the differences were not statistically significant. The mean duration of the analgesia was significantly longer in the group one patients receiving buprenorphine plus bupivacaine (690 ± 35 minutes) and it was lowest in group three patients receiving bupivacaine (170 ± 31 minutes) alone. The mean highest pain score (VAS scale) was significantly lower (3.4 ± 0.6) in group one patients and it was highest in group three (6.7 ± 0.8) patients. Requirement of continuation of epidural analgesia after 15 hours of operation and requirement of diclonfenac injections as well as incidence of itching and pruritus was significantly lower in group one patients. Incidence of nausea and vomiting was the lowest in group one patients. Incidence of respiratory depression, sedation and hypotension were nil in all three group of patients. Epidural buprenorphine combined with bupivacaine produced significantly longer duration and better quality of analgesia than bupivacaine combined with clonidine or bupivacaine alone, and it was safe in LSCS patients, for post-operative analgesia.

Transfusion of neocytes concentrate/pooled neocytes in ß-thalassemic patients.

PURPOSE OF STUDY: Study was aimed to observe benefits of transfusion of neocytes/pooled neocytes over packed RBCs by super transfusion regimen in ß-thalassemic patients and its comparison with related studies. MATERIALS AND METHODS: Twelve cases were selected and were equally divided into control and study group in which packed RBCs and neocytes were transfused respectively for one year. In study group, average 8 transfusions were required over 14 in control group. RESULTS: A marked extension of transfusion interval was observed in study group patients receiving neocytes transfusion (avg. 45.8 days; range, 32-54) over control group patients i.e. those receiving conventional packed RBCs (avg. 26.1; range 22-30). There is an average 40.8% reduction in the volume of RBCs required in the study group compared to control group and this difference is statistically significant (p = 0.00075). In study group, 20.1% reduction in iron overload and increase of iron by 9.6% in control group was reported. CONCLUSION: We observed that neocytes transfusion is effective in extending the transfusion interval as well as in reducing the blood requirement and iron over load.