Fishbone perforating Meckel's diverticulum: an acute appendicitis mimicker.

Perforation of Meckel's diverticulum by a foreign body is rare, but when it occurs, it can mimic acute appendicitis, leading to diagnostic challenges. We present a case of a 45-year-old male initially diagnosed with acute appendicitis, but intra-operative exploration revealed a perforated Meckel's diverticulum with a fish bone. Meckel's diverticulum perforation remains diagnostically elusive, highlighting the need for intra-operative vigilance in cases of inconsistent findings like the presence of bilious fluid in the abdominal cavity. This case report underscores the importance of considering perforated Meckel's diverticulum in the differential diagnosis of right iliac fossa pain and the necessity of surgical exploration for atypical presentations to ensure timely diagnosis and appropriate management.

Electroconvulsive Therapy in Transgender and Gender Diverse Population: A Case Report and Review of Literature.

Objective: Present a case of a transgender and gender diverse (TGD) individual receiving gender affirming hormone therapy (GAHT) who presented with first episode bipolar mania and received electroconvulsive therapy (ECT). To understand the safety and efficacy of ECT in the TGD population including those receiving GAHT through literature review. Materials and Methods: Case report using informed consent from an individual TGD patient who received ECT. A review of the literature was conducted using PubMed, Embase, and Medline. Results: The case illustrated safe and effective ECT use in a TGD individual receiving GAHT. Eight studies were reviewed. GAHT has been reported to interfere with certain anaesthetic agents used in ECT. ECT appeared to be a safe and effective treatment in the TGD samples in those studies. Conclusion: There is limited literature on the safety and efficacy of ECT for TGD individuals receiving GAHT. More research is required to address mental health inequalities in this population and to support safe and effective gender affirming treatment modalities.

Quality of patient-oriented online information on treatment of dementia: A comparative assessment of web pages in English and Hindi language.

Background: Management of dementia involves a multidisciplinary approach which also requires active participation from family members and caregivers. Thus, having easy access to information about dementia care is pertinent. Internet-based information is an emerging method for the same. Aim: To perform a comparative assessment of patient-oriented online information available on treatment of dementia over web pages in English and Hindi language. Methods: Observational study was conducted online through a general internet search engine (www.google.com). Web pages containing patient-oriented online information on treatment of dementia in English and Hindi were reviewed to assess their content and quality, esthetics, and interactivity. Appropriate descriptive and inferential statistics were conducted using the Statistical Package for the Social Sciences. Results: A total of 70 web pages met the eligibility criteria. Content quality assessed using the DISCERN score was significantly higher for English web pages compared to Hindi web pages (P < 0.01). About 72.4% (21/29) of English and only 9.8% (4/41) of Hindi web pages had a total DISCERN score of 40 or above, indicating good quality. For esthetics, the median score for English pages was significantly higher than for Hindi web pages (P < 0.01). The web pages with Health On Net (HON) certification had significantly better content quality. Conclusion: Our study revealed a scarcity of good quality online information about dementia and its treatment, especially in the Hindi language. English language websites showed better content quality than Hindi websites. HON Code label might be used as an indicator of better content quality for online resources informing on dementia treatment by lay people.

Inventory model for green products with payment strategy, selling price and green level dependent demand using teaching learning based optimization algorithm.

There has been a lot of research on pricing and lot-sizing practices for different payment methods; however, the majority has focused on the buyer's perspective. While accepting buyers' credit conditions positively impacts sales, requesting advance payments from purchasers tends to have a negative effect. Additionally, requiring a down payment has been found to generate interest revenue for the supplier without introducing default risk. However, extending the credit period, along with offering delayed payment options, has the potential to increase sales volume, albeit with an elevated risk of defaults. Taking these payment schemes into account, this study investigates and compares the per-unit profit for sellers across three distinct payment methods: advance payment, cash payment, and credit payment. The consumption rate of the product varies non-linearly not only with the time duration of different payment options but also with the price and the level of greenness of the product. The utmost objective of this work is to determine the optimal duration associated with payment schemes, selling price, green level, and replenishment period to maximize the seller's profit. The Teaching Learning Based Optimization Algorithm (TLBOA) is applied to address and solve three numerical examples, each corresponding to a distinct scenario of the considered payment schemes. Sensitivity analyses confirm that the seller's profit is markedly influenced by the environmental sustainability level of the product. Furthermore, the seller's profitability is more significantly affected by the selling price index compared to the indices of the payment scheme duration and the green level in the demand structure.

Endothelin Receptor Blocker Reverses Breast Cancer-Induced Cardiac Remodeling.

Background: Although some cancer therapies have overt and/or subclinical cardiotoxic effects that increase subsequent cardiovascular risk in breast cancer patients, we have recently shown that the breast tumor itself can also induce cardiac hypertrophy through the activation of the endothelin system to contribute to cardiovascular risk. However, the extent to which the suppression of the activation of the endothelin system could improve cardiac remodeling in breast cancer patients has yet to be investigated. Objectives: We aimed to retrospectively assess the cardiac morphology/function in patients with breast cancer before receiving cancer chemotherapy and to investigate if the suppression of the activation of the endothelin system improves cardiac remodeling in a mouse model of breast cancer. Methods: Our study involved 28 previously studied women with breast cancer (including 24 after tumor resection) before receiving adjuvant therapy and 17 control healthy women. In addition, we explored how the endothelin system contributed to breast cancer-induced cardiac remodeling using a mouse model of breast cancer. Results: Our results indicate that before chemotherapy, breast cancer patients already exhibit relative cardiac remodeling and subclinical cardiac dysfunction, which was associated with the activation of the endothelin system. Importantly, our mouse data also show that the endothelin receptor blocker atrasentan significantly lessened cardiac remodeling and improved cardiac function in a preclinical model of breast cancer. Conclusions: Although our findings should be further examined in other preclinical/clinical models, our data suggest that endothelin receptor blockers may play a role in cardiac health in individuals with breast cancer. (Understanding and Treating Heart Failure With Preserved Ejection Fraction: Novel Mechanisms, Diagnostics and Potential Therapeutics [Alberta HEART]; NCT02052804 and Multidisciplinary Team Intervention in Cardio-Oncology [TITAN]; NCT01621659).

Assessment tools for complex post traumatic stress disorder: a systematic review.

Appropriate screening tools are required to accurately detect complex post traumatic stress disorder (CPTSD). This systematic review aimed to assess and compare measurement tools. A literature search using key words 'complex post traumatic stress disorder', 'PTSD', and 'assessment' was undertaken on Embase and PsychINFO during February 2022 by two reviewers. Inclusion criteria included full text papers between 2002-2022 which evaluated CPTSD using assessment tools. Exclusion criteria included reviews, editorials, meta-analyses, or conference abstracts. Twenty-two papers met selection criteria. Thirteen studies used the International Trauma Questionnaire (ITQ). Two studies each evaluated CPTSD with the International Trauma Interview (ITI) or Symptoms of Trauma Scale (SOTS). The Developmental Trauma Inventory (DTI), Cameron Complex Trauma Interview (CCTI), Complex PTSD Item Set additional to the Clinician Administered PTSD Scale (COPISAC), Complex Trauma Questionnaire (ComplexTQ), and Scale 8 of the Minnesota Multiphasic Personality Inventory Scale (MMPI) were used by a single study each. The ITQ was the most thoroughly investigated, validated across different populations, and is a convenient questionnaire for screening within the clinical setting. Where self-report measures are inappropriate, the ITI, SOTS, and COPISAC are interview tools which detect CPTSD. However, they require further validation and should be used alongside clinical history and examination.

Validated and reliable screening tools are required to accurately detect and manage complex post traumatic stress disorder (CPTSD)The International Trauma Questionnaire (ITQ) is the most thoroughly investigated, validated across different populations, and is a freely available and convenient tool for screening within clinical settingsIn circumstances where self-report measures are inappropriate, the ITI, SOTS, and COPISAC are interview tools which detect CPTSD, but require further validation and should be used alongside clinical history and examinationFurther research is needed to ensure appropriate assessment tools for the detection and diagnosis of CPTSD are available.

Treatment gap for mental and behavioral disorders in Punjab.

Background and Aims: There is no data on the treatment gap and health care utilization for mental disorders from Punjab. The present study reports on the same by using the data collected during the National Mental Health Survey. Settings and Design: Multisite, multistage, stratified, random cluster sampling study conducted in four districts, namely Faridkot, Moga, Patiala, and Ludhiana (for urban metro areas). Data were collected from October 2015 to March 2016. Materials and Methods: Mini International Neuropsychiatric Interview 6.0.0 and Adapted Fagerstrom Nicotine Dependence Scale were used to diagnose mental and behavioral disorders and tobacco use disorder, respectively. Pathways Interview Schedule of the World Health Organization was applied to persons having any disorder to assess treatment gap and health care utilization. Exploratory focused group discussions (FGDs) were conducted to understand the community perceptions regarding mental and behavioral disorders. Results: The treatment gap for mental and behavioral disorders was 79.59%, and it was higher for common mental disorders than severe mental disorders and higher for alcohol and tobacco use disorders as compared to opioid use disorders. The median treatment lag was 6 months. Only seven patients out of 79 were taking treatment from a psychiatrist, and the average distance traveled by the patient for treatment was 37.61 ± 45.5 km. Many attitudinal, structural, and other barriers leading to high treatment gaps were identified during FGDs in the community, such as stigma, poor knowledge about mental health, deficiency of psychiatrists, and distance from the hospital. Conclusions: Vertical as well as horizontal multisectoral integration is required to reduce the treatment gap and improve healthcare utilization. Increasing mental health literacy, providing high-quality mental health services at the primary-healthcare level and human resources development are the need of the hour.

Prevalence of vitamin D deficiency among psychiatric inpatients: a systematic review.

Objectives: Vitamin D deficiency is associated with worse physical and mental health outcomes. Low vitamin D levels are more common among people who experience mental health issues. This is particularly vital due to the outdoor restrictions which arose from the COVID-19 pandemic. This systematic review assessed vitamin D deficiency and insufficiency among psychiatric inpatients.Methods: A literature search was performed using the key words 'vitamin D', 'mental health', 'mental illness' and 'inpatient' and articles were selected by two independent reviewers. Eighteen studies were identified as eligible according to inclusion and exclusion criteria.Results: Vitamin D deficiency (29 - 96%) and insufficiency (20 - 63%) were common among psychiatric inpatients. Over half of the studies recommended or advised consideration of vitamin D level screening among psychiatric inpatients, while nine recommended consideration of vitamin D supplementation.Conclusions: Screening for vitamin D deficiency during psychiatric admission may be clinically indicated and improve patient wellbeing and outcomes.Key pointsLow vitamin D levels are very common among people admitted to inpatient mental health services.Vitamin D level screening upon inpatient psychiatric admission is warranted to optimise general health outcomes.Vitamin D supplementation should be considered among inpatients with vitamin D deficiency or insufficiency.

TRIM35-mediated degradation of nuclear PKM2 destabilizes GATA4/6 and induces P53 in cardiomyocytes to promote heart failure.

Pyruvate kinase M2 (PKM2) is a glycolytic enzyme that translocates to the nucleus to regulate transcription factors in different tissues or pathologic states. Although studied extensively in cancer, its biological role in the heart remains unresolved. PKM1 is more abundant than the PKM2 isoform in cardiomyocytes, and thus, we speculated that PKM2 is not genetically redundant to PKM1 and may be critical in regulating cardiomyocyte-specific transcription factors important for cardiac survival. Here, we showed that nuclear PKM2 (S37P-PKM2) in cardiomyocytes interacts with prosurvival and proapoptotic transcription factors, including GATA4, GATA6, and P53. Cardiomyocyte-specific PKM2-deficient mice (Pkm2 Mut Cre+) developed age-dependent dilated cardiac dysfunction and had decreased amounts of GATA4 and GATA6 (GATA4/6) but increased amounts of P53 compared to Control Cre+ hearts. Nuclear PKM2 prevented caspase-1-dependent cleavage and degradation of GATA4/6 while also providing a molecular platform for MDM2-mediated reduction of P53. In a preclinical heart failure mouse model, nuclear PKM2 and GATA4/6 were decreased, whereas P53 was increased in cardiomyocytes. Loss of nuclear PKM2 was ubiquitination dependent and associated with the induction of the E3 ubiquitin ligase TRIM35. In mice, cardiomyocyte-specific TRIM35 overexpression resulted in decreased S37P-PKM2 and GATA4/6 along with increased P53 in cardiomyocytes compared to littermate controls and similar cardiac dysfunction to Pkm2 Mut Cre+ mice. In patients with dilated left ventricles, increase in TRIM35 was associated with decreased S37P-PKM2 and GATA4/6 and increased P53. This study supports a previously unrecognized role for PKM2 as a molecular platform that mediates cell signaling events essential for cardiac survival.

Psychological stress among anesthesia residents during COVID-19 pandemic and how to mitigate them.

The impact of the novel coronavirus disease 19 (COVID-19) has overburdened the anesthesia fraternity both physically and mentally. The academic and training schedule of the medical residents in the last year was also disrupted. Since we are in the early phase of the second peak of the COVID-19 pandemic, it is time to reconsider the causes of stress in anesthesia residents and methods to mitigate them. In this non-systematic review, authors have included articles from PubMed, Medline, and Google scholar with keywords "identify strategies" "preventing and treating psychological disorders," and "medical students" from year 2010 onwards were included. Apart from these keywords, we have included the coping strategies and early psychiatric consultation methods. This review article aims at early identification, workplace environment changes, and implementation of early coping strategies in anesthesia residents during this second peak of COVID-19.

Prevalence of mental health disorders among health-care providers of COVID-19 positive and suspected cases.

Background: Health-care providers (HCP) engaged in demanding work like being involved in the care of COVID-19 positive and suspected cases are likely to have a lot of stress, anxiety, depression, and other mental health issues. It will be noteworthy to have an idea about the magnitude of the mental health problems in them to formulate effective intervention strategies for their well-being. Aims and Objectives: The aim of this study is to determine whether frontline HCP engaged in the treatment and care of COVID-19 positive and suspect cases experienced increased mental health problems. Methodology: Two hundred and fifty-one frontline HCPs engaged in COVID-19 duty and 97 nonfrontline (controls) HCP were assessed and compared using tools like General Health Questionnaire 12, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale. Appropriate statistical tools such as analysis of variance and Chi-square were used. Results: Frontline HCP who were directly involved in COVID-19 duty had a higher proportion (28.3%) of psychological morbidities as compared to 19.6% among controls; HCP-frontline had significantly 2.17 times chances of having psychological distress compared to HCP controls. Among, HCP-frontline 13.1% had clinical depression, whereas in the HCP control, this was 6.2%. Further, 20.3% of HCP frontline and 10.3% of HCP control had clinical anxiety, and the difference between the two groups was statistically significant (P = 0.0011). Conclusion: Frontline HCPs working in demanding work such as COVID-19 patient care are susceptible to psychological distress, anxiety, and depression which warrant urgent attention.

Muscle LIM Protein Force-Sensing Mediates Sarcomeric Biomechanical Signaling in Human Familial Hypertrophic Cardiomyopathy.

BACKGROUND: Familial hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease and is typically caused by mutations in genes encoding sarcomeric proteins that regulate cardiac contractility. HCM manifestations include left ventricular hypertrophy and heart failure, arrythmias, and sudden cardiac death. How dysregulated sarcomeric force production is sensed and leads to pathological remodeling remains poorly understood in HCM, thereby inhibiting the efficient development of new therapeutics. METHODS: Our discovery was based on insights from a severe phenotype of an individual with HCM and a second genetic alteration in a sarcomeric mechanosensing protein. We derived cardiomyocytes from patient-specific induced pluripotent stem cells and developed robust engineered heart tissues by seeding induced pluripotent stem cell-derived cardiomyocytes into a laser-cut scaffold possessing native cardiac fiber alignment to study human cardiac mechanobiology at both the cellular and tissue levels. Coupled with computational modeling for muscle contraction and rescue of disease phenotype by gene editing and pharmacological interventions, we have identified a new mechanotransduction pathway in HCM, shown to be essential in modulating the phenotypic expression of HCM in 5 families bearing distinct sarcomeric mutations. RESULTS: Enhanced actomyosin crossbridge formation caused by sarcomeric mutations in cardiac myosin heavy chain (MYH7) led to increased force generation, which, when coupled with slower twitch relaxation, destabilized the MLP (muscle LIM protein) stretch-sensing complex at the Z-disc. Subsequent reduction in the sarcomeric muscle LIM protein level caused disinhibition of calcineurin-nuclear factor of activated T-cells signaling, which promoted cardiac hypertrophy. We demonstrate that the common muscle LIM protein-W4R variant is an important modifier, exacerbating the phenotypic expression of HCM, but alone may not be a disease-causing mutation. By mitigating enhanced actomyosin crossbridge formation through either genetic or pharmacological means, we alleviated stress at the Z-disc, preventing the development of hypertrophy associated with sarcomeric mutations. CONCLUSIONS: Our studies have uncovered a novel biomechanical mechanism through which dysregulated sarcomeric force production is sensed and leads to pathological signaling, remodeling, and hypertrophic responses. Together, these establish the foundation for developing innovative mechanism-based treatments for HCM that stabilize the Z-disc MLP-mechanosensory complex.

A reversible metabolic stress-sensitive regulation of CRMP2A orchestrates EMT/stemness and increases metastatic potential in cancer.

An epithelial-to-mesenchymal transition (EMT) phenotype with cancer stem cell-like properties is a critical feature of aggressive/metastatic tumors, but the mechanism(s) that promote it and its relation to metabolic stress remain unknown. Here we show that Collapsin Response Mediator Protein 2A (CRMP2A) is unexpectedly and reversibly induced in cancer cells in response to multiple metabolic stresses, including low glucose and hypoxia, and inhibits EMT/stemness. Loss of CRMP2A, when metabolic stress decreases (e.g., around blood vessels in vivo) or by gene deletion, induces extensive microtubule remodeling, increased glutamine utilization toward pyrimidine synthesis, and an EMT/stemness phenotype with increased migration, chemoresistance, tumor initiation capacity/growth, and metastatic potential. In a cohort of 27 prostate cancer patients with biopsies from primary tumors and distant metastases, CRMP2A expression decreases in the metastatic versus primary tumors. CRMP2A is an endogenous molecular brake on cancer EMT/stemness and its loss increases the aggressiveness and metastatic potential of tumors.

Stress, Coping, and Resilience Among Home-Quarantined Persons During the COVID-19 Pandemic: Findings From a Community Study.

Objective: To assess stress, coping, and resilience among home-quarantined individuals via a community survey during the coronavirus disease 2019 (COVID-19) pandemic.Methods: In this cross-sectional study, a combined list was generated of all contacts of positive COVID-19 cases, traced by a contact tracing team, and international travelers who had entered the country after March 8, 2020 (2 weeks before the air travel shutdown on March 22, 2020 in India). This community-based study was conducted among people who were quarantined in their homes and international travelers who arrived in the country after declaration of lockdown. Stress and coping were assessed via the 12-item General Health Questionnaire, 10-item Perceived Stress Scale, and Brief Resilient Coping Scale. The participants with higher perceived stress scores (≥ 14) were asked to seek help from telemedicine services. Study data were collected from April 8, 2020, to May 20, 2020.Results: The mean age of the 153 study participants was 40.10 years, and 41.8% were women. Poor coping was identified in 25.5% of the sample, and moderate/high stress was present in 49.7%. Significantly higher stress was noted in women (P = .007). Higher age, joint family structure, and contacts of COVID cases were significant predictors of moderate/severe perceived stress in the logistic regression.Conclusions: Adequate psychological supportive services should be provided to home-quarantined persons through provision of information, rapid communication, and timely supplies of general and medical items.

Demographic and clinical factors associated with psychiatric inpatient admissions during the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic may cause a major mental health impact. We aimed to identify demographic or clinical factors associated with psychiatric admissions where COVID-19 was attributed to contribute to mental state, compared to admissions which did not. METHODS: A retrospective cohort study was undertaken of inpatients admitted to Northern Psychiatric Unit 1, Northern Hospital in Melbourne, Victoria, Australia during 27/02/2020 to 08/07/2020. Data were extracted for participants who identified COVID-19 as a stressor compared to participants who did not. Fisher's exact test and Mann-Whitley rank sum test were used. RESULTS: Thirty six of 242 inpatients reported the COVID-19 pandemic contributed to mental ill health and subsequent admission. Reasons given included social isolation, generalized distress about the pandemic, barriers to support services, disruption to daily routine, impact on employment, media coverage, re-traumatization, cancelled ECT sessions, loss of loved ones, and increased drug use during the lockdown. Chronic medical conditions or psychiatric multimorbidity were positively associated and smoking status was negatively associated with reporting the COVID-19 pandemic as a contributor to mental ill health. CONCLUSION: Screening and identifying vulnerable populations during and after the global disaster is vital for timely and appropriate interventions to reduce the impact of the pandemic worldwide.

A missed medial humeral epicondyle fracture with incarcerated fragment in the elbow joint and ulnar nerve palsy: A rare case report.

Medial epicondyle fracture associated with incarcerated intra-articular fragment and ulnar nerve palsy is uncommon and frequently missed. We report a case of 13-year-old boy with incarcerated medial epicondyle fracture fragment in ulnohumeral joint and ulnar nerve palsy, which was managed successfully by open reduction internal fixation and ulnar nerve transposition.

Elucidating the Effect of Step Cooling Heat Treatment on the Properties of 2.25 Cr-1.0 Mo Steel Welded with a Combination of GMAW Techniques Incorporating Metal-Cored Wires.

The prospect of using metal-cored wires instead of solid wires during gas metal arc welding (GMAW) of 2.25 Cr-1.0 Mo steels embraces several challenges. The in-service requirements for the equipment made up of these steels are stringent. The major challenge faced by the manufacturers is temper embrittlement. In the current study, the temper embrittlement susceptibility of the welded joint was ascertained by subjecting it to step cooling heat treatment. A 25 mm thick 2.25 Cr-1.0 Mo weld joint was prepared using a combination of the regulated metal deposition (RMD) and GMAW processes incorporating metal-cored wires. After welding the plates were exposed to post-weld heat treatment followed by a rigorous step cooling heat treatment prescribed by API standards. The temper embrittlement susceptibility of the weld joint was ascertained by Bruscato X-factor as well as by formulating ductile-to-brittle transition temperature (DBTT) curves by carrying out the impact toughness testing at various temperatures. Detailed microscopy and hardness studies were also carried out. It was established from the study that the X-factor value for the welded joint was 15.4. The DBTT for the weld joint was found to occur at -37 °C which was well below 10 °C. Optical microscopy and scanning electron microscopy indicated the presence of carbides and the energy dispersive X-ray spectrometry studies indicated the presence of chromium and manganese-rich carbides along with the presence of sulfur near the grain boundaries. This study establishes a base for the usage of metal-cored wires particularly in high temperature and pressure application of Cr-Mo steels.

Can EEG Predict Response to Atomoxetine in attention deficit hyperactivity disorder at 1 Week?

Objective: The objective of the study is to predict the early changes in electroencephalography (EEG) at 1 week and its correlation to clinical response at 6 weeks after treatment with atomoxetine in children with ADHD. Method: In 50 children (6-14 years) with ADHD (Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-5]), Vanderbilt ADHD Parent Rating Scale (VADPRS) and Vanderbilt ADHD Teachers Rating Scale (VADTRS) were applied at baseline, 1, 4, and 6 weeks. EEG was recorded using International 10-20 System of electrode placement at baseline and at 1 week after atomoxetine treatment. EEG changes at 1 week after atomoxetine therapy was correlated to clinical response at 6 weeks. Results: Patients were classified as responders or nonresponders based on the VADPRS/VADTRS findings. After 1 week of treatment, responders' theta cordance values were decreased, whereas nonresponders' values didn't decrease significantly. Conclusion: Patients with decreased theta cordance values, especially in the left temporoparietal region, at 1 week were likely to respond to atomoxetine while those without any such change were likely to be nonresponders.

Treatment non-responsiveness in depression following Efavirenz administration.

Depression is found as a comorbid condition in patients with human immunodeficiency virus (HIV) infection. Antiretroviral drugs used for the treatment of such infection may result in emergent depression. One such antiretroviral drug is efavirenz (EFV). Induction or exacerbation of depression with EFV has been reported in studies, which resolved after stopping EFV. We report a case of a 23-year-old male patient suffering from HIV for 5 years with treatment nonresponsive depressive symptoms due to EFV which improved after stopping it.