Comparison of NLR (neutrophil/lymphocyte ratio) and PLR (platelet/lymphocyte ratio) as inflammatory markers in 1st episode mania and bipolar mania: A preliminary study.

Background: There are various factors including inflammation that have been studied in bipolar disorder. NLR (Neutrophil to lymphocyte ratio) and PLR (platelet to lymphocyte ratio) are one of them. Various psychotropic drugs can affect the inflammatory state. Aim: This study was planned to find NLR and PLR in bipolar disorder (mania) and psychotropic drug naïve 1st episode mania. Materials and Methods: Total of 120 subjects were chosen including, 40 bipolar mania, 40 drugs naïve 1st episode mania, and 40 healthy controls. The severity of mania was assessed by the Young Mania Rating Scale. Blood samples were collected in the morning hours in order to get blood counts. Results: A significantly higher values of neutrophil counts and NLR, while the significant lower values of lymphocyte counts in both 1st episode and bipolar mania compared to healthy control were observed. The first episode mania group had significantly higher neutrophil counts and NLR in comparison to bipolar mania. Conclusion: Results suggest a possible inflammatory pathophysiology of mania. Psychotropic medicines may have an anti-inflammatory effect, signified by the fact that 1st episode mania group has a greater level of inflammation in comparison to bipolar mania.

Prevalence and clinical correlates of co-morbid attention deficit hyperactivity disorder in euthymic adults with bipolar disorder: A cross-sectional study.

Background: Bipolar disorders (BDs) are co-morbid with attention deficit hyperactivity disorder (ADHD), making diagnosis and management more difficult and associated with poorer outcomes. So, this study was planned to find the prevalence and clinical implication of co-morbid ADHD in BD. Materials and Methods: In this cross-sectional study, a total of 110 euthymic BD patients were taken. They were screened for childhood ADHD symptoms and adult ADHD symptoms using the Wender Utah Rating Scale for ADHD and Adult ADHD Self-Report Screening Scale for DSM-5. Those were divided into three groups: Group A included BD patients without ADHD, Group B included bipolar patients with co-morbid adult ADHD (BD-aADHD), and Group C included bipolar patients who had a diagnosis of childhood ADHD (BD-cADHD). Results: The ADHD prevalence of 27% was found in bipolar patients. The age of onset of an episode of BD was significantly earlier and the total duration of illness was significantly higher in BD-aADHD and BD-cADHD compared to the BD without ADHD. The BD-aADHD and BD-cADHD groups showed a significantly higher number of total, manic and major depressive episodes as compared to the BD without ADHD group. BD-aADHD showed a significant greater number of hypomanic episodes as compared to BD without ADHD. Conclusions: The present study concludes that ADHD is a lifetime co-morbid condition in adults with BD. These patients have a more chronic and disabling course of BD which underscores the need to understand the potential benefit of controlling ADHD symptoms in this population.

Anatomy-based definition of point A utilizing three-dimensional volumetric imaging approach for high-dose-rate (HDR) intracavitary brachytherapy dose prescription when treating cervical cancer using limited resources.

This study was designed to determine whether volumetric imaging could identify consistent alternative prescription methods to Manchester/point A when prescribing radiation dose in the treatment of cervical cancer using HDR intracavitary brachy-therapy (ICBT). One hundred and twenty-five treatment plans of 25 patients treated for carcinoma of the cervix were reviewed retrospectively. Each patient received 5 fractions of HDR ICBT following initial cisplatin-based pelvic chemoradiation, and radiation dose was originally prescribed to point A (ICRU-38). The gross tumor volume (GTV) and high-risk clinical target volume (HR-CTV) were contoured in three dimensions on the CT datasets, and inferior-superior, anterior-posterior, and left-right dimensions HR-CTV were recorded along with multiple anatomic and skeletal dimensions for each patient. The least square-best fit regression lines were plotted between one half of the HR-CTV width and pelvic cavity dimension at femoral head level and at maximum cavity dimension. The points in both plots lie reasonably close to straight lines and are well defined by straight lines with slopes of 0.15 and 0.17; intercept on y-axes of -0.08 and -0.03, point A, at the same level as defined based on applicator coordinates, is defined using this correlation, which is a function of distance between femoral heads/dimensions of maximum pelvic cavity width. Both relations, defined by straight lines, provide an estimated location of point A, which provides adequate coverage to the HR-CTV compared to the point A defined based on applicator coordinates. The point A defined based on femoral head distance would, therefore, be a reasonable surrogate to use for dose prescription because of subjective variation of cavity width dimension. Simple surrogate anatomic/skeletal landmarks can be useful for prescribing radiation dose when treating cervical cancer using intracavitary brachytherapy in limited-resource settings. Our ongoing work will continue to refine these models.

Support vector regression model of wastewater bioreactor performance using microbial community diversity indices: effect of stress and bioaugmentation.

The relationship between microbial community structure and function has been examined in detail in natural and engineered environments, but little work has been done on using microbial community information to predict function. We processed microbial community and operational data from controlled experiments with bench-scale bioreactor systems to predict reactor process performance. Four membrane-operated sequencing batch reactors treating synthetic wastewater were operated in two experiments to test the effects of (i) the toxic compound 3-chloroaniline (3-CA) and (ii) bioaugmentation targeting 3-CA degradation, on the sludge microbial community in the reactors. In the first experiment, two reactors were treated with 3-CA and two reactors were operated as controls without 3-CA input. In the second experiment, all four reactors were additionally bioaugmented with a Pseudomonas putida strain carrying a plasmid with a portion of the pathway for 3-CA degradation. Molecular data were generated from terminal restriction fragment length polymorphism (T-RFLP) analysis targeting the 16S rRNA and amoA genes from the sludge community. The electropherograms resulting from these T-RFs were used to calculate diversity indices - community richness, dynamics and evenness - for the domain Bacteria as well as for ammonia-oxidizing bacteria in each reactor over time. These diversity indices were then used to train and test a support vector regression (SVR) model to predict reactor performance based on input microbial community indices and operational data. Considering the diversity indices over time and across replicate reactors as discrete values, it was found that, although bioaugmentation with a bacterial strain harboring a subset of genes involved in the degradation of 3-CA did not bring about 3-CA degradation, it significantly affected the community as measured through all three diversity indices in both the general bacterial community and the ammonia-oxidizer community (α = 0.5). The impact of bioaugmentation was also seen qualitatively in the variation of community richness and evenness over time in each reactor, with overall community richness falling in the case of bioaugmented reactors subjected to 3-CA and community evenness remaining lower and more stable in the bioaugmented reactors as opposed to the unbioaugmented reactors. Using diversity indices, 3-CA input, bioaugmentation and time as input variables, the SVR model successfully predicted reactor performance in terms of the removal of broad-range contaminants like COD, ammonia and nitrate as well as specific contaminants like 3-CA. This work was the first to demonstrate that (i) bioaugmentation, even when unsuccessful, can produce a change in community structure and (ii) microbial community information can be used to reliably predict process performance. However, T-RFLP may not result in the most accurate representation of the microbial community itself, and a much more powerful prediction tool can potentially be developed using more sophisticated molecular methods.