Elevated Cortisol Levels and Manic Symptoms in a 16-Year-Old Female: A Case Report.

This case report presents the clinical presentation, diagnosis, and management of a 16-year-old female with elevated cortisol levels who was diagnosed with mania. The patient exhibited symptoms consistent with a manic episode, including extreme euphoria, decreased need for sleep, impulsivity, and heightened irritability. Laboratory investigations revealed an elevated morning cortisol level, prompting further psychiatric evaluation. A diagnosis of bipolar I disorder, manic episode, was made based on established criteria. The patient was initiated on mood stabilizers and antipsychotic medications alongside psychoeducation for the patient and her family. This case underscores the potential association between cortisol dysregulation and mood disorders, highlighting the importance of comprehensive assessment and personalized treatment approaches in adolescents with bipolar disorder. Further research is needed to elucidate the underlying mechanisms linking cortisol dysregulation and mood disturbances and explore novel therapeutic interventions targeting hypothalamic-pituitary-adrenal axis dysfunction.

A Rare Presentation of Delusional Parasitosis With Koro-Like Syndrome.

Delusional parasitosis (DP) with Koro-like syndrome poses a complex clinical challenge, demanding a comprehensive and empathetic approach from healthcare professionals. This exceptional combination of fixed beliefs about infestation and experiences of genital retraction can profoundly impact patients' well-being and daily functioning. The associated stigma and misconceptions further compound the difficulties faced by individuals struggling with these co-occurring conditions. Given the rarity of encountering both conditions simultaneously, navigating the diagnosis and treatment of delusional parasitosis with Koro-like syndrome requires a thorough understanding of its multifaceted nature. Embracing a holistic strategy encompassing psychoeducation, psychotherapy, and pharmacological interventions is essential for effectively addressing these dual conditions.

A Bird's-Eye Perspective: An Unusual Case of Very Late-Onset Schizophrenia-Like Psychosis With Visual Hallucinations Included in Its Manifestations Versus the Dementia Prodrome.

Very late-onset schizophrenia-like psychosis (VLOSLP) is still a paradox; certain characteristics such as episodic progression of psychosis including delusions and hallucinations involving various modalities, as well as the absence of negative symptoms, are strongly predictive of VLOSLP. We describe an interesting case of a 61-year-old male who presented with a second episode of psychosis along with mild to moderate cognitive impairment like having difficulty in buttoning for over eight months at our tertiary care hospital. Previously, during the first episode, he was treated by a private practitioner; adequate doses for an adequate duration of two atypical antipsychotics were given; and up to 25% global improvement was reported by the caregiver. During the current episode, he experienced delusions, in which he had a conviction that a "WIFI" was capable of "thought-making" functions. During the past four months, his delusions exacerbated and were accompanied by hallucinations of other modalities, like visual and kinesthetic hallucinations, which profoundly impacted his daily life. He used to hear voices. While listening to the voices, he also experienced voices coming out of his mouth. All these were experienced by him in clear consciousness daily for a few hours. All plausible medical causes of late-onset psychosis, such as neuroinflammatory/immunological disorders, were ruled out. Neuroimaging revealed T2-weighted image (T2WI)/fluid-attenuated inversion recovery (FLAIR) hyperintensity in bilateral subcortical and periventricular deep white matter, suggestive of small vessel ischemic changes in the brain. The diagnosis of VLOSLP is completely rationalized by evidence-based medicine. Hence, the role of cerebrovascular risk factors, as well as age-related neurobiological processes, in the pathogenesis of VLOSLP is discussed. Future research ought to emphasize identifying a particular biomarker that would be highly predictive for accurately diagnosing VLOSLP and giving it an identity to separate it from various overlapping clinical conditions such as dementia with Lewy bodies (DLB) and other types of dementia with psychosis so that the patient can be given specific treatment.

Journey of Marijuana From "Folk Tales" to "Doors of Justice": A Comprehensive Review.

This comprehensive review delves into the intricate journey of marijuana in India, tracing its historical and cultural significance from ancient times to the present day. Despite its deep-rooted presence in religious rituals, traditional medicine, and cultural festivities, marijuana faces stringent prohibition under the Narcotic Drugs and Psychotropic Substances Act 1985. This review critically examines the current legal framework, highlighting its societal impacts and limitations. Through an evidence-based analysis, it advocates for a reevaluation of marijuana laws to align with contemporary realities, promoting public health, social equity, and economic development. By envisioning a future of evidence-based regulation and innovation, India can unlock the full potential of marijuana as a "miracle crop" for the betterment of its people and society.

Navigating the Shadows: A Comprehensive Review of Suicide in the Geriatric Population.

This review critically examines the complex landscape of suicide within the geriatric population, defined as individuals aged 65 and older. By synthesizing existing research, we elucidate critical findings related to the prevalence, risk factors, and challenges associated with suicide in this demographic. Social isolation, mental health issues, and the intricate psychosocial dimensions of ageing emerge as pivotal factors contributing to the vulnerability of older individuals. The conclusion underscores a compelling call to action, urging collaborative efforts from healthcare professionals, policymakers, and communities to implement targeted prevention strategies. Our vision for the future involves building a supportive and resilient community for the geriatric population, emphasizing age-friendly policies, robust social support networks, and destigmatizing mental health discussions. Through this comprehensive exploration, we aim to contribute to a deeper understanding of suicide in the geriatric population and inspire effective interventions that prioritize the well-being and dignity of older individuals.

Bridging the Gap: A Holistic View of Personality Factors in Individuals With and Without Alcohol Use.

This comprehensive review examines the intricate interplay between personality factors and alcohol use, shedding light on the dynamic relationship that shapes the initiation, progression, and outcomes of alcohol-related behaviors. The exploration encompasses vital personality traits such as sensation seeking, impulsivity, neuroticism, extroversion, agreeableness, conscientiousness, and openness to experience. The bidirectional nature of this association is underscored, emphasizing how personality influences and is influenced by alcohol consumption patterns. Protective personality factors, including resilience, emotional regulation, and social support, are identified as crucial elements in mitigating the risk of alcohol use disorders (AUDs). The implications for clinical practice advocate for tailored interventions that address individual personality profiles, while policy considerations highlight the need for targeted prevention efforts that acknowledge the diverse ways individuals respond to alcohol use. Furthermore, a call for future research emphasizes emerging perspectives, improved methodologies, and ongoing exploration of intervention strategies to advance our understanding of this complex relationship and refine approaches for prevention and treatment. As we navigate this evolving field, the insights gleaned hold promise for shaping more compelling and nuanced interventions to address the diverse needs of individuals affected by AUDs.

Exploring Body Image Dissatisfaction and Psychiatric Co-morbidities in Rural India: A Comprehensive Review.

This comprehensive review examines the intricate landscape of body image dissatisfaction (BID) in rural India, shedding light on the multifaceted factors influencing individual perceptions and societal expectations. Delving into cultural nuances, economic disparities, and gender-specific experiences, the study highlights the pervasive nature of BID across diverse age groups. Unveiling the complex interplay between BID and psychiatric co-morbidities, such as depression and anxiety, underscores the urgency of integrated mental health interventions. The review concludes with a resounding call to action for policymakers, healthcare professionals, and communities. It advocates for culturally sensitive mental health policies, targeted healthcare training, and community-driven initiatives to foster environments conducive to positive body image and mental well-being. By acknowledging these challenges and committing to collaborative solutions, this review aims to contribute to developing comprehensive strategies that address BID in rural India and pave the way for healthier and more resilient communities.

Assessing the Behavioral and Personality Changes in Alcohol Dependence Syndrome in Wardha, Central India.

Background Alcohol dependence syndrome occurs when the consumption of alcohol is uncontrollable. Most of the alcohol drinkers are usually males. There is a rise in the incidence of road traffic accidents under the influence of alcohol due to locomotor and cerebral dysfunction. Alcohol is a significant cause and contributing factor for domestic violence, family disharmony, and displeasure in families. Research studies have shown that after the lockdown of COVID-19, the consumption of alcohol decreased in India. This study was conducted to assess the behavioral and personality changes in alcohol dependence syndrome. Methods This study was conducted at a rural tertiary care hospital in Wardha, Maharashtra, Central India. Sixty-two males participated in the study. Out of which, 56 were included in the study. There were urban and rural participants in the study. The study was conducted for a period of six months. The participants who were being treated for alcohol withdrawal and alcohol dependence syndrome were included in the study. The individuals unwilling to participate in the research and those admitted to the intensive care unit were excluded from this study. The primary outcome measure of the study was to assess the behavioral and personality changes in alcohol dependence syndrome. Participants were screened using the Cut-Down, Annoyed, Guilty, and Eye-Opener (CAGE) and the Alcohol Use Disorders Identification Test (AUDIT) questionnaires. The diagnosis of alcohol dependence syndrome was made according to the International Classification of Diseases, Tenth Revision, (ICD-10) criteria. The participants were assessed using a self-report questionnaire. The parameters of assessment were aggressive behavior, domestic violence, workplace violence, verbal abuse, and variables including the forensic aspects of alcohol consumption, such as road traffic accidents, etc. Previous research and similar studies on factors related to alcohol dependence syndrome were compared to establish a conclusion for the study. Results Participants reported to have decreased psychomotor function upon alcohol consumption compared to the time they were not under the influence of alcohol. Aggressive behavior associated with irritability and agitation was observed in 89.28% (50 out of 56) participants. A total of 76.78% (43 out of 56) had road traffic accidents at least once under the influence of alcohol. Of the sample, 85.71% (48 out of 56) committed verbal abuse at the workplace and home as a result of aggression under the influence of alcohol. And 69.64% (39 out of 56) of the sample had memory loss after consumption of alcohol. Conclusion There are several behavioral changes in individuals who are alcohol dependent, which may affect their day-to-day activities and cause poor performance in the workplace. Participants in the study showed a notable positive relation between alcohol dependence syndrome and aggressive behavior, verbal aggression, domestic violence, memory loss, and road traffic accidents under the influence of alcohol. Alcohol dependence syndrome can be linked with decreased quality of life due to problems faced in daily activities like psychomotor functions, sleeping, etc. During the treatment of alcohol dependence or withdrawal from alcohol, individuals experience socio-behavioral changes. Cognitive behavior therapy, including cognitive neuroscience, can help in managing these behavior and personality changes in alcohol dependence syndrome.

Unraveling the Web of Delusional Parasitosis: A Case Report.

Delusional parasitosis (DP) is a psychiatric condition characterized by the false belief of skin infestation. However, the coexistence of medical conditions, such as iron deficiency anemia, may complicate the clinical presentation and treatment approach. The present case provides an overview of the challenges faced with the diagnosis and management of DP in a patient with a co-morbid medical condition. It highlights the importance of multidisciplinary collaboration in achieving a favorable outcome. Through this case, we shed light on the possible multifactorial origins of DP and emphasize the importance of a comprehensive approach to care for patients with this condition. It also underscores the need for timely recognition and appropriate treatment to improve the quality of life for individuals affected by this debilitating psychiatric condition.

A nude mutant rat derived from Sprague Dawley-National Institute of Nutrition rat colony with normal thymus: A potential model for noncommunicable diseases.

BACKGROUND: A spontaneous mutant rat with a hairless phenotype and an intact thymus was discovered in a long-standing Sprague Dawley-National Institute of Nutrition (SD/NIN) rat colony at a national animal resource facility. OBJECTIVE: We conducted extensive phenotypic and biochemical analyses on this mutant strain to determine its suitability as a preclinical model for immunocompetent testing in noncommunicable disease research. MATERIALS AND METHODS: We subjected the mutant rats to strict and frequent phenotypic and genetic surveillance to accomplish this objective. The animals were assessed for food intake, body weight, blood cell profile, clinical chemistry, adipose tissue deposition, and bone mineral density (BMD) using total electrical body conductance (TOBEC) and dual-energy X-ray absorptiometry (DXA) analysis. RESULTS: Initially, only two hairless mutant rats, a male and a female, were born from a single dam in the SD/NIN rat strain. However, the results indicate that the mutant colony propagated from these unique pups displayed distinct phenotypic features and exhibited differences in feeding behavior, weight gain, and clinical biochemistry. The food conversion rate was significantly higher in nude females (2.8-fold) while 26% lower in nude males. Both sexes of nude rats had significantly higher triglycerides and lower glucose levels in females. However, glucose levels did not change in male nude rats. Furthermore, nude female and male rats had significantly lower fat (TOBEC) and bone mineral content (DXA). Nonetheless, BMD was only slightly lower (7%-8%) compared to the heterozygous groups. CONCLUSIONS: These findings indicate that the spontaneous mutant rat has the potential to serve as an immunopotent and modulatory testing system in pharmacokinetics/pharmacodynamics and toxicology, which can be further explored for therapeutic drug discovery.

Opioid-Based vs Opioid-Free Anesthesia in Breast Cancer Surgery.

Introduction: Breast cancer is the most widely recognized malignant growth in ladies in India and accounts for 14% of all tumors in women. Modified radical mastectomy (MRM) is a surgery done for breast cancer. It leads to about 30% chances of postoperative nausea and vomiting (PONV) and 40% pain in the immediate postoperative period. Objectives: Changes in blood pressure after intubation, waiting time for postoperative pain medication, and possibility of adverse effects. Methodology: After the approval of ethical committee, the study was conducted in the procedure and possible complications associated with the procedure were explained to patients. Written informed consent was obtained from each patient. Result and Conclusion: We conclude that opioid-free anesthesia is "more effective in reducing the incidence of postoperative nausea and vomiting, produces stable hemodynamics, and reduces incidence of side effects when compared with opioid-based general anesthesia in patients undergoing breast cancer surgeries."

Effect of ethyl gallate and propyl gallate on dextran sulfate sodium (DSS)-induced ulcerative colitis in C57BL/6 J mice: preventive and protective.

OBJECTIVE AND DESIGN: Inflammatory bowel disease (IBD) is an idiopathic inflammatory condition of the digestive system marked by oxidative stress, leukocyte infiltration, and elevation of inflammatory mediators. In this study, we demonstrate the protective effect of ethyl gallate (EG), a phytochemical, and propyl gallate (PG), an anti-oxidant, given through normal drinking water (DW) and copper water (CW) in various combinations, which had a positive effect on the amelioration of DSS-induced ulcerative colitis in C57BL/6 J mice. MATERIALS AND METHODS: We successfully determined the levels of proinflammatory cytokines and anti-oxidant enzymes by ELISA, tracked oxidative/nitrosative stress (RO/NS) by in vivo imaging (IVIS) using L-012 chemiluminescent probe, disease activity index (DAI), and histopathological and morphometric analysis of colon in DSS-induced colitis in a model. RESULTS: The results revealed that oral administration of ethyl gallate and propyl gallate at a dose of 50 mg/kg considerably reduced the severity of colitis and improved both macroscopic and microscopic clinical symptoms. The level of proinflammatory cytokines (TNF-α, IL-6, IL-1ß, and IFN-γ) in colonic tissue was considerably reduced in the DSS + EG-treated and DSS + PG-treated groups, compared to the DSS alone-treated group. IVIS imaging of animals from the DSS + EG and DSS + PG-treated groups showed a highly significant decrease in RO/NS species relative to the DSS control group, with the exception of the DSS + PG/CW and DSS + EG + PG/CW-treated groups. We also observed lower levels of myeloperoxidase (MPO), nitric oxide (NO), and lipid peroxidation (LPO), and restored levels of GST and superoxide dismutase (SOD) in DSS + EG-DW/CW, DSS + PG/DW, and DSS + EG + PG/DW groups compared to DSS alone-treated group. In addition, we showed that the EG, PG, and EG + PG treatment significantly reduced the DAI score, and counteracted the body weight loss and colon shortening in mice compared to DSS alone-treated group. In this 21-day study, mice were treated daily with test substances and were challenged to DSS from day-8 to 14. CONCLUSION: Our study highlights the protective effect of ethyl gallate and propyl gallate in various combinations which, in pre-clinical animals, serve as an anti-inflammatory drug against the severe form of colitis, indicating its potential for the treatment of IBD in humans. In addition, propyl gallate was investigated for the first time in this study for its anti-colitogenic effect with normal drinking water and reduced effect with copper water.

Role of Physical Activity on Mental Health and Well-Being: A Review.

In addition to the apparent physical health benefits, physical activity also affects mental health positively. Physically inactive individuals have been reported to have higher rates of morbidity and healthcare expenditures. Commonly, exercise therapy is recommended to combat these challenges and preserve mental wellness. According to empirical investigations, physical activity is positively associated with certain mental health traits. In nonclinical investigations, the most significant effects of physical exercise have been on self-concept and body image. An attempt to review the current understanding of the physiological and psychological mechanisms by which exercise improves mental health is presented in this review article. Regular physical activity improves the functioning of the hypothalamus-pituitary-adrenal axis. Depression and anxiety appear to be influenced by physical exercise, but to a smaller extent in the population than in clinical patients. Numerous hypotheses attempt to explain the connection between physical fitness and mental wellness. Physical activity was shown to help with sleep and improve various psychiatric disorders. Exercise in general is associated with a better mood and improved quality of life. Physical exercise and yoga may help in the management of cravings for substances, especially in people who may not have access to other forms of therapy. Evidence suggests that increased physical activity can help attenuate some psychotic symptoms and treat medical comorbidities that accompany psychotic disorders. The dearth of literature in the Indian context also indicated that more research was needed to evaluate and implement interventions for physical activity tailored to the Indian context.

A Rare Presentation of Late-Onset Mania Following Right-Sided Lacunar Infarct.

Stroke can result in various psychiatric disorders. It is uncommon for people to experience their first episode of mania later in life, amounting to only 1% as compared to post-stroke depression, where the incidence is comparatively high. Significant attention has been paid to the study of post-stroke depression. However, reports of manic episodes following a stroke are uncommon. Just five reported cases of mania or bipolar disorder following a cerebral infarction due to damage to the left hemisphere had been published as of late 1996. There is insufficient evidence to conclude whether late-onset mania has an organic or non-organic basis. There hasn't been a lot of research done in this area. In this report, we present a case of an elderly woman who presented with mania after being treated with an anti-depressant following a chronic cerebral infarction.

Defining Prolonged Length of Stay (PLOS) Following Elective Laparoscopic Cholecystectomy and Derivation of a Preoperative Risk Score to Inform Resource Utilization, Risk Stratification, and Patient Consent.

OBJECTIVE: The present study defines prolonged length of stay (PLOS) following elective laparoscopic cholecystectomy (LC) and its relationship with perioperative morbidity. A preoperative risk tool to predict PLOS is derived to inform resource utilization, risk stratification and patient consent. BACKGROUND: Surgical candidates for elective LC are a heterogeneous group at risk of various perioperative adverse outcomes. Preoperative recognition of high-risk patients for PLOS has implications on feasibility for day surgery, resource utilization, preoperative risk stratification, and patient consent. METHODS: Data for all patients who underwent elective LC between January 2015 and January 2020 across 3 surgical centers (1 tertiary referral center and 2 satellite units) in 1 health board were collected retrospectively (n=2166). The optimal cut-off of PLOS as a proxy for operation-related adverse outcomes was found using receiver operating characteristic curves. Multivariate logistic regression was conducted on a derivation subcohort to derive a preoperative model predicting PLOS. Receiver operating characteristic curves were performed to validate the model. Patients were stratified by the risk tool and the risks of PLOS were determined. RESULTS: A LOS of ≥3 days following elective LC demonstrated the best diagnostic ability for operation-related adverse outcomes [area under curve (AUC)=0.87] and defined the PLOS cut-off. The rate of PLOS was 6.6% (144/2166), 86.1% of which had a perioperative adverse outcome. PLOS was strongly associated with all adverse outcomes (subtotal, conversion-to-open, intraoperative complications, postoperative complication/imaging/intervention) ( P <0.001). The preoperative model demonstrated good diagnostic ability for PLOS in the derivation (AUC=0.81) and validation cohorts (AUC=0.80) and stratified patients appropriately. CONCLUSIONS: Morbidity in PLOS patients is significant and pragmatic patient selection in accordance with the risk tool may help centers improve resource utilization, risk stratification, and their consent process. The risk tool may help select candidates for cholecystectomy in a strictly ambulatory/outpatient center.

Index Admission Cholecystectomy for Biliary Colic Precludes the Risk of Readmissions with Biliary Complications and should be Standard Treatment.

BACKGROUND: Emergency biliary colic admissions can be managed with an index or elective laparoscopic cholecystectomy (LC). Opting to perform an elective LC may have significant repercussions such as the risk of readmissions before operation with further attacks or with biliary complications (e.g. cholecystitis, pancreatitis, choledocholithiasis). The risk of readmission and biliary complications in patients admitted with biliary colic but scheduled for elective surgery has never been investigated. The secondary aim was to compare rates of peri-operative morbidity between the index admission, elective and readmission LC cohorts. METHOD: All patients admitted with a diagnosis of biliary colic over a 5-year period and proceeding to LC were included in the study (n = 441). The risk of being readmitted and suffering further morbidity whilst awaiting elective LC was investigated. Peri-operative morbidity was compared between the index admission, elective and readmitted LC groups using univariate and multivariate analysis. RESULTS: Following a biliary colic admission, the risk of readmission whilst awaiting elective LC is significant (2 months-25%; 10 months-48%). In this group, the risks of subsequent biliary complications (18.0%) and the requirement for ERCP (6.5%) were significant. Patients who are readmitted before LC, suffer a more complicated peri-operative course (longer total length of stay, higher post-operative complications, imaging and readmission). DISCUSSION: Index admission LC for biliary colic avoids the significant risk of readmission and biliary complications before surgery and should be the gold standard. Readmitted patients are likely to have higher rates of peri-operative adverse outcomes. Patients should be counselled about these risks.

A Rare Presentation of Quadrigeminal Cistern (Tectal Plate) Lipoma With Visual Hallucinations in a Patient of Schizophrenia: A Case Report.

Intracranial lipomas are rare benign congenital tumours, consisting of <0.1% of all primary brain tumours. They are asymptomatic and are thus incidentally discovered whenever brain imaging is advised due to any other organic cause. These lipomas can rarely present with acute psychosis or schizophrenia-like symptoms characterised by abnormal perceptions, cognition, mood, and behaviour. One of the most frequent symptoms of schizophrenia is hallucination. In patients with schizophrenia, hallucinatory experiences can have an impact on any of the five senses; however, auditory hallucinations are the most common. Although tactile, olfactory, and gustatory hallucinations are uncommon, visual hallucinations are also frequently experienced; their existence should prompt a clinician to think about whether there may be an underlying medical or neurological condition that is the root of the entire syndrome. Thus, the presence of visual hallucinations in a patient with psychosis should not be neglected and brain imaging should be done to rule out any organic brain disease. Schizophrenia-like symptoms in a patient of quadrigeminal lipoma are rare and not many cases have been reported in this context. Quadrigeminal lipoma presenting with headache, seizure, loss of consciousness, and aggression has been reported but not with acute psychosis or schizophrenia. Hereby, we report a case of a 35-year-old female who presented with psychosis with predominant visual hallucinations, which suspected an underlying organic pathology and brain imaging showed the presence of quadrigeminal cistern lipoma. The idea behind choosing this case is to report a very rare condition with an even more atypical associated presentation.

Depression, anxiety, stress and resilience among undergraduate health sciences students of a rural tertiary healthcare centre in Maharashtra during the Covid-19 lockdown: A cross-sectional, online survey.

Background The Covid-19 pandemic caused a rapidly evolving and confused situation. Health sciences students (HSSs) are not immune to depression, anxiety and stress during such a pandemic. We aimed to assess the relation between depression, anxiety, stress and resilience among undergraduate HSSs during the Covid-19 lockdown. Methods We conducted a cross-sectional, online survey at a rural tertiary healthcare centre in Maharashtra. Data were recorded from study participants on sociodemographic details using the 21-item Depression, Anxiety and Stress Scale (DASS-21) and the Brief Resilience Scale (BRS). Data were analysed using SPSS software version 15.0. Results A total of 381 students participated in the online survey. The prevalence of depression, anxiety and stress were 7.6%, 6.3% and 1.0%, respectively. There was a positive correlation between all three sub-scales of DASS-21. On BRS, 5 (1.3%) participants had high resilience, 216 (56.7%) had normal resilience and 160 (42.0%) had low resilience. Those respondents who had high resilience had lower rates of depression, anxiety and stress on DASS-21 sub-scales. Conclusion A proportion of HSSs had anxiety, depression and stress during the Covid-19 outbreak and lockdown. Respondents with high resilience had less frequent depression, anxiety and stress. In the long run, strengthening resilience of HSSs may be useful.

Visual Dysfunction in Posterior Cortical Atrophy: A Masquerade.

Posterior cortical atrophy, considered an atypical dementia, is a syndrome characterised by dysfunction of posterior cortical regions with prominent visuospatial and visuoperceptual impairment at presentation. We report the case of posterior cortical atrophy, which was diagnosed six years after the onset of visual symptoms. The patient is a 67-year-old married gentleman, with six years history of visual impairment, characterised by difficulty in locating and manipulating door handles, overreaching objects and difficulty in depth perception. He had a history of repeated visits to ophthalmologists and underwent multiple unsuccessful changes in eyeglasses and a cataract surgery to correct acuity. The patient also developed recent memory deficits about two years back, insidious in onset and gradually progressed and symptoms of visual and auditory hallucinations about six months back. Cognitive and functional assessments, and imaging findings were consistent with a diagnosis of posterior cortical atrophy, possible Alzheimer's disease. The patient was started on cognitive enhancers and low dose antipsychotics. He was engaged in meaningful and cognitively stimulating activities. Environmental manipulations and home safety recommendations for visual impairment were conveyed to the family. In the early stages of posterior cortical atrophy, visual symptoms predominate, while episodic memory, executive functioning, language, and insight are substantially retained. Better identification, prognosis, and treatment of posterior cortical atrophy will result from increased knowledge and understanding of the condition among neurologists, psychiatrists, general doctors, ophthalmologists, and optometrists.

Development of Surgical Error Reduction System (SERS) for Laparoscopic Appendectomy by using Observational Human Reliability Analysis (OCHRA) model and to analyse its impact on patient outcomes.

This project is to develop a surgical error reduction system (SERS) for laparoscopic appendectomy by using observational Human Reliability Analysis (OCHRA) model and to analyse it impact on patient's outcome.