Referral Network Pathways of Care for Psychiatric Disorders in Kashmir - A Study from India. / Kesmir'de Psikiyatrik Bozukluklarin Tedavisine Yönelik Sevk Yollari - Hindistan'dan Bir Çalisma.

OBJECTIVE: Access to psychiatry services in Kashmir is challenging because of active enduring conflict, insecurity and a fundamental role played by the traditional health workers. We aimed to assess the main pathways to mental health services in Kashmir, India. METHODS: This cross-sectional hospital-based study was performed from March 2012 to June 2017 in the outpatient psychiatry department at a psychiatric disease hospital in Kashmir. A convenience sampling method was used to select newly referred patients to the services. A survey was developed to collect information on demographic data and the main pathways for patients when seeking care for mental disorders. RESULTS: A total of 518 patients were interviewed. About half of the respondents (48.8 %) attended clinical consultation from a general pathway like a physician or a neurologist, while 31.8% were visiting a psychiatrist for a significant psychiatric disorder. For some patients (17.8%), their initial pathway to mental health services is traditional healers. CONCLUSION: The current study revealed different pathways to seeking psychiatric care in Kashmir India. Further studies are needed to address the treatment gap and ways to improve access to mental health services for the Kashmir population.

Prevalence of Mental Disorders Among Patients with Multimorbidity Visiting Primary Care Settings in Slums of Karachi, Pakistan.

BACKGROUND: Anxiety and depression often exacerbate multimorbidity conditions, leading to increased disability rates among affected individuals. OBJECTIVE: The study aimed to assess the mental health status of individuals with multimorbidity belonging to the marginalized population of Karachi, Pakistan. Specifically, the prevalence of anxiety and depression was investigated. METHODS: A multicenter cross-sectional study was conducted between July 2022 and June 2023 in 10 primary healthcare clinics located in 4 peri-urban areas of Karachi. A total of 9331 participants were included in the study. The Patient Health Questionnaire 4 (PHQ-4), Generalized Anxiety Disorder 7 (GAD-7), and Patient Health Questionnaire 9 (PHQ-9) were used to assess symptoms of anxiety and depression. The data collected were analyzed using the statistical analysis system (SAS) version 9.4. RESULTS: Among the study participants, 2894 (31%) were men and 5534 (59.3%) were women. The prevalence of moderate to severe anxiety was 31% among men and 59.3% among women. The age group between 41 and 60 years exhibited the highest rates of moderate to severe anxiety, 19.3% as evaluated by GAD-7 and 34.6% by PHQ-9. The Pathan ethnic group had the highest prevalence of anxiety (11%) and depression (28.3%) in the neighborhoods. Unemployed participants showed moderate to severe anxiety in 21.3% of the cases and moderate to severe depression in 25.5% of the cases. CONCLUSION: The study revealed a significant cooccurrence of anxiety and depression among individuals with multimorbidity in the marginalized population of Karachi, Pakistan. Furthermore, the presence of anxiety symptoms in multimorbidity patients with depression indicates a more unfavorable health state. It is essential to explore the implementation of screening measures and therapeutic interventions for comorbid anxiety and depression in this population to improve clinical outcomes.

Effects of Soaking and Germination Treatments on the Nutritional, Anti-Nutritional, and Bioactive Characteristics of Adzuki Beans (Vigna angularis L.) and Lima Beans (Phaseolus lunatus L.).

Lima beans (Phaseolus lunatus) and adzuki beans (Vigna angularis) are some of the most nutritious underutilized pulses that are significant in being used as basic ingredients for the preparation of various food products. The present study aimed to determine the impact of soaking and germination on nutritional and bioactive components, in vitro protein digestibility, reducing power, metal chelating capacity, antioxidant activity, and anti-nutritional components of lima and adzuki beans. The findings showed that during the germination treatment, the in vitro protein digestibility of lima and adzuki beans increased by 14.75 and 10.98%, respectively. There was an increase in the antioxidant activity of lima beans by 33.48% and adzuki beans by 71.14% after 72 h of germination, respectively. The reducing power assay of lima and adzuki beans indicated an increase of 49.52 and 36.42%, respectively, during germination. Similarly, the flavonoid and metal chelating activity increased in lima and adzuki beans after 72 h of germination. In contrast, the anti-nutrients, such as phytic acid, tannin content, and trypsin inhibitor activity, decreased significantly p < 0.05 after 72 h of germination. These results are encouraging and allow for utilizing the flour obtained from the germinated beans in functional bakery products, which can contribute to eradicating protein deficiency among some population groups. At the same time, promoting soaking and germination of the beans as a way to enhance the nutritional quality and reduce anti-nutrients can contribute to the interest in these underutilized pulses. They could be seen as an additional tool to improve food security.

Defect engineered magnetism induction and electronic structure modulation in monolayer MoS2.

The electronic, magnetic, and optical characteristics of a defective monolayer MoS2 were examined by employing density functional theory (DFT)-based first-principles calculations. The effects of several defects on the electrical, magnetic, and optical properties, including Mo vacancies, MoS3 vacancies, and the substitution of a single Mo atom by two S atoms were studied in this work. Our first-principles calculations revealed that different types of defects produced distinct energy states within the band gap, leading to a band gap reduction after the introduction of various types of defects, which caused a change from semiconducting to metallic behavior. The spin-up and spin-down states were separated in the case of MoS3 vacancy. The total magnetization was ∼ -0.83 µB/cell, and the absolute magnetization was ∼ 1.23 µB/cell. Moreover, spin-up states had a 0.45 eV band gap, whereas spin-down states were metallic. Consequently, it can be promising for spin filter applications. It was disclosed that the broadband part of the electromagnetic spectrum has a high absorption coefficient, which is necessary for applications including impurity detection, photodiodes, and solar cells. Designing spintronic and optoelectronic devices will benefit from the modification of the electrical, optical, and magnetic properties by defect engineering of MoS2 monolayers presented here.

Impact of Medicaid Expansion on Surgical Care and Outcomes for Hepatobiliary Malignancies.

BACKGROUND: As part of the Patient Protection and Affordable Care Act, some states expanded Medicaid eligibility to adults with incomes below 138% of the federal poverty line. While this resulted in an increased proportion of insured residents, its impact on the diagnosis and treatment of hepatopancreaticobiliary (HPB) cancers has not been studied. STUDY DESIGN: The National Cancer Database (NCDB) from 2010 to 2017 was used. Patients diagnosed with HPB malignancies in states which expanded in 2014 were compared to patients in non-expansion states. Subset analyses of patients who underwent surgery and those in high-risk socioeconomic groups were performed. Outcomes studied included initiation of treatment within 30 days of diagnosis, stage at diagnosis, care at high volume or academic center, perioperative outcomes, and overall survival. Adjusted difference-in-differences analysis was performed. RESULTS: A total of 345,684 patients were included, of whom 55% resided in non-expansion states and 54% were diagnosed with pancreatic cancer. Overall survival was higher in states with Medicaid expansion (HR .90, 95% CI [.88-.92], P < .01). There were also better postoperative outcomes including 30-day mortality (.67 [.57-.80], P < .01) and 30-day readmissions (.87 [.78-.97], P = .02) as well as increased likelihood of having surgery in a high-volume center (1.42 [1.32-1.53], P < .01). However, there were lower odds of initiating care within 30 days of diagnosis (.77 [.75-.80], P < .01) and higher likelihood of diagnosis with stage IV disease (1.09 [1.06-1.12], P < .01) in expansion states. CONCLUSION: While operative outcomes and overall survival from HPB cancers were better in states with Medicaid expansion, there was no improvement in timeliness of initiating care or stage at diagnosis.

A Preliminary Controlled Trial of Endoscopic Ultrasound-guided Fiducial Markers to Guide Pancreas Surgery.

OBJECTIVE: Endoscopic ultrasound (EUS) is routinely used for fiducial marker placement (FMP) to guide stereotactic radiation of pancreatic tumors, but EUS-FMP explicitly to guide surgery has not been studied in a prospective, controlled manner. Multipurpose EUS systems have been developed that facilitate simultaneous EUS-FMP at the time of biopsy. We aimed to evaluate the feasibility of EUS-FMP to guide pancreatic resection. METHODS: In this prospective trial, we enrolled patients with resectable pancreas masses undergoing tissue sampling and placed preloaded fiducials immediately after biopsy. Intraprocedure confirmation of carcinoma, neuroendocrine, and nonlymphomatous neoplasia by rapid on-site evaluation and lesion size <4 cm was required. The main outcomes were the feasibility and ease of preoperative placement and intraoperative detection of the markers using predefined Likert scales. RESULTS: In 20 patients, EUS-FMP was successful before planned surgery and placement was technically straightforward (Likert Scale: 9.1 ± 1.3; range: 1, most challenging to 10, most facile). Intraoperative detection was feasible and improved when compared with a pre-established comparator of 5 representing an equivalent lesion without a marker (Likert Scale: 7.8 ± 2.2; range: 1, most difficult to 10, most facile; P = 0.011). The mean tumor size on EUS was 1.7 ± 0.9 (range: 0.5 to 3.6) cm. CONCLUSION: EUS-FMP is feasible and safe for resectable pancreatic tumors before surgery and may assist in perioperative detection. Preloaded fiducials may be considered for placement at the time of initial referral for EUS-fine needle biopsy.

High energy density storage, antifungal activity and enhanced bioimaging by green self-doped heteroatom carbon dots.

Self-heteroatom-doped N-carbon dots (N-CDs) with a 2.35 eV energy gap and a 65.5% fluorescence quantum yield were created using a one-step, efficient, inexpensive, and environmentally friendly microwave irradiation method. FE-SEM, EDX, FT-IR, XRD, UV-VIS spectroscopy, FL spectroscopy, and CV electrochemical analysis were used to characterise the produced heteroatom-doped N-CDs. The graphitic carbon dot surface is doped with heteroatom functional groups such (S, P, K, Mg, Zn) = 1%, in addition to the additional passivating agent (N), according to the EDX surface morphology and the spontaneous heteroatom doping was caused by the heterogeneous chemical composition of pumpkin seeds. These spontaneous heteroatom-doped N-CDs possess quasispherical amorphous graphitic structure with an average size of less than 10 nm and the interplaner distance of 0.334 nm. Calculations utilising cyclic voltammetry showed that the heteroatom-doped N-CDs placed on nickel electrodes had a high specific capacitance value of 1044 F/g at a scan rate of 10 mV/s in 3 M of KOH electrolyte solution. Furthermore, it demonstrated a high energy and power density of 28.50 Wh/kg and 3350 W/kg, respectively. The higher value of specific capacitance and energy density were attributed to the fact that the Ni/CDs electrode material possesses both EDLC and PC properties due to the sufficient surface area and the multiple active sites of the prepared N-CDs. Furthermore, the heteroatom N-CDs revealed the antifungal action and bioimaging of the "Cladosporium cladosporioides" mould, which is mostly accountable for economic losses in agricultural products. The functional groups of nitrogen, sulphur, phosphorus, and zinc on the surface of the CDs have strong antibacterial and antifungal properties as well as fluorescence enhanced bioimaging.

Trans-aortic DORV repair.

Double-outlet right ventricle (DORV) is a group of complex ventriculoarterial connections. In the literature, there are reports of trans-aortic correction of tetralogy of Fallot, as well as ventricular septal defects and complex DORV without right ventricular outflow tract obstruction. However, a pure trans-aortic approach for DORV ventricular septal defect (VSD) right ventricular outflow tract obstruction repair is not reported in the literature. We present a case of pure trans-aortic repair of DORV VSD pulmonary stenosis (PS) in an adult. A 20-year-old male with a known case of DORV, VSD, and PS presented with cyanosis. A pure trans-aortic repair of DORV was done. Complete trans-aortic DORV VSD PS repair is yet to be reported in the literature. The trans-aortic approach avoids a right atriotomy, right ventriculotomy, and injury to coronary arteries in cases of complicated tetralogy of Fallot and avoids injury to the tricuspid valve. This approach can be used in selected patients for intracardiac repair. The advantages are excellent visualization of the defects and avoidance of injury to the aortic cusps and bundle of His. In addition, placement of the VSD patch on the left ventricular outflow side may prevent residual shunts after repair. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-023-01564-x.

"Taste modification" strategy for prevention and control of hypertension in India: need for robust clinical trials.

Hypertension is an important modifiable risk factor for cardiovascular disease (CVD). Among normotensives, excessive dietary salt elevates the blood pressure and thereby increases the risk of CVD events. Despite such solid evidence, there is no effective approach to address excessive salt intake in India. Instead of just encouraging patients to lower their salt intake, we must provide an alternative technique by fostering an environment that facilitates this behaviour change. In this Viewpoint, we propose 'Taste Modification' strategy, i.e., a salt-reduction technique in which individuals are informed that adding spices/herbs to meals will reduce their salt intake. We hypothesise that a gradual reduction in salt intake can aid in the treatment of hypertension over time. The goal is to progressively substitute salt with spices for effective salt reduction. However, the 'Taste Modification' strategy must be first validated using multicentric clinical trials.