A Randomized, Open Labelled, Single Centered Study of Metformin in Preventing Metabolic Syndrome Associated with Initiation of Atypical Antipsychotic Therapy in Adolescents and Young Adults

BACKGROUND: Schizophrenia is a debilitating brain disorder characterized by a chronic remitting and relapsing course of psychosis that is superimposed on persistent "deficit" features such as negative symptoms and cognitive dysfunction. Metformin is a member of biguanide class of oral hypoglycemic agents. It has been tried for the prevention of metabolic syndrome associated with the use of atypical antipsychotics. OBJECTIVE: The purpose of the study was to evaluate the effectiveness and safety of Metformin along with Risperidone to prevent antipsychotic-induced metabolic syndrome in first episode schizophrenia patients. METHODS: A randomized, open labelled, prospective study was conducted in the Department of psychiatry, Tirunelveli Medical College from March 2013 to February 2014. Around 96 patients with 18 to 40 years of age who have been diagnosed with first episode schizophrenia based on DSM - IV criteria and on treatment with T.Risperidone 2 mg twice a day for ≤ 2 months were enrolled for the study. They were randomized into 2 groups. Group1 patients were given T. Risperidone (2 mg twice daily, n=48) and group 2 Patients were given T.Metformin (500 mg twice daily, n=48) along with T.Risperidone for 6 months. The primary endpoint assessed was the proportion of patients developing metabolic syndrome at the end of 6 months in both the groups. The secondary end points were the changes in body mass index, waist circumference, fasting blood sugar and triglycerides from baseline to the end point and the proportion of patients progressing a stage higher from the baseline in terms of BMI at the end of 3 months. RESULTS: Baseline characteristics were similar in both the groups (p>0.05) except that the patients in group II had higher BMI levels (p < 0.001) and larger waist circumference levels (p = 0.04). Of the 48 patients in group I, 10 patients developed metabolic syndrome and of the 48 patients in group II, only 1 patient developed metabolic syndrome. There was a significant reduction in BMI and waist circumference at the end of 3 months (p < 0.001) and at the end of 6 months (p < 0.001) when compared to baseline in group II individuals. There is significant reduction in FBS and Triglyceride levels at the end of 6 months of treatment (p < 0.001) in group II individuals. When compared to group I, significantly lesser proportion of patients in group II progressed to the next stage in terms of BMI, 3 months after treatment. There was significant statistical difference between both the groups (p<0.05) in terms of BMI, WC, FBS, triglycerides. The treatment emergent adverse effects with Metformin was generally mild and did not lead to any discontinuation. CONCLUSION: The use of Metformin along with Risperidone was safe and effective in the prevention of metabolic syndrome induced by atypical antipsychotics. This may have a good impact on the long term cardiovascular morbidity and mortality of the schizophrenia patients

The Effect of School-Based Mindfulness Intervention on Student Attention and Executive Function: A Meta-Analysis

Schools are facing increasing responsibility to foster the social-emotional development of students. One way in which schools can improve student functioning is through school-based mindfulness interventions. Using mindfulness practices, in particular, can teach students to increase their attention of surroundings and internal experiences, and awareness of their thoughts and behaviors. While the evidence-base for mindfulness interventions in schools continues to grow, there are several studies that show promising outcomes. The purpose of this study was to determine how large the effect sizes for school-based mindfulness studies are in regard to increasing student attention, cognitive flexibility, and working memory. Results indicate an overall positive, small-to-moderate effect of school-based mindfulness intervention on student attention and executive functioning. Results suggest that mindfulness techniques may be a reasonable addition to any classroom. Future research should work to clearly communicate the components of school-based mindfulness interventions. Additionally, future research should evaluate the benefit of using school-based mindfulness interventions with at-risk students or students who receive special education services. Future meta-analyses would benefit from clear reporting of participant characteristics and investigation of narrow constructs relating to the behavioral and emotional functioning of students

Cardiovascular magnetic resonance of the right ventricle

Introduction: Whilst most of the attention has been devoted to the left ventricle in cardiovascular disease, the right ventricle has been somewhat neglected. In the last decades, there has been a renewal of interest in the right ventricle, in part driven by advances in cardiovascular imaging. Methods: Cardiovascular magnetic resonance is arguably the best imaging modality for the study of the right ventricle. In this research thesis, cardiovascular magnetic resonance was used as the primary research tool to assess the right ventricle in different conditions and settings. Results: This thesis encompasses five studies that have been published as peer - reviewed articles. The results of these studies were the following: 1)Right ventricular dilatation and dysfunction was found in a group of patients with Marfan syndrome, further supporting the existence of a Marfan - related cardiomyopathy; 2) In thalassaemia major, right ventricular volumes and ejection fraction differed from healthy controls, and new reference ranges based on patients without iron overload were derived; 3) Myocardial iron loading in thalassaemia major was associated with progressive right ventricular dysfunction; 4) Right ventricular dysfunction due to myocardial siderosis was reversible with effective iron chelation therapy, and; 5) In advanced heart failure, right ventricular function was a predictor of response and outcomes in patients undergoing cardiac resynchronization therapy. Conclusion: The right ventricle is an essential component of the circulatory system, and should be more widely evaluated in patients with cardiopulmonary disease

Production and characterisation of acellular porcine pulmonary heart valve conduits

Cardiac valve replacement is the second most common heart operation. Currently available replacement heart valves all have limitations. This study aimed to produce and characterise a decellularised, biocompatible porcine pulmonary root conduit for use in the Ross procedure. A process for the decellularisation of porcine pulmonary roots was developed incorporating trypsin (2.25 × 104 Unit.ml-1) digestion of the adventitial surface of the scraped pulmonary artery and sequential treatment with: hypotonic Tris buffer (HTB; 10mM Tris pH 8.0, 0.1% (w/v) EDTA, 10KIU aprotinin), 0.1% (w/v)SDS in HTB, two cycles of DNase and RNase, and sterilisation with 0.1% (v/v) peracetic acid. Histology confirmed an absence of cells and retention of the gross histoarchitecture. DNA levels were reduced by >90 % throughout the decellularised tissue and functional genes were not detected using PCR. Immunohistochemistry showed a lack of α-gal epitopes and confirmed cell removal but a loss of collagen IV. In vitro biocompatibility studies indicated the decellularised leaflets were not cytotoxic while the pulmonary wall was shown to reduce 3T3 cells viability in 3 out of 6 samples. Uniaxial tensile testing to failure demonstrated no significant difference in the tensile properties between the fresh and decellularised leaflets and pulmonary walls in the circumferential and radial directions with the exception of the elastin phase slope of the pulmonary artery in both directions which showed a significant decrease in the decellularised tissue. Pulsatile flow testing indicated the decellularised pulmonary roots had excellent hydrodynamic function and leaflet kinematics in comparison to the fresh tissue. Initial attempts to culture fresh pulmonary roots in a heart valve bioreactor were unsuccessful, indicating a need to develop the physiological culture system further. Overall the decellularised porcine pulmonary roots have excellent potential for development of a tissue engineered solution for right ventricular out flow tract reconstruction during the Ross procedure

Professionalism in medicine. What is it and how can it be taught?

This study examines the conceptual framework and teaching of medical professionalism from the perspectives of the literature on the subject, clinicians engaged in clinical teaching regarding professionalism, and medical students. I begin with a brief history and overview of the concepts of professionalism in medicine. I follow that with a Best Evidence in Medical Education (BEME) systematic review of the literature to identify the best evidence for how professionalism should be defined and taught. This review found that there is as yet no overarching conceptual context that is universally agreed upon. The development of ways to teach and assess professionalism has been encumbered, and failed to progress, in large part because of this amorphous nature of the various definitions promoted. The review also found no unifying accepted theory or set of accepted practice criteria for teaching professionalism. Evident themes in the literature are that role modelling and personal reflections, ideally guided by faculty, are the important elements in current teaching programs, and are widely believed to be the most effective techniques for developing professionalism. While it is generally agreed that professionalism should be part of the whole of a medical curriculum, the specifics of sequence, depth, detail, and the nature of how to integrate professionalism with other curriculum elements remain matters of evolving theory. No teaching methodology has been demonstrated in the literature to be effective or accepted for use across a wide range of medical schools. I next developed and carried out qualitative studies to discover what conceptual understanding (mental models) of professionalism medical students and clinical educators held, how these two groups view current professionalism training as a component of medical education, and how they think it should be taught. I found that medical students achieve professionalism through the influence of their exposure to seasoned professionals and through informal peer reflection. The doctors in my study group achieved professionalism not through any formal training they received, but as a result of the actions and attitudes they witnessed during their training, which created a path to reflective practice that they have sustained. I conclude by proposing a conceptual model for instilling professionalism through medical education. This model captures the formative influences on professionalism and provides a framework for understanding professional performance. The teaching of professionalism should be integrated into all years of the medical curriculum, and across all disciplines included in the curriculum. Some attributes of professionalism, such as ethics and communication skills, can be introduced in early years. Mentoring and exposure to positive role models hold the most promise as effective teaching methods. Guided reflection turns transient incidents and experiences into true learning moments, solidifying and honing professionalism. Ultimately professionalism should be viewed as an ethos. I hope that my findings will improve our ability to instil professionalism in our students

B-Complex Vitamins

This book provides the most current information on the effects of vitamin B deficiency as well as the roles of niacin (vitamin B3), pyridoxine (vitamin B6), folate (vitamin B9), and vitamin B12 in numerous disorders. Chapters discuss novel applications of B-complex vitamins, such as thiamin in patients with critical conditions, dietary supplements in the prevention of renal stones, and treatment of COVID-19. Throughout, the authors discuss the effects of vitamin B deficiency from retrospective, perspective, and prospective points of view

On the Origin of Dementia : a Population Perspective on Risk and Aetiology

Recent years have seen a surge in dementia research, with increasing awareness that preventive strategies are key to curbing the dementia epidemic. Drawing from long-term population-based studies, this thesis describes the burden of dementia in terms of (healthy) life years lost, lifetime risk of developing disease, and the past and potential effects of preventive interventions on dementia incidence. Furthermore, the role of (disturbances in) cerebral blood flow, for instance due to carotid artery stenosis, and that of cerebral autoregulatory mechanisms in the onset of dementia is extensively discussed. In the subsequent chapter, a literature review that ties coronary heart disease and heart failure to the risk of dementia is followed by exploration of potential underlying mechanisms, including thromboembolic disease (e.g. Von Willebrand factor and ADAMTS13), (vascular) amyloid-β, and aortic valve calcification. Finally, the heritability of dementia and Alzheimer’s disease is yielded for both aetiological and predictive purposes. In particular, the role of the Apolipoprotein E (APOE) gene is described in mortality and for clinical trial design, followed by the use of parental family history and common genetic variants for risk prediction. This thesis concludes with methodological considerations and recommendations – or rather a wish list – for future research to strive and take dementia into the realm of forgotten diseases

Electrocortical correlates of autism / by Stephanie Powers Whitmont.

A review of the autism literature identified basic concepts of disorder and main issues associated with the historical emergence of an organic approach to etiology. A critical review of the electrocortical studies in this literature revealed several problems, which collectively challenge the validity and reliability of many conclusions drawn about EEG variables in autism. Major problems were sample heterogeneity, motor artefacts, failure to control for cognitive ability, and confused interpretation of experimental outcome

Environmental Effects on Health: Ignorance and Undone Science

Considerable research has been completed showing that environmental exposures can have significant effects on people’s health, especially in terms of autoimmune conditions, cancers, and neurological and psychological conditions. Health effects are possible at exposure levels far below those generally considered safe by orthodox health authorities. A prime example is multiple chemical sensitivity (MCS), where sufferers themselves have made clear, short-term associations between health effects and low-level environmental exposures. The condition of MCS is not clearly definable and significantly overlaps with other, largely unrecognised health conditions including fibromyalgia (FMS), chronic fatigue syndrome (CFS), electro hypersensitivity syndrome (EHS) and chronic inflammatory response syndrome (CIRS). The orthodox medical diagnostic process is implicated in the production of ignorance on such health conditions. Despite the large amount of research showing health effects from low level environmental exposures, there remains much “undone science” in the field - research that could be done but isn’t. The reasons for undone science and the consequent societal ignorance are generally due to society’s ingrained desire for technological improvements. Industry, responsible for technological developments the use of chemical products or radiation devices, is not interested in possible health effects, so expensive scientific research into them is left undone. When subsequent research or firsthand experiences of health effects start to be realised there is ample evidence that the industries responsible for environmental exposures then become active in generating ignorance. Due to close ties with industry, medical and health systems become complicit in industry’s strategy, and knowledge is manipulated by the industry funding of scientific studies, which then influences the conclusions of the research. The support of industry products by institutions, including regulatory agencies, due to conflicts of interest also contributes to knowledge manipulation. Common industry strategies of generating ignorance also include using doubt, blame, power, industry shills, astroturfing, smear campaigns, media manipulation and fact checking services. Future generations of children who inherit contaminants from their conception will be most affected by the gross neglect of their effect on health. The carry-through of health effects and their magnification in subsequent generations is a tragedy in the making

A history of stigma : towards a sociology of mental illness and American psychiatry

Using genealogical discourse analysis, this project examines how American psychiatrists utilized the concept of stigma in The American Journal of Psychiatry as it relates to illness and treatment from 1846-2007. Once historicized, stigma takes the form of four themes, i.e. the stigma of psychiatric practice, euphemistic stigma, the stigma of treatment, and the stigma of mental ilhness. These themes each result in numerous strategies to diminish their effects in the population and the individual patient through national campaigns to combat stigma. This thesis also identifies the role of an emerging medicalization of mental illness' stigma and how this medicalization has specific implications for psychiatric treatment and social inclusion. The alignment of stigma alongside particular diagnostic categories has far reaching consequences as it attempts to circumvent the critical discourse which began with the anti-psychiatry movement in the 1960s. In this way, this thesis reveals American psychiatry's effort to de-stigmatize itself through campaigns to reduce the stigma of mental illness