Emotion Processing Deficit in Euthymic Bipolar Disorder: A Potential Endophenotype

Background: Emotion processing deficits have been described in patients with bipolar disorder (BD) and are considered one of the core cognitive abnormalities in BD with endophenotype potential. However, the literature on specific impairments in emotion processing cognitive strategies (directive/cortical/higher versus intuitive/limbic/lower) in euthymic adult BD patients and healthy first-degree relatives/high-risk (HR) subjects in comparison with healthy controls (HCs) is sparse. Methods: We examined facial emotion recognition deficits (FERD) in BD (N = 30), HR (N = 21), and HC (N = 30) matched for age (years), years of education, and sex using computer-administered face emotions–Matching And Labeling Task (eMALT). Results: The three groups were significantly different based on labeling accuracy scores for fear and anger (FA) (P \u3c 0.001) and sad and disgust (SD) (P \u3c 0.001). On post-hoc analysis, HR subjects exhibited a significant deficit in the labeling accuracy of FA facial emotions (P \u3c 0.001) compared to HC. The BD group was found to have significant differences in all FA (P = 0.004) and SD (P = 0.003) emotion matching as well as FA (P = 0.001) and SD (P \u3c 0.001) emotion labeling accuracy scores. Conclusions: BD in remission exhibits FERD in general, whereas specific labeling deficits of fear and anger emotions, indicating impaired directive higher order aspect of emotion processing, were demonstrated in HR subjects. This appears to be a potential endophenotype. These deficits could underlie the pathogenesis in BD, with possible frontolimbic circuitry impairment. They may have potential implications in functional recovery and prognosis of BD

Dengue infection in India: A systematic review and meta-analysis

<div><p>Introduction</p><p>Dengue is the most extensively spread mosquito-borne disease; endemic in more than 100 countries. Information about dengue disease burden, its prevalence, incidence and geographic distribution is critical in planning appropriate control measures against dengue fever. We conducted a systematic review and meta-analysis of dengue fever in India</p><p>Methods</p><p>We searched for studies published until 2017 reporting the incidence, the prevalence or case fatality of dengue in India. Our primary outcomes were (a) prevalence of laboratory confirmed dengue infection among clinically suspected patients, (b) seroprevalence in the general population and (c) case fatality ratio among laboratory confirmed dengue patients. We used binomial–normal mixed effects regression model to estimate the pooled proportion of dengue infections. Forest plots were used to display pooled estimates. The metafor package of R software was used to conduct meta-analysis.</p><p>Results</p><p>Of the 2285 identified articles on dengue, we included 233 in the analysis wherein 180 reported prevalence of laboratory confirmed dengue infection, seven reported seroprevalence as evidenced by IgG or neutralizing antibodies against dengue and 77 reported case fatality. The overall estimate of the prevalence of laboratory confirmed dengue infection among clinically suspected patients was 38.3% (95% CI: 34.8%–41.8%). The pooled estimate of dengue seroprevalence in the general population and CFR among laboratory confirmed patients was 56.9% (95% CI: 37.5–74.4) and 2.6% (95% CI: 2–3.4) respectively. There was significant heterogeneity in reported outcomes (p-values<0.001).</p><p>Conclusions</p><p>Identified gaps in the understanding of dengue epidemiology in India emphasize the need to initiate community-based cohort studies representing different geographic regions to generate reliable estimates of age-specific incidence of dengue and studies to generate dengue seroprevalence data in the country.</p></div

Circulating dengue virus serotypes by state and region, India, 1982–2015.

<p>Circulating dengue virus serotypes by state and region, India, 1982–2015.</p

Meta-regression of variables associated with the proportion of laboratory confirmed dengue infections, based on a univariate and multivariate model.

<p>(n = 180).</p

Dengue seroprevalence by age, reported in 3 studies from India.

<p>Dengue seroprevalence by age, reported in 3 studies from India.</p

Flow diagram showing the article selection in the systematic review on dengue in India.

<p>Flow diagram showing the article selection in the systematic review on dengue in India.</p

Prevalence (proportion) of laboratory confirmed dengue among clinically suspected patients in India.

<p>Error bars indicate 95% confidence intervals. Diamonds show the pooled estimates with 95% confidence intervals based on random effects (RE) model.</p

Distribution of median age of laboratory confirmed dengue cases by year of study, India.

<p>Distribution of median age of laboratory confirmed dengue cases by year of study, India.</p

Proportion of severe dengue infections among laboratory confirmed dengue cases in India.

<p>Proportion of severe dengue infections among laboratory confirmed dengue cases in India.</p

Seroprevalence of dengue in India.

<p>Error bars indicate 95% confidence intervals. Diamonds show the pooled estimates with 95% confidence intervals based on random effects (RE) model.</p