Efficacy of an indicated intervention program for Indian adolescents with subclinical depression

Subclinical depressive symptoms in adolescents are associated with a host of impairments and constitute a risk factor for future depression. The aim of the present study was to study the efficacy of a school-based group coping skills program for Indian adolescents with subclinical depression. Adolescents (n = 120) across two schools comprised the intervention and control groups and were assessed at baseline, post-intervention, and 3 months no-contact follow-up. The intervention group adolescents received the 8-weekly Coping Skills program in same-gender groups of 4-8 adolescents each, and the control group adolescents received one interactive psycho-educatory session. The intervention group evidenced clinically significant reductions in depressive symptoms, negative cognitions, and academic stress, and increased social problem solving and coping skills, at both post-intervention and follow-up. With regard to moderators, initial levels of depressive symptoms and homework compliance were found to partially moderate the effect of intervention. No effects were found for parental depression, gender, and age. The present study calls for future development and implementation of programs to address subclinical psychopathology among adolescents in Indian schools

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Suicidal risk and childhood adversity: A study of Indian college students

Background: The study was undertaken in response to reported increase in deaths due to suicide and suicidal behaviors in the youth. Aim: The objectives of the study were to assess childhood adversity and suicidal risk and to study the relationship between adverse childhood experiences and suicidal risk, in Indian students.Method: A cross sectional study design was conducted with 436 undergraduate students in the age range of 18-25. Suicidal risk was assessed using Scale for Suicidal Ideation and Beck's Hopelessness Scale. Parental Bonding Instrument and Early Trauma Inventory-Self Report (Short Form) were used to assess adverse childhood experiences.Results: Suicidal risk in terms of suicidal ideation and hopelessness was reported by 15% and 9%, respectively. Physical abuse is the most common form of early trauma, experienced in both males and females. Males experienced significantly more traumatic experiences in all domains. Affectionless control, which is considered as the pathogenic form of parent child bonding, is widely reported. A moderate degree of association exists between suicidal risk and early exposure to trauma. Higher suicidal ideation, hopelessness and trauma are reported in respondents with affectionless parental control and neglectful parenting.Conclusion: The study provides evidence of correlation between suicidal risk and childhood adversity in the Indian setting. (C) 2012 Elsevier B.V. All rights reserved

Elevated antimeasles antibody titre: An association in autoimmune encephalitis

Introduction: Autoimmune encephalitis is a group of treatable noninfective encephalitic disorders with great clinical implications. They have a close resemblance to prion disease and some slow virus infections. We report the presence of significant titers of antimeasles antibody in some of our patients with autoimmune encephalitis resulting in diagnostic and therapeutic problems. Patients and Methods: Patients seen by us in the last 4 years with high titers (1:625 dilution) cerebrospinal fiuid (CSF) antimeasles antibody positivity were reviewed retrospectively. The data collected were assessed using SPSS- Statistical Package for Social Sciences Version 15.0 (IBM corporation) software. The groups which showed elevated antimeasles antibody titers but did not have other parameters suggestive of subacute sclerosing panencephalitis (Group 2) were segregated and compared with those who had the typical features (Group 1) using Fisher's Exact Test. Results: There were 33 patients with antimeasles antibody in CSF. Group 1 had 27 and Group 2 had 6 patients. Group 1 had lower age, cognitive dysfunction, slow myoclonus, less generalized tonic-clonic seizures, and focal seizures. Group 2 patients belonged to the higher age, had significant psychosis (P = 0.02), incontinence of bowel and bladder (P = 0.0001). Slow myoclonus was significant in the first group (P = 0.028), and weakness was significant in the second group (P = 0.028) and double incontinence in the second group (P = 0.0001). Magnetic resonance imaging showed significant gray matter and cerebellar involvement in Group 2 P = 0.005 and P = 0.028, respectively. Conclusions: Patients who show significant titers of antimeasles antibodies in the CSF but belonging to older age group with psychosis, generalized tonic-clonic seizures, double incontinence, focal myoclonus, and electroencephalographic and imaging noncorroborative need to be investigated for autoimmune encephalitis in view of the great prognostic and therapeutic relevance

Treatment-related fluctuations in guillain barre syndrome and the conundrum of additional cycles of plasmapheresis

Introduction: In Guillain Barre syndrome (GBS), worsening of weakness or disability after initial period of recovery or stabilization is described as treatment-related fluctuations (TRF). Aim: This study aims to describe the clinical characteristics and outcome of six patients with GBS and TRF. Patients and Methods: Six patients with GBS fulfilling NINCDS criteria, evaluated at a tertiary care university hospital during 2008–2017, were diagnosed to have TRF. They form the basis of this report. Results: All patients were men and their mean age was 40 years. At presentation, mean duration of illness was 15 days; the illness had plateaued in three and progressive in other three patients. Two of the four patients had variant GBS. Initially, five patients were treated with large volume plasmapheresis (LVPP) and one patient with methyl prednisolone. At 17–28 days after disease onset, three patients developed new neurologic deficits (bilateral facial paresis in two; paralytic ileus in one). Other three patients with worsening of limb weakness (medical research council sum score of >5) and disability (Hughes disability grade by ≥1) fulfilled Kleyweg's criteria for TRF. All the six patients were treated with the completion of five cycles or additional cycles of LVPP. Conclusion: Awareness about TRF is essential for correct diagnosis and management of patients with GBS

Elderly pedestrian neurotrauma: A descriptive study from a premier neurotrauma center in India

Context: Experience with elderly pedestrian neurotrauma at a major neurotrauma tertiary center. Aims: To highlight the specific injuries and outcome of the elderly pedestrian neurotrauma patients within the city of Bangalore and its surrounding districts. Settings and Design: A retrospective study consisting of demographic data, clinical findings, radiological details, and outcomes. Materials and Methods: A study was conducted at the casualty services, in which 143 consecutive elderly pedestrian (age >60 years) head injury victims were studied from June to September 2009. The records from the hospital mortuary were analyzed from 2007 to 2009. An analysis of 77 elderly patients who died as a pedestrian in accidents during this period was performed. Statistical Analysis Used: SPSS 15. Results: The elderly pedestrians constituted 27% (143/529) of all pedestrian traumas. Two wheelers were the most common accident vehicle (56.6%, 81/143). Most of the injuries (38.5%, 55/143) occurred during peak traffic hours, that is, 4 pm to 9 pm. Majority sustained moderate to severe head injury (61%, 87/143). More than three‑fourths of patients required a computed tomography (CT) scan (77%, 110/143), in which there was a higher frequency of contusion (31.5%, 45/143), and subdural hemorrhage (23.1%, 33/143). Most of the injured (43.3%, 13/30) underwent surgery for intracranial hematoma. The mortality rate was 22.8% (8/35). Nearly one‑fourth of conducted postmortems among pedestrians belonged to the elderly age group (77/326, 23.6%). Conclusions: Elderly pedestrian neurotrauma patients sustain a more severe injury as evident by poorer Glasgow Coma Score (GCS) scores and CT scan findings, and hence have a higher mortality rate

Comparison of illness severity scoring systems for mortality prediction in Neurointensive Care Unit in India

Background: Illness severity scoring systems (SSs) are increasingly being used to provide information about patients’ severity of illness and outcome in terms of mortality or length of Intensive care Unit (ICU) and hospital stay. In this retrospective study, we compared the predictive power of Acute Physiology and Chronic Health Evaluation (APACHE) II and IV, Simplified Acute Physiology Score (SAPS), Mortality Prediction Model at 24 h and Glasgow Coma Scale (GCS) with actual in-hospital 28 day mortality in patients admitted to neuro-ICU over a period of 6 months. Methods: The data required for calculation of above scores was retrieved from medical records. The 28-day post-admission outcome including in-hospital mortality was measured by Glasgow Outcome Scale (GOS). Logistic regression was used to determine the mortality prediction power of each SS. Results: A total of 197 adult patients with varied neurological diagnosis were included in this study. The in-hospital 28-day mortality rate was 19.8%, and the scores of all the SSs correlated significantly with GOS (P < 0.001). All the scores were significantly different between survivors and non-survivors. The accuracy of all the SSs to predict survival and non-survival was more than 80%. The highest accuracy rate was seen for GCS and SAPS (84.3% and 83.8%, respectively). Conclusions: The SSs used in this study had good predictive power, and they had good discriminative ability between survivors and non-survivors. GCS and SAPS have the highest predictive ability, GCS having added advantage of being simple and practical

Anatomical Variations of the Temporomesial Structures in Normal Adult Brain - A Cadaveric Study

Background: Despite significant evolutional, functional, and clinical interest, the anatomical variations of the temporomesial structures in cadaveric samples have received little attention. This study was undertaken to document the anatomical variations observed in the temporal lobe of human brain with emphasis on the structures present in temporomesial region. Materials and Methods: Using 26 postmortem cadaveric cerebral hemispheres (13 right and 13 left hemispheres), several neurosurgically significant mesial structures were studied by blunt dissection under the operating microscope. The observed surface-based qualitative variations and right-left asymmetries were tabulated under well-defined, moderately defined, and ill-defined classification. Results: Among the areas, uncus (100%), limen insulae (88.4%), rhinal sulcus and hippocampus (81%), intralimbic gyrus (77%), Heschl's gyrus (73%), gyrus ambiens, semilunar gyrus, sulcus semiannularis, and calcar avis (69.2%) were well defined, and band of Giacomini (38.4%) was found to be distinctly ill-defined areas in the list. Further, our analysis confirmed the presence of consistent left-greater-than-right asymmetry in all the areas of interest in temporal region under well-defined category. Rightward asymmetry was noticed in moderately defined and ill-defined classification. However, no asymmetry was detected in the uncal region. P value for all the obtained results was >0.05. Conclusion: Our study offers a preliminary anatomic foundation toward the better understanding of temporal lobe structures. These variations may prove valuable to neurosurgeons when designing the appropriate and least traumatic surgical approaches in operating the temporomesial lesions