Electroconvulsive therapy in geriatric patients: A literature review and program report from Virginia Commonwealth University, Richmond, Virginia, USA

Electroconvulsive therapy (ECT) is an effective therapeutic intervention in the elderly patients with major depression, especially those with psychosis, suicidality, catatonia, nutritional compromise, and resistance to medications. Response rates can be as high as 80%. We present an extensive review of the relevant literature, provide a description of the ECT program at Virginia Commonwealth University in Richmond, Virginia, USA, and present results of our experience with ECT in fifty elderly patients. The treatments were safe, well tolerated, and produced high response rates, variably between 68% and 84%. Patients in the long‑term maintenance ECT program continue to show sustained benefits from ECT

Delayed Onset and Prolonged ECT-Related Delirium

Electroconvulsive therapy (ECT) is effective in the treatment of depression. Delayed post-ECT delirium is rare but can occur in a small subset of patients with risk factors and in most cases resolves with the use of psychotropic medications. We report a unique presentation of a patient who developed a delayed post-ECT delirium with fecal incontinence that commenced 24 hours after the administration of ECT. The condition resolved spontaneously after 48 hours without the use of psychotropic medications

Effect of sustained released metformin therapy on phenotypic and biochemical markers of insulin resistance in polycystic ovary syndrome in South Indian women

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in young women. Insulin resistance (IR) may play a substantial part in the pathogenesis of PCOS, which leads to type 2 diabetes mellitus (T2DM), cardiovascular disorders and ovarian cancer. Metformin is an insulin sensitizing agent, however its role in PCOS is still controversial.Methods: Sixty women newly diagnosed with PCOS and healthy age matched controls between 18 to 45 years were enrolled after obtaining informed consent. Women in the PCOS group were started on metformin-SR 1gram orally, which was then increased to 1.5 grams after two weeks and continued for 6 months. Fasting blood sugar (FBS), fasting insulin (FI), SHBG, TT, free androgen index (FAI), homeostatic model assessment of Insulin resistance (HOMA-IR), homeostatic model assessment of β- cell function (HOMA-B), homeostatic model assessment of Insulin sensitivity (HOMA-S) and quantitative insulin sensitivity check index (QUICKI) were measured in the control group as well as PCOS group before and after metformin therapy.Results: After six months of metformin-SR therapy, PCOS group showed significant reduction in FI, HOMA-IR, HOMA- β, HOMA-S QUICKI, TT and FAI and significant increase in SHBG levels.Conclusions: Six months of metformin-SR therapy favorably altered markers of IR, TT, SHBG, anovulation and hyperandrogenism in normoglycemic women with PCOS

QTc Prolongation in Veterans With Heroin Dependence on Methadone Maintenance Treatment

Background: QTc prolongation and Torsade de Ppointes have been reported in patients on methadone maintenance. Objectives: In this study, QTc was compared before and after the veteran (n = 49) was on a stable dosage of methadone for 8.72 ± 4.50 years to treat heroin dependence. Risk factors were correlated with the QTc once the veteran was on a stable dose of methadone. Differences in the clinical risk factors in subgroups of veterans with below and above mean QTc change was compared. Patients and Methods: ECG data was obtained from a 12-lead electrocardiogram (pre-methadone and on methadone) on 49 veterans. Data and risk factors were retrospectively collected from the medical records. Results: The mean QTc at baseline (pre-methadone) was 426 ± 34 msec and after being on methadone for an average of 8.72 ± 4.50 years was significantly higher at 450 ± 35 msec. No significant relationships were found between QTc prolongation and risk factors except for calcium. The methadone dosage was significantly higher in veterans with a QTc change above the mean change of ≥ 24 msec (88.48 ± 27.20 mg v.s 68.96 ± 19.84 mg). None of the veterans experienced cardiac arrhythmias. Conclusions: The low complexity of medical co-morbidities may explain the lack of a significant correlation between any risk factor with the QTc except calcium and methadone dosage. The absence of TdP may be explained by the low prevalence of QTc values \u3e 500 msec as well as the retrospective design of the study. During long-term methadone treatment, there was a slight increase in the QTc interval but we did not find evidence of increased cardiac toxicity as a reason for treatment termination

Influence of Intrinsic Myocardial Conduction on Paced QRS Morphology During Cardiac Resynchronization Therapy Follow up

We report two cases of patients of cardiac resynchronization therapy (CRT) whose ECGs, during follow up, showed different paced QRS morphology as compared to those of immediate post-device implantation. Parameters of leads, including sensitivity and capture thresholds, were unchanged. There was no lead dislodgement confirmed on fluoroscopy. The ECGs obtained in device off mode showed different intrinsic QRS morphology as compared to those of pre-implant morphology. These changes were attributable to electrolyte imbalance in one patient and progressive intraventricular conduction defect in the other. These cases demonstrate that intrinsic myocardial conduction pattern influences paced QRS morphology. Irreversible change in paced QRS morphology may indicate poor prognosis

Surface and bulk infrared modes of crystalline and amorphous silica particles: a study of the relation of surface structure to cytotoxicity of respirable silica.

Surface IR (infrared) modes of crystalline and fumed (amorphous) silica particles, calcined at temperatures up to 1095 degrees C, have been studied by Fourier transform infrared spectroscopy. The ability of these same particles to lyse cells has been measured by a hemolysis protocol. The untreated crystalline and amorphous materials differ by a factor of 40 in specific surface area, and the intensity per unit mass of the sharp surface silanol band near 3745 cm-1 in the amorphous material is an order of magnitude larger than in the crystalline material. A similar difference is observed in the lysing potential of the two materials. The intensity of the silanol band increases after calcination for both materials, reaching peak values near 500 degrees C, followed by a dramatic drop at higher calcination temperatures, and reaching negligible values for materials calcined near 1100 degrees C. The lysing potential data follow essentially the same pattern for both crystalline and fumed silica. These results are consistent with the hypothesis that the surface silanol groups are involved in cell lysis. Further experiments are suggested to evaluate the relationship between the surface structure of silica particles and their potential cytotoxicity

High intensity exercise training programme following cardiac transplant

A 26-year-old male patient who presented with symptoms of end stage cardiac failure as a result of dilated cardiomyopathy, had an orthotopic cardiac transplantation. A comprehensive cardiac rehabilitation programme was provided to him and he was introduced to a sport (tennis). The exercise training programme progressed from low intensity training to high intensity programme over a period of 15 months. A cardio-pulmonary exercise test done 22 months after surgery suggested that he was able to achieve the aerobic capacity comparable to that of a normal South Indian subject. He participated successfully in the World Transplant Games in Sydney and returned safely. This suggests that after a proper cardiac rehabilitation programme, patients undergoing heart transplantation can achieve normal physiological responses to lead a normal active lif

Total serum cholesterol level in patients with major depressive disorder: Simple yet undermined

Human brain cholesterol acts as structural components of cellular membrane, synapse and dendrite formation.Researchers have found a possible association between low serum cholesterol levels and mood disorders though the literature from India in this regard is limited. To estimate serum levels of total cholesterol in patients with major depressive disorder. 75 patients of MDD were compared with equal number of age and sex matched controls. 5 ml of fasting sample of blood was obtained in a plain vacutainer to analyse total cholesterol level by Cholesterol oxidase-peroxidase method. Statistical analysis: The obtained results were tabulated and analyzed by multiple logistic regression analysis, independent t-test, Chi-square test and area under the curve. The mean level of cholesterol in cases (158.85±61.22 mg/dL) which was significantly lower compared to the controls (182.71±40.98 mg/dL) with P <0.01. The symptoms of MDD negatively correlated with lower serum cholesterol level with odds ratio of 0.99. There was statistically significant lower level of cholesterol in the MDD group below 140 mg/dL compared to the control group with P <0.001. As the measurement of total serum cholesterol is simple and cost effective, it can be used as an important biochemical marker for MDD

Activation of fibrinolytic pathways is associated with duration of supraceliac aortic cross-clamping

Purpose The cause of the coagulopathy seen with supraceliac aortic cross-clamping (SC AXC) is unclear. SC AXC for 30 minutes results in both clotting factor consumption and activation of fibrinolytic pathways. This study was undertaken to define the hemostatic alterations that occur with longer intervals of SC AXC. Methods Seven pigs underwent SC AXC for 60 minutes. Five pigs that underwent infrarenal aortic cross-clamping (IR AXC) for 60 minutes and 11 pigs that underwent SC AXC for 30 minutes served as controls. No heparin was used. Blood samples were drawn at baseline, 5 minutes before release of the aortic clamp, and 5, 30, and 60 minutes after unclamping. Prothrombin time, partial thromboplastin time, platelet count, and fibrinogen concentration were measured as basic tests of hemostatic function. Thrombin-antithrombin complexes were used to detect the presence of intravascular thrombosis. Fibrinolytic pathway activation was assessed with levels of tissue plasminogen activator antigen and tissue plasminogen activator activity, plasminogen activator inhibitor-1 activity, and α2-antiplasmin activity. Statistical analysis was performed with the Student t test and repeated measures of analysis of variance. Results Prothrombin time, partial thromboplastin time, and platelet count did not differ between groups at any time. Fibrinogen concentration decreased 5 minutes (P = .005) and 30 minutes (P = .006) after unclamping in both SC AXC groups, but did not change in the IR AXC group. Thrombin- antithrombin complexes increased in both SC AXC groups, but were not significantly greater than in the IR AXC group. SC AXC for both 30 and 60 minutes produced a significant increase in tissue plasminogen activator antigen during clamping and 5 minutes after clamping. This increase persisted for 30 and 60 minutes after clamp release in the 60-minute SC AXC group. Tissue plasminogen activator activity, however, increased only in the 60-min SC AXC group during clamping (P = .02), and 5 minutes (P = .05) and 30 minutes (P = .06) after unclamping, compared with both control groups. Conclusions Thirty and 60 minutes of SC AXC results in similar degrees of intravascular thrombosis and fibrinogen depletion. Although SC AXC for both 30 and 60 minutes leads to activation of fibrinolytic pathways, only 60 minutes of SC AXC actually induces a fibrinolytic state. Fibrinolysis appears to be an important component of the coagulopathy associated with SC AXC, and is related to the duration of aortic clamping