18 research outputs found
Psychiatric Sequelae in Head Injury patients ā A Case Control Study.
INTRODUCTION:
Classification of head injuries
The head injuries are classified according to severity of head
Injures. The severity of head injures is best gauged by the depth and the
Duration of the impairment of consciousness following the head injury.
In gauging the head injury. Glasgow coma scale (gcs) is most
Commonly used (teasedale & jennet).
Head injury classification
Head injury glasgow coma scale
Mild 13-15
Moderate 9-12
Severe 3 -8
Head injuries can also be classified as :
1) penetrating
2) non penetrating
According to nature of damage as :
concussion
contusion
laceration
According to site of injury
right
left
bilateral
frontal
parietal
temporal
occipital
frontoparietal
parieto occipital
temporoparietal
According to site of bleed
extradural
epidural
subdural
subarachnoid
intracerebral
Head injury is 2nd most important causes of mortality after
Cancer. Early mortality has considerably improved as a result of
Advances in the management of the early acute stages.
Chronic sequale remain, a challenge to medical care and
Communal resources, mental sequale outstrip the physical as a cause of
Difficulty with rehabilitation, hardship at work, and social incapacity
Generally.
Clinical features
Acute behavioral consequences.
Most patients admitted to hospital have a mild injury. Minority
Of these patients develop acute complications . Brain swelling, delayed
Haematoma and intracranial infection) or prolonged postconcussional
Symptoms.
Most common consequence of head injury is impairment of
Consciousness, ranging from transient confusion to protracted coma.
The glasgow coma score (gcs) is commonly used to grade the severity
Of traumatic brain injury. Scale gives a quantitative assessment of level
Of consciousness and neuro-logical status based on patterns of eye
Opening, as well as best verbal and motor responses.
Gcs scores between 13 and 15 define mild brain injury, 9-12
Define moderate brain injury and scores between 3 and 8 define severe
Brain injury.
Early phase of recovery from traumatic brain injury is
Characterized by disorientation, confusion and impaired memory
Function. Post traumatic amnesia occurs during the period when the
Patient is disoriented and confused. Duration of post traumatic amnesia
Used as a measure of traumatic brain injury.
Duration of post traumatic amnesia has proved to be a good
Predictor of the degree of disability, vocational outcome and severity of
Personality change after traumatic brain injury. Delirium in brain injury
Patients may be due to structural brain damage, cerebral edema, brain
Hypoxia, seizures, electrolyte imbalance, infections, medications or
Alcohol withdrawal.
Chronic behavioral consequences
Cognitive disorders ā cognitive disturbances are one of the most
Important long term sequale of severe traumatic brain injury. Study on
127 patients after 1 year follow up showed slower information
Processing and greater impairment in memory than control group.
Memory functions are also impaired in traumatic brain injury patients.
Dsm iv t.r diagnosis of amnesia disorder due to traumatic brain injury
And chronic subtype may be made for those non demented patients.
Several neuro psychological tasks are present to quantify these
Deficits.
Dementia
Dementia is a syndrome defined by dsm ā iv tr by impairment
Of memory and at least one other cognitive domain in the absence of
Alteration of consciousness.
Apart from memory disturbances, these patients may be severely
Apathetic and withdrawn.
Traumatic brain injury is associated with expression of amyloid
Precursor protein, oxidative stress and an increased deposition of
Amyloid ā b peptides that leads to onset of dementia.
Personality changes
Traumatic brain injury patients may experience significant
Personality changes. These patients may be irritable, childish, anxious
Or aggressive. Disinhibition is frequent and striking clinical feature that
May lead to antisocial behavior, at the other end they may become
Apathetic, abulic and withdrawn.
Some investigators divide these changes in to 2 syndromes a
Pseudo-depressed personality syndrome characterized by apathy and
Blunted affect, and a pseudopsychopathic personality syndrome which is
Characterized by disinhibition, egocentricity and sexual ina
Propriateness. Dsm ā iv tr defines personality change due to
Traumatic brain injury as a persistent personality disturbance that
Represents a change from individualās previous personality.
Roberts (1976, 79) survey of long term outcome of severe head
Injuries found the commonest pattern of personality change had a
Distinctly frontal character, termed it as āfronto ā limbic dementiaā.
Temporal lobe injury associated with aggression and poor
Impulse control.
Mood disorders
Depressive disorders
Depressive disorders appear to be frequent complication among
Patients with traumatic brain injury patients.
According to dsm ā iv tr diagnostic criteria, depressive
Disorder due to brain injury is divided in to
(1) with major depressive like episode.
(2) with depressive features.
Frequency varies from 6 to 77 percent, in another study major
Depression frequency was 61 percent. In another study 2 years after
Injury depression was found to be 42 percent.
In another study 91 patients followed up for 2 years. 47 patients
Developed mood disorder in the first year of follow up. Major depressive
Disorder was occurred in 30 patients, nine patients had minor depression
And remaining had manic or mixed episodes. Concluded that
Approximately one half of traumatic brain injury patients develop mood
Disorder in the first year of injury.
Patients who were vulnerable developing mood disorders were
Not significantly different with regard to demographic variables, severity
Of brain injury or degree of functional disability.
Depressed patients were more likely to have a personal history of
Mood and anxiety disorders than the nondepressed group.
Analysis of the oxford collection of head injury records
Suggested that depressive symptoms were more common among patients
With right hemisphere lesions. Symptoms of depression also more
Among patients frontal and parietal lesions than among patients with
Other lesion locations.
(jorge, robinson) study of depressive disorder in patients after
Traumatic brain injury was associated with left dorsolateral frontal or
Left basal ganglia lesions.
Most consistent clinical correlate of depressive disorder is poor
Psychosocial adjustment.
Secondary mania ā have been reported in a number of organic
Disorders such as thyroid disease, uremia and vitamin b12 deficiency or
After open heart sugery.
Recent study reported 6 of 66 patients had secondary mania one
Year after injury. Secondary mania was not related to type or severity of
Brain injury but a association was found with lesions in the ventral and
Anterior aspects of temporal lobe.
Differential diagnosis of mania after traumatic brain injury
Include substance induced mood disorder, psychotic syndrome
Associated with epilepsy.
Anxiety disorders
Anxiety disorders after traumatic brain injury may manifest
Themselves as pathological worrying, anxious foreboding and autonomic
Symptoms.
Prevalence of obsessive-compulsive disorder occurring after
Traumatic brain injury has been estimated to be 2 to 4 percent.
Post traumatic stress disorder following tbi is characterized by
Recurrent intrusive recollections, distressing dreams, and flash backs of
Traumatic event.
There has been controversy regarding whether ptsd can develop
After traumatic brain injury, it has been thought that loss of
Consciousness is inversely proportional to development of ptsd
Prevalence of ptsd to be 27 to 38 percent after traumatic brain
Injury.
Vulnerability to anxiety disorders after traumatic brain injury has
Been studied extensively but no specific characteristic has been noted in
Terms of severity of brain injury, or social, physical or cognitive
Impairment but one study noted the symptoms present with right orbito
Frontal cortex lesions.
In patients with anxious depression focal right hemispheric
Lesions was found.
Psychotic disorders
Frequency of psychotic disorders in traumatic brain injury was
7%, these symptoms were observed within 2 years after head injury
Positive symptoms were more frequent.
Pathology of brain injury
neuropathological classification of traumatic brain injury
Lesions.
Focal lesions
intra cranial ā extra cerebral haemorrhage (epidural and subdural
Hemotomas and subarachnoid hemorrhage).
intra cerebral hemorrhage.
focal ischaemic lesions.
Diffuse lesions
diffuse axonal injury.
diffuse ischaemic damage.
Pathology
Types of primary and secondary brain injuries.
First level of categorization of head injury divides them into
Closed or penetrating injuries depending on the integrity of meningeal
Coverings. Missile wounds are the most frequent cause of penetrating
Brain injuries.
Motor vehicle accidents are the most frequent cause of closed
Trauma, which represents the majority of tbi.
Primary brain damage is produced by contact and inertial forces
That occur at the time of injury. Contact forces may result in laceration
To the scalp, skull fractures, intracranial hemorrhages, contusion and
Intracerebral hemorrhages.
Inertial loading consists of acceleration, deceleration and
Rotational forces that result in diffuse axonal injury and eventually acute
Subdural hematoma from the tearing of subdural bridging veins.
Secondary brain damage is produced by pathological processes
That are initiated at the moment of injury but spans a variable period
After the traumatic episode.
These include brain damage secondary to ischaemia (that
Resulting from hypertension or hypoxia or both), brain swelling, raised
Intracranial pressure and infection.
Focal lesions consists of contusions and lacerations that usually
Occur at the surface of brain. More prominent at the crest of cerebral
Gyri and have a predilection for the frontal and temporal poles.
Lacerations are usually accompanied by extracerebral hemorrhages
(burst lobe).
Intracranial extracerebral hemorrhages occur in the epidural
Space. (ie between the skull and dura), the subdural space (ie between
Dura and arachnodi) or the subarachnoid space.
Intracerebral hemorrhages are often multiple involving frontal
And temporal lobes and basal ganglia and may have a delayed onset (ie
Hours or days after trauma).
Diffuse lesions include diffuse axonal injury which occur within
Corpus callosum, thalamus and dorsolateral quadrants of the upper
Brainstem. Pathologic processes include fragmentation of the
Axolemma, axonal transport disruption axonal bulb formation,
Astrogliosis and microglial activation.
Ischaemic damage is highly prevalent among patients with head
Injuries.
The influence of these different patterns of injury on the
Psychiatric disorders after traumatic brain injury has not been
Extensively studied.
Focal and diffuse lesions usually coexist in traumatic brain
Injured patients. .
Cognitive impairment after head injury
Cognitive impairment is, of course, the direct result of the
Damage to brain tissue which has occurred. Minor injuries are
Compatible with full intellectual recovery, even when indubitable loss of
Consciousness has occurred, in the sense that the patient feels himself to
Be unimpaired and psychometric tests
Treatment of head injury :
The treatment of acute stages of head injury and neurosurgical
Interventions and early complications have not been covered up as they
Are rarely dealt by the psychiatrists.
Once the patient starts recovering and is out of neurosurgical care
Psychological management has great importance in determining the
Prognosis of the patient.
Early management :
Initial convalescent period is usually undertaken in hospital and
Ideally in an atmosphere as free from stress as possible. Mental exertion
Should be avoided at the same time physical activity should be
Encouraged. Gradual exercises should be started with would also boost
Up patients morale.
Time should be devoted to exploration of patientās anxieties.
Fears should be brushed aside. Explanations should be given regarding
The initial symptoms. More detailed and specialized care is required by
Patients who have more severe brain damage with neurological sequelae
And intellectual impairment. Also special attention should be given
Towards patients with minor injures but with persistent psychiatric
Disability.
Neurological sequelae
These are treated mainly with the help of neurologist,
Physiotherapist and occupation therapist.
Rehabilitation of cognitive functions is a very challenging task.
Full psychometric assessment is very essential. There may be
Impairments of memory, verbal ability, comprehension, visuospatial
Ability, attention and manual dexterity.
A optimistic approach is required in order to install enthusiasm
With ready allowance for fatigue and tolerance for short comings. The
Programme should be graded with goals at any stage which should
Rational, realistic and achievable.
Xangwill has stressed that the emphasis should be placed on
Reeducation, compensation and substitution in rehabilitation.
Reeducation involves retraining of the patients in skills and
Accomplishments which have been impaired. Compensatory functions
Must be trained, if attempts at reeducation fail. Compensatory functions
Like using props for memory or methods of expression in severe motor
Dysphasia can be used. Substitution is required when damage to a
Particular function is irreparable. Newcombe had reviewed various
Strategies to assist rehabilitation with cognitive retraining.
Personality changes following head injury are difficult to modify.
Psychotherapy is relatively superficial and should be aimed to help the
Patient to achieve some insight into what he is lacking. A behavioural
Modification should be tried to reduce disruptive behaviour and
Encourage constructive behaviour. Psychotherapy and hebavioural
Therapies may be of use in patients with depression, phobias or
Headaches and postconcussional syndrome.
Tranquillizing drugs such as benzodiazepaines may help to
Relieve tension and anxiety. Antidepressants will help in depression.
Chlorpromazine will be of help in patients with frontal lobe injures.
Antipsychotic will help in acute delirium, psychosis and outburst of
Violence. Anticonvulsants like carbamazapine may be of help in
Preventing outburst of aggression
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Not AvailableIndia holds unique position in the world in terms of rich diversity of vegetable oil sources and oil crops followed by cereal crops. Mostly nine annual oilseeds crops are growing in India, namely, groundnut, rapeseed-mustard, sesame, safflower, niger, soybean and sunflower, forming the edible group and linseed and castor, forming the non-edible group. Linseed due to its unique nutritional value has high potential to be an edible oil crop as well. In addition cotton seed, rice bran and seeds of some tree species are being exploited for edible oil.Oilseed crops serve as important raw material for the manufacture of soaps, paints and varnishes, hair oils, lubricants, textiles, auxiliaries, pharmaceuticals, etc. apart from oils and fats. Oilcakes and meals are majorly used in animal feeds and as manures.
India contributes about 6-7% of the world oilseeds production. While the huge annual import value of over 56,000 crores worth edible oil is much publicised, hardly any efforts are made to enhance the annual export value of over 25,000 crores through value addition for which technologies are available. In order to resolve these issues 21st Century should adopt āThree Pronged Strategyā in planning the research and development activities for the industry. The three strategies are high-income strategy for maximization of the land use, biomass utilization to optimally exploit non-oil biomass and value added strategy to focus on high value products such as oleo chemicals and phytonutrients (Rethinam, 2009). Advantage of exports can further be consolidated with proper policy back-up and value addition. In this context an effort is made through this article to highlight the opportunities for value addition in annual oilseeds. India contributes to 85% of castor oil production reaping only 15% of global value. Opportunities for value addition in India for the oilseeds are briefly presented below.Not Availabl
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Not AvailableA new series of eco-friendly cross linked guar gum-g-poly(acrylate) porous superabsorbent hydrogels wasprepared by in situ grafting polymerization and cross-linking on to a natural guar gum employing N,N-methylene bis acrylamide as cross linker. Morphological and structural characterization of the prepared hydrogels (SPHs) done by Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy(SEM) and solid state C13NMR spectroscopy confirmed formation of porous grafted and crosslinked hydrogel structure. Increase in cross linker concentration in the feed mass exhibited decrease in porosity and increase in density of the hydrogels. Swelling of an optimized hydrogel (SPH) in response toexternal stimuli namely, salt solutions, fertilizer solutions, temperature, and pH exhibited high swellingratios in various environments. Swelling rate of the SPH was faster than the corresponding nonporous superabsorbent hydrogel. The prepared hydrogels can serve as excellent carriers of pesticides, fertilizers and agriculturally important microbes. Biocontrol formulations based on a representative SPH exhibited excellent shelf-life characteristics and bioefficacy against phytopathogenic fungus Pythium aphanidermatum.Not Availabl
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Not AvailableNanocitrates of iron (Fe) and zinc (Zn) in the form of plant nanonutrients were examined for their behavior in soil and the uptake of these by 20-day old groundnut (Arachis hypogaea) seedlings under greenhouse conditions. The Fe (0.04 to 0.008 mmol/kg of soil) and Zn (0.02 to 0.004 mmol/kg of soil) nanocitrates were applied to soil and compared with commercial counterparts (FeSO4, ZnSO4, nano-Fe, nano-Zn, Fe-EDTA, Zn-EDTA). The combined nanocitrate compositions were also formulated by physical means and characterized. The plant uptake of Fe and Zn was determined through atomic absorption spectrometry (AAS). All the treated plants showed good germination and higher vigor indexes compared to the control treatments. The highest available Fe and Zn soil contents after leaching were 150.5 and 18.9 mg/kg, respectively, in combined nanocitrate compositions, whereas in the control (untreated) soil, the Fe and Zn contents were 6.0 and 0.7 mg/kg, respectively. The plantās Fe content was 0.48 mg/pot for the combined nanocitrate composition, and that of the untreated plant sample was 0.02 mg/pot. The plantās Zn content was 82.3 Ī¼g/pot for pure zinc citrate, and the respective untreated-plant Zn content was 2.1 Ī¼g/pot. These values are better than those observed for commercial fertilizers. Additionally, no trend in promotional and antagonistic correlations between Fe and Zn in combined nanocitrates was observed in the studied period (20 days in duration). Among the 34 synthesized citrates, six nanocitrates show promising trends for evaluation under field conditions with higher stability.Not Availabl
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Not AvailableA series of iron (Fe) and zinc (Zn) plant nanonutrients in citrate form were prepared by an eco-friendly solid-state grinding of the respective nitrates and citric acid. Ball-milling of the as-prepared Fe and Zn citrates resulted in nanosize particles. The as-prepared and ball-milled Fe and Zn citrates were characterized using Fourier-transform infrared spectroscopy (FTIR), thermogravimetric analysis and differential thermal analysis (TGA/DTA), and powder X-ray diffraction (XRD). The particle size and morphology of the obtained samples were studied using a scanning electron microscope (SEM) and transmission electron microscope (TEM). The obtained nanosized Fe and Zn citrates were analyzed for their plant uptake in the test crop soybean (var. JS-335) using the white-sand technique. The concentration of nutrients was estimated by atomic absorption spectrometry (AAS). A significant increase in nutrient absorption was observed in 6 h ball-milled samples of both Fe (789.8 Ī¼g per g of dry weight) and Zn (443.8 Ī¼g per g of dry weight) citrates. Such an increased nutrient absorption is due to the high mobility of nanocitrates. Therefore, nanocitrates can serve as an excellent source of plant nutrients in agriculture.Not Availabl
Production of polyhydroxybutyrate (PHB) from Pseudomonas plecoglossicida and its application towards cancer detection
The present work focuses on the fermentative production of Polyhydroxybutyrate (PHB) from an unexplored organism Pseudomonas plecoglossicida for this biopolymer production. The produced biopolymer was characterized using FTIR, NMR and GCMS analysis. As Polyhydroxyalkanoates (PHAs) exhibit a high level of biocompatibility and biodegradability, they are used for several biomedical applications. A simple and rapid cancer detection assay was developed using the PHB extracted from P.Ā plecoglossicida. Breast cancer cells (T47D) were taken as a test sample, with the normal epithelial cells (PCS-600-010) as control. The assay checked for the ability of cells to attach to the surface of the PHB sheet. Primarily a docking study was made to understand the interaction of specific target proteins present in breast cancer cells (BRCA1) with the PHB molecules, where the surface adherence property was clearly denoted. Further authentication was done using the contact angle detection test which elucidated that only cancer cells showed the adherence effect, and normal cells did not exhibit such adherence property towards the PHB sheets. Hence, the produced biopolymer will likely be helpful in developing a novel cancer detection tool, by studying the surface adherence property of the cell towards the PHB sheet. Keywords: Cancer cells, Contact angle detection, PHB, Pseudomonas plecoglossicid