No abstract available.
Leg* ; Muscle Cramp* ; Psychomotor Agitation*

Electroconvulsive therapy (ECT) is a time tested treatment modality for the management of various psychiatric disorders. There have been a lot of modifications in the techniques of delivering ECT over decades. Despite lots of criticisms encountered, ECT has still been used commonly in clinical practice due to its safety and efficacy. Research evidences found multiple neuro-biological mechanisms for the therapeutic effect of ECT. ECT brings about various neuro-physiological as well as neuro-chemical changes in the macro- and micro-environment of the brain. Diverse changes involving expression of genes, functional connectivity, neurochemicals, permeability of blood-brain-barrier, alteration in immune system has been suggested to be responsible for the therapeutic effects of ECT. This article reviews different neurobiological mechanisms responsible for the therapeutic efficacy of ECT.
Brain ; Electroconvulsive Therapy* ; Immune System ; Mental Disorders ; Neurobiology ; Permeability ; Therapeutic Uses

No abstract available.
Catatonia* ; Lorazepam* ; Seizures*

Simultaneous bilateral intertrochanteric fractures are very rare. There is a paucity of data in current literature documenting patients with such kind of hip fractures. It is severe and potentially life-threatening, associated with a high morbidity. The major determinants of successful outcome are high vigilance, early single stage stabilization and mobilization as well as management of associated comorbid conditions that may influence the long term rehabilitation of patients. Here we reported 4 cases of concurrent bilateral trochanteric fractures along with review of the literature. Our study aimed to discover its frequency, identify the injury mechanisms as well as factors present in the pathogenesis of these fractures, and outline the available treatment modalities.
Adult ; Aged ; Female ; Fracture Fixation, Internal ; methods ; Hip Fractures ; surgery ; Humans ; Male

BACKGROUND: AND PURPOSE: To adequately evaluate the extent of neurocognitive impairment in patient living with human immunodeficiency virus (PLHIV), a battery of neuropsychological tests is typically administered which are neither cost effective nor time efficient in the outpatient clinical setting. The aim of the study was to assess neurocognitive status and functional ability of people living with HIV and find a brief screening tool to identify those who would benefit from a full diagnostic evaluation. METHODS: The study enrolled 160 PLHIV (80 pre-antiretroviral therapy [ART] and 80 on ART) fulfilling the inclusion and exclusion criteria. Neurocognitive assessment and an assessment of Functional ability was done by using the Montreal Cognitive Assessment (MoCA) and Lawton and Brody Instrumental Activities of Daily Living Scale scale, respectively. RESULTS: The study population consisted of 75.6% males and 24.4% females with mean age of 44±10 years. The overall prevalence of HIV associated neurocognitive disorder (HAND) in the study subjects was 52.5%. Of these, 47.5% had asymptomatic neurocognitive impairment and 5% had minor neurocognitive disorder. In MoCA, the most frequently affected domains were Language (97.6%), visuospatial ability (92.9%) and memory (71.4%). CONCLUSIONS The prevalence of HAND in both groups were similar suggesting that neurocognitive impairment starts early in HIV infection. Memory and Visuospatial function impairment had the most predictive potential for detecting the presence of HAND. HAND screening is recommended in all PLHIV at enrolment into care. Simple tools like MoCA can be used in busy outpatient settings by healthcare workers to screen for HAND.

No abstract available.
Spine

No abstract available.
Depressive Disorder, Treatment-Resistant* ; Transcranial Magnetic Stimulation*

Background: This study aimed to evaluate and compare the efficacy of oral premedication with ibuprofen on the anesthetic efficacy of inferior alveolar nerve block (IANB) using 2% lignocaine and 1:100000 epinephrine in tobacco-chewing (TC) and non-tobacco-chewing (NTC) patients with symptomatic irreversible pulpitis (SIP) during nonsurgical endodontic intervention (NEI). Methods: This multicenter, prospective, double-blind, two-arm parallel-group randomized controlled trial involving 160 patients was conducted for a period of 9 months. The patients were classified into the study (TC patients) and control (NTC patients) groups, which were subdivided into two subgroups 1 hour before the procedure based on oral premedication with tab ibuprofen 600 mg. Nicotine dependence was assessed using the Modified Fagerstrom Tolerance Nicotine Scale. Patients were administered an IANB injection of 2% lignocaine containing epinephrine 1:100000 after premedication. Pulpal anesthesia before NEI was confirmed using electric pulp testing and cold spraying. Patients rated their pain on the 10-point visual analog scale (VAS) during NEI thrice at the dentin, pulp, and instrumentation levels. No pain at each level indicated the success of anesthesia. Results: The success and failure rates did not differ between the premedication and non-premedication subgroups in the TC or NTC groups (P > 0.05). However, the success rate was higher in the premedication subgroup of the NTC group (52.5%) than in the TC group (45%). Most patients with premedication experienced failure at the instrumentation level, whereas patients in the non-premedication group experienced pain at the dentin level. Failure rates of IANB did not differ significantly at different levels between the groups (P > 0.05). The mean VAS scores differed significantly at the dentin level in both groups, with lower values in the premedication group (P < 0.05). Conclusions The efficacy of ibuprofen premedication with IANB during NEI did not differ significantly between the TC and NTC patients with SIP. The effect of premedication was more significant in the NTC group than in the TC group. A causal relationship between nicotine consumption and the success of premedication could not be established, and further studies are required to validate the results of the present study.

Objective:Polycystic ovary syndrome(PCOS)is a pathophysiological disorder affecting reproductive and metabolic indices in females.The present study was designed to compare the efficacy of metformin and D-chiro-inositol in PCOS patients.Methods:In a tertiary care hospital in North India,prospective observational research was undertaken on 100 patients with PCOS,which was diagnosed based on European Society of Human Reproduction and Embryology Guidelines and ultrasound of lower abdomen.The study involves various clinical characteristics into considera-tion for the determination of statistical significance(P＜0.05)in PCOS patients.Student's t-test along with the association between PCOS and patients taking metformin and D-chiro-inositol,as well as their impact on various biochemical parameters,were investigated finally using Pearson Correlation Analysis.Results:This study comprises 50 patients taking metformin and 50 patients taking D-chiro-inositol in women suffering from PCOS.Body mass index(BMI)and waist-to-hip ratio(WHR)were statistically significant(P＜0.05)within the groups of both metformin and D-chiro-inositol.Biochemical parameters such as luteinizing hormone(LH),follicle stimulating hormone(FSH),anti-mullerian hormone(AMH)and glycated hemoglobin(HbA1c)were found to be statistically significant(P＜0.05)in both groups.LH,FSH and AMH(14.40±0.52;14.28±0.53;1.99±0.10)were comparatively lower in patients taking D-chiro-inositol as compared to metformin group(14.17±0.42;19.88±1.01;2.61±0.04).HbA1c(3.71±0.08)with P＜0.05 was found to be decreased more in metformin group as compared to patients taking D-chiro-inositol(4.90±0.09).A positive correlation was found between HbA1c and LH in metformin,& HbA1c and FSH in D-chiro-inositol groups,respectively.Conclusion:The results indicate that D-chiro-inositol shows better results in reducing clinical variables involved in causing PCOS as compared to metformin whereas metformin has better glycemic control in PCOS patients.