Case Record

PARANOID SCIZHOPHRENIA: Client was apparently normal until 10yrs back, owned a petty shop, when he frequently quarrelled with his family. On enquiry he was said to have a love affair with a girl in the neighbourhood. His parents disliked this. Meanwhile he sent a gift to the girl, for which her uncle assaulted him. Later he started expressing suspicious ideas about her uncle claiming that he had sent few men to threaten him. He also kept telling that people in the streets are talking ill of him and are plotting to kill him. He hence started taking a long route to his own shop in order to protect himself from the persecutors sent by his girl friend’ s uncle. Gradually his work performance declined. He often kept his shop closed and on enquiry by parents, he would give lame excuses. Over the next 2 yrs he was irregular to job, and began saying that he now loved another girl, a teacher. Suddenly one noon, he told his parents that his ex-girl friend’s uncle had misbehaved with his new lover and that a few men tried to ssault her sexually. On enquiry by his parents, all people in their locality denied about any such event. Later his business started declining further due to frequent absenteeism. Meanwhile he suddenly began washing his bike’s seat every time before boarding it, claiming it was dirty. He also started sprinkling water on his shirt and hair telling that it was hot outside. At his shop also he started washing hands every time he took money from a female slum dweller. He explained that he had fear of contamination with dirt and hence his behaviour. No h/o thoughts being inserted, with drawn or broad casted. No h/o low mood, guilt, hopelessness, helplessness, crying spells. No h/o elated mood, spending sprees, boastful talk. No h/o repetitive checking, counting behaviours. No h/o head injury, seizures, LOC. BPAD- ADOLESCENT ONSET: Client was apparently normal 3 weeks back, when his parents noticed that he was very restless. He was awake all through throughout the night, wandering about the house. He stayed awake lying on his bed at times, and loitering about at other times. He never sat at one place in their house, often went out of their house. They also found him talking excessively than before and often at times his speech was irrelevant. He now started claiming that he was“thalapathy”, no one can defeat him and he has come to this world to save the world. He often became irritable for unprovoked reasons and assaulted his sister and mother frequently. He was also found crying occasionally for unknown reasons. When enquired about this behaviour he failed to reply and kept quiet. He also had to be reminded at times to brush, take bath, eat etc. With these complaints persisting for three weeks, he was brought to IMH for first time. No h/o suspiciousness / hearing voices. No h/o low mood, suicidal attempts. No h/o fever/ head injury/ LOC. LATE ONSET SCHIZOPHRENIA: Client was apparently normal 2 yrs back, when she initially began saying that she could hear Jesus speaking to her through the walls of their house. She was often seen by her son, facing the walls and muttering as if answering someone. Gradually her visits to the church increased in frequency and even at home she was seen spending time reading bible excessively than before. Even at night during sleep, she would often get up and suddenly start doing prayer. She would continue praying until late sun rise, then sleep for a couple of hours and start her household chores. Such behaviour continued for the next couple of months. Suddenly, one day she told her son, that here after she would not go to church or pray at home. On enquiry, she said few people in the church were threatening to kill her. He also started saying that 2 people a man and woman (named Senthuram and Poongothai) took blood from her brain. She would say that the couple had a sieve plate embedded with blades which they kept on her head, pressed it hard in order to pierce the skull and late drew blood. She also said that this couple had appointed around 150 men, to do this job and that those men had been drawing blood from her brain over the past 15 yrs. She stated that she could feel the pain of the blades piercing her skull, but she was helpless as the 150 men threatened to kill her if she resisted them and interrupted them. She continued to complain about such incidents happening to her almost daily over the next 6 months. In spite of these complaints she continued to her daily chores. ALCOHOL DEPENDENCE SYNDROME: Client was apparently working as a salesman in a plastic company, was regular to job, when he was introduced to alcohol by his colleagues on a festive occasion. He initially drank a large glass of beer, experienced high, nausea, vomiting and there after stopped drinking for next 1 month. Then he drank beer again, but did not experience any side effects and thereafter began drinking over the weekends. Over the next 6 months he drank beer. For trial he drank brandy once and experienced much more high than beer. Since this alternative was cheaper and gave more high, he thereafter continued brandy one quarter i.e. 180ml over weekends for the next 1 year. Gradually he increased the quantity to 360ml as he did not experience high with 180ml. now he began drinking 3 days a week, as he got tremors when he did not drink. Over the next 6 months both the quantity and frequency of drinking increased. Now for the past 3 years he drinks daily about 360-540 ml. He begins drinking early in the morning as he develops tremors if he does not drink. After the first drink of about 90 ml he goes to job. Then around 12pm he again consumes around 90ml of brandy and continues to work, though he gets in to unnecessary quarrels with his employers due to the same. Later towards the evening he again consumes 180ml of alcohol in an intoxicated state. For the past 1 year he has developed sleep disturbances. He finds it difficult to fall asleep and also gets frequently awakened during the sleep. When he gets awakened in sleep he consumes around 60-90 ml of left over brandy and tries to resume back to sleep. Morning while getting up itself the first he does is to search for left over brandy or searches for money to buy, or for articles to be mortgaged for the same he has incurred lot of debts due to his behaviour of daily uncontrollable drinking. His prime interest for the past 1 year is in procuring alcohol and he ignores all his alternative sources of pleasure. Apart from these he also has poor appetite and eats very inadequately. At home when he returns in an intoxicated state he gets in to quarrels with his parents for trivial reasons. When questioned about his behaviour the previous night, on few occasions he failed to recall what had happened the previous night. No h/o hematemesis, malena, jaundice. No h/o head injury, seizures, LOC. No h/o hearing voices, talking or laughing to self. No h/o elated mood, spending sprees or boastful talk. No h/o crying spells, suicidal attempts. No h/o recurrent intrusive thoughts/ images. UNDIFFERENTIATED SCHIZOPHRENIA: Client was apparently normal 5 years back, going to work regularly as an electrician. One evening he began laughing to himself and on enquiry by his parents he failed to reply. He did not sleep the whole night. The following day he was taken to church, where he remained quiet, but after returning home he became abusive and assaultive, and started shouting at his family members. He was later forcibly locked in a room and he remained sleepless the whole night. Consequently he was taken to a physician next day, who referred him to a psychiatrist. On consulting the psychiatrist he was admitted and treated with parenteral injections and discharged after 10 days. Later he took drugs regularly, his sleep improved, but he stayed at home not going for work over the next one year giving lame excuses. He also became irritable at times for unprovoked reasons. A year later he again began working in a moulding factory and took drugs regularly. About 2 years after the first episode he again became sleepless, developed anger outbursts and assaultive behaviour. He also displayed self injurious behaviour by cutting his hand. When prevented by parents from doing so and on being enquired about his behaviour, he said he didn’t know why he cut he hands. He was again taken to the same psychiatrist and treated over the next 3 months (details of treatment and follow up are not available). Over the next 6 months his symptoms worsened gradually and he was treated with ECT. He was well over the next 4 months, when his brother got married. Later his work performance declined and he frequently absented himself from his work place. He explained to his mother that began seeing women naked even when they were dressed and hence he stopped going for work. No h/o low mood, crying spells. No h/o fever/ head injury/ LOC. No h/o seizures. No h/o substance abuse

Acceptability of, and willingness to pay for, community health insurance in rural India

AbstractObjectivesTo understand the acceptability of, and willingness to pay for, community health insurance coverage among residents of rural India.MethodsWe conducted a mixed methods study of 33 respondents located in 8 villages in southern India. Interview domains focused on health-seeking behaviors of the family for primary healthcare, household expenditures on primary healthcare, interest in pre-paid health insurance, and willingness to pay for such a product.ResultsMost respondents reported that they would seek care only when symptoms were manifest; only 6 respondents recognized the importance of preventative services. None reported impoverishment due to health expenditures. Few viewed health insurance as necessary either because they did not wish to be early adopters, because they had alternate sources of financial support, or because of concerns with the design of insurance coverage or the provider. Those who were interested reported being willing to pay Rs. 1500 ($27) as the modal annual insurance premium.ConclusionsPenetration of community health insurance programs in rural India will require education of the consumer base, careful attention to premium rate setting, and deeper understanding of social networks that may act as financial substitutes for health insurance

Fig 9 -

Effect of SW-AgNPs on callus cells: A, Callus of groundnut variety TMV2 subjected to SW-AgNP treatments; B, Fresh weight of callus in different treatments; C, graph depicting per cent mortality (trypan stained cells as Blue bars) and per cent cells accumulating H2O2 (DAB stained cells as red bar); C inset of micrograph of calli cells stained with Trypan blue.</p

Mitochondria-targeted therapy with metformin and MitoQ reduces oxidative stress, improves mitochondrial function, and restores metabolic homeostasis in a murine model of Gulf War Illness

Gulf War Illness (GWI) is a cluster of medically unexplained chronic symptoms, including neurological and gastrointestinal impairments, and muscle fatigue, suffered by veterans of the Persian Gulf War. A GWI model in C57BL/6 mice exposed to the nerve gas prophylactic pyridostigmine-bromide (PB) and the insecticide permethrin (PER) was used to test the effect of mitochondria-potentiating agents, metformin and MitoQ on chronic fatigue, observed in GWI. The exposure of mice to PB/PER resulted in enhanced oxidative stress, impaired mitochondrial function, and reduced autophagy. Treatment with the anti-diabetic drug metformin and the mitochondria-targeted antioxidant available as a dietary supplement, MitoQ, activated the AMPK signaling, reduced oxidative stress, and attenuated inflammation in gastrocnemius muscle tissue compared to untreated mice. The combination of metformin and MitoQ was found to be more effective than the individual treatments in activating AMPK. The combination treatment rescued autophagy and improved mitochondrial respiration. Chronic fatigue assessments by the hanging wire and rotarod tests, and voluntary wheel running activities showed improved physical activity/strength in mice treated with metformin and MitoQ. The results suggest the potential therapeutic benefit of a combination formulation of metformin and MitoQ in addressing the molecular and energetic impairments of skeletal muscle in GWI

Fig 8 -

Dynamic light scattering and zeta potential of SW-AgNPs: A, shows the hydrodynamic size distribution of SW-AgNPs by DLS analysis; B, Negative ζ-potential of SW-AgNPs.</p

Fig 12 -

Cytotoxicity of SW-AgNPs on cervical cell lines: A, cytotoxicity evaluated using MTT assay; B, Cytotoxicty as evaluated by the NRU assay. CaSKi and SiHA are cervical cancer cell lines and HCK1T is a normal cervical cell line. C, Cytotoxicity of UV sterilized SW-AgNPs (UV) on cervical cell lines as compared to autoclaved SW-AgNPs (A), commercial AgNP (C), Plant Extract (PE) and citrate buffer (CB).</p

Fig 4 -

FTIR spectrum of plant extract and SW-AgNPs: A, Phytosynthesis at room temperature and B, Phytosynthesis at 95°C.</p

Screening of plants for levels of phenolics and flavonoids.

Screening of plants for levels of phenolics and flavonoids.</p

Fig 10 -

Effect of SW-AgNPs on defense/stress enzymes superoxide dismutase and peroxidase activities in the protein extracts of groundnut TMV-2 calli: A, peroxidase activity; B, In gel POX isozyme activity; C, SOD activity; D, In gel SOD isozyme activity; Reductant, aqueous sandalwood leaf extract.</p