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Objective Glenohumeral (GH) osteoarthritis (OA) is the third most common large joint disease, after hip and knee OA. This study aimed to identify risk factors for GH OA.Methods We used data from the Dallas Shoulder cohort, including individuals aged 40–85. Those with confirmed GH OA based on X-ray were cases, and those without were controls. Univariate, least absolute shrinkage and selection operator and multivariate analyses identified risk factors, including age, body mass index (BMI), sex, work-related shoulder problems, shoulder disability, dislocation, previous trauma, surgery, smoking, hypertension, diabetes, depression, heart disease, OA, night pain and overall sleep quality.Results A total of 1827 cases and 1556 controls were identified for GH OA. In univariate analysis, significant associations with GH OA were found for increasing age (>40 to ≤50: OR 3.29, 95% CI 2.44 to 4.45; >50 to ≤60: OR 5.90, 95% CI 4.49 to 7.77; >60 to ≤70: OR 12.18, 95% CI 9.22 to 16.08 and >70: OR 16.54, 95% CI 12.47 to 21.94), higher BMI (≤19: OR 1.44, 95% CI 1.01 to 2.04; >25 to ≤30: OR 1.57, 95% CI 1.32 to 1.86; >30 to ≤35: OR 1.85, 95% CI 1.54 to 2.22 and >35: OR 1.77, 95% CI 1.28 to 2.45), prior shoulder injury (OR 1.30; 95% CI 1.12 to 1.50), shoulder surgery history (OR 0.71; 95% CI 0.57 to 0.87), shoulder pain at night (OR 1.35; 95% CI 1.07 to 1.70) and hypertension (OR 0.70; 95% CI 0.60 to 0.81). In multivariate analysis, significant associations remained for age (>40 to ≤50: OR 2.99, 95% CI 2.21 to 4.06; >50 to ≤60: OR 5.48, 95% CI 4.14 to 7.23; >60 to ≤70: OR 11.22, 95% CI 8.44 to 14.88 and >70: OR 16.65, 95% CI 12.45 to 22.17), BMI (≤19: OR 1.49, 95% CI 1.01 to 2.20; >25 to ≤30: OR 1.45, 95% CI 1.20 to 1.77; >30 to ≤35: OR 1.70, 95% CI 1.39 to 2.09 and >35: OR 1.78, 95% CI 1.25 to 2.55) and previous shoulder trauma (OR 0.80; 95% CI 0.68 to 0.94).Conclusion We identified increasing age and higher BMI as factors associated with GH OA. Due to the large sample size, many risk factors were assessed. Since the shoulder is not a weight-bearing joint, the BMI-GH OA link is likely molecular and systemic, warranting further investigation.Level of evidence Prognostic level III.

Fatty infiltration of the rotator cuff muscles is very common following rotator cuff tears and is one of the most important factors in determining treatment. Current clinical practice relies on subjective evaluation of fatty infiltration through categorical scoring based on the Goutallier classification system. The Dixon magnetic resonance imaging (MRI) sequence provides flexibility in selecting echo times for water–fat separation. The Dixon method, therefore, has the potential to provide robust and high-quality fat quantification that allows for more accurate calculation of fat fraction (%Fat) of the rotator cuff muscles than the Goutallier classification system. However, significant variance exists in sequencing and post-processing methodology within the recent application of Dixon sequences to quantify rotator cuff fatty infiltration. In this paper, we conducted a systematic review to synthesize the relevant literature utilizing Dixon sequencing for the quantification of rotator cuff fatty infiltration. The literature search was extracted from 1094 articles, with 12 studies included in the final review. Regardless of the varying sequencing pattern and post-processing techniques among studies, the findings suggest the Dixon method is reliable for quantitatively calculating the fat fraction of the rotator cuff muscles, even at very low levels of fatty infiltration. In addition, a quantitative difference in fat fraction was observed between participants with different degrees of tear vs. those without any shoulder pathologies. Multi-point Dixon imaging has the potential to be utilized clinically to objectively quantify fatty infiltration and may lead to improved clinical decision making for patients with rotator cuff tears.

Purpose: To analyze the literature regarding obesity, body mass index (BMI), and rotator cuff disease (RCD). Methods: In this Systematic Review and Meta-analysis, we queried PubMed, Embase, Cochrane, Cumulative Index to Nursing & Allied Health, and Science Direct using key words (August 25, 2023). Analytic observational studies (cohort, case-control, and cross-sectional studies) with more than 30 participants per comparison group, evaluating the association between obesity and rotator cuff pathology, were eligible for inclusion. Meta-analysis was performed to quantitatively summarize associations between BMI and RCD to report odds ratios and corresponding 95% confidence intervals (CIs) for regression-based models and BMI mean differences between cases and controls. Risk Of Bias In Non-randomised Studies – of Interventions tool was used to evaluate risk of bias across all studies in the systematic review. Results: After full-text review of 248 articles, 27 presented data on obesity and RCD, and 17 qualified for meta-analysis. Individuals with RCD were 1.21 times (95% CI 1.10-1.34) as likely to have overweight and 1.44 times (95% CI 1.32-1.59) as likely to have obesity compared with those without RCD. Each 5-unit increase in BMI was associated with 35% greater odds of having rotator cuff tear (95% CI 1.06-1.71). In-depth assessment for risk of bias shows quality of studies varies greatly and highlights outcome heterogeneity, lack of temporality, confounding and selection bias as major concerns for individual studies. Conclusions: In this study, we found a positive association between elevated BMI and RCD. Level of Evidence: Level III, systematic review and meta-analysis of Level II-III studies.

Objective The primary goal of this study is to evaluate the relationship between Body Mass Index (BMI) and muscle atrophy in individuals with rotator cuff tears.Methods This study consists of patients with rotator cuff tears identified by MRI from two independent cohorts, the Rotator Cuff Outcomes Workgroup (ROW) and the Multicenter Orthopaedic Outcomes Network (MOON). Presence of atrophy (yes/no) and severity of atrophy (as an ordinal variable) were assessed on MRI by expert physicians. We used multivariable regression models to evaluate the relationship between BMI and muscle atrophy while adjusting for age and sex in each study, conducted sensitivity analyses for full-thickness tear and combined results using inverse variance-weighted meta-analysis.Results A total of 539 patients (MOON=395, ROW=144) from the combined cohorts had MRI data available on muscle atrophy. Among these patients, 246 (46%) had atrophy of at least one of the muscles of the rotator cuff and 282 (52%) had full-thickness tears. In meta-analysis across both cohorts, each 5 kg/m2 increase in BMI was associated with a 21% (aOR=1.21, 95% CI=1.02, 1.43) increased odds of having muscle atrophy among individuals with any tear size, and 36% (aOR=1.36, 95% CI=1.01–1.81) increased odds among individuals with full-thickness tear.Conclusions Higher BMI was associated with significantly higher odds of muscle atrophy in patiens with rotator cuff tears. More study is needed to unders1tand why and how this relationship exists, as well as whether interventions to reduce BMI may help improve outcomes for these patients.Level of Evidence III.

OBJECTIVES: Physically-demanding occupations may increase rotator cuff disease (RCD) risk and need for surgery. We linked a job-exposure matrix (JEM) to the UK Biobank cohort study to measure physical occupational exposures and estimate associations with RCD surgery. METHODS: Jobs and UK Standard Occupational Classification (SOC) codes were recorded during the UK Biobank verbal interview. Lifetime job histories were captured through a web-based survey. UK SOC codes were linked to a JEM based on the US O*NET database. O*NET-based scores [static strength, dynamic strength, general physical activities, handling/moving objects (range=1–7), time spent using hands, whole body vibration, and cramped/awkward positions (range=1–5)] were assigned to jobs. RCD surgeries were identified through linked national hospital inpatient records. Multivariable Cox regression was used to calculate hazard ratios (HR) as estimates of associations with RCD surgery. Among those with lifetime job histories, associations were estimated for duration of time with greatest exposure (top quartile of exposure). RESULTS: Of 277 808 people reporting jobs, 1997 (0.7%) had an inpatient RCD surgery. After adjusting for age, sex, race, education, area deprivation, and body mass index, all O*NET variables considered were associated with RCD surgery (HR per point increase range=1.10–1.45, all P10 years of work (eg, HR for 11–20 versus 0 years with static strength score ≥4 = 2.06, 95% confidence interval 1.39–3.04). CONCLUSIONS: Workplace physical demands are an important risk factor for RCD surgery, particularly for workers with more than a decade of exposure.

Background: The planet has been hit by the novel coronavirus since December 2019, which has not only affected the day-to-day activities but has also affected the health-seeking approach of the general population. The reports from the National Institute on Drug Abuse survey hint toward a rise in opioid use in the states. Even in India, the utilization of health services, especially the outpatient department (OPD) and opioid substitution clinics have been affected due to the impact of COVID-19 and subsequent national and regional lockdowns. The Indian studies reflect upon the experience and measures to continue the treatment facilities in substance users, yet none are available to reflect upon the impact of COVID-19 on the pattern of opioid use or functionality of OPD services. Objective: The objective of this study is to study the impact of COVID-19 pandemic on treatment seeking among opioid users from OPD-based opioid treatment centers: a retrospective study. Methodology: A retrospective study was done in an OPD-based opioid treatment center of a tertiary care hospital to analyze the impact of COVID-19 on treatment-seeking opioid users by comparing the data of pre-COVID-19 (April 2019–March 2020) and during COVID-19 (April 2020–March 2021) OPD visits by opioid users. The OPD visits data were collected, including the number of visits, the total number of buprenorphine tablets dispensed, and the dose of buprenorphine consumed per month. The data collected were further analyzed for the descriptive and analytic statistics using the SPSS software version 23.0. Results: During the pre-COVID-19 (April 2019–March 2020) duration, there were a total of 1104 (average 92/month) OPD visits and 4818 (Average 401/month) buprenorphine tablets were dispensed; whereas during the COVID-19 year (April 2020–March 2021), it was 980 (average 81.66/month) visits and 5174 (431/month) tablets. The results were further compared using the paired t-test, which was found to be statistically significant for the number of tablets dispensed, whereas not statistically significant for the number of OPD visits and doses. Conclusion: Although the COVID-19 pandemic has affected the feasibility to seek treatment in opioid users, it has not significantly affected OPD visits for opioid treatment at our center. Although the policy changes such as Indian Psychiatry Society (IPS) interim guidelines for opioid substitution therapy have been beneficial to facilitate the harm reduction and treatment-seeking attitude and have not affected the treatment seeking as expected due to lockdown and transportation which have been a hurdle. Further regulations on opioid treatment OPD, Tele-consultation services and mobile mental health services may be helpful to ensure continuity of treatment and harm reduction among the opioid users.

Rotator cuff myosteatosis following cuff tears is very common and one of the most important prognostic factors in clinical management. Quantitative ultrasound-based imaging techniques (QUBIT) are frequently used along with magnetic resonance imaging (MRI) to evaluate rotator cuff fatty degeneration. However, the examination of rotator cuff tissue integrity by QUBIT is lacking a standardized imaging protocol and procedural methodologies. In this scoping review, we synthesized the current state of QUBIT against the reference imaging modalities in patients with rotator cuff tears. The literature search was extracted from 963 studies, with 22 studies included in the final review in accordance with the preferred reporting items for systematic reviews and meta-analyses extensions for scoping reviews. The selected studies included human participants and focused on measuring at least one prognostic or diagnostic factor using ultrasonography-based imaging with reference to MRI. The findings suggest both conventional B-mode ultrasound and shear wave elastography imaging were comparable to MRI-based imaging techniques for the evaluation of fatty infiltration and rotator cuff tear characterization. This review establishes guidelines for reporting shoulder-specific QUBIT aimed at developing a standardized imaging protocol. The objective was to enhance the diagnostic and prognostic capabilities of QUBIT in the clinical setting.

The efficacy of chemotherapy depends on the tumor microenvironment. This microenvironment consists of a complex cellular network that can exert both stimulatory and inhibitory effects on tumor genesis. Given the increasing interest in the effectiveness of cannabis, cannabinoids have gained much attention as a potential chemotherapy drug. Cannabinoids are a group of marker compounds found in Cannabis sativa L., more commonly known as marijuana, a psychoactive drug used since ancient times for pain management. Although the anticancer potential of C. sativa , has been recognized previously, increased attention was generated after discovering the endocannabinoid system and the successful production of cannabinoid receptors. In vitro and in vivo studies on various tumor models have shown therapeutic efficiency by modifying the tumor microenvironment. However, despite extensive attention regarding potential therapeutic implications of cannabinoids, considerable clinical and preclinical analysis is needed to adequately define the physiological, pharmacological, and medicinal aspects of this range of compounds in various disorders covered in this review. This review summarizes the key literature surrounding the role of cannabinoids in the tumor microenvironment and their future promise in cancer treatment.

Background: Sleep plays a vital role in maintaining optimum physical and mental functioning and can be implicated in affecting the quality of life (QOL) and cognition in elderly population. This study aims to assess quality of sleep, QOL and to assess the effect of quality of sleep on QOL and cognition in elderly population Materials and Methods: A cross-sectional study was done in elderly population in which 30 were healthy control, 30 depressed, and 30 with mild neurocognitive disorder (NCD) who were assessed using Pittsburg Sleep Quality Index, World Health Organization QOL (WHOQOL)-BREF, Geriatric Depression Scale-Short form, and Addenbrooke's Cognitive Examination Scale-Revised (ACE-R). Statistical analysis was done using SPSS 20 software using descriptive methods and Pearson's correlation test. Results: Mean Pittsburgh Sleep Quality Index (PSQI) score was the lowest and mean WHOQOL-BREF score highest in healthy control compared to elderly with mild NCD and depression, the difference being statistically significant in both cases (P < 0.01). PSQI scores have negative correlation with the ACE-R scores when studied in healthy control group (P < 0.05, r = −0.136) and WHOQOL-BREF domain scores overall (P < 0.01 r = −0.485, −0.497, −0.350, −0.475). Conclusion: Quality of sleep in elderly with depression and mild NCD is lower as compared to healthy control. Sleep may affect QOL and cognition in elderly and thus it would be essential to screen and identify sleep-related issues and intervene early.

Abstract Background Shoulder impingement syndrome is one of the most common causes of shoulder pain, accounting for approximately 30% of all shoulder pain. Approximately 35% of patients with shoulder impingement syndrome are refractory to conservative treatment. For patients who fail conservative treatment, there is no established treatment to successfully treat their chronic pain. Prior randomized control trials have demonstrated efficacy for the use of a single lead intramuscular peripheral nerve stimulation of the axillary nerve at the motor points of the deltoid muscle for treatment of hemiplegic shoulder pain. This is the first controlled trial to utilize the same novel technology to treat shoulder impingement syndrome outside of the stroke population. Methods This is a dual-site, placebo-controlled, double-blinded, randomized control trial. Participants will be randomized to two treatment groups. The intervention group will be treated with active peripheral nerve stimulation of the axillary nerve of the affected shoulder and the control group will be treated with sham peripheral nerve stimulation of the axillary nerve of the affected shoulder. Both groups will receive a standardized exercise therapy program directed by a licensed therapist. Discussion This study protocol will allow the investigators to determine if this novel, non-pharmacologic treatment of shoulder pain can demonstrate the same benefit in musculoskeletal patients which has been previously demonstrated in the stroke population. Trial registration Clinicaltrials.gov, NCT03752619 . Registered on 26 November 2018.

Abstract More than five decades have been invested in understanding glucose biosensors. Yet, this immensely versatile field has continued to gain attention from the scientific world to better understand and diagnose diabetes. However, such extensive work done to improve glucose sensing devices has still not yielded desirable results. Drawbacks like the necessity of the invasive finger‐pricking step and the lack of optimization of diagnostic interventions still need to be considered to improve the testing process of diabetic patients. To upgrade the glucose‐sensing devices and reduce the number of intermediary steps during glucose measurement, fourth‐generation glucose sensors (FGGS) have been introduced. These sensors, made using robust electrocatalytic copper nanostructures, improve diagnostic efficiency and cost‐effectiveness. This review aims to present the essential scientific progress in copper nanostructure‐based FGGS in the past 10 years (2010 to present). After a short introduction, we presented the working principles of these sensors. We then highlighted the importance of copper nanostructures as advanced electrode materials to develop reliable real‐time FGGS. Finally, we cover the advantages, shortcomings, and prospects for developing highly sensitive, stable, and specific FGGS.

In this work, the 3D interconnected cobalt oxide nanoflakes (CON) were grown successfully on nickel foam (NF) at ambient conditions by the electrodeposition method, further followed by calcination. The deposition of Co3O4 was carried out for different deposition times of 10 min, 15 min, and 20 min and enumerated as CON-10, CON-15, and CON-20 respectively. The CON samples were characterized for their Physico-chemical studies by XRD, FT-IR, FE-SEM, and EDS. FE-SEM micrographs of CON nanostructures showed the uniform deposition of the 3D interconnected nanoflakes on NF. The sample CON-15 exhibited the highest specific capacitance (Cs) of 444 Fg−1 also the specific energy (SE) of 26.07 Whkg−1, specific power (SP) of 541.66 Wkg−1, and efficiency (ɳ) of 77 % at 1 mAg−1 with outstanding cycling stability of 86 % capacitance retention after 1000 cycles.

The purpose of this review is to highlight recent scientific developments and provide an overview of virus self-assembly and viral particle dynamics. Viruses are organized supramolecular structures with distinct yet related features and functions. Plant viruses are extensively used in biotechnology, and virus-like particulate matter is generated by genetic modification. Both provide a material-based means for selective distribution and delivery of drug molecules. Through surface engineering of their capsids, virus-derived nanomaterials facilitate various potential applications for selective drug delivery. Viruses have significant implications in chemotherapy, gene transfer, vaccine production, immunotherapy and molecular imaging.

Background: Rising population of elder people and associated rise in health problems, frailty and disabilities have significant socioeconomic and health care implications. Mental health related disability contributes significantly in the global disability statistics and is an important health and quality of life indicator. Assessment of disabilities in elderly is essential part of routine evaluation, further it also helps the clinicians in identifying current functional status and choosing and monitoring therapeutic interventions and need for social welfare schemes. Methods: In order to understand the process of disability assessment in geriatric psychiatry and to gather information about social welfare schemes a literature review in Google Scholar and PubMed electronic database, and website of various ministries under Government of India was done, using developed key search terms for articles published up to February 2021. The identified eligible articles were reviewed for ideas and concepts, which were then integrated and categorized under broader themes. Finally, the broad categories were discussed briefly based on the above framework. Results: Review findings are summarized under the following headings: concept of ageing and disability, assessment of disability, process of certification, and social welfare schemes. Conclusions: The process of disability assessment comprises of comprehensive clinical evaluation, use of standardized rating instruments and disability certification wherever warranted or asked for. It is now being acknowledged worldwide by provisions of various social welfare benefits, that living with disability and increased care needs should be an integral part of definition of successful ageing.

Background: Gentamicin is widely used as an antibiotic for the treatment of gram negative infections. Evidences indicates that oxidative stress is involved in gentamicin-induced nephrotoxicity. In Ayurvedic medicine, Punica granatum Linn. is considered as 'a pharmacy unto itself”. It has been claimed in traditional literature, to treat various kidney ailments due to its antioxidant potential. Objective: To explore the possible mechanism of action of methanolic extract of P. granatum leaves (MPGL) in exerting a protective effect on gentamicin-induced nephropathy. Material and methods: Animals were administered with gentamicin (80 mg/kg/day i.m.) and simultaneously with MPGL (100, 200 and 400 mg/kg p.o.) or metformin (100 mg/kg p.o.) for 8 days. A satellite group was employed in order to check for reversibility of nephrotoxic effects post discontinuation of gentamicin administration. At the end of the study, all the rats were sacrificed and serum–urine parameters were investigated. Antioxidant enzymes and tumor necrosis factor alpha (TNF-α) levels were determined in the kidney tissues along with histopathological examination of kidneys. Results: Increase in serum creatinine, urea, TNF-α, lipid peroxidation along with fall in the antioxidant enzymes activity and degeneration of tubules, arterioles as revealed by histopathological examination confirmed the manifestation of nephrotoxicity caused due to gentamicin. Simultaneous administration of MPGL and gentamicin protected kidneys against nephrotoxic effects of gentamicin as evidenced from normalization of renal function parameters and amelioration of histopathological changes. Conclusion: Data suggests that MPGL attenuated oxidative stress associated renal injury by preserving antioxidant enzymes, reducing lipid peroxidation and inhibiting inflammatory mediators such as TNF-α. Keywords: Gentamicin, Nephropathy, Oxidative stress, Punica granatum

Abstract Background A small library of quinazolin-4-one clubbed thiazole acetates/acetamides lacking toxicity-producing functionalities was designed, synthesized, and evaluated for antidiabetic potential as glucokinase activators (GKA). Molecular docking studies were done in the allosteric site of the human glucokinase (PDB ID: 1V4S) enzyme to assess the binding mode and interactions of synthesized hits for best-fit conformations. All the compounds were evaluated by in vitro enzymatic assay for GK activation. Results Data showed that compounds 3 (EC50 = 632 nM) and 4 (EC50 = 516 nM) showed maximum GK activation compared to the standards RO-281675 and piragliatin. Based on the results of the in vitro enzyme assay, docking studies, and substitution pattern, selected compounds were tested for their glucose-lowering effect in vivo by oral glucose tolerance test (OGTT) in normal rats. Compounds 3 (133 mg/dL) and 4 (135 mg/dL) exhibited prominent activity by lowering the glucose level to almost normal, eliciting the results in parallel to enzyme assay and docking studies. Binding free energy, hydrogen bonding, and π–π interactions of most active quinazolin-4-one derivatives 3 and 4 with key amino acid residues of the 1V4S enzyme were studied precisely. Preliminary in-silico absorption, distribution, metabolism, excretion, and toxicity (ADMET) prediction was carried out using SwissADME and PreADMET online software which revealed that all the compounds have the potential to become orally active antidiabetic agents as they obeyed Lipinski's rule of five. Conclusion The results revealed that the designed lead could be significant for the strategic design of safe, effective, and orally bioavailable quinazolinone derivatives as glucokinase activators.

Abstract Background Proximal humeral fractures can be treated non-operatively or operatively with open reduction and internal fixation (ORIF) and arthroplasty. Our objective was to assess practice patterns for operative and non-operative treatment of proximal humeral fractures. We also report on complications, readmissions, in-hospital mortality, and need for surgery after initial treatment of proximal humeral fractures in California, Florida, and New York. Methods The State Inpatient Databases and State Emergency Department Databases from the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality, were used for the states of California (2005–2011), Florida (2005–2014), and New York (2008–2014). Data on patients with proximal humeral fractures was extracted. Patients underwent non-operative or operative (ORIF or arthroplasty) treatment at baseline and were followed for at least 4 years from the index presentation. If the patient needed subsequent surgery, time to event was calculated in days, and Kaplan-Meier survival curves were plotted. Results At the index visit, 90.3% of patients with proximal humeral fractures had non-operative treatment, 6.7% had ORIF, and 3.0% had arthroplasty. 7.6% of patients initially treated non-operatively, 6.6% initially treated with ORIF, and 7.2% initially treated with arthroplasty needed surgery during follow-up. Device complications were the primary reason for readmission in 5.3% of ORIF patients and 6.7% of arthroplasty patients (p

# Background Clinicians of many specialties within sports medicine care for athletes with shoulder instability, but successful outcomes are inconsistent. Consistency across specialties in the diagnosis of shoulder instability is critical for care of the athlete, yet the extent of divergence in its diagnosis is unknown. # Hypothesis Physicians differ from rehabilitation providers in which findings they deem clinically important to differentiate shoulder instability from impingement, and in how they diagnose athlete scenarios with atraumatic shoulder instability. # Study Design Cross-sectional study. # Methods Physicians (orthopaedic surgeons, primary care sports medicine physicians) and rehabilitation providers (physical therapists, athletic trainers) were asked via an online survey to rate clinical factors used to diagnose shoulder instability. Clinicians were also asked to diagnose two athlete scenarios with concurrent clinical findings of atraumatic shoulder instability and impingement, differentiated by the absence or presence of a positive sulcus sign. # Results Responses were recorded from 888 clinicians. Orthopaedic surgeons (N=170) and primary care sports medicine physicians (N=108) ranked physical examination factors as more important for the diagnosis of shoulder instability than patient history factors, whereas physical therapists (N=379) and athletic trainers (N=231) preferred patient history factors. Orthopaedic surgeons differed from physical therapists and athletic trainers in their clinical diagnoses for both scenarios (*P*≤0.001). # Conclusion A lack of consistency exists among sports medicine clinicians in recognizing which clinical factors are important when used to diagnose shoulder instability and in diagnoses given with concurrent findings of impingement. # Level of Evidence Level 3.

Background: Schizophrenia has far-reaching consequences for both – patients, and spouses as caregivers. Perception of caregiving and marital adjustment appears to depend on various factors and also on each other. Objective: To study caregiving experiences and marital adjustment in spouses of patients having schizophrenia. Materials and Methods: A cross-sectional study was done with spouses of 100 consecutive patients having schizophrenia in a tertiary care teaching institute. Scales used included Experience of caregiving inventory (ECI), Dyadic adjustment scale (DAS), Multidimensional scale of perceived social support (MSPSS) and Positive and negative syndrome scale (PANSS). Statistical analysis was done using SPSS-20 software using correlation, regression analysis, t-test and descriptive statistics as applicable. Results: Mean average of total positive score of ECI was higher (2.56) than a negative score; and for DAS, it was highest for consensus (3.07) and minimum for affect expression scale (1.66). Better dyadic adjustment (P-value < 0.001), more age of spouse currently and at the time of marriage, and high social support were positively correlated with positive caregiving experiences (P-value = 0.010, r = 0.257; P-value = 0.04, r = 0.202, P < 0.001, r = 0.610 respectively). Negative caregiving experiences were related to joint family system, higher PANSS scores and higher number of hospitalizations. Conclusion: Factors affecting caregiving experience and marital relationship in schizophrenia need to be identified, and targeting them through psychiatrists or other informal sources, might improve the overall quality of life of spouse as a caregiver and also the patients.

Background: Genetic polymorphisms in drug metabolizing enzymes (DMEs) impart distinct drug metabolizing capacity and a unique phenotype to an individual. Phenytoin has large inter-individual variability in metabolism due to polymorphisms in CYP2C9 and CYP2C19. As per Ayurveda, Prakriti imparts a unique phenotype to an individual. Objective: To assess whether Prakriti can substitute phenotyping [therapeutic drug monitoring (TDM)] and genotyping in individualizing therapy with phenytoin in epilepsy patients. Methods and materials: This was a cross-sectional study conducted over a period of three years. Prakriti was assessed using standardized and validated software. Polymorphisms in CYP2C9 and CYP2C19 were assessed using Polymerase Chain Reaction (PCR)-Restriction fragment length polymorphism (PCR-RFLP). Plasma concentrations of phenytoin (phenotype) were determined using reverse phase-high performance liquid chromatography (RF-HPLC). Results: Total 351 patients were enrolled for the study. Kapha vata (KV) (39%) was the predominantly observed Prakriti followed by vata kapha (VK) (20.8%) and vata pitta (VP) (8.83%) among the patients. The CYP2C9 and CYP2C19 genotype distributions were in accordance with Hardy–Weinberg equilibrium. There was no association between Prakriti and genotypes and Prakriti and phenotype (p > 0.05 each). Patients with CYP2C9 *1/*3 genotype were thrice more likely to have toxic plasma concentrations of phenytoin as compared to those with wild-type genotype (*1/*1) (Adjusted odds ratio – 3.36; 95% C.I. 1.61, 7.01). However, no such association was observed between polymorphisms of CYP2C19 and phenotype. Conclusions: We did not find any association between Prakriti and either phenotype or genotypes suggesting that Prakriti assessment would be of limited utility in individualizing phenytoin therapy in epilepsy patients.

Aims and Objectives: To study and compare the perception of old age and self in elderly women living in community and in old age homes. Materials and Methods: By using a cross sectional study design 60 elderly females (30 each from community and old age homes) were assessed using a semi-structured proforma and an interview questionnaire. Data was qualitatively analysed and frequency computation was done. Results: The elderly women living in community had more of an attitude of ′acceptance′ towards old age and ′generativity′ was a part of ageing for them. They were found to be more satisfied with life and had better emotional support, whereas elderly in old age home perceived better instrumental support. Conclusion: Both community living and living in an old age home, have certain positive aspects. From a perspective of future policies and outreach services, it would be interesting to note the same and use best of both the worlds to provide the best for the elder in either setting.

Aims and Objectives: This study aimed to assess the suicidal ideations, hopelessness and impulsivity in depressed and non-depressed elderly and to study the relationship of suicidal ideations with hopelessness and impulsivity in them. Materials and Methods: This cross sectional study was done on 60 elderly patients (30 cases and 30 controls) above the age of 60 years. The scales used were Geriatric Suicide Ideation Scale, Beck Hopelessness Scale, Barrat′s Impulsiveness Scale, Geriatric Depression Scale. Results: Mean Geriatric Suicide Ideations Scale scores, mean Beck Hopelessness Scale scores and mean Barrat′s Impulsiveness Scale and scores of depressed elderly were higher than that of elderly who were not depressed and these differences were statistically significant. Hopelessness was a significant predictor of suicidal ideation in the entire sample as well as in the depressed and non-depressed elderly when the two groups were considered separately. Impulsivity when considered alone was a significant predictor of suicidal ideations in the entire sample. Conclusion: Hopelessness and impulsivity both by themselves are significant predictors for suicidal ideations in the elderly and when both are considered together hopelessness is a better predictor of suicidal ideations than impulsivity.

Aims and Objectives: To study loneliness, depression and coping mechanism and the relationship between these factors in depressed and non-depressed elderly. Materials and Methods: Cross sectional study was done on 46 depressed and 48 non-depressed elderly were assessed clinically and using Geriatric Depression Scale-Short form [GDS-SF], loneliness scale, and brief cope scale. Statistical analysis was done using SPSS 20 software. Result: Mean GDS scores, mean loneliness (emotional and social) scores of depressed patients were higher than that of non- depressed, and this difference was found to be statistically significant [GDS: t = 14.33, p

Introduction: We depend on eyesight more than any other of our senses to maneuver through the space around us. In a fraction of a second, our eyes work with our brain to tell us the size, shape, colour, and texture of an object. Our eyes are body’s most highly developed sensory organs. The use of computers and television in the era of information technology has given new heights to the professional success rate and it saves time but on the other hand, it has led to an increase in the number of patients with ocular complaints. Aims: The objective of the study was to study the effect of eye exercise techniques along with kapalbhati pranayama on Visual Reaction Time (VRT). Material & Methods: Total 60 subjects in an age group of 18– 30 were recruited in the study. All the subjects were divided into two equal groups (study group and control group) containing 30 subjects (18 male & 12 female) each. Both the male and female subjects were selected on the basis of their voluntary involvement. Visual reaction time for red and green light was recorded from all 60 subjects before the start of the study. Study group subjects were trained to practice various eye exercise techniques and kapalbhati pranayama for 8 weeks regularly whereas control group were busy with their routine activities. After 8 weeks, visual reaction time was measured for red and green light from all 60 subjects. Statistical Analysis: Data expressed as Mean ± S.D, Student t –test was applied for analysis of data, p value 0.05). Conclusion: The results of our study suggest that simple eye exercises along with pranayama helps in improvement of visual reaction time.

BackgroundFatty infiltration (FI) is one of the most important prognostic factors for outcomes after rotator cuff surgery. Established risk factors include advancing age, larger tear size, and increased tear chronicity. A growing body of evidence suggests that sex and obesity are associated with FI; however, data are limited.MethodsWe recruited 2 well-characterized multicenter cohorts of patients with rotator cuff tears (Multicenter Orthopaedic Outcomes Network [MOON] cohort [n = 80] and Rotator Cuff Outcomes Workgroup [ROW] cohort [n = 158]). We used multivariable logistic regression to evaluate the relationship between body mass index (BMI) and the presence of FI while adjusting for the participant's age at magnetic resonance imaging, sex, and duration of shoulder symptoms, as well as the cross-sectional area of the tear. We analyzed the 2 cohorts separately and performed a meta-analysis to combine estimates.ResultsA total of 27 patients (33.8%) in the Multicenter Orthopaedic Outcomes Network (MOON) cohort and 57 patients (36.1%) in the Rotator Cuff Outcomes Workgroup (ROW) cohort had FI. When BMI < 25 kg/m2 was used as the reference category, being overweight was associated with a 2.37-fold (95% confidence interval [CI], 0.77-7.29) increased odds of FI and being obese was associated with a 3.28-fold (95% CI, 1.16-9.25) increased odds of FI. Women were 4.9 times (95% CI, 2.06-11.69) as likely to have FI as men.ConclusionsAmong patients with rotator cuff tears, obese patients had a substantially higher likelihood of FI. Further research is needed to assess whether modifying BMI can alter FI in patients with rotator cuff tears. This may have significant clinical implications for presurgical surgical management of rotator cuff tears. Sex was also significantly associated with FI, with women having higher odds of FI than men. Higher odds of FI in female patients may also explain previously reported early suboptimal outcomes of rotator cuff surgery and higher pain levels in female patients as compared with male patients.

The article offers information on clinical practice guidelines for the assessment and management of mild neurocognitive disorder (Mild NCD). Topics discussed include the development of diagnostic criteria for Mild NCD; the role of cognitive reserve in managing the disorder; and the progression and management strategies, including early diagnosis and multidisciplinary approaches.