Search

Circulating plasma miRNAs have emerged as potential early predictors of glucometabolic disorders. However, their biomarker potential remains unvalidated in populations with diverse genetic backgrounds, races, and ethnicities. This study aims to validate the biomarker potential of plasma miR-9, miR-29a, miR-192, and miR-375 for early detection of prediabetes and type 2 diabetes mellitus (T2DM) in Nepali populations that represent distinct genetic backgrounds, races, and ethnicities. A total of 46 adults, categorized into healthy controls (n = 25), prediabetes (n = 9), and T2DM (n = 12) groups, were enrolled. Baseline sociodemographic, anthropometric, and clinical characteristics were collected. Fold change in plasma expression of all four miRNAs was quantified using RT-qPCR against the RNU6B reference gene. Their biomarker potential was determined by receiver operating characteristic (ROC) curve analysis. Multivariate discriminant function and hierarchical cluster analyses were used to evaluate the effectiveness of the miRNA panel in reclassifying study participants who were initially categorized according to their glucose tolerance status. Plasma expression of all four miRNAs was significantly upregulated in T2DM patients compared to normoglycemic controls. Furthermore, the expression of only miR-29a and miR-375 was upregulated in T2DM patients than in prediabetic individuals. Notably, only miR-192 expression was significantly upregulated in prediabetic individuals than in the normoglycemic controls. The miRNA expression profiles had the potential of reclassifying the participants into three original groups with an accuracy of 69.6 %. ROC curve analysis identified miR-192 as the predictor for both prediabetes and T2DM, while miR-9, miR-29a, miR-192, and miR-375 were predictive only for T2DM. The specific set of miRNA combinations significantly improved their predictive accuracy. This study validates the early predictive biomarker potential of plasma miR-9, miR-29a, miR-192, and miR-375 also in the Nepali population and paves the way for future translational studies to validate their utility in clinical laboratories.

Background: Obsessive compulsive disorder (OCD) is a clinically heterogeneous psychiatric disorder in terms of symptom content and insight. Aim: To study the various factors associated with insight in OCD. Materials and Methods: A cross-sectional hospital-based study was conducted among 40 patients with OCD who were evaluated on Yale-Brown Obsessive-Compulsive Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Brown Assessment of Beliefs Scale, Meta-Cognitions Questionnaire, WHOQOL-BREF, and Sheehan Disability Scale. Statistical analysis was done using SPSS version 22. Results: Metacognition, severity of OCD, and associated disability were the significant predictors for insight in patients with OCD. Conclusion: Factors associated with insight in OCD can enhance our understanding in the management of OCD.

Introduction: Cardiovascular disease is the leading cause of death globally, and ST elevation myocardial infarction remains main contributor to this mortality. Thrombolysis in myocardial infarction risk score which was derived from randomized clinical trials has been validated in non-selected western patient populations. The objective of this study was to find out the applicability of Thrombolysis in myocardial infarction risk score in our study population. Methods: A prospective observational study was conducted in admitted patients of cardiology unit, Manipal teaching hospital from February 25, 2020 to December 31, 2021. All consecutive patients admitted with diagnosis of acute ST elevation myocardial infarction were selected. Patients admitted with diagnosis of ST segment elevation myocardial infarction and undergone either primary, rescue or elective coronary reperfusion therapy were included for analysis. Results: Total of 339 cases with mean age of 60.62 ±12.64 were diagnosed to have acute ST elevation myocardial infarction and undergone coronary reperfusion therapy. Nearly two third cases were male and majority (61.35%) cases were below age of 65 years. Age of 65 years and above, Killip class III-IV [OR:20.54 (CI: 8.63–48.87), p100 beats/ min [(OR: 5.79 (CI: 2.81 – 11.92), p

Background: One of the most important relationships between a man and a woman is marriage. Marriage is a social union as well as a legal contract between people that creates kinship. It is a primary institution of society. Marriage involves an emotional and legal commitment that is quite important in any adult life and even same in the persons with depression. Faulty marital relationship not only affects the couples but it inflicts longitudinal negative impact upon the entire family system and individual members of families. Methodology: The present study aims to compare the pattern of dyadic adjustment and marital communication between married individuals with depression and married healthy controls. Cross-sectional study design was used. Purposive sampling technique was used to collect the data for the study. The study group comprised of 30 married individuals with depression, whereas the other group consisted of 30 married healthy controls. Both the groups were examined on sociodemographic datasheet, the Dyadic Adjustment Scale (DAS), and the Marital Communication Inventory (MCI). Result: It was found that there were significant differences in the dyadic adjustment and marital communication of persons with depression compared to healthy controls, and there was no significant difference between males and females of depression patients in dyadic adjustment and marital communication. Conclusion: There is need to involve the spouse in the treatment process, and couple-based interventions will help for better marital adjustment and communication with depression patients compared to the healthy controls.

The species composition of bumblebees (Bombus species) across the elevation gradients in Chitwan-Annapurna Landscape (CHAL) was studied from April to November 2019. We performed opportunistic surveys to collect the bumblebee specimens. The walking transects were followed in the accessible places along the Kaligandaki, Marshyandi, and Budhigandaki river basins in different habitats (e.g., agricultural, forest, grassland and home garden). We identified 16 Bombus species from the sampling areas. The highest relative abundance was of B. haemorrhoidalis (20%), followed by B. festivus (20%) and B. eximius (19%). The least abundant species were B. branickii, B. miniatus, B. novus, and B. pressus with 1% relative abundance of each. We examined the effects of elevation on bumblebee richness and found a significant relationship. The Highest species richness was detected in the mid-elevation. Likewise, the highest species richness and diversity were found in the forest habitat in Gorkha site (n = 12, Shannon index H’ = 2.18) followed by the grassland habitat of the Mustang site (n = 11, Shannon index H’ = 2.10). Whereas, comparatively, species diversity was higher in habitats of the Gorkha site comparing Manang and Mustang. The elevation gradients create immense variations in microclimatic conditions and vegetation dynamics, which influence bumblebee abundance, species richness and diversities in different habitats in the study area. The mid-elevation range (2000–3000 m asl) of CHAL exhibited the highest species richness probably due to the higher availability of pollinator-dependent flowering plants in this range. The landcover composition and anthropogenic activities along the elevation gradient is the governing factor for the species composition, distribution and diversity of bumblebees in CHAL. We recommend to decision-makers for formulating their conservation strategies under a socio-ecological framework.

This study aimed to see the psychological well-being of the caregivers and its relationship with the clinical characteristics of children with Intellectual Disability (ID). Methods: A total of 20 caregivers of children with intellectual disability were purposively selected from Central Institute of Psychiatry and Deepshika Institute of Child Development and Mental Health, Ranchi. Socio-demographic and clinical data of caregivers and their children with intellectual disability was collected using specially designed clinical datasheet. The caregivers were assessed with General Health Questionnaire-28 (GHQ-28), Ryff’s Psychological wellbeing scale, Family Interview for Stress and Coping in Mental Retardation (FISC-MR), Social Problem-Solving Inventory (SPSI-R) and Self-determination scale (SDS). Intelligence quotient of the child was assessed with the average score of VSMS and DST and percentage of disability using Assessment of Disability in Persons with Mental Retardation (ADPMR). Results & Conclusions: Study identified a significant relationship in the caregiver’s psychological well-being associated with the clinical characteristics of children with intellectual disability. There is decreased psychological wellbeing in the caregivers and is related to the clinical characteristics of the children with intellectual disability. There are very few culturally sensitive parent intervention practices directed to the key caregivers of children with intellectual disability and that these practices should be enhanced.

Introduction: Irony comprehension (IC) has been described as a schizophrenia (SCZ) disease marker. High variability exists in the measurement of IC. We aimed to assess content and “known-groups” validity of an Indian, comic-based, computerized-IC task. Methods: A 15-story IC task was prepared. Content validity of the IC task stimuli was assessed by experts in mental health. Performance on the IC task was compared between 15 SCZ patients and 15 healthy controls (HC). Known-groups validity was assessed using discriminant function analysis. Results: Content validity of the IC task was optimum. Lower number of correct responses and longer reaction times for irony stimuli were seen in SCZ patients, compared to HC. Both these measures showed 100% accuracy in discriminating SCZ from HC, therefore, implying excellent “known-groups” validity. Conclusion: The newly designed IC task has good psychometric properties, in terms of content and “known-groups” validity.

Aim: The purpose of this study is to assess the effect of the COVID-19 pandemic on the volume of ST-elevation myocardial infarction (STEMI) patients and also to assess changes in patient characteristics, door-in-to-door-out (DIDO) time, door-to-balloon time (D2B) time, and STEMI outcomes during the pandemic. Methods: Patient data were retrieved retrospectively from the electronic medical record system of King Hamad University Hospital and Mohammed Bin Khalifa Cardiac Centre in the Kingdom of Bahrain. Data were compared and analyzed for the two time periods: before the pandemic (January 2019–March 2020) and during the pandemic (April 2020June 2021). Results: There was a decline of 11.1% in patients who presented with STEMI during the pandemic. There were no major differences between the patient demographics and the baseline characteristics during the two study periods. Recommended DIDO time and D2B time could be achieved only for 7.1% and 35.7% of all STEMI cases during the pandemic. However, no significant differences were noted in the 30 days of mortality, reinfarction, cardiogenic shock, hospital length of stay, and return to the hospital within 30 days for the STEMI patients in the two time periods. Conclusions: There was a decline in patients who presented with STEMI during the pandemic. This was also associated with a lower number of STEMI cases achieving the recommended DIDO time and D2B time as compared to the prepandemic period. However, there was no significant difference in the patient outcomes in the two time periods.

Abstract Background Reference intervals (RIs) for clinical chemistry test parameters are specific to the method of measurement and population under service. However, there has been no locally available dry chemistry based RIs for the Nepalese population. Thus, the present study aimed to establish dry chemistry based RIs for sodium, potassium, urea, and creatinine specific to adult populations of Kaski districts, Nepal Methods This was a cross-sectional study conducted at the Manipal Teaching Hospital, Pokhara, Kaski, Nepal on 360 healthy adult participants aged 18–65 years. The test parameters under study were analyzed using a fully automated OCD Vitros 350 dry chemistry analyzer following the protocols provided by the reagent kit manufacturer. The RIs were estimated using reference limits at 2.5th and 97.5th percentiles. The normal distribution of the data was tested by Kolmogorov–Smirnov, and Shapiro–Wilk tests. The differences between males and females RIs were compared by the Mann-Whitney test while age-specific RIs for each sex was compared by One-Way-ANOVA and Dunnett’s Multiple Comparisons Tests. All the data were managed and analyzed using MS Excel and SPSS version 20. Results The RIs of urea, creatinine, sodium, and potassium specific to the adult population of Kaski district, Nepal are as follows: urea: 4.20–13.70 mmol/L (males: 4.70–13.99; females: 4.20–13.23); creatinine: 44.20–106.10 μmol/L (males: 48.82–106.10; females: 35.40–83.78); sodium 135–146 mmol/L (males: 135–146; females: 135–146) and potassium 3.60–5.10 mmol/L (males: 3.54–5.0; females: 3.60–5.10). These RIs were found to be different from currently used RIs provided by the reagent manufacturer. RIs of all the test parameters were significantly influenced by the age of the study participants. However, only the RIs of urea, creatinine, and potassium were significantly influenced by sex. Conclusions The present study has for the first time established dry chemistry based RIs for selected renal function test parameters specific to the adult population of Kaski district, Nepal. This result will aid the clinician in minimizing the errors in result interpretation and making a precise clinical decision.

This quasi-experimental, nonrandomized intervention study reports the effect of person-centred, culturally appropriate music on psychological wellbeing of residents with advanced dementia in five rural residential aged care homes in Australia. Seventy-four residents attended in person-centred music sessions and culturally appropriate group sessions. Interest, response, initiation, involvement, enjoyment, and general reactions of the residents were assessed using the Music in Dementia Assessment Scale (MiDAS), and interviews and focus groups were conducted with aged care staff and musicians. The overall effect of person-centred sessions at two-time points were: during the intervention—351.2 (SD 93.5); and two-hours post intervention—315.1 (SD 98.5). The residents presented a moderate to high level of interest, response, initiation, involvement, and enjoyment during the session and at post-intervention. However, the MiDAS sub-categories’ mean scores differed between the time-points: interest (t59 = 2.8, p = 0.001); response (t59 = 2.9, p = 0.005); initiation (t59 = 2.4, p = 0.019); and involvement (t59 = 2.8, p = 0.007), indicating a significant decline in the effect of person-centred music over time. Interestingly, during the period of time, most of the residents were observed with no exhibitions of agitation (87.5%), low in mood (87.5%), and anxiousness (70.3%), and with a presentation of relaxation (75.5%), attentiveness (56.5%), and smiling (56.9%). Themes from qualitative data collected regarding culturally appropriate group music sessions were behavioural change, meaningful interaction, being initiative, increased participation, and contentment. The findings suggest that the integration of music into care plans may reduce the residents’ agitation and improve their emotional wellbeing in rural aged care homes.

Introduction: Cardiovascular Diseases (CVDs) are the leading cause of global morbidity and mortality. However, their prevalence is disproportionately distributed, with the highest rate in low-income countries, moderate in middle-income countries, and the lowest in high-income countries. Several studies conducted elsewhere, have identified that certain liver enzymes in serum could predict incident CVDs in adults. Aim: To explore the association between liver enzymes and CVDs in adults. Materials and Methods: This was a hospital-based case-control study conducted at Manipal Teaching Hospital, Pokhara, Kaski, Nepal, from January 2018 to December 2021 among 400 adult subjects (200 healthy controls and 200 CVD patients). Socio-demographic, physiological, and biochemical variables were collected with structured questionnaires and appropriate standardised and validated measurement methods. The p-value (two-tailed)

Abstract Background Studies have demonstrated that heart failure (HF) patients who receive direct pharmacist input as part of multidisciplinary care have better clinical outcomes. This study evaluated/compared the difference in prescribing practices of guideline-directed medical therapy (GDMT) for chronic HF patients between two multidisciplinary clinics—with and without the direct involvement of a pharmacist. Methods A retrospective audit of chronic HF patients, presenting to two multidisciplinary outpatient clinics between March 2005 and January 2017, was performed; a Multidisciplinary Ambulatory Consulting Service (MACS) with an integrated pharmacist model of care and a General Cardiology Heart Failure Service (GCHFS) clinic, without the active involvement of a pharmacist. Results MACS clinic patients were significantly older (80 vs. 73 years, p

Abstract Background High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. Methods Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n = 31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up. Results The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n = 27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medications, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. Conclusions Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration ANZCTR, ACTRN12618000263291 . Registered on 20th February 2018.

Background: Worldwide chronic kidney disease is one of the primary public health problems. This study aimed to find the activity of liver enzymes alanine aminotransferase, aspartate transaminase, alkaline phosphatase, and Gamma-glutamyl transferase in the patient's serum before and after dialysis in Chronic kidney disease. Materials and Methods: This was a case-control study including 68 cases with chronic kidney disease coming for hemodialysis at dialysis centers and 140 healthy individuals as control. Serum samples were used for the analysis of serum urea and creatinine, liver enzymes aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase using ErbaChem-300 liquid Chemistry autoanalyzer. Pearson’s bivariate correlation analysis and ANOVA were used to correlate variables between the controls and cases. p < 0.05 was considered to be statistically significant. Results: Urea and creatinine levels were significantly higher in both pre and post-hemodialysis as compared to healthy controls with a p-value (p < 0.001). Alanine aminotransferase and aspartate transaminase levels were significantly lower in both pre and post-hemodialysis as compared to healthy controls. On the other hand, serum alkaline phosphatase levels were significantly higher in pre and post hemodialysis as compared to healthy control. Moreover, serum gamma-glutamyl transferase levels were significantly higher in pre and post hemodialysis as compared to healthy control. Conclusion: The study showed differences in the level of liver enzymes in pre and post hemodialysis in chronic kidney disease.

Urban forests impose significant challenges to the animals that inhabit them due to the altered properties of available substrates from anthropogenic interventions. To cope with these structural peculiarities, urban species exhibit behavioral adjustments to successfully exploit the urban habitat. The present study examined habitat use and positional behavior of northern palm squirrels (Funambulus pennantii) in the urban forests of Kathmandu, Nepal, to test such behavioral modifications. Between July and August 2018, we collected focal animal instantaneous data on the behavior, locomotor/postural mode, forest layer, tree crown part, and substrate type, size, and inclination use of four different individuals. Our results indicated a primarily arboreal species, mostly using the middle canopy layers and the intermediate and central tree parts. Moreover, tree branches and artificial substrates were commonly used that were mainly large and horizontal. Locomotion was dominated by quadrupedalism and claw climb, whereas postures by quadrupedal stand, and, to a lesser extent, sit and claw cling. Most of our initial predictions were only partly supported by our findings. This behavioral idiosyncrasy most likely reflects the adaptive flexibility of the species to human-modified habitats. In this way, northern palm squirrels apparently expanded their ecological niche and successfully persisted against anthropogenic pressures throughout their range. As urban expansion is inexorable, more research is required to understand the behavioral and ecological flexibility of animals that effectively exploit these impacted habitats.

Abstract Background Previous attempts of Mental Health Systems Assessment in India were restricted in scope and scale. Information on all aspects of mental health systems (leadership/governance, legislation, financing, service delivery, workforce, access to essential medicines, information systems, intersectoral activities, and monitoring and evaluation) was scarcely available. The National Mental Health Survey-Mental Health Systems Assessment (NMHS-MHSA), a unique endeavor, assessed the performance of mental health systems and services through health systems assessment framework. The present paper discusses the design and methodology adopted under NMHS-MHSA along with emphasizing its implication for India and other LMICs. Methods NMHS-MHSA was undertaken in 12 Indian states by contextually adapting WHO-AIMS instrument. Data was collated from several secondary sources including interviews of key stakeholders. Utilizing the data a set of 15-quantitative, 5-morbidity and 10-qualitative indicators were developed to summarize the functional status of mental health systems in the surveyed states. This information was authenticated through state level stakeholder’s consultation and consensus building workshops following which a state mental health systems report card with indicators was developed. Conclusion The process and robust method of data compilation enabled NMHS-MHSA to be a reliable and comprehensive method for assessing mental health systems at the state level. It’s envisaged that the assessment provides requisite impetus for strengthening mental health program and mental health systems in India. Being less resource intensive, low -and middle- income countries can adopt NMHS-MHSA tool and methodology to assess their mental health systems with contextual modifications.

The concept of mood disorders dates back to eternity. This long history of the emotions and their disorders has a fascinating journey. As with any history concerned with disease concepts, the conceptual history of mood disorders must be scrutinized through close attention to nosological texts in tracing how categories were created how they evolved over the time. This article covers the evolution of the concept of mood disorders and its journey from the Hippocratic era to the Kraepelin's dichotomization between dementia praecox (schizophrenia) and manic-depressive insanity (bipolar and unipolar disorders) and its culmination into the contemporary classifications of mood disorders. It also addresses the problem of boundaries between the different mood disorders in terms of their conceptualization and classification. The shortcomings of the classificatory systems and the current progress in the nosology have also been discussed.

Objectives: The study was carried out to compare hepatoprotective activity of organic versus non organic Camelia sinensis methanol extracts in albino mice. Materials and Methods: In vivo hepatoprotective activity of methanol extracts of organic and non-organic Camelia sinensis extracts (200 and 400 mg/kg) were evaluated using experimental CCl4 induced toxicity model. The mice were divided into seven group (n=6). The mice were administered once daily with 10% DMSO (negative control), 25 mg/kg Silymarin (positive control), organic tea methanol extracts (200mg/kg, 400mg/kg) and nonorganic tea methanol extracts (200mg/kg, 400mg/kg) for seven days followed by the hepatotoxicity induction using carbontetrachloride. The blood samples were collected and subjected to biochemical analysis. In addition, histopathological examination of the hepatocytes was performed to observe any damage in a cellular level. Ballooning degeneration, cytic necrosis, confluent necrosis, submassive necrosis, micro and macro vesicular steatosis, lymphocyte infiltration were observed in the treatment and CCl4 induced toxicity model. Results: Severe hepatic damage due to CCl4 was indicated by significant increase in the liver enzymes level including Aspartate Aminotransferase (AST), Alanine Aminotransaminase (ALT) and Alkaline Phosphatase (ALP). The elevated levels of these enzymes were reduced in a dose-dependent manner in biochemical analysis by the organic and nonorganic tea methanol extracts. The reduction of liver enzymes level is better in organic treated mice than that of non-organic treated mice. Mice injected with CCl4 have ballooning degeneration with confluent necrosis along with mixed infiltration of inflammatory cells which represents that the liver is highly injured. However, the organic extracts treated mice showed potent hepatoprotective effect with minimal focal ballooning degeneration indicating that the hepatocytes morphology resembling towards normal. Interestingly, the non-organic extracts showed a hepatoprotective effect but there are massive micro-vesicular steatosis and focal lymphocytes. We found a superior hepatoprotective activity of organic extracts than that of non-organic extracts. The liver injury produced by CCl4 has been reversed by the Silymarin which is the positive control in the experiment. Conclusion: The study revealed that the hepatoprotective activity of organic Camelia sinensis is better than the non organic Camelia sinensis.

The striped hyena (Hyaena hyaena Linnaeus, 1758) is one of the large carnivores of forest and grassland ecosystems across Africa and Asia and is currently threatened throughout its range. Hyena habitats are shrinking, due to the increase of human-dominated landscapes. The aim of this study was to identify hyena habitat use as indicated by visitation frequency in the human-dominated landscape of lowland Nepal. We followed a camera trap protocol for the estimation of hyena presence and visitation frequency. We used a generalized additive modelling approach with zero-inflated Poisson distribution to evaluate the effects of environmental variables on capture frequency. Our results showed that the two most important and significant predictors of hyena frequency data were canopy volume and maxD (the maximum among the shortest distances to water sources, agriculture land and villages). The highest hyena frequencies were in sites with low canopy volume, i.e. riverbeds and grasslands, whereas lower frequencies were observed in dense forests, i.e. acacia and riverine forests. Additionally, hyena frequency increased with increasing maxD up to 5–6 km and then dropped sharply at larger maxD values. Overall, our study suggests that hyenas prefer open landscapes along rivers and human settlements, where the following combination of conditions is met: adequate cover, access to food and water. The preservation of natural open landscapes close to human settlements and rugged hilly areas seems crucial for the long-term conservation of hyenas.

Background: The social, economic, and physical environments are widely recognized as important determinants of health and affect the outcome of service delivery. The differences in the patient outcomes can be inferred upon by looking into the process and content of service delivery. Methods: This study is a mixed-methods, prospective cohort study to be conducted at two community extension clinics run by the Central Institute of Psychiatry, Ranchi, Jharkhand. Service users diagnosed with a common mental disorder (CMDs) will be recruited during the study period of three years. The main objective is to ascertain the unmet needs of patients with CMDs. The secondary goals involve measuring the clinical outcome through the lens of process-oriented recovery, service satisfaction, and accessibility, and analyzing the barriers to access healthcare services along with the impact on the carers. Focus group discussions with participants will help understand the reasons behind their unmet needs and factors essential in service delivery. Discussion: Healthcare, as well as social care, aims to deliver services according to need. In a country with 15 million people with CMDs, evaluation of needs could create a platform for the rational distribution of services.

Background: Absconding from psychiatric hospitals is of great concern for patients and caregivers. Absconding affects not only the treatment and safety of these patients but also patient’s caregivers and the community. Further investigation is needed to examine the pattern of this event and the characteristics of patients who abscond. Hence, our study was aimed to examine the sociodemographic and clinical profiles of inpatients who absconded from a psychiatric hospital in five years and to compare them with matched controls. Methods: A retrospective chart review of inpatients who absconded and matched control inpatients during the specified period of five years from January 2014 to December 2018 was done at a psychiatric hospital. Each control was matched with a corresponding absconding case on the following order: (a) admission ward, (b) admission period, (c) diagnosis, and (d) age. Results: Among 20,052 adult admissions during the specified period, 38 patients absconded, with a rate of 1.8 per 1,000 admissions. Most of them were male, from a younger age group, diagnosed with schizophrenia or mood disorder, and having comorbid substance use disorder, irritable affect, impaired judgment, and absent insight. Most of the events occurred within the first two weeks of admission. About 11% of them had a history of prior absconding from the hospital. Conclusion: Knowledge about the associated sociodemographic and clinical profile would help clinicians and mental health care professionals to prevent absconding. Further risk assessment using a patient’s profile would help to reduce absconding events from psychiatric hospitals in the future.

A knowledge of history becomes important in learning the way concepts have evolved and how they are understood in different and conflicting traditions in psychiatry. Modern psychiatry and its history has always been observed through the prism of western science which has its own evolutionary line in which the eastern sciences can't fit and are always at a disadvantage. Especially the colonial bid to prove its legitimacy as a civilizing mission led to representation of European medicine as morally superior to the eastern practices resulting in a biased history. Though in reality, the history of psychiatry is heterogeneous and consists of many different scientific and cultural traditions which vary between populations. hence the Indian concept of “unmada” can't be compared or conformed to “schizophrenia” without addressing its cultural and historical contexts. Many suggest that in case of Indian patients, an understanding of illness through a Vedantic model of psych seems more appealing in comparison to the western constructs, as such an attitude has been transferred over generations. Therefore, a knowledge of history of psychiatry, especially from an Indian perspective becomes important.

Introduction: There is growing awareness of the heterogeneity of obsessive-compulsive disorder (OCD) and of the multiple systems involved in its pathogenesis. Identification of obsessive-compulsive spectrum disorders (OCSDs) may have important implications in the management and prognosis of OCD, but there is a paucity of research in the domain of identification of OCSD in probands with OCD. There are few studies that have examined OCSD in the first-degree relatives (FDR) of OCD patients, some of these were not controlled, and these studies have no final agreements over outcomes, and therefore, this area needs to be further explored. Objectives: The objective of this study was to assess the prevalence of OCSDs in OCD probands; and its relationship to sociodemographic and clinical variables, comparing each aspect by a control group of schizophrenia probands. Materials and Methods: Sixty patients each of OCD and schizophrenia, diagnosed by the Diagnostic and Statistical Manual of Mental Disorders IV Text Revision,[1] above 18 years of age and giving informed consent, were interviewed using the Structured Clinical Interview for OCSD, Yale–Brown Obsessive-Compulsive Rating Scale, Hamilton Rating Scale for Depression, and Hamilton Rating Scale for Anxiety. Results: In OCD group, 22 OCSDs were found in 11 subjects whereas in schizophrenia group, 2 OCSDs (self-injury) were found in two probands. When the two groups were compared in terms of individual OCSDs, there was no significant difference between them. However, when the comparison was made taking into account all OCSDs taken together, it was significantly higher (P = 0.016) in the OCD group compared to the schizophrenia group. Conclusion: OCSDs were significantly more in OCD probands as compared to schizophrenia probands. This suggests a familial aggregation of these disorders.

Background: False-belief (FB) tasks are used to assess the theory of mind (ToM) functioning, which has been found to be impaired in schizophrenia. FB task stimuli used so far in neuroimaging studies in schizophrenia have been sentence-based ones. We aimed to validate an Indian, colour-comic based FB task by using an online-electroencephalogram (EEG) paradigm discriminating schizophrenia patients and healthy controls. Materials and Methods: Fifteen schizophrenia patients and 15 healthy controls performed online FB task during a 256-channel-EEG recording. 'Content' and 'known-groups' validity were examined using offline behavioural measures. Evoked gamma spectral-power in four regions of interest (ROIs) was compared between groups. Social functioning was also assessed. Results: Strength of classifying the groups was significant for both the number of correct responses and the reaction-times on the FB tasks. Social functioning was found to be poorer in patients. On the comparative analysis of evoked gamma spectral-power in the ROIs, very small effect size and observed power were noted. Conclusion: 'Content' and 'known-groups' validity of the culturally undermined comic-based FB task are good. Our findings reiterate that ToM functioning is impaired in schizophrenia. Our results were inconclusive in inferring whether evoked gamma spectral-power could be used as a neural validator for poor ToM functioning.

Background: Prodrome has recently been proposed as target for early intervention but their phenomenology remains obscure and often certain temperamental characteristics are confused with prodromal symptoms leading to the possibility of over-reporting. Methods: Fifty-one consecutively admitted patients, between the age group of 18-60 years, fulfilling the ICD-10 criteria for mania with psychotic symptoms were included. They were rated on Young Mania Rating Scale (YMRS) and were started on appropriate medications. After they attained remission (YMRS

Abstract Background Globally, there is a growing concern over pesticides use, which has been linked to self-harm and suicide. However, there is paucity of research on the epidemiology of pesticides poisoning in Nepal. This study is aimed at assessing epidemiological features of pesticides poisoning among hospital-admitted cases in selected hospitals of Chitwan District of Nepal. Methods A hospital-based quantitative study was carried out in four major hospitals of Chitwan District. Information on all pesticides poisoning cases between April 1 and December 31, 2015, was recorded by using a Pesticides Exposure Record (PER) form. Results A total of 439 acute pesticides poisoning cases from 12 districts including Chitwan and adjoining districts attended the hospitals during the 9-month-long study period. A majority of the poisoned subjects deliberately used pesticides (89.5%) for attempted suicide. The total incidence rate was 62.67/100000 population per year. Higher annual incidence rates were found among young adults (111.66/100000 population), women (77.53/100000 population) and individuals from Dalit ethnic groups (98.22/100000 population). Pesticides responsible for poisoning were mostly insecticides (58.0%) and rodenticides (20.8%). The most used chemicals were organophosphates (37.3%) and pyrethroids (36.7%). Of the total cases, 98.6% were hospitalized, with intensive care required for 41.3%. The case fatality rate among admitted cases was 3.8%. Conclusions This study has indicated that young adults, females and socially disadvantaged ethnic groups are at a higher risk of pesticides poisoning. Pesticides are mostly misused intentionally as an easy means for committing suicide. It is recommended that the supply of pesticides be properly regulated to prevent easy accessibility and misuse. A population-based study is warranted to reveal the actual problem of pesticides exposure and intoxication in the community.

Abstract Background Atherogenic dyslipidemia is an important modifiable risk factor for cardiovascular disease among patients of type 2 diabetes mellitus. Timely detection and characterization of this condition help clinicians estimate future risk of cardiovascular disease and take appropriate preventive measures. The aim of this study was to determine the prevalence, pattern and predictors of dyslipidemia in a cohort of Nepalese patients with type 2 diabetes. Results We found mixed dyslipidemia as the most prevalent (88.1%) and isolated dyslipidemia (10.1%) as the least prevalent forms of dyslipidemia in our patients. The most prevalent form of single dyslipidemia was high LDL-C (73.8%) and combined dyslipidemia was high TG, high LDL-C and low HDL-C (44.7%). Prevalence of all single and mixed dyslipidemia was higher in patients with poor glycemic control and hypertension. The glycemic status of patients correlated with their fasting serum lipid profile. Dyslipidemia was associated mainly with male gender, poor glycemic control and hypertension. Conclusions Atherogenic dyslipidemia is associated mainly with male gender, poor glycemic control and hypertension. It is highly prevalent in Nepalese patients with type 2 diabetes. Urgent lifestyle modification, sustained glycemic control and aggressive lipid lowering treatment plans are necessary to minimize the future risk of cardiovascular disease in this population.

Ecology and conservation status of bumblebee species remains poorly understood, especially in rapidly degrading urban ecosystems, which is important considering the role of bumblebees in the pollinations. We collected more than 200 bumblebee (Bombus spp.) specimens under six species in different parts of the Kathmandu valley (Kathmandu, Lalitpur, and Bhaktapur cities) in Nepal. The species of bumblebees were analyzed with their host plant types and the land use change using remote sensing and field observation data. We found that the bumblebees exert strong variation and were significantly affected by the families of the host plants and the nature of flowers (open and closed type) rather than colors and categories (invasive and noninvasive). We underline that the rapid habitat loss by changing land use in the study area can be a potential threat to the conservation of these important pollinators, and thus, need focused habitat conservation efforts.

This study examined the variation of generic composition and nematode indices to evaluate the soil health status under differently treated tomato growing experimental plots. The study was conducted from 2016 to 2018 in summer and winter seasons on a traditionally tomato (Lycopersicon esculentum) growing farm in the Northern part of the Kathmandu valley, Nepal. Soil samples were taken from four types of replicating plots (each 5 × 5 m sq.) each using a different pest control method consisting of: cattle manure (MP), chemical pesticides (PP), botanical pesticides (BP), and a control plot (CP). The nematode communities were extracted, colonizer-persister (c-p) values assigned and ecological indices such as maturity index (MI), enrichment indexes (EI), structural index (SI) and channel index (CI) were calculated. The low abundance of all indices in pesticide applied plots during both seasons (winter and summer) was recorded. This result indicated pesticide application can be linked to the sensitivity of nematode genera. Nematode indices such as maturity index (MI), enrichment index (EI) and structural index (SI) were significantly affected with lower mean value especially in chemical pesticides applied plots during both the summer and winter seasons. The decomposition channel index (CI) did not exhibit significant variation in our analysis of treatment plots in either season. There was a positive response towards moisture content, soil temperature and nitrogen–carbon ratios for these indices. Nematode genera and indices showed significant variation for pest management practices in tomato grown plots.

ObjectivesThe National Mental Health Survey (NMHS) of India was undertaken with the objectives of (1) estimating the prevalence and patterns of various mental disorders in representative Indian population and (2) identifying the treatment gap, healthcare utilisation, disabilities and impact of mental disorders. This paper highlights findings pertaining to depressive disorders (DD) from the NMHS.DesignMultisite population-based cross-sectional study. Subjects were selected by multistage stratified random cluster sampling technique with random selection based on probability proportionate to size at each stage.SettingConducted across 12 states in India (representing varied cultural and geographical diversity), employing uniform, standardised and robust methodology.ParticipantsA total of 34 802 adults (>18 years) were interviewed.Main outcome measurePrevalence of depressive disorders (ICD-10 DCR) diagnosed using Mini International Neuropsychiatric Interview V.6.0.ResultsThe weighted prevalence of lifetime and current DD was 5.25% (95% CI: 5.21% to 5.29%, n=34 802) and 2.68% (95% CI: 2.65% to 2.71%, n=34 802), respectively. Prevalence was highest in the 40–59 age groups (3.6%, n=10 302), among females (3.0%, n=18 217) and those residing in cities with population >1 million (5.2%, n=4244). Age, gender, place of residence, education and household income were found to be significantly associated with current DD. Nearly two-thirds of individuals with DD reported disability of varying severity, and the treatment gap for depression in the study population was 79.1%. On an average, households spent INR1500/month (~US$ 23.0/month) towards care of persons affected with DD.ConclusionAround 23 million adults would need care for DD in India at any given time. Since productive population is affected most, DD entails considerable socioeconomic impact at individual and family levels. This is a clarion call for all the concerned stakeholders to scale up services under National Mental Health Programme in India along with integrating care for DD with other ongoing national health programmes.

Background: This study was carried out to enumerate the level of difference in functional impairment and quality of life (QOL) in obsessive-compulsive disorder (OCD) patients and normal control group to find out the relationship among ICD functional impairment and QOL. Methodology: Thirty patients diagnosed with OCD as per International Classification of Diseases Diagnostic Criteria for Research-10 were taken for study. The control group consists of 30 normal participants from the community. Functional impairment and QOL questionnaires were administered on both groups to measure functional impairment and QOL in OCD. Results: The mean age of onset of OCD was (23.8 ± 7.25), mean duration of illness was (6.3 ± 4.47), and mean duration of treatment was (2.56 ± 2.47). It was also observed that total score as well as all the domains of the World Health Organization QOL-BREF, OCD patients scored significantly less (P < 0.001) compared to normal controls. Dysfunctional Analysis Questionnaire (DAQ)-Social area and DAQ-Personal area had statistically significant positive correlation (P < 0.05) with an obsessive subscale of Yale–Brown Obsessive Compulsive Scale (Y-BOCS) whereas DAQ-social area (P < 0.05), DAQ-Personal Area (P < 0.05) had statistically significant positive correlation with a total score of Y-BOCS. Conclusion: The presence of functional impairment leads to poor QOL in the persons with OCD.

An amendment to this paper has been published and can be accessed via the original article.

The shifting cultivation is an indigenous land use system widely prevalent and practiced in North East India. Around the globe, the tropical countries practise this form of land use called commonly as shifting cultivation or swidden or slash and burn agriculture. Being one of the dominant land use systems, shifting cultivation calls for investigation by the interested researchers and academicians. Hence, the purpose of the present endeavor is to analyze the basic social dimensions of shifting cultivation through interventions analysis of secondary information and strategies for improvement. The review lays focus on shifting cultivation in India and blending the accumulated experiences with those of other countries. The review takes into account social characteristics of the shifting cultivation, the underlying causes of the shifting cultivation, the Government of India initiatives and impacts to control the shifting cultivation, sustainability, livelihood and food security and the shifting trends in shifting cultivation and the strategies for livelihood improvement. The analysis reveals that the shifting cultivators have an intricate relationship with the land and have a strong affinity and respect towards the land as it is a way of life. The trends in shifting cultivation though depict some patterns of change but the data are highly varied. From the literature, it is observed that there is a transition taking place in the various countries in varied form from subsistence based system to dual economy. The jhum land use is debatable as the practice is criticized as an unscientific form of land use, which causes land degradation and ecosystem fragility. As a result, the region is experiencing colossal loss of vegetation cover and top fertile soils through erosion from steep slopes. Therefore, a significant, multidimensional strategy is required to transform the large scale agricultural degraded land from a financial and environmental liability to valuable assets. However, the systematic and detailed study needs to be conducted in the North Eastern Region on the social dimension of shifting cultivation and strategies for its improvement.

Objective: Risk factors for inpatient suicide are different from those in the general population. We examined sociodemographic and clinical variables of patients who committed suicide as an inpatient in a psychiatric hospital in India. Methods: Matched retrospective nested case–control design was adopted. Ten patients who died by suicide as inpatients between 2000 and 2013 were included, along with fifty controls, matched with respect to age, sex, diagnosis, and period of admission. Results: Suicide completers were mostly unskilled in occupation (P = 0.03), had a history of past suicide attempts (P < 0.001), shorter duration of hospital stay (P = 0.001), poorer improvement on psychopathology (P = 0.02), and were having more suicidal ideation (P = 0.02). Significantly more completers were receiving antidepressants (P = 0.04). Conclusion: This study adds to the existing sparse literature on inpatient suicides from Asia. Strength of the study was close matching between case and controls and blindedness. Limitations were retrospective design, and variations in prescription behavior and treatment decisions.

Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014-15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015-16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015-16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.

Introduction: Amoebiasis is defined as human infection with protozoan parasite, Entamoeba histolytica regardless of the clinical outcome. It commonly resides in large intestine but can invade to other organs. Amoebic Liver Abscess (ALA) is the most common complication of invasive amoebiasis. Aim: To study various aspects of ALA like demographic profiles, clinical features, radiological and laboratory findings and treatment. Materials and Methods: A cross-sectional study was performed in the Department of Microbiology, Maulana Azad Medical College, New Delhi, India, from October 2012 to April 2014. Pus, blood and stool samples were taken from each patient after taking informed consent and examined for trophozoite by microscopy, IgG antibody and antigen of Entamoeba histolytica by ELISA respectively. The results were presented as mean for quantitative variables and percentages for qualitative data. Calculations were done using Microsoft Excel software. Results: Total 65 patients with age more than 18 year were enrolled in the study out of which 39 cases (60%) were diagnosed as ALA. The age ranged from 18 to 90 years (mean age 37.1 year). Male patients were dominated over female. About 74.3% patients were addicted to alcohol. Most patients had acute presentation. Pain in abdomen and fever were the most common symptoms observed (97.4% and 94.8% respectively). The right lobe was involved in 76.9% cases. Solitary abscess was found in 82.0% cases out of which 64.1% were in right lobe. Volume of abscess ranged between 70 cc and as much as 1200 cc. Volume less than 300 cc was seen in 17 cases (43.5%) and more than 300 cc was seen in 22 cases (56.5%). Pleural effusion and intra peritoneal rupture were the two complications (28.2% and 10.2%) found in this study. All patients were treated successfully with or without help of percutaneous intervention. Conclusion: ALA presents itself through various non specific symptoms and signs. Confirmation of diagnosis is made possible with the help of radiological and microbiological methods. Prompt diagnosis and treatment can markedly reduce the complication and mortality.

Background: Alcohol-dependent patients are traditionally believed to have insecure attachment styles, higher anger expression, and lower self-esteem. There is a need to study them together. Aim: To understand the relationships amongst various of the socio-emotional factors. Materials and Methods: Forty male patients with Alcohol dependence syndrome and 40 matched healthy controls (General Health Questionnaire-12 score

Background: Attentional/cognitive impulsivity has been demonstrated as being associated with an increased risk for suicide and other self-harming behaviors, along with a more severe course in patients with bipolar disorder. That an alteration of the various serum lipid fractions might be associated with increased impulsivity has been proposed in the past, but evidences are ambiguous and mainly based on western population data. Objective: The present study was aimed to analyze the attentional impulsivity and various serum lipid fractions in bipolar patients, from an Indian perspective. Materials and Methods: At presentation, 60 drug free/naïve first episode Mania patients were rated on the Barratt impulsiveness scale-version 11 and Young Mania Rating Scale; body mass index (BMI) was calculated and blood samples were analyzed for total cholesterol (TC), high density lipoproteins, low density lipoproteins and very low density lipoproteins (VLDL), triglycerides (TG) and apolipoproteins A1 and B. Results: The analysis revealed statistically significant negative correlation and inverse linear relationship between TC, TG, VLDL and BMI with attentional impulsivity. Conclusion: The present study adds to the growing literature on a complex relationship between lipid fractions and attentional impulsivity. The findings present interesting insights into the possible substrates of human behavior at biochemical levels. The implications are many, including a need to introspect regarding the promotion of weight loss and cholesterol reduction programs in constitutionally vulnerable population.

During the course of our attempts to develop a potential herbal medicine, we had previously prepared PF2401-SF, a standardized fraction of S. miltiorrhiza, and reported its hepatoprotective activity in vitro as well as in vivo. Since apoptosis of activated hepatic stellate cells (HSCs) is a well-accepted anti-fibrotic strategy, in this study, we investigated the direct effect of PF2401-SF on t-HSC/Cl-6 cells in vitro and on CCl4-induced liver injury in vivo. We evaluated the activation and cleavage of hallmarkers of apoptosis, namely, caspase 3, 8, 9 and PARP. Upregulation of the pro-apoptotic Bax protein and downregulation of the anti-apoptotic Bcl2 protein were also analyzed. Furthermore, in the PF2401-SF treated rats, apoptosis induction of activated HSCs was demonstrated by reduced distribution of α-SMA-positive cells and the presence of high number of TUNEL-positive cells in vivo. Our data suggest that PF2401-SF can mediate HSCs apoptosis induction, and may be a potential herbal medicine for the treatment of liver fibrosis.

Introduction: Urinary Tract Infection (UTI) is a well- known complication of Diabetes Mellitus (DM). Its spectrum ranges from Asymptomatic Bacteriuria (ABU) to acute pyelonephritis. Many studies have delineated an increased prevalence of ABU in DM whereas to the same degree other studies have come to naught showing insignificant association. Hence, this study was drafted to evaluate the presence of ABU among diabetics and assess various risk factors. Methods: Total of 116 diabetic adults without symptoms of UTI attending medical out-patient department, Manipal Teaching Hospital were enrolled by detailed clinical history, examination and laboratorial examination as per standard set of questionnaire from February 2013 to May 2014. Data were analyzed by SPSS (17.0). Results: The rate of ABU in diabetic adults was 10.3% and was significantly associated with duration of DM, fasting blood glucose level and poor glycaemic control. Escherichia coli was the most frequently isolated pathogen which was sensitive to Nitrofurantoin and Imipenem. Conclusion: Being asymptomatic, diabetics fail to recognise ABU, however, ABU is preponderant in DM and is linked mainly with duration of DM and poor glycaemic control. Hence screening for ABU is imperative in diabetic adults if above mentioned risk factors are present.

A fixed point theorem is proved in a Banach space E which has uniformly normal structure for asymptotically regular mapping T satisfying: for each x,y in the domain and for n=1,2,⋯,‖Tnx−Tny‖≤an‖x−y‖+bn(‖x−Tnx‖+‖y−Tny‖)+cn(‖x−Tny‖+‖y−Tny‖), where an,bn,cn are nonnegative constants satisfying certain conditions. This result generalizes a fixed point theorem of Górnicki [1].

Many correlations are available in the literature to predict the higher heating value (HHV) of raw biomass using the proximate and ultimate analyses. Studies on biomass torrefaction are growing tremendously, which suggest that the fuel characteristics, such as HHV, proximate analysis and ultimate analysis, have changed significantly after torrefaction. Such changes may cause high estimation errors if the existing HHV correlations were to be used in predicting the HHV of torrefied biomass. No study has been carried out so far to verify this. Therefore, this study seeks answers to the question: “Can the existing correlations be used to determine the HHV of the torrefied biomass”? To answer this, the existing HHV predicting correlations were tested using torrefied biomass data points. Estimation errors were found to be significantly high for the existing HHV correlations, and thus, they are not suitable for predicting the HHV of the torrefied biomass. New correlations were then developed using data points of torrefied biomass. The ranges of reported data for HHV, volatile matter (VM), fixed carbon (FC), ash (ASH), carbon (C), hydrogen (H) and oxygen (O) contents were 14.90 MJ/kg–33.30 MJ/kg, 13.30%–88.57%, 11.25%–82.74%, 0.08%–47.62%, 35.08%–86.28%, 0.53%–7.46% and 4.31%–44.70%, respectively. Correlations with the minimum mean absolute errors and having all components of proximate and ultimate analyses were selected for future use. The selected new correlations have a good accuracy of prediction when they are validated using another set of data (26 samples). Thus, these new and more accurate correlations can be useful in modeling different thermochemical processes, including combustion, pyrolysis and gasification processes of torrefied biomass.