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Aim: To study of the effect of concentric needle (CN) electrode position on Motor unit potential (MUP) parameters. Subjects and Methods: Manual scanning EMG of right Biceps brachii muscle was done using Keypoint.Net EMG system. The bandwidth was 2 Hz-10 KHz. When the first recruited MUP was visualised on oscilloscope, all of its subsequent firings were recorded continuously for 1-2 minutes (400-1000 discharges). During this time, CN electrode was gradually advanced so as to maximise amplitude and minimise rise time (< 500 µsec). As the electrode was advanced, if the MUP showed significant changes in amplitude or morphology, electrode was held steady and 20-40 discharges of the MUP at that site were collected. For off-line analysis with Multi-MUP program, 4-7 templates corresponding to different positions of CN electrode within the motor unit (MU) territory were identified. For templates with > 4 discharges and clean baseline, duration cursors were positioned and MUP parameters were calculated. Results: 15 MUPs were sampled from 2 patients with neuromuscular disorders. The number of sites of recording per MUP was 6.1(0.99). At different sites within the MU, MUP parameters changed, sometimes markedly. The grand mean coefficients of variation for MUP parameters were: duration.9.3(4.4), amplitude.45.5(17.8) area.22.9(10.4), phases.28.6(17.9), turns.46.6(19.7), thickness.28.7(12.4), size index.1.3(196.6). Conclusion: Among all the MUP parameters, duration showed least variation within the territory of a given MU. Greater variability of size index, amplitude, and thickness makes them less reliable for evaluation of neuromuscular disorders. [ABSTRACT FROM AUTHOR]

Context: Temporal lobe epilepsy can affect central auditory processing (CAP) skills. Auditory temporal ordering (ATO) is a CAP skill that can be evaluated using duration pattern test (DPT)., Aim: The aim is to evaluate ATO in patients with medial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (MTLE + HS) and without hippocampal sclerosis (MTLE-HS) and in their subgroups., Settings and Design: It was a prospective cross-sectional behavioral observational study conducted in a tertiary neuropsychiatric hospital., Subjects and Methods: The subjects were patients with refractory MTLE (N = 100), comprising 50 "MTLE + HS" patients and 50 "MTLE-HS". Age-range matched normal healthy subjects (n = 50) formed the control group. Both groups were administered duration pattern test (DPT)., Statistical Analysis Used: Analysis of variance (ANOVA) with post hoc analysis, Dunnett's two-sided and Bonferroni, paired sample t-test, Pearson's correlation, and independent t-test., Results: The clinical groups performed significantly poorer than the control group, and however, did not differ significantly between them. The age at onset and the duration of the seizures did not have significant relation with the test measures., Conclusions: Patients with "MTLE + HS" as well as those with "MTLE-HS" and their respective subgroups revealed abnormal ATO indicating CAP dysfunction., Competing Interests: None

Background: With improved access to highly active antiretrieval treatment, many children with perintally acquired HIV are now able live longer. These children are now reaching into adolescence and sexually active. This qualitative, explorative study examines the sexual and reproductive health (SRH) needs and concerns of adolescents living with HIV (ALHIV) in India., Materials and Methods: We used qualitative research design to collect the data. Twenty participants were recruited from two nongovernmental organizations which provide shelter care, education, and emotional and social support to HIV/AIDS orphan children located in Bengaluru District of Karnataka State using purposive sampling. In-depth interview guide was prepared and used to elicit the adolescents' concerns, knowledge, and perspective related to sexuality, marriage, child bearing, and barriers in availing SRH services in the context of HIV., Results: Totally, four themes were emerged from that qualitative data based on thematic analysis, which are as follows: "Perceived challenges in relation to romantic relationship;" "Confusion regarding whether to marry person with HIV positive or HIV negative;" "Aspiration to have children," and "Perspective of ALHIV in relation to SRH needs and concerns.", Conclusion: The findings of the research brought out the need for policies and guidelines specifically targeting the SRH needs and concerns of ALHIV., Competing Interests: There are no conflicts of interest.

Siblings of persons with schizophrenia are important in providing long-term social support to the patients. Interventions addressing their needs are very sparse. Hence, this study aimed at testing the short-term effects of brief need based psychoeducation on knowledge, self-stigma, and burden among siblings of persons with schizophrenia. In this prospective controlled open label trial, 80 siblings of persons with schizophrenia were allocated in equal numbers to the brief need based psychoeducation group and the treatment-as-usual group. The outcomes were measured at baseline, and after the first and third month post-intervention. RM-ANCOVA was conducted to test the effect of the brief psychoeducation on outcome scores. The groups were similar with respect to socio-demographic, clinical, and outcome scores at the baseline. There was a significant group×time interaction effect on knowledge (F=8.71; p<0.01; η p 2 =0.14) and self-stigma scores (F=14.47; p<0.001; η p 2 =0.21), wherein the brief psychoeducation group showed a significant increase in knowledge and reduction in self-stigma with medium effect size through baseline to the third month follow-up as compared to the treatment as usual group. We also observed a significant main effect of time; irrespective of the group allocation, there was a significant increase in the knowledge through baseline to third month follow-up (F=5.69; p=0.02; η p 2 =0.09). No main or interaction effects of group and time were observed on burden. The findings suggest that brief need based psychoeducation may increase knowledge about the illness and reduce self-stigma. Further systematic studies are warranted to test this intervention for long-term effects., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: The incidence of long-term survival in glioblastoma (GBM), i.e., >3 years, ranges from 3% to 5%. Although extensive research is performed in novel therapies for prolonging survival, there is a scarcity of research focusing on the impact of tumor and treatment on cognitive, psychological, and social status of survivors. This study is an attempt to look into this poorly addressed important issue., Materials and Methods: Nine patients (six adults and three children) with GBM who had survived >3 years were included in the study. The quality of life (QOL) functions were assessed with the World Health Organization QOL Questionnaire BREF questionnaire. The neuropsychological assessment was done using the National Institute of Mental Health and Neurosciences neuropsychology battery for adults and children. The scores were compared with normative data., Results: The physical and psychological health-related QOL of long-term GBM survivors were affected considerably due to fatigue, poor quality of sleep, inability to concentrate, presence of depression, financial burden with impaired personal and social relationships ( P < 0.05). Different domains of cognitions such as motor speed ( P = 0.0173), mental speed ( P = 0.0022), sustained attention ( P = 0.0001), long-term memory ( P = 0.0431), mental flexibility ( P < 0.05), and planning and executive functions ( P < 0.05) were significantly impaired affecting personal, social, and professional lives., Conclusion: The health-related QOL and cognition are significantly impaired in GBM long-term survivors. As the incidence of long-term survival is very less, there is a need for larger multicenter studies to come up with definitive results, which in turn can help in formatting the rehabilitative and support programs for these patients., Competing Interests: There are no conflicts of interest.

Aim: To review the results of QuantiFERON TB gold (QFT-G) in our patient population of presumed ocular tuberculosis and the effect of antitubercular therapy (ATT) on the QFT-G result., Materials and Methods: Retrospective review of 82 cases of presumed ocular tuberculosis with a successful response to ATT and 6 months follow-up post-ATT. Appropriate statistical analysis was done for associations between QFT-G and independent variables. Pre-ATT QFT-G values were also compared to the post-ATT value., Results: There were no statistically significant differences in the results of QFT-G with age (0.635), gender (0.096), history of oral steroids (0.171), or type of uveitis (0.664). There was a statistically significant association between a positive QFT-G and serpiginous-like choroiditis (0.048). The majority of our patients had positive QFT even after completion of ATT but with a significant drop in the mean values post ATT (0.010)., Conclusions: Our study shows significant association of positive QFT with serpiginous-like choroiditis and persistent positivity even after completion of ATT in majority of cases in our population. There was, however, a drop in the mean values of QFT-G post-ATT.

Objective: This study aims to discuss the prevalence of polycystic ovary (PCO) and Polycystic ovary syndrome (PCOS) in women with epilepsy (WWE) on valproate (VPA), carbamazepine (CBZ), or phenobarbitone (PB), drug naive WWE and women with bipolar affective disorder (BPAD) on VPA., Materials and Methods: This prospective study included 190 women aged 18-45 years, who had epilepsy or BPAD (on VPA), and consented for study. Patients were grouped as Group 1 (n = 40): WWE on VPA, Group 2 (n = 50): WWE on CBZ, Group 3 (n = 50): WWE on PB, Group 4 (n = 30): drug naïve WWE, and Group 5 (n = 20): women with BPAD on VPA. All women were interviewed for medical, menstrual, drug and treatment history, nature of epilepsy, and seizure control. Chi-square test and Fisher's exact test were done to compare results between the groups., Results: Fifty-two women (52/190; 27.4%) had menstrual disturbances, in which oligomenorrhea was the most common (55.8%). There was a significant difference in the occurrence of PCOS in patients on VPA versus normal population (P = 0.05) and patients on other antiepileptic drugs (AEDs) (P = 0.02). There was, however, no significant difference in the occurrence of PCO between patients on VPA and the untreated epileptic women. VPA group (Epilepsy + BPAD) had a significantly higher occurrence of obesity than other treatment groups (P = 0.043, OR = 2.11)., Conclusions: The study observed significantly higher occurrence of PCO in patients on VPA compared to other AEDs and the normal population. The importance of proper clinical evaluation before initiating VPA is highlighted.

There is a lack of studies on siblings of persons with schizophrenia (SOPS) in Asia. This study aims to explore the needs of SOPS in India. 15 SOPS participated in this qualitative explorative study. All the interviews were audio recorded and later transcribed. Data analysis was carried out using General Inductive Approach. Five themes emerged from the data: managing illness or socio-occupational functioning; follow up services; informational needs; personal needs; and miscellaneous needs. SOPS in India have some distinctive needs. Identifying these needs might help in developing and designing specific psychosocial interventions for better management., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Understanding the complex relationship among determinants of real-world functioning in schizophrenia patients in remission is important in planning recovery-oriented interventions. We explored two path-analytical models of functioning in schizophrenia. 170 Schizophrenia patients remitted from positive symptoms underwent fairly comprehensive assessments of cognition - neurocognition (NC) and social cognition (SC), residual symptoms - insight, motivation and other negative symptoms, and socio-occupational functioning. We explored (a) a cascading model, where NC predicted functional outcome through its effects on other determinants and (b) a combined model, incorporating additional direct paths from each of the determinants. The combined model, and not the cascading model demonstrated a good fit. Post-hoc trimming of the combined model by elimination of non-significant paths maintained the goodness-of-fit and was retained as the final model. In addition to the direct paths, this final model demonstrated that (a) NC influenced functioning through SC and insight and (b) SC influenced functioning through motivation and negative symptoms. This suggests that NC and SC may influence functional outcome directly, as well as indirectly, via specific impact on insight, and motivation and negative symptoms respectively., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: This study was conducted to compare the efficacy of phenytoin, valproate and levetiracetam in patients with GCSE., Methods: This randomised controlled prospective study was conducted on 150 patients to compare the efficacy of phenytoin (n = 50), valproate (n = 50) and levetiracetam (n = 50) along with lorazepam in patients with GCSE. All recruited patients received i.v. lorazepam (0.1mg/kg) followed by one of the 3 AEDs viz. phenytoin (20 mg/kg), valproate (30 mg/kg), and levetiracetam (25 mg/kg). Those who remained uncontrolled with 1st AED, received the other two AEDs sequentially. Clinical, imaging, EEG, etiological factors were analysed. Predictors of poor seizure control and outcome at discharge and at one month follow-up were assessed., Results: In the phenytoin subgroup, the seizures could be controlled in 34 (68%) with lorazepam+phenytoin infusion. In the valproate subgroup (n = 50), seizures could be controlled in 34 (68%) with lorazepam+valproate infusion. In the levetiracetam subgroup (n = 50), seizures could be controlled in 39 (78%) with lorazepam+levetiracetam infusion. There was no statistically significant difference between the subgroups (p = 0.44). Overall, following lorazepam and 1st AED, 107/150 (71.3%) were controlled; with addition of 2nd AED, 130/150 (86.7%) and by adding 3rd AED, 138/150 (92%) were controlled. Fifteen out of 110 (13.6%) expired within 1 month of SE: phenytoin-6; valproate-4; and levetiracetam-5. Interestingly, 3 patients in the levetiracetam had post-ictal psychosis., Significance: Phenytoin, valproate, and levetiracetam are safe and equally efficacious following lorazepam in GCSE. The choice of AEDs could be individualised based on co-morbidities. SE could be controlled in 92% of patients with AEDs only and anaesthetics were not required in them., (Copyright © 2015 Elsevier B.V. All rights reserved.)

This prospective cross-sectional study compared 25 children with pervasive developmental disorder and epilepsy and 25 children having pervasive developmental disorder without epilepsy on pervasive developmental disorder scores, Childhood Autism Rating Scale scores, language disability, presence of regression, and epileptiform abnormalities. Epilepsy phenotype was also studied. Children with pervasive developmental disorder and epilepsy had higher pervasive developmental disorder scores (P = .001), higher Childhood Autism Rating Scale scores (P = .016), and lower social quotient (P = .09). More than 50% of children with pervasive developmental disorder and epilepsy and 12% of children having pervasive developmental disorder without epilepsy had epileptiform abnormalities in electroencephalography (EEG). Regression of milestones was significantly associated with epilepsy and epileptiform abnormalities. Children with pervasive developmental disorder and epilepsy might have a worse developmental trajectory requiring intensive management. A behavioral phenotype of autism may coexist often in children with epilepsy, EEG abnormalities, and regression. Seizures might be difficult to control in these children despite adequate compliance. Studies with larger sample size and longitudinal follow-up will provide better understanding., (© The Author(s) 2014.)

Background and Aims: Electroconvulsive therapy (ECT) is an established modality of treatment for severe psychiatric illnesses. Among the various complications associated with ECT, oxygen desaturation is often under reported. None of the previous studies has evaluated the predictive factors for oxygen desaturation during ECT. The objective of this study was to evaluate the incidence of oxygen desaturation during recovery from anesthesia for modified ECT and evaluate its risk factors in a large sample., Materials and Methods: All patients aged above 15 years who were prescribed a modified ECT for their psychiatric illness over 1 year were prospectively included in this observational study. The association between age, body mass index (BMI), doses of thiopentone and suxamethonium, stimulus current, ECT session number, pre- and post-ECT heart rate and mean arterial pressure, seizure duration, and pre- and post ECT oxygen saturation, was systematically studied., Results: The incidence of oxygen desaturation was 29% (93/316 patients). Seizure duration and BMI were found to be significantly correlated with post ECT desaturation., Conclusion: In this prospective observational study, the incidence of oxygen desaturation during recovery from anesthesia for ECT was high. The study identified obesity and duration of seizure as the independent predictors of this complication. This knowledge is likely to help in identifying and optimizing such patients before subsequent ECT sessions.

Aim: To analyze the clinic profile of polymerase chain reaction proven viral anterior uveitis in a south Indian patient population., Materials & Methods: Retrospective, nonrandomized study between January 2009 and July 2012., Results: Out of the 36 patients with polymerase chain reaction (PCR)-positive viral anterior uveitis, 24 patients had varicella zoster virus (VZV) anterior uveitis, 7 patients had HSV anterior uveitis, 3 patients had cytomegalovirus (CMV) anterior uveitis, and 2 patients had chikungunya virus related anterior uveitis. Corneal involvement was seen in 21 cases (58.33%). An altered iris pattern was seen in 14 cases (38.89%). Increase in intraocular pressure (IOP) at the time of inflammation was seen in 10 cases (27.78%). Reactivations were seen in 22 cases (61.11%). A comparison of herpes simplex virus (HSV)- and VZV-related anterior uveitis did not reveal any significant factors except for a previous history of herpes zoster in VZV-associated uveitis., Conclusion: We see isolated viral anterior uveitis related to HSV, VZV, CMV, and chikungunya viruses in our patient population. Corneal involvement, pigmented keratic precipitates, an abnormal iris pattern, increase in IOP, and reactivations are seen as a spectrum of viral anterior uveitis in our patient population as well.

Background: Metabolic side effects of antipsychotics contribute to morbidity and non-compliance in treatment of psychosis. Multiple studies suggest that metabolic side effects correlate with response to antipsychotic treatment. However, few studies have systematically looked at this. We conducted an exploratory, naturalistic, prospective, trans-diagnostic study to examine this association., Methods: 100 patients with psychosis, initiated on antipsychotic treatment alone, were assessed on Brief Psychiatric Rating Scale (BPRS), visual analog scale for appetite, anthropometric measurements (weight, waist circumference, body mass index), and fasting serum lipid and glucose profiles at baseline, 2-4 weeks (n=71) and 8-12 weeks (n=39)., Results: Subjects who dropped out at first/second follow-ups did not differ from those who followed-up, in age, sex, illness duration and BPRS scores. On forward stepwise multiple linear regression analysis, early (2-4 weeks) increase in appetite and triglyceride levels (R(2)=0.257; p=0.003) together predicted 26% variance in treatment response (BPRS score reduction) at first follow-up. At second follow-up 16% of variance in treatment response was predicted by early (2-4 weeks) increase in triglyceride levels (R(2)=0.169; p=0.009)., Conclusions: Early appetite and triglyceride changes predicted antipsychotic treatment response. Involvement of dopaminergic, serotonergic and histaminergic neural pathways could explain the association between appetite and treatment response. Insulin signaling pathways have been implicated in lipid changes with antipsychotics. Study findings suggest metabolic side effects may be early predictors of antipsychotic response. These findings warrant further examination to elucidate the interaction between metabolic pathways and psychotic illnesses, and possibly mechanism of action of antipsychotics beyond dopamine blockade., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Purpose: To evaluate the role of intermittent prophylaxis with clobazam in the management of HWE in a long-term prospective study., Material and Methods: Two hundred and sixty patients [M:F - 194:66] with HWE were recruited. Patients were divided into: (a) 'HWE alone' (n=198) - received intermittent clobazam prophylaxis, 1-1½h prior to hot water head bath (group A); (b) 62 patients (20.4%) with 'HWE with spontaneous seizures were treated with continuous AEDs along with intermittent clobazam therapy (group B)., Results: Patients (n=198) in group A was followed for mean of 17.6 ± 10.6 months (range: 3-57). One hundred and forty seven patients (74.2%) had excellent response with complete seizure freedom with clobazam therapy while 12 (6.1%) had >75% reduction in seizure frequency. Remaining 39 (19.7%) required additional standard AED along with clobazam and 18 patients among them developed spontaneous/unprovoked seizure at follow up of 6.7 ± 4.1 months. Forty five patients in group B were seizure free while on continuous AEDs., Conclusions: Intermittent clobazam prophylaxis prior to head water bath might be a preferred mode of treatment of pure HWE. Additional AEDs are required if they have associated non-reflex unprovoked seizure., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Schizophrenia patients experience substantial impairments in social cognition (SC) and these deficits are associated with their poor functional outcome. Though SC is consistently shown to emerge as a cognitive dimension distinct from neurocognition, the dimensionality of SC is poorly understood. Moreover, comparing the components of SC between schizophrenia patients and healthy comparison subjects would provide specific insights on the construct validity of SC. We conducted principal component analyses of eight SC test scores (representing four domains of SC, namely, theory of mind, emotion processing, social perception and attributional bias) independently in 170 remitted schizophrenia patients and 111 matched healthy comparison subjects. We also conducted regression analyses to evaluate the relative contribution of individual SC components to other symptom dimensions, which are important clinical determinants of functional outcome (i.e., neurocognition, negative symptoms, motivational deficits and insight) in schizophrenia. A three-factor solution representing socio-emotional processing, social-inferential ability and external attribution components emerged in the patient group that accounted for 64.43% of the variance. In contrast, a two-factor solution representing socio-emotional processing and social-inferential ability was derived in the healthy comparison group that explained 56.5% of the variance. In the patient group, the social-inferential component predicted negative symptoms and motivational deficits. Our results suggest the presence of a multidimensional SC construct. The dimensionality of SC observed across the two groups, though not identical, displayed important parallels. Individual components also demonstrated distinct patterns of association with other symptom dimensions, thus supporting their external validity., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objective: In view of the conflicting results of cognitive and behavioral consequences of PB, the present study was planned to analyze its efficacy, serial neuropsychological functions and its impact on psychosocial functioning in adults with epilepsy while on phenobarbitone (PB)., Methodology: This prospective multi-centric study carried out across 4 centers in India included 75 adult patients of ≥18 years (M:F=52:23; age: 27.3 ± 8.5 years) with epilepsy who were prescribed phenobarbitone and underwent serial standardized neuropsychological assessment (NIMHANS battery for adults) at baseline, 1 month, 3 months, 6 months and 12 months. The demographic, seizure details and outcome measures were recorded., Results: Of the 75 patients, 63 had completed clinical and neuropsychological assessment, i.e. visit 1 (baseline), visit 4 (6 months) and visit 5 (12 months). There was no deterioration rather an improvement during the follow visits in all the neuropsychological functions. The results indicate that 16 neuropsychological variables changed significantly, viz. mental speed (p<0.001), sustained attention (p<0.001), focused attention (p<0.002), planning (p<0.001), concept formation (p<0.05), set shifting (p<0.001), verbal learning (p<0.0001), verbal memory (p<0.0001), visual memory (p<0.0001) and intelligence (p<0.001). The scales measuring the outcome of psychosocial functioning significantly changed during follow up included happiness (p<0.002), Impact of Epilepsy on patient's life (p<0.02), A-B Neuropsychological Assessment (p<0.015), HADS anxiety (p<0.001) and emotional disorder (p<0.006). There was a significant reduction in seizure severity as measured by Liverpool Seizure Severity Scale (p<0.002) and seizure freedom was maintained., Conclusions: This study demonstrated that phenobarbitone is effective, well tolerated AED and do not have cognitive impairment over one year. There was variable but distinct improvement in cognition and psychosocial functioning, and effective seizure control could be one of the factor for it., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Social cognition (SC) and neuro-cognition (NC) have emerged as predictors of functional outcome and possible endophenotype-markers in schizophrenia. The distinctiveness of these two domains is not well established. Factor analysis is used to identify distinct cognitive dimensions. This paper aims to systematically review studies reporting factor analysis of SC and NC in schizophrenia to provide empirical evidence for (a) distinctiveness of SC and NC; and (b) factor structure of SC. The review comprised 20 studies. Most of the studies were cross-sectional, involving variably defined 'stable' schizophrenia patients, using objective assessments of SC and NC. A quality check on reporting practices of factor analytic studies showed important deficiencies in reporting both exploratory and confirmatory factor analyses. There was fairly consistent evidence for the existence of distinct SC and NC factors, with eight out of nine studies supporting this separateness of the two cognitive dimensions. The results were inconsistent regarding factor structure of SC. Unitary, binary and multi-factorial constructs were reported, possibly due to variability and lack of comprehensiveness of the SC measures used. This review highlights distinctiveness of SC and NC dimensions in schizophrenia. It thus provides construct validity for cognition in schizophrenia and offers clues regarding the potential neural processes underlying these cognitive dimensions. Future studies exploring the factor structure of SC should be guided by more careful theoretical work and use comprehensive measures of SC in large homogeneous samples of schizophrenia patients., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background & Objectives: The complementary and alternative medicines (CAM) have not been systematically evaluated for the management of HIV/AIDS patients. In a prospective, single-site, open-label, non-randomized, controlled, pilot trial, we evaluated a polyherbal formulation (PHF) for its safety and efficacy in treating subjects with HIV-AIDS., Methods: A total of 32 and 31 subjects were enrolled under the PHF and highly active antiretroviral treatment (HAART) arms, respectively, and followed up for a period of 24 months. Plasma viral RNA, CD4 cell count and blood chemistry were monitored at 3-month intervals. Following mid-term safety evaluation, 12 subjects from the PHF arm were shifted to HAART and were followed separately as PHF-to-HAART arm, for the rest of the period., Results: The HAART arm was characterized by significant improvements in CD4 cell count (154.4 cells/μl/year, P<0.001) and reduction in plasma viral load within 3 to 6 months (-0.431+ 0.004 log 10 IU/month, P<0.001). In contrast, the PHF arm showed a profile of CD4 cell loss at remarkably slower kinetics (14.3 cells/μl/year, P=0.021) and insignificant reduction in the viral load. The PHF and HAART arms did not differ significantly in the occurrence of AIDS-related illnesses over the study period of 24 months. In the PHF-to-HAART arm, the rates of CD4 count and reduction in viral load were significant and comparable to that of the HAART group. In the PHF arm, at 1 month, a significant increase in CD4 cell count and a concomitant decrease in viral load were seen., Interpretation & Conclusions: The PHF appears to have provided protection by delaying the kinetics of CD4 cell reduction. Given the several study limitations, drawing assertive inferences from the data is challenging. Future studies with a stringent study design are warranted to confirm these findings.

Background: The aim of this study is to determine the preferences and perspectives regarding the Quantiferon TB Gold test for the diagnosis of tuberculosis (TB) in India. A survey was distributed among 46 uveitis specialists, rheumatologists, and pulmonologists with a minimum of 2 years experience in the management of tuberculosis, in order to restrict the respondents to specialists who have used this test in their practice in the diagnosis of tuberculosis. Topics included demographics, usage, logistics, effectiveness, and preferences related to the Quantiferon TB Gold test., Results: Among the 37 responders, there were 19 uveitis specialists, 9 rheumatologists, and 9 pulmonologists with the majority having more than 7 years of experience in treating tuberculosis. Latent TB was the most common type of tuberculosis reported by 81% of the responders. Although 92% agree that Quantiferon TB Gold assay is used for the diagnosis of latent TB, only 32% use this test always in their practice. Limiting factors include the higher cost (35.14%), limited data from countries endemic for TB and hence limited interpretation of results (32.43%), the inability to differentiate active and latent TB (32.43%), and technical issues related to the test (18.92%). A combination of the Mantoux test and Quantiferon TB Gold test was the preferred test for investigation in 51% of the responders rather than solo tests., Conclusions: Within this group of specialists dealing with different forms of tuberculosis, perspectives of this test and preferences are many. The increased cost and limited data from India with respect to interpretation of the results are the most common limiting factors in using this test.

Purpose: This study characterized the demographic, clinical, EEG and imaging profile, and therapeutic outcome among patients with hot water epilepsy (HWE)., Methodology: This prospective study included 70 patients with HWE (M:F=55:15; age: 25.3±8.4 years). Details of demography, seizure characteristics and outcome, and imaging/EEG observations were recorded., Result: There was male dominance. Majority of the patients belonged to Mandya: 30.5%, Ramanagara: 30.0% and Mysore: 15.2% districts of Karnataka, India. Forty-five patients (M:F=37:8; age: 24.6±10.1 years) had features of 'HWE alone'. Twenty-five (M:F=18:7; age: 26.7±7.9 years) had HWE with spontaneous seizures. The age at onset of seizures was comparable in both the groups - HWE: 18.7±10.2 years vs. HWE with spontaneous seizure: 16.8±10.3 years (p=0.34). The duration of seizures were more in HWE with spontaneous seizure group: 119.5±66.9 months compared to HWE alone: 69.9±13.8 months (p=0.028). Inter-ictal EEG (n=70) showed epileptiform activities in 15 patients (21.4%). The therapeutic outcome after 3-8 months of follow up were - (a) HWE group: 6 stopped hot water head bath; 39 were on intermittent clobazam therapy - seizure free: 33; and 6 received AEDs; (b) HWE with spontaneous seizure group: all were on AEDs and seizure free., Conclusions: Three-fourth of patients belonged to 'Mandya-Mysore belt of Karnataka'. There was increased duration of seizures among those with additional spontaneous seizure. About 3/4th subjects with HWE alone were seizure free with intermittent clobazam and remaining patients on AEDs were seizure free, confirming the earlier observations from this center., (Copyright © 2012 Elsevier B.V. All rights reserved.)

The aim of the study was to examine quality of life, functioning, disability, work and social adjustment, depression, anxiety and dysfunctional cognitions in patients with anxiety disorders. One hundred patients with anxiety disorders and 98 non-clinical participants were recruited for the study. A cross sectional design was adopted. The participants were assessed on the WHOQoL-BREF, Global Assessment of Functioning (GAF), Sheehan Disability Scale (SDS), the Work and Social Adjustment Scale (WSAS) and Dysfunctional Attitudes Scale (DAS). Data was analyzed using descriptive statistics, Mann-Whitney test, Spearman's Rho and regression analysis. Patients with anxiety disorders reported significantly lower quality of life than the community sample (df=98, p<.001). A shorter duration of illness was associated with lower quality of life. QoL was significantly correlated with severity of anxiety, depression and stress as well as with measures of disability and adjustment. Partial correlations indicated that depression did not significantly impact the relationship between work and social adjustment and QoL. Work and social adjustment, depression and dysfunctional cognitions emerged as significant predictors of QoL. The findings of the study are discussed in the light of existing research and the implications for future interventions are highlighted., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Purpose: This report describes the work functioning of schizophrenia patients receiving antipsychotic treatment in a rural south Indian community and examines the factors associated with it., Methods: We assessed work functioning of 201 patients who have completed a minimum of 3 years of follow-up as part of a cohort study of schizophrenia patients receiving community-based treatment. 'Work' section of the Indian disability evaluation and assessment scale (IDEAS) was used to evaluate work-related disability at the time of recruitment and after a mean (SD) 47.0 (9.6) months of follow-up. Patients with moderate to profound work-related disability were compared with those with no or mild disability across socio-demographic and clinical variables., Results: 75 (37.3 %) were agriculturists; 58 (28.9 %) were pursuing household jobs; 28 (13.9 %) were daily wage labourers; 7 (3.5 %) were skilled labourers; 7 (3.5 %) were involved in other jobs. 26 (12.9 %) were not doing any sort of work. The proportion of patients with moderate or profound disability reduced from 137/201 (68.2 %) at baseline to 82/201 (40.8 %) at follow-up (p < 0.001). Work-related disability reduced significantly [mean (SD) work score on IDEAS was 2.2 (1.6) at baseline and 1.1 (1.2) at follow-up; t = -9.1; p < 0.001]. Logistic regression analysis showed that work-related disability was significantly associated with male gender, longer duration of illness, higher psychopathology and poor treatment adherence., Conclusion: Nearly two-thirds of schizophrenia patients living in this rural south Indian community had satisfactory work functioning, a rate, which is substantially higher than rates reported from high-income countries. Agrarian work atmosphere and rural sociocultural milieu may have contributed to this in our sample. However, substantial proportion of patients remains considerably disabled. This highlights the need for concerted, community-level efforts to improve their functioning.

Primary headache disorders are a major public-health problem globally and, possibly more so, in low- and middle-income countries. No methodologically sound studies of prevalence and burden of headache in the adult Indian population have been published previously. The present study was a door-to-door cold-calling survey in urban and rural areas in and around Bangalore, Karnataka State. From 2,714 households contacted, 2,514 biologically unrelated individuals were eligible for the survey and 2,329 (92.9 %) participated (1,103 [48 %] rural; 1,226 [52 %] urban; 1,141 [49 %] male; 1,188 [51 %] female; mean age 38.0 years). The focus was on primary headache (migraine and tension-type headache [TTH]) and medication-overuse headache. A structured questionnaire administered by trained lay interviewers was the instrument both for diagnosis (algorithmically determined from responses) and burden estimation. The screening question enquired into headache in the last year. The validation study compared questionnaire-based diagnoses with those obtained soon after through personal interview by a neurologist in a random sub-sample of participants (n = 381; 16 %). It showed high values (> 80 %) for sensitivity, specificity and predictive values for any headache, and for specificity and negative predictive value for migraine and TTH. Kappa values for diagnostic agreement were good for any headache (0.69 [95 % CI 0.61-0.76]), moderate (0.46 [0.35-0.56]) for migraine and fair (0.39 [0.29-0.49]) for TTH. The survey methodology, including identification of and access to participants, proved feasible. The questionnaire proved effective in the survey population. The study will give reliable estimates of the prevalence and burden of headache, and of migraine and TTH specifically, in urban and rural Karnataka.

We studied the temporal resolution ability in patients with refractory complex partial seizures and mesial temporal sclerosis (MTS) using Gaps-In-Noise (GIN) test in a prospective cross-sectional study. Thirteen patients with right MTS (age: 31±7.67 years; M:F=8:5) and 13 patients with left MTS (age: 25.76±8.26 years; M:F=9:4) having normal hearing and mini-mental state examination (MMSE) score of >23/30 were recruited. Fifty healthy volunteers (26.3±5.17 years; M:F=28:22) formed the control group. Gaps-In-Noise test demonstrated impaired temporal resolution: 69.2% of patients with right MTS (RMTS) and 76.9% of patients with left MTS (LMTS) had abnormal scores in the right ear for gap detection threshold (GDT) measure. Similarly, 53.8% of patients in the RMTS group and 76.9% of patients in the LMTS group had abnormal scores in the left ear. In percentage of correct identification (PCI), 46.1% of patients with RMTS and 69.2% of patients with LMTS had poorer scores in the right ear, whereas 46.1% of patients with RMTS and 61.5% of patients with LMTS had poorer scores in the left ear. Both patient groups, viz., RMTS and LMTS, demonstrated bilateral temporal resolution deficits., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Aim: To look for clinical parameters that will assist in making a diagnosis of tubercular or sarcoid uveitis in a South Indian patient population, Methods: Retrospective, nonrandomized, comparative study of 51 patients with a diagnosis of biopsy-proven tuberculosis and sarcoidosis. These patients had a minimum of 1-year follow-up after initiating treatment for either disease. Multivariate logistic regression analysis was used to determine clinical predictors of tubercular uveitis., Results: The mean age group was 47.08 ± 11.19 years. There were 39 women and 12 men in the study. Multivariate logistic regression analysis shows likelihood of uveitis being tubercular in etiology using 3 variables: Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and a positive Mantoux test 76.6%., Conclusion: A combination of Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and positive Mantoux test may be used clinically to differentiate tubercular from sarcoid uveitis in our patient population.

Background: Tobacco use contributes significantly to the diseases burden in India. Very few tobacco users spontaneously quit. Therefore, beginning 2002, a network of 19 tobacco cessation clinics (TCCs) was set up over a period of time to study the feasibility of establishing tobacco cessation services., Methods: Review of the process and operational aspects of setting up TCCs was carried out by evaluation of the records of TCCs in India. Baseline and follow-up information was recorded on a pre-designed form., Results: During a five-year period, 34 741 subjects attended the TCCs. Baseline information was recorded in 23 320 cases. The clients were predominantly (92.5%) above 20 years, married (74.1%) and males (92.2%). All of them received simple tips for quitting tobacco; 68.9% received behavioural counselling for relapse prevention and 31% were prescribed adjunct medication. At six-week follow-up, 3255 (14%) of the tobacco users had quit and 5187 (22%) had reduced tobacco use by more than 50%. Data for three, three-monthly follow-ups was available for 12 813 patients. In this group, 26% had either quit or significantly reduced tobacco use at first follow-up (three-months), 21% at the second (six-months) and 18% at the third follow-up (nine-months) had done so., Conclusions: It is feasible to set up effective tobacco cessation clinics in developing countries. Integration of these services into the health care delivery system still remains a challenge.

In the present study, effect of Na-Bu on the pRb phosphorylation was analysed in the primary cultures of 12 VS tumors. Primary cultures of VS tumors were established from the fresh tumor tissues removed surgically and were treated with Na-Bu. Na-Bu treatment for 48 h led to morphological changes and apoptotic cell death in VS tumor cells. Na-Bu treatment decreased level of total pRb and phosphorylated form of pRb and caused specific dephosphorylation at Ser 249/Thr 252 and Ser 567. In the untreated and Na-Bu treated cells (when present), pRb was localised in the nucleus. Moreover, in Na-Bu treated cells the nucleus appeared highly condensed as compared to untreated cells. Results of the present study indicated that Na-Bu treatment modulated pRb phosphorylation status and caused apoptotic cell death in VS tumors.

Context: Longer duration of untreated psychosis (DUP) is known to be associated with poorer outcome of schizophrenia. DUP is also known to be longer in lower- and middle-income countries. Methodologically sound studies that have examined the association of DUP and outcome of schizophrenia in these countries are lacking., Aim: The aim was to evaluate the association between DUP and outcome of never-treated schizophrenia patients., Setting and Design: This study was conducted at the National Institute of Mental Health and Neurosciences, Bangalore, using a prospective cohort design., Materials and Methods: 119 patients with schizophrenia/schizophreniform disorder diagnosed using the computerized diagnostic interview schedule for DSM-IV (CDIS-IV) were further assessed for DUP with the interview for retrospective assessment of onset of schizophrenia (IRAOS). After a mean (SD) follow-up period of 55.9 (37.2) weeks, the social and occupational functioning and psychopathology of 93 (80.2% of the surviving patients) patients were assessed using the social and occupational functioning scale (SOFS) and the positive and negative syndrome scale (PANSS), by raters blind to the DUP data. Spearman's correlation and Kendall's tau-B test were used to analyze the relationship between DUP and the outcome variables., Results: The mean DUP was 90.2 (median=30.1; SD=121.9) weeks. SOFS and PANSS scores at follow-up were statistically significantly associated with DUP, but not with other baseline variables (SOFS: rho=0.22, P=0.03; PANSS: rho=0.23, P=0.03). Among those with the shortest DUP (<16 weeks; n=33), 45.5%, 30.3%, and 24.2% had no impairment, mild-moderate impairment, and severe impairment, respectively. In contrast, 19.4%, 38.7%, and 41.9% of those with the longest DUP (>72 weeks; n=31) had no, mild-moderate, and severe impairment, respectively (Kendall's Tau-b=0.194; P=0.025)., Conclusions: The delay in accessing treatment among patients with psychosis is considerable in India, a lower- to middle-income country. Longer DUP is associated with poorer psychopathological and functional outcomes in persons with schizophrenia/schizophreniform disorder.

Social cognition is a cognitive domain that is under substantial cultural influence. There are no culturally appropriate standardized tools in India to comprehensively test social cognition. This study describes validation of tools for three social cognition constructs: theory of mind, social perception and attributional bias. Theory of mind tests included adaptations of, (a) two first order tasks [Sally-Anne and Smarties task], (b) two second order tasks [Ice cream van and Missing cookies story], (c) two metaphor-irony tasks and (d) the faux pas recognition test. Internal, Personal, and Situational Attributions Questionnaire (IPSAQ) and Social Cue Recognition Test were adapted to assess attributional bias and social perception, respectively. These tests were first modified to suit the Indian cultural context without changing the constructs to be tested. A panel of experts then rated the tests on likert scales as to (1) whether the modified tasks tested the same construct as in the original and (2) whether they were culturally appropriate. The modified tests were then administered to groups of actively symptomatic and remitted schizophrenia patients as well as healthy comparison subjects. All tests of the Social Cognition Rating Tools in Indian Setting had good content validity and known groups validity. In addition, the social cure recognition test in Indian setting had good internal consistency and concurrent validity., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objective: Can dysautonomic symptoms occurring within a year of developing motor symptoms distinguish Multiple system atrophy-Parkinsonian (MSA-P) from Parkinson's disease (PD)?, Patients and Methods: Seventy-two Parkinsonian patients diagnosed as probable PD or MSA-P., Results: PD (n = 58, 80.6%) and MSA (n = 14, 19.4%) patients were of similar age and had motor symptoms for similar duration. PD first presents with motor symptoms (68.3%) while MSA-P presents with dysautonomia (85.7%). Urinary incontinence was reported by MSA-P (64%) at their first visit and was absent in most PD (98%) patients., Conclusions: Urinary incontinence and orthostatic symptoms occurring in a parkinsonian patient within one-year history of motor symptoms suggests a diagnosis of MSA-P with high accuracy and their absence suggests PD.

Objective: Facial emotion recognition deficits have been consistently demonstrated in schizophrenia and can impair socio-occupational functioning in these patients. Treatments to improve these deficits in antipsychotic-stabilized patients have not been well studied. Yoga therapy has been described to improve functioning in various domains in schizophrenia; however, its effect on FERD is not known., Method: Antipsychotic-stabilized patients randomized to receive Yoga (n=27), Exercise (n=17) or Waitlist group (n=22) were assessed at baseline, 2nd month, and 4th month of follow-up by raters blind to group status. Assessments included Positive and Negative Syndrome Scale (PANSS), Socio-Occupational Functioning Scale (SOFS), and Tool for Recognition of Emotions in Neuropsychiatric DisorderS (TRENDS)., Results: There was a significant positive correlation between baseline FERD and socio-occupational functioning (r=0.3, P=0.01). Paired samples t test showed significant improvement in positive and negative symptoms, socio-occupational functioning and performance on TRENDS (P<0.05) in the Yoga group, but not in the other two groups. Maximum improvement occurred at the end of 2 months, and improvement in positive and negative symptoms persisted at the end of 4 months., Conclusion: Yoga therapy can be a useful add-on treatment to improve psychopathology, FERD, and socio-occupational functioning in antipsychotic-stabilized patients with schizophrenia., (© 2010 John Wiley & Sons A/S.)

Background: Substantial evidence exists for HLA and other host genetic factors being determinants of susceptibility or resistance to infectious diseases. However, very little information is available on the role of host genetic factors in HIV-TB coinfection. Hence, a longitudinal study was undertaken to investigate HLA associations in a cohort of HIV seropositive individuals with and without TB in Bangalore, South India., Methods: A cohort of 238 HIV seropositive subjects were typed for HLA-A, B, and DR by PCR-SSP and followed up for 5 years or till manifestation of Tuberculosis. HLA data of 682 HIV Negative healthy renal donors was used as control., Results: The ratio of males and females in HIV cohort was comparable (50.4% and 49.6%). But the incidence of TB was markedly lower in females (12.6%,) than males (25.6%). Further, HLA-B*57 frequency in HIV cohort was significantly higher among females without TB (21.6%, 19/88) than males (1.7%, 1/59); P = 0.0046; OR = 38. CD4 counts also were higher among females in this cohort., Conclusion: This study suggests that HIV positive women with HLA-B*57 have less occurrence of TB as compared to males.