Deception in prison assessment of substance abuse

The relationship of The Paulhus Deception Scales (PDS; ) to the Texas Christian University Drug Screen I was investigated in participants screened for a voluntary in-prison substance abuse treatment program. Mean PDS scores for 35 female and 277 male prison inmates were significantly higher than the inmate norms in the test manual. All three PDS scale scores were negatively related to symptom endorsement and to the diagnosis of drug dependence. Almost 37% of participants produced protocols of questionable validity, with 22% faking-good and 14.7% faking-bad. However, over 90% of participants obtained scores that were not covered by the manual's profile typology. These findings underline the importance of deception to correctional assessment and the need for more information on the psychometrics and operating characteristics of the PDS in correctional settings.     

Mortality characteristics during the two waves of COVID-19 in India:A retrospective observational study

Objective:To evaluate patient demographic characteristics and risk factors for mortality during the first and the second wave among COVID-19 patients in a tertiary care hospital of India.Methods:Data were taken from the hospital’s electronic system for COVID-19 patients from August 2020 to December 2020,and the second from January 2021 to May 2021.The mortality rate,demographic and clinical characteristics,laboratory profile,and reasons for the death of the two waves were retrieved and compared,and the risk factors of the two waves were determined.Results:In the first wave,1177 COVID-19 cases visited the hospital and 96(8.2%)died.In comparison,the death rate in the second wave was significantly higher(244/2038,12.0%)(P<0.001).No significant difference in age[60(50-69)vs.60.5(53-70),P=0.11]or gender(P=0.34)was observed between the two waves.Compared to the first wave.there were significantly more cases with fever,cough,weakness,loss of taste and smell,and sore throat during the second wave(P<0.05),but significantly fewer cases with kidney disease(6.6%vs.13.5%,P=0.038)and diabetes mellitus(35.7%vs.50.0%,P=0.015).Besides,during the second wave,more patients had abnormal X-ray findings,higher levels of lymphocytes and serum ferritin(P<0.05).In addition,there were significant differences in the rate of death cases with acidosis,septic shock,acute kidney injury,diabetes mellitus,cardiovascular events,hypothyroidism(P<0.05).Multivariate regression showed that during the first wave,age(OR:1.10;95%CI:1.02-1.21),diabetes mellitus(OR:3.16;95%CI:2.08-3.53),and abnormal X-ray(2.67;95%CI:2.32-2.87)were significant independent risk factors of mortality;while in the second wave,age(OR:1.13;95%CI:1.12-1.28),diabetes mellitus(OR:8.98;95%CI:1.79-45.67),abnormal X-ray(OR:12.83;95%CI:2.32-54.76),high D-dimer(OR:10.89;95%CI:1.56-134.53),and high IL-6(OR:7.89;95%CI:1.18-47.82)were significant independent risk factors of mortality.Conclusion:Overall mortality and incidence of severe diseases are higher in the second wave than the first wave.Demographic characteristics,co-morbidities,and laboratory inflammatory parameters,especially D-dimer and IL-6,are significant risk facors of mortality during the COVID-19 pandemic.     

Role of age at asthma diagnosis in the asthma-obesity relationship

OBJECTIVE:

To determine whether age at asthma diagnosis has an impact on the previously described relationship between asthma and obesity.

METHODS:

Data were provided from Cycle 1.1 (2000/2001) of the Canadian Community Health Survey, a nationally representative health survey that included 6871 participants (2464 males and 4407 females) with asthma. Body mass index was used to categorize participants as normal weight (18.5 kg/m² to 24.9 kg/m²), overweight (25 kg/m² to 29.9 kg/m²) or obese (30 kg/m² or greater). Multivariate logistic regression analyses were used to estimate the odds of overweight and obesity by self-reported age at asthma diagnosis, after accounting for current age and other covariables.

RESULTS:

In fully adjusted models, males diagnosed with asthma during adolescence (12 to 20 years of age) were at elevated odds of obesity (OR 1.58; 95% CI 1.03 to 2.43) compared with asthmatic patients diagnosed during childhood (0 to 11 years of age). Women diagnosed with asthma in mid life (21 to 44 years of age) and later life (45 to 64 years of age) were 43% (OR 1.43; 95% CI 1.08 to 1.90) and 56% (OR 1.56; 95% CI 1.00 to 2.44) more likely to be obese than those diagnosed in childhood, respectively.

CONCLUSIONS:

The impact of age at asthma diagnosis on the asthma-obesity relationship differed between males and females. However, the identification of high-risk groups of asthmatic patients may strengthen primary prevention strategies for obesity and related comorbidities at multiple levels of influence.     

A Novel BMPR2 Mutation Associated with Pulmonary Arterial Hypertension in an Octogenarian

We describe the case of an 83-year-old man with a family history of pulmonary hypertension (PH) who presented with severe pulmonary arterial hypertension (PAH) and later tested positive for a novel bone morphogenetic protein receptor 2 (BMPR2) gene mutation. To our knowledge, this may be the oldest reported patient with PAH in whom a BMPR2 mutation was initially identified.     

Role of Percutaneous Nephrostomy in Advanced Cervical Carcinoma with Obstructive Uropathy: A Case Series

Aims and Objective:

Over 70% of the cases present in advanced stages of the disease and are associated with poor prognosis and high mortality rates. In many of them, it is difficult to offer definitive treatment as they present in uremia due to associated obstructive uropathy. There are no clear-cut guidelines for performing percutaneous nephrostomy (PCN) in patients of advanced cervical cancer. The results are unpredictable in terms of benefits achieved in these cases. Thus, we evaluated our experiences with PCN in the management of cervical cancer patients presenting with obstructive uropathy.

Material and Methods:

15 patients of cervical cancer with obstructive uropathy and deranged renal functions were retrospectively evaluated for the role of PCN in their management

Results:

PCN was done in 15 patients of advanced cervical cancer. The mean age of patients was 44.5 years. Twelve (80%) patients presented primarily with advanced cervical carcinoma and obstructive uropathy. Three (20%) were already treated. Symptomatic improvement and significant fall of mean serum creatinine value from 7.5 mg% to 0.9 mg% over a period of 1-3 weeks was noted post PCN. Out of 12 patient with primary untreated advanced disease, curative treatment was possible in 3, palliative radiotherapy/chemo-therapy in 7 and only symptomatic treatment in 2 cases, after obstructive uropathy was managed with PCN insertion. Out of 3 already treated patients, 2 were disease free after curative radiotherapy/surgery. PCN was done to prevent permanent kidney damage in them. One patient was defaulter of curative radiotherapy. She had progressive residual disease. Complications like hemorrhage (20%), infection (26%), reinsertion for dislodgment/misplacement (53%), percutaneous leak or perinephric leak (20%), blockage of PCN (33%) were noticed.

Conclusion:

In spite of inherent, albeit manageable complications, PCN is a simple and safe technique. One of the major benefits observed was ability to administer either curative/palliative radiotherapy or chemotherapy in 85% of patients (11 out of 13 with disease). There was no active disease in remaining 2 patients. Therefore, the decision to attempt PCN in carefully selected cervical cancer patients is justified.     

Folie à deux: an old diagnosis with a new technology

The implantable cardioverter defibrillator (ICD) is the treatment of choice for life-threatening ventricular tachyarrhythmias. Despite this, indications for explantation have been described. Psychiatric complications have been considered in the decision to not re-implant a previously explanted device but never as a primary indication for explantation. The case of a woman who requested ICD explantation amidst concerns that the titanium used in its construction was absorbing harmful negative electromagnetic field energy from the environment resulting in intermittent bouts of fatigue, diaphoresis and an overall sense of impending doom is presented. She and her husband had significant psychosocial impairment because of this belief system. The present case is the first known report of a psychiatric complication as the primary indication for ICD explantation. It is illustrative of diagnostic dilemmas, competency and the importance of quality of life.     

Codon optimization and ubiquitin conjugation of human immunodeficiency virus-1 Tat lead to enhanced cell-mediated immune responses

The transactivator protein, Tat, is a potential candidate for developing a vaccine against human immunodeficiency virus (HIV-1). Since Tat is not immunodominant, especially when delivered as a genetic vaccine, we expressed codon-optimized subtype-C Tat as a molecular conjugate of ubiquitin, to elicit antigen-specific cell-mediated immune responses. Immunization of mice with different ubiquitin-Tat constructs elicited a strong cellular, but not a humoral, immune response. The combination of codon-optimization and ubiquitin-mediated processing of Tat induced a Th-1 type cellular immune response that was detectable without in vitro stimulation, suggesting its potential utility for destruction of virus-infected cells via CTL-mediated lysis. Preliminary attempts at characterizing the immunodominant regions identified a novel T-helper epitope within the core domain of Tat.     

Medetomidine analogs as selective agonists for the human alpha2-adrenoceptors

alpha(2)-Adrenoceptor (AR) agonists have therapeutic applications in a variety of diseases. Medetomidine, an alpha(2)-AR agonist, belongs to 4-substituted imidazole class of compounds and is highly selective for the alpha(2)-AR. The benzylic methyl group of medetomidine and naphthalene imidazole was proposed to interact with rat brain alpha(2)-ARs via a methyl binding pocket in a manner analogous to its presence in alpha-methyl norepinephrine. A series of derivatives containing hydrophilic and hydrophobic substituents, as well as chiral and conformationally rigid analogs were used. In current binding and functional studies using human alpha(2)-AR subtypes expressed in Chinese hamster ovary cells, optimal interactions were observed with the presence of the methyl group on the benzylic carbon atom of naphthyl imidazole. Data obtained with various analogs have demonstrated that size, electronegativity, lipophilicity, chirality and conformational flexibility of the substituents at the carbon bridge of naphthyl imidazole are important factors for interaction of the imidazole class of ligands with these alpha(2)-AR subtypes. Taken collectively, the results obtained support the existence of the methyl binding pocket for optimal ligand receptor binding interactions in human alpha(2)-AR subtypes. Further, the results also suggest that, additional modifications of medetomidine and naphthyl methyl imidazole at the benzylic carbon atom, and/or on the aromatic and imidazole ring systems could provide insights into the chemical requirements for optimizing alpha(2)-AR subtype selectivity. This could eventually lead to the discovery of promising compounds for the evaluation of the physiological importance of the three alpha(2)-AR subtypes.     

Embryonic stem cells: a great hope for a new era of medicine

Current stem-cell research has the potential to lead to new approaches for the treatment of cardiovascular, neurodegenerative and musculoskeletal diseases, as well as diabetes and cancer. Stem-cell-based approaches could be employed in cell-replacement therapy or in drug treatments that encourage adult stem cells to migrate and activate at a site of injury or disease. For such therapeutic approaches to be successful, a greater understanding of the signaling pathways that determine the diverse developmental fates of these cells is needed. From a drug-discovery perspective, efforts are being deployed in developing cell-based assays to screen for small molecules that can modulate stem-cell fate. Such compounds will provide new insights into stem-cell biology, and may ultimately contribute to effective disease treatments.