Symptoms of delirium: an exploratory factor analytic study among referred patients

Objective

Factor analytic studies of delirium symptoms among patients referred through consultation-liaison psychiatric services are rare. We examined the factor structure of delirium symptoms in referred patients and determined whether combining items from several delirium rating scales influenced the factor structure of delirium symptoms.

Method

Eighty-six patients with delirium (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) referred though the consultation-liaison services were assessed with structured rating scales. Nineteen symptom items extracted from the Delirium Rating Scale—Revised-98 (DRS-R-98), the Memorial Delirium Assessment Scale and the Confusional State Evaluation Scale were subjected to an exploratory (principal component) factor analysis. A second such analysis was conducted on 15 items of the DRS-R-98 for comparison.

Results

Compared with prior studies, patients were younger and the majority had hyperactive delirium. Principal components analysis identified two factors: (1) a “cognitive” factor comprising of disturbances in language, thought processes, orientation, attention, short- and long-term memory, visuospatial ability, consciousness (awareness) and perseveration accounted for 28.9% of the variance and (2) a “behavioral” factor consisting of sleep-wake cycle disturbances, delusions, perceptual disturbances, motor agitation, affect-lability, distractibility, irritability and temporal onset accounted for 18.9% of the variance. An identical factor structure was obtained with the DRS-R-98 items.

Conclusions

Similar to previous factor analytic studies, the present study supported the existence of two principal dimensions of delirium, cognitive and behavioral. Additionally, it extended the results of earlier investigations to a wider group of patients with delirium, suggesting that these dimensions might provide important clues to the neurobiology of delirium.     

Metabolic syndrome among patients receiving clozapine: A preliminary estimate

Objective:

To study the prevalence of metabolic syndrome in patients receiving clozapine.

Materials and Methods:

For this study, 100 patients attending the psychiatry outpatient clinic of a tertiary care hospital who were receiving clozapine for more than three months were evaluated for the presence of metabolic syndrome using the International Diabetes Federation (IDF) and modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria.

Results:

Forty-six patients fulfilled IDF criteria and 47 met modified NCEP ATP-III criteria of metabolic syndrome. There was significant correlation between these two sets of criteria used to define the metabolic syndrome (Kappa value –0.821, P < 0.001). Among the individual parameters studied, increased waist circumference was the most common abnormality, followed by abnormal blood glucose levels and elevated triglyceride levels. All these abnormalities were seen in more than half (52-61%) of the patients. When the sample was divided into two groups, i.e., those with and without metabolic syndrome, patients with metabolic syndrome had significantly higher body mass index and had spent more time in school. Logistic regression analysis revealed that these two variables together explained about 19% of the variance in metabolic syndrome (adjusted r² = 0193; F = 12.8; P < 0.001).

Conclusion:

The findings of the present study suggest that metabolic syndrome is highly prevalent in subjects receiving clozapine.     

Safety and efficacy of percutaneous nephrolithotomy in the pediatric population

PURPOSE: We reviewed our experience with percutaneous nephrolithotomy (PCNL) in patients in the pediatric age group and compared its efficacy and safety over a 5-year period. PATIENTS AND METHODS: We studied retrospectively and prospectively 31 patients who were treated with PCNL for renal stones larger than 1.5 cm. Variables assessed were stone bulk, size, location, and type. Metabolic and anatomic factors were also assessed. PCNL punctures and number of tracts were recorded. Clearance with PCNL and ancillary procedures was recorded. RESULTS: There were 31 renal units. Mean age of the patients was 9.6 years (range 1.5-15 years). Fifteen (48.4%) patients had single calculi; eight (25.8%) patients had staghorn calculi. Lower-pole access was the preferred route of entry, and upper-pole access was used only when necessary. We used a 22F nephroscope for the procedure. We dilated the tract to 30F in the majority of patients, but limited dilation to 24F when appropriate. If needed, we used a ureteroscope. Complete clearance was achieved in 83.9% of patients after PCNL and in 90.32% of patients after dual therapy (PCNL + shockwave lithotripsy). Average hemoglobin drop was less than 1 g/dl. Factors responsible were the size of the tract (larger than 24F) and the number of tracts. Six patients were treated for an anatomic abnormality. A metabolic abnormality was diagnosed in three patients. CONCLUSION: PCNL is effective in children, with a clearance rate of 83% and, with dual therapy, more than 90%. We recommend that tract dilation be restricted to 24F or smaller whenever possible. Approximately 40% of patients had either an anatomic or metabolic abnormality.     

Diet-induced obesity increases melanoma progression: involvement of Cav-1 and FASN

Recent population-based epidemiological studies strongly hint towards a link between obesity and its occurrence as well as progression of several cancers including melanoma. Although effects of obesity on breast, colon and liver cancers have been extensively investigated, the links between obesity and melanoma remain largely unexplored. Present study aimed to understand the effect of high fat diet-induced weight gain on susceptibility of C57BL/6J mice to melanoma. For this, mice routinely were fed on high fat diet for 6 months (HFD mice). Subsequently, mouse melanoma cells were injected subcutaneously in control as well as HFD mice and followed for tumor initiation and progression. We provide strong evidence that diet-induced obesity leads to increased melanoma progression in male C57BL/6J mice. We observed that increased melanoma progression is associated with enhanced Cav-1 and FASN expression in tumors from HFD mice. Cav-1 and FASN are co-ordinately regulated and Cav-1 interacts with FASN in melanoma cells. Enhanced levels of Cav-1, FASN and pAkt control melanoma cell proliferation. Our study establishes a causative relationship between diet-induced obesity and melanoma progression as well as demonstrates that obesity affects important tumorigenic pathways in melanoma.     

onunion of paediatric talar neck fracture

Fractures of the paediatric talus are in- frequent injuries, most complicated by posttraumatic arthro- sis and avascular necrosis in the course of treatment. Non- union in children has not been reported before in literature. We report a case of a 12-year-old boy who had a nonunion of Hawkins type II fracture of talar neck. The nonunion was treated surgically with a good clinical outcome. The goalsof management in nonunion of paediatric talar neck fracture are different from those in fresh fractures. A suboptimal re- duction should be acceptable without trying a radical sur- gery which may cause further impairment.     

Influence of depressive symptoms and premorbid adjustment on factor structure of phenomenology of schizophrenia: a study from India.

This study investigated the nature of factor structure of schizophrenia syndromes using a sample of 151 patients with schizophrenia according to DSM-IV. The patients were assessed on the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), Hamilton Depression Rating Scale (HDRS) and the Phillips Rating Scale of Premorbid Adjustment in schizophrenia. Three factors-negative syndrome, reality-distortion syndrome and disorganized syndrome were extracted when only SAPS and SANS were analysed. Addition of the Phillips Rating Scale scores to SAPS and SANS ratings in the factorial equation led to splitting of the negative syndrome though reality-distortion and disorganized syndromes remained stable. Factor analysis of the HDRS scores with SAPS and SANS ratings resulted in the HDRS loading highly on reality-distortion syndrome and splitting of negative syndrome. Factor analysis of all the variables taken together resulted in delineation of four factors. The study suggests a link between depression and reality distortion. Apathy and anhedonia seem to be linked to premorbid adjustment.     

Pucker sign in proximal humeral fractures: implications on management

Fracture of the surgical neck of humerus in young patients is a relatively rare injury. We reviewed the available material on the topic and identified puckering at the shoulder in high-energy fracture of the surgical neck as a finding which has been reported infrequently but signifies a need for open reduction. We present a review of the literature on the subject and our similar experience in two young males who had puckering and ecchymosis at the shoulder.