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This study examines the utilization of metal-cored filler wire in conjunction with the gas metal arc welding (GMAW) technique for welding high-strength S690QL steel. Since welding parameters significantly impact the bead quality and weld joint integrity, the main objective was to identify the optimal welding parameters. To achieve this, the input variables including the current (A), voltage (V), and gas flow rate (GFR), and their effects were evaluated for reinforcement (R), width (W), depth of penetration (DOP), and the width of the heat-affected zone (HAZ). For a more efficient and cost-effective investigation, a Box–Behnken design, which is based on response surface methodology, was used for bead-on-plate trials. Mathematical regression models, derived from experimental data, were rigorously validated using the analysis of variance, main effects plots, residual analysis, and the R 2 and Adj. R 2 values. Additionally, the heat transfer search (HTS) algorithm was employed for process optimization. While single-objective optimization provided optimal settings for individual responses, simultaneous optimization aimed to strike a balance between multiple, sometimes conflicting, objectives. This comprehensive approach resulted in specific values, including a reinforcement (R) of 4.285 mm, a width (W) of 9.906 mm, a DOP of 2.039 mm, and an HAZ width of 2.020 mm. These values were achieved with specific input parameters: current (221 A), voltage (24 V), and GFR (21 L·min−1). The Pareto solutions offered a nuanced selection of the most suitable configuration, taking into account the desired values for R, W, DOP, and HAZ. The close alignment between predicted and experimentally measured values for the responses highlights the precision and suitability of the HTS algorithm in estimating critical bead geometries during GMAW of S690QL plates.

Background: Postpartum depression (PPD) is a serious concern with multifactorial etiology. Association between prenatal anxiety, pain, and depression has been theorized. Aim: In this randomized controlled trial, we studied the effect of pain relief by combined spinal epidural (CSE) and other factors influencing PPD. Methods: After thorough assessment and obtaining prenatal baseline parameters, parturients were randomly assigned to group 1 (CSE) and group 2 (control) (n = 31 each). Group 1 received 0.5 ml of 0.5% hyperbaric bupivacaine with 12.5 mcg of fentanyl intrathecally and 6 ml of 0.1% levobupivacaine with 2 mcg/ml fentanyl programmed intermittent epidural bolus every 60 min and patient-controlled epidural analgesia (PCEA) bolus of the same drug with a lockout interval of 15 min. Group 2 underwent normal vaginal delivery without neuraxial analgesia. Patients in both the groups were assessed for PPD using Edinburgh Postnatal Depression Scale (EPDS) at day 3 and 6 weeks postpartum. Results: The EPDS score at 6 weeks postpartum was significantly lower in group 1 than in group 2 (P < 0.05). The pain score assessed using visual analog scale was significantly lesser in group 1 than in group 2 (P < 0.001). Multivariate linear regression analysis showed that prenatal anxiety, greater pain interference scores, and perceived stress were major determinants of PPD. Conclusion: CSE analgesia using PCEA pump with PIEB facility in laboring parturients resulted in lesser EPDS scores and hence lesser postpartum depression. Effective pain control may be an important component to prevent PPD. [ABSTRACT FROM AUTHOR]

Objective. Present a case of a transgender and gender diverse (TGD) individual receiving gender affirming hormone therapy (GAHT) who presented with first episode bipolar mania and received electroconvulsive therapy (ECT). To understand the safety and efficacy of ECT in the TGD population including those receiving GAHT through literature review. Materials and Methods. Case report using informed consent from an individual TGD patient who received ECT. A review of the literature was conducted using PubMed, Embase, and Medline. Results. The case illustrated safe and effective ECT use in a TGD individual receiving GAHT. Eight studies were reviewed. GAHT has been reported to interfere with certain anaesthetic agents used in ECT. ECT appeared to be a safe and effective treatment in the TGD samples in those studies. Conclusion. There is limited literature on the safety and efficacy of ECT for TGD individuals receiving GAHT. More research is required to address mental health inequalities in this population and to support safe and effective gender affirming treatment modalities. [ABSTRACT FROM AUTHOR]

Background: Bipolar affective disorders are dimensional illnesses in which patients experience, during the long-term course of illness, fluctuating levels of severity of manic and depressive symptoms interspersed with symptom-free periods. It is a highly exhausting and relapsing psychiatric disorder associated with significant morbidity and comorbidity. The World Health Organization Disability Assessment Schedule (WHODAS) is an International Classification of Functioning-based multidimensional instrument that was developed for measuring disability. Aim and Objective: The present study aimed to check the correlation and inter-rater agreement amongst the patient, caregiver, and clinician-administered version of the WHODAS 2.0 among persons with bipolar affective disorder. Materials and Methods: The study was cross-sectional in nature. Thirty samples of patients with bipolar affective disorder as per ICD-10 criteria were selected using a consecutive sampling technique. Patients above 18 years of age with a total duration of illness of at least more than 2 years were included and used self, proxy, and interviewer-administered versions of WHODAS 2.0. Results: The total score of WHODAS 2.0 shows that the interclass correlation coefficient between the patient and caregiver, caregiver and clinician, and patient and clinician was 0.655 (0.469--0.802), 0.599 (0.395--0.767), and 0.722 (0.586--0.820), respectively, indicative of moderate reliability. Caregivers showed a higher mean in cognition, 3.73 (3.13); mobility, 2.63 (1.73); and self-care, 0.867 (1.25), than other raters. Clinicians showed a higher mean (standard deviation) in getting along with people, 4.13 (1.69); life activities of the household, 5.46 (2.67); and participation in society, 10.70 (2.56), than other raters. Conclusion: People suffering from bipolar affective disorder are prone to disability albeit in the mild-to-moderate variety. The findings show that there was moderate reliability between the patient and caregiver, caregiver and clinician, and patient and clinician among the patient rated, caregiver rated on the overscore of WHODAS 2.0. [ABSTRACT FROM AUTHOR]

Perforation of Meckel's diverticulum by a foreign body is rare, but when it occurs, it can mimic acute appendicitis, leading to diagnostic challenges. We present a case of a 45-year-old male initially diagnosed with acute appendicitis, but intra-operative exploration revealed a perforated Meckel's diverticulum with a fish bone. Meckel's diverticulum perforation remains diagnostically elusive, highlighting the need for intra-operative vigilance in cases of inconsistent findings like the presence of bilious fluid in the abdominal cavity. This case report underscores the importance of considering perforated Meckel's diverticulum in the differential diagnosis of right iliac fossa pain and the necessity of surgical exploration for atypical presentations to ensure timely diagnosis and appropriate management. [ABSTRACT FROM AUTHOR]

Appropriate screening tools are required to accurately detect complex post traumatic stress disorder (CPTSD). This systematic review aimed to assess and compare measurement tools. A literature search using key words 'complex post traumatic stress disorder', 'PTSD', and 'assessment' was undertaken on Embase and PsychINFO during February 2022 by two reviewers. Inclusion criteria included full text papers between 2002–2022 which evaluated CPTSD using assessment tools. Exclusion criteria included reviews, editorials, meta-analyses, or conference abstracts. Twenty-two papers met selection criteria. Thirteen studies used the International Trauma Questionnaire (ITQ). Two studies each evaluated CPTSD with the International Trauma Interview (ITI) or Symptoms of Trauma Scale (SOTS). The Developmental Trauma Inventory (DTI), Cameron Complex Trauma Interview (CCTI), Complex PTSD Item Set additional to the Clinician Administered PTSD Scale (COPISAC), Complex Trauma Questionnaire (ComplexTQ), and Scale 8 of the Minnesota Multiphasic Personality Inventory Scale (MMPI) were used by a single study each. The ITQ was the most thoroughly investigated, validated across different populations, and is a convenient questionnaire for screening within the clinical setting. Where self-report measures are inappropriate, the ITI, SOTS, and COPISAC are interview tools which detect CPTSD. However, they require further validation and should be used alongside clinical history and examination. Validated and reliable screening tools are required to accurately detect and manage complex post traumatic stress disorder (CPTSD) The International Trauma Questionnaire (ITQ) is the most thoroughly investigated, validated across different populations, and is a freely available and convenient tool for screening within clinical settings In circumstances where self-report measures are inappropriate, the ITI, SOTS, and COPISAC are interview tools which detect CPTSD, but require further validation and should be used alongside clinical history and examination Further research is needed to ensure appropriate assessment tools for the detection and diagnosis of CPTSD are available [ABSTRACT FROM AUTHOR]

Mental disorders are a global public health concern, with India grappling with a high burden of mental health issues. Emerging among these challenges are behavioral addictions (BAs), encompassing behaviors such as gambling, internet, and gaming addiction. BAs, particularly prevalent among youth, pose significant mental health threats. Various countries are taking steps to address BAs, with initiatives including research, treatment centers, and policies. Efforts like the Behavior Resource Hub and SHUT Clinic offer interventions in India. Combining therapy and medication, technology-based interventions, and behavioral therapy have shown promise. Prevention strategies, including awareness, education, and early risk identification, are vital. Despite progress, India must increase awareness, conduct research, and establish effective frameworks to address BAs comprehensively. Collaboration, awareness campaigns, and preventive measures targeting youth are crucial to managing this emerging public mental health challenge. [ABSTRACT FROM AUTHOR]

Background: Benzodiazepines are routinely prescribed for various psychiatric disorders. They are effective for short term management but commonly seen to be prescribed for long term against the recommended guidelines leading to various adverse effects in patients. There is dearth of Indian literature pertaining to prescription as well as deprescribing of benzodiazepines and Z drugs. Aims and Objectives: To assess the prescription pattern of benzodiazepines and Z drugs among patients visiting the department of psychiatry in a tertiary care hospital. Material and Methods: Case record files of patients visiting the inpatient and outpatient setting from 1st January 2017 to 31st December 2017 were retrieved and analysed for sociodemographic and clinical details and prescription of benzodiazepines. Results: A total of 975 records of patients were included in the study. The mean age group was 36.79 + 13.05years. Benzodiazepines prescription was maximum in patients with anxiety spectrum disorders (38.4%). Clonazepam was the most commonly prescribed benzodiazepine (47.%). More than 50 percent of the patients continued to consume benzodiazepines for more than 3 months). There was significant positive association of long term benzodiazepine usage with duration of illness, diagnosis, type of benzodiazepines received and length of outpatient treatment. Conclusion: The study concludes that majority of patients continue to consume benzodiazepines beyond the recommended period of usage. Thus there is a need for structured guidelines for prescribing and deprescribing of benzodiazepines and Z drugs. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization Disability Assessment Schedule-2.0 (WHODAS 2.0) is a disability assessment instrument which is based on the conceptual framework of the International Classification of Functioning, Disability, and Health. It provides a global measure of disability and it has seven domains-specific scores. Objective: The present study aims to check the concordance among the patient, proxy, and clinician-rated versions of WHODAS 2.0 in India. Materials and Methods: This study was cross-sectional and comparative in nature. Sixty samples of patients with severe mental illness (SMI) were selected using a consecutive sampling procedure as per the International Classification of Diseases (ICD-10) criteria. Using patient, proxy, and clinician administrative version of WHODAS 2.0, the study was conducted at the outpatient department of Mental Health Institute and Department of Psychiatry, Government Medical College and Hospital Sector 32, Chandigarh, India. Patients diagnosed with SMI as per the ICD-10 aged above 18 years of age with a total duration of illness of at least more than 2 years were included. Those who refused to participate were excluded. The data were analyzed using the SPSS software. The normality of quantitative data was checked by the measures of Kolmogorov-Smirnov tests of normality. The continuous data were reported as mean ± standard deviation. The categorical variables were reported as counts and percentages. The group comparisons were made with the help of ANOVA test. Results: This study included 60 patients with SMI, and the results show that there was no significant difference found among the patient, proxy, and clinician's assessment for most items, but the mean score of the clinician-rated version score (68.733) was higher in comparison to patient- and proxy-rated versions of WHODAS 2.0. Conclusion: The overall inter-reliability of WHODAS 2.0 among the patients, proxy, and clinician was moderate. There was no significant difference among the patient, proxy, and clinician's assessments for most items. This highlights the fact that one does not have to rely on professionals' ratings for assessing the disability among patients with SMI. [ABSTRACT FROM AUTHOR]

Pyruvate kinase M2 (PKM2) is a glycolytic enzyme that translocates to the nucleus to regulate transcription factors in different tissues or pathologic states. Although studied extensively in cancer, its biological role in the heart remains unresolved. PKM1 is more abundant than the PKM2 isoform in cardiomyocytes, and thus, we speculated that PKM2 is not genetically redundant to PKM1 and may be critical in regulating cardiomyocyte-specific transcription factors important for cardiac survival. Here, we showed that nuclear PKM2 (S37P-PKM2) in cardiomyocytes interacts with prosurvival and proapoptotic transcription factors, including GATA4, GATA6, and P53. Cardiomyocyte-specific PKM2-deficient mice (Pkm2 Mut Cre+) developed age-dependent dilated cardiac dysfunction and had decreased amounts of GATA4 and GATA6 (GATA4/6) but increased amounts of P53 compared to Control Cre+ hearts. Nuclear PKM2 prevented caspase-1–dependent cleavage and degradation of GATA4/6 while also providing a molecular platform for MDM2-mediated reduction of P53. In a preclinical heart failure mouse model, nuclear PKM2 and GATA4/6 were decreased, whereas P53 was increased in cardiomyocytes. Loss of nuclear PKM2 was ubiquitination dependent and associated with the induction of the E3 ubiquitin ligase TRIM35. In mice, cardiomyocyte-specific TRIM35 overexpression resulted in decreased S37P-PKM2 and GATA4/6 along with increased P53 in cardiomyocytes compared to littermate controls and similar cardiac dysfunction to Pkm2 Mut Cre+ mice. In patients with dilated left ventricles, increase in TRIM35 was associated with decreased S37P-PKM2 and GATA4/6 and increased P53. This study supports a previously unrecognized role for PKM2 as a molecular platform that mediates cell signaling events essential for cardiac survival. Factors in heart failure: During heart failure, transcription factors involved in cardiomyocyte survival are repressed. Here, Lorenzana-Carrillo et al. studied the role of pyruvate kinase M2 (PKM2), a glycolytic enzyme, in regulating the transcription factors GATA4/6 and P53. Mice lacking PKM2 in cardiomyocytes had decreased GATA4/6 but increased P53 and developed dilated cardiomyopathy. In adult cardiomyocytes, they observed direct interaction between nuclear PKM2 and the transcription factors, where PKM2 prevented cleavage and degradation of GATA4/6 but promoted P53 degradation. The E3 ubiquitin ligase TRIM35 was found to degrade nuclear PKM2, resulting in cardiac dysfunction when overexpressed in cardiomyocytes in mice, and TRIM35 was up-regulated in human heart failure tissue samples. Results help identify the role of PKM2 in cardiomyocyte survival in heart failure. [ABSTRACT FROM AUTHOR]

Objectives: Vitamin D deficiency is associated with worse physical and mental health outcomes. Low vitamin D levels are more common among people who experience mental health issues. This is particularly vital due to the outdoor restrictions which arose from the COVID-19 pandemic. This systematic review assessed vitamin D deficiency and insufficiency among psychiatric inpatients. Methods: A literature search was performed using the key words 'vitamin D', 'mental health', 'mental illness' and 'inpatient' and articles were selected by two independent reviewers. Eighteen studies were identified as eligible according to inclusion and exclusion criteria. Results: Vitamin D deficiency (29 − 96%) and insufficiency (20 − 63%) were common among psychiatric inpatients. Over half of the studies recommended or advised consideration of vitamin D level screening among psychiatric inpatients, while nine recommended consideration of vitamin D supplementation. Conclusions: Screening for vitamin D deficiency during psychiatric admission may be clinically indicated and improve patient wellbeing and outcomes. Low vitamin D levels are very common among people admitted to inpatient mental health services. Vitamin D level screening upon inpatient psychiatric admission is warranted to optimise general health outcomes. Vitamin D supplementation should be considered among inpatients with vitamin D deficiency or insufficiency. [ABSTRACT FROM AUTHOR]

In this work, a modified and advanced welding technique named regulated metal deposition (RMD) has been implemented for joining ASTM A387-11-2 low alloy steel plates. Mechanical behavior and microstructure of welded joints have been experimentally investigated after the recommended heat-treatment process. The microstructures of welded joints were examined using optical and scanning electron microscopes. Optical microscopy indicated the existence of bainitic and martensitic phases in the base material and weld zone, respectively. Scanning electron microscopy combined with energy dispersive x-ray analysis displayed the presence of martensitic colonies as well as deposits of carbide precipitates in both weldments. The mechanical properties of these weldments, namely micro-hardness, tensile strength, and impact strength were also investigated. A comparative study has also been carried out for the same material using the conventional gas metal arc welding, in which the microstructure and mechanical behavior of regulated metal deposition weldments have been compared to those of gas metal arc weldments. Regulated metal deposition weldments showed better mechanical behavior than the gas metal arc weldments for low alloy steel. [ABSTRACT FROM AUTHOR]

We describe a case of late-onset periodic catatonia with atypical course in an elderly male with onset at the age of 70 years with brief episodes of sudden agitation lasting for a few hours of the day, followed by immobility, mutism, ambitendency, withdrawal, and urinary incontinence for the next few days. Four such episodes with complete recovery over the next few days and no residual behavioral symptoms lasting for several years (up to 7 years) without any long-term prophylactic psychotropic use. During the fourth such episode, the patient presented to our facility with a similar abrupt onset of symptoms. All biochemical investigations and neuroimaging findings were found to be noncontributory. On clinical examination, a diagnosis of periodic catatonia was suspected, which was later confirmed by immediate response to the intravenous diazepam challenge given under vitals monitoring in a high-dependency unit setting. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic may cause a major mental health impact. We aimed to identify demographic or clinical factors associated with psychiatric admissions where COVID-19 was attributed to contribute to mental state, compared to admissions which did not. Methods: A retrospective cohort study was undertaken of inpatients admitted to Northern Psychiatric Unit 1, Northern Hospital in Melbourne, Victoria, Australia during 27/02/2020 to 08/07/2020. Data were extracted for participants who identified COVID-19 as a stressor compared to participants who did not. Fisher's exact test and Mann-Whitley rank sum test were used. Results: Thirty six of 242 inpatients reported the COVID-19 pandemic contributed to mental ill health and subsequent admission. Reasons given included social isolation, generalized distress about the pandemic, barriers to support services, disruption to daily routine, impact on employment, media coverage, re-traumatization, cancelled ECT sessions, loss of loved ones, and increased drug use during the lockdown. Chronic medical conditions or psychiatric multimorbidity were positively associated and smoking status was negatively associated with reporting the COVID-19 pandemic as a contributor to mental ill health. Conclusion: Screening and identifying vulnerable populations during and after the global disaster is vital for timely and appropriate interventions to reduce the impact of the pandemic worldwide. [ABSTRACT FROM AUTHOR]

Background: There are very few specialised hospital with quality assurance services catering to the needs of the elderly with mental illness. The concept of 'Appointment adherence' has received little attention in the field of geriatric mental health from India. There is a need to study the pattern of 'drop-out' amongst geriatric patients. Method: An initial cohort of first 105 cases presenting to the clinic were followed up to explore their socio-demographic and clinical variables, overall functioning and satisfaction with the services. Adopting a 'naturalistic approach,' and using the 'service evaluation framework', at the assessment period of about 36 months, tools like socio-clinical profile, Hindi Mental State Examination (HMSE), Everyday Abilities Scale for India (EASI), Global Assessment of Function (GAF) scale, WHOQOL-BREF-Hindi version, Patient Satisfaction Scale (PAT-SAT) and 'Service Evaluation (SSS-16 and SSS-10 Practitioner Versions)' were administered. Result: 68 cases were available for assessment of functional outcome and satisfaction parameters were assessed for 78 of the cases. 75% had functional disorders and medical morbidity was present in more than 50% of cases. The mean score for WHOQOL-BREF and GAF were 44.4 (poor quality of life) and 72.91 (slight impairment in socio-occupational functioning) respectively. PAT-SAT score in all the sub-categories were above average. 'Organic' diagnosis patients had lower QoL on certain domains compared to 'functional' patients. Only 30.47% patients were coming for follow-up with 25.71% having died. Of the 32/68 (34.29%) cases who had dropped out, 50% were adherent to treatment in different ways. Additionally, GAF scores were lower in 'drop-out' group. Conclusions: There is a relatively high rate of 'drop-out' over a 3-year period. However, if patients keep coming for follow-up (i.e. do not 'drop-out'), they are more likely to show improvement in their level of social and occupational functioning. [ABSTRACT FROM AUTHOR]

The paper contains an exclusive interview of Ratan Thiyam (1948), the famous theatre director from the Northeast and one of the major protagonists of the Theatre of Roots movement in India. The paper also provides the authors’ experience with the place, Imphal, (capital of Manipur state), its people, and its milieu which intimately informed the creative self of Thiyam and his theatre abode—the Chorus Repertory Theatre (CRT). Manipur is a state of an enigma for many outside the state, not only in the mainland but even in other parts of the Northeast as well because Manipur is seen as a place that has been a theatre of political turmoil and unrest following protracted militancy, ethnic anxieties and the tumults of identity assertions besides being subjected to the draconian AFSPA for the longest period of time. Against such a backdrop life continues to thrive in Imphal which provides elaborate nuances and contradictions turning the cityscape itself into a space of performance. The interview was taken on the sidelines of the National Theatre Festival 2017, at the CRT where some of the significant contemporary Indian plays were also performed including Thiyam’s Urubhangam. The paper attempts to look at Thiyam’s theatre against the cultural and spatial context of Manipur and to see how theatre can evolve as an organic form of artistic expression. [ABSTRACT FROM AUTHOR]

Background: Disability certification is an essential requirement to avail of the various disability benefits including disability pension, family pension, insurance, income tax rebate, travel concession etc. The lack of awareness among persons with mental illness and their caregivers is a major barrier in availing such benefits. Aim of the study: To assess the socio-demographic and clinical variables along with the pattern of utilization of disability certificates for disability benefits by the persons with disability (PwD) having a mental illness. Materials and Methods: Consecutive patients who obtained disability certificates due to mental illness in the last 5.5 years were contacted and their responses were recorded on a semi-structured questionnaire telephonically. Result: Over a period of 5.5 years 123 certificates were issued to individuals of which 100 were contacted. Out of the 123 cases, 11 could not be contacted, one patient didn't collect the certificate to date, 6 patients expired after obtaining the certificate and 5 didn't come for reassessment. Out of the 100 cases who participated in the study, 91 persons (91%) mentioned that these certificates were useful for them. Regarding the disability-related benefits, 51% had received a disability pension, 43% used it for travel concession and the rest (1% to 9%) used it for getting income tax rebates, insurance and family pension. While exploring and interviewing for additional benefits other than those available currently by the Government of India, 13% wanted to get free medicines, 17% wanted increased job opportunities and 2% wanted to have a smooth procedure for availing benefits. Of those contacted, 19% also disseminated the information about the disability certification and the related benefits to other needy persons. Conclusion: The utilization of disability certificates by those with mental illness is largely limited mostly to availing pension or travel concession. [ABSTRACT FROM AUTHOR]

The impact of the novel coronavirus disease 19 (COVID-19) has overburdened the anesthesia fraternity both physically and mentally. The academic and training schedule of the medical residents in the last year was also disrupted. Since we are in the early phase of the second peak of the COVID-19 pandemic, it is time to reconsider the causes of stress in anesthesia residents and methods to mitigate them. In this non-systematic review, authors have included articles from PubMed, Medline, and Google scholar with keywords "identify strategies" "preventing and treating psychological disorders," and "medical students" from year 2010 onwards were included. Apart from these keywords, we have included the coping strategies and early psychiatric consultation methods. This review article aims at early identification, workplace environment changes, and implementation of early coping strategies in anesthesia residents during this second peak of COVID-19. [ABSTRACT FROM AUTHOR]

Background: Health-care providers (HCP) engaged in demanding work like being involved in the care of COVID-19 positive and suspected cases are likely to have a lot of stress, anxiety, depression, and other mental health issues. It will be noteworthy to have an idea about the magnitude of the mental health problems in them to formulate effective intervention strategies for their well-being. Aims and Objectives: The aim of this study is to determine whether frontline HCP engaged in the treatment and care of COVID-19 positive and suspect cases experienced increased mental health problems. Methodology: Two hundred and fifty-one frontline HCPs engaged in COVID-19 duty and 97 nonfrontline (controls) HCP were assessed and compared using tools like General Health Questionnaire 12, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale. Appropriate statistical tools such as analysis of variance and Chi-square were used. Results: Frontline HCP who were directly involved in COVID-19 duty had a higher proportion (28.3%) of psychological morbidities as compared to 19.6% among controls; HCP-frontline had significantly 2.17 times chances of having psychological distress compared to HCP controls. Among, HCP-frontline 13.1% had clinical depression, whereas in the HCP control, this was 6.2%. Further, 20.3% of HCP frontline and 10.3% of HCP control had clinical anxiety, and the difference between the two groups was statistically significant (P = 0.0011). Conclusion: Frontline HCPs working in demanding work such as COVID-19 patient care are susceptible to psychological distress, anxiety, and depression which warrant urgent attention. [ABSTRACT FROM AUTHOR]

Medial epicondyle fracture associated with incarcerated intra-articular fragment and ulnar nerve palsy is uncommon and frequently missed. We report a case of 13-year- old boy with incarcerated medial epicondyle fracture fragment in ulnohumeral joint and ulnar nerve palsy, which was managed successfully by open reduction internal fixation and ulnar nerve transposition. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to predict the early changes in electroencephalography (EEG) at 1 week and its correlation to clinical response at 6 weeks after treatment with atomoxetine in children with ADHD. Method: In 50 children (6-14 years) with ADHD (Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-5]), Vanderbilt ADHD Parent Rating Scale (VADPRS) and Vanderbilt ADHD Teachers Rating Scale (VADTRS) were applied at baseline, 1, 4, and 6 weeks. EEG was recorded using International 10-20 System of electrode placement at baseline and at 1 week after atomoxetine treatment. EEG changes at 1 week after atomoxetine therapy was correlated to clinical response at 6 weeks. Results: Patients were classified as responders or nonresponders based on the VADPRS/VADTRS findings. After 1 week of treatment, responders' theta cordance values were decreased, whereas nonresponders' values didn't decrease significantly. Conclusion: Patients with decreased theta cordance values, especially in the left temporoparietal region, at 1 week were likely to respond to atomoxetine while those without any such change were likely to be nonresponders. [ABSTRACT FROM AUTHOR]

This study introduces an inventory system with a non-instantaneous deteriorating product with credit facility and variable demand depending on the selling price. Two different selling prices are considered in the deterioration and non-deterioration periods. Shortages are partially backlogged and dependent on the length of the customers' waiting time upto the arrival of fresh lot. Alternative trade-credit policy is applied herein, and several cases, sub-cases and situations are investigated. The corresponding optimization problems of different cases, sub-cases and situations are solved using an interval-oriented multi-section technique with the help of interval mathematics and interval order relations. A numerical example with three different credit periods is studied and solved to validate the said problem. Also, two different case studies are investigated. Then to investigate the effect of changes of several system parameters on the optimal policy, post optimality analyses are performed. [ABSTRACT FROM AUTHOR]

Background: Pain and depression are associated, but it is uncertain if effective pain relief during labor by labor analgesia reduces the incidence of postpartum depression (PPD). This randomized, controlled study assessed whether combined spinal-epidural (CSE) labor analgesia is associated with a decreased risk of PPD. Other reported risk factors for PPD were also assessed. Materials and Methods: Parturients were randomly assigned to either CSE labor analgesia or normal vaginal delivery (n = 65 each). CSE parturients received 0.5 ml of 0.5% hyperbaric bupivacaine intrathecally and PCEA with continuous infusion of 0.1% levobupivacaine and 2 µg/ml fentanyl @5 ml/h along with patient-controlled boluses with a lockout interval of 15 min. Parturients of both the groups were assessed using Edinburgh Postnatal Depression Scale (EPDS) for depressive symptoms at day 3 and PPD at 6 weeks (primary outcome; defined as EPDS score ≥10 at 6 weeks postpartum). Secondary outcomes included pain scores, maternal satisfaction, and Apgar scores at 1 and 5 min. Parturients were also screened for several risk factors for PPD. Results: Incidence of PPD was 22.3%. The difference in incidence of PPD between the CSE group vs. control group was not significant (27.7% vs. 16.9%; Fisher's exact P = 0.103). Of all the risk factors analyzed in logistic regression model, perceived stress during pregnancy was the only significant predictor of the development of PPD (adjusted Odds Ratio 11.17, 95% Confidence interval 2.86043.55; P = 0.001). Conclusion: CSE analgesia in laboring parturients does not reduce PPD at 6 weeks. Instead, perceived high stress during pregnancy appears to be the most important factor. [ABSTRACT FROM AUTHOR]