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Osteoporosis is a diminishing of the bone that prompts break with least compel. It influences postmenopausal ladies and elderly of both sexual orientations. Bone Mineral Density (BMD) is one of the parameter identified with bone quality. Double Energy X-beam Absorptiometry (DXA) is at present considered as the “highest quality level” for measuring BMD. Morphometric analysis of femur bone is done on both radiographic images and Computed tomography image. An aggregate number of 50 (n = 50) Indian ladies, 18 solid pre menopausal ladies (n = 18, 36.3±8.7 years) and 32 post menopausal ladies (n = 32, 58±9.1 years) whose age extended from 20–85 years were incorporated. The patients are subjected to take X-ray, CT and DXA. The outcomes gotten by DXA found that 20% and 34% of the Indian ladies were having osteoporosis and osteopenia separately. Using SPSS software, the morphometrics analysis like neck of the bone, width of the neck, thickness of shaft, width of acetabular bone is measured and in CT images using MIMICS software the Hounsfield is measured in neck of femur, trochanter head and shaft. Est volume is calculated through measured Hounsfield unit. These qualities were observed to be diminished by −29%, −23%, −17%, −15%, and −10% separately, when contrasting with typical Indian ladies. The obtained square of the correlation coefficients (r2) were 0.22, 0.25, 0.23, 0.41, and 0.34 respectively. In osteoporotic women, The estimated volume of femur neck were significantly reduced by 71.8% and in measured BMD DXA value is reduced by 36.7% compared with normal women. Further, osteoporotic women, the mean values of BMD-DXA as well as Est-vol. BMD of trochanter were significantly (p = 0.01) reduced by 45.7% and 80.2% respectively, when comparing to normal healthy women. The femur neck and aggregate hip BMD and Singh’s list were lesser by 41.6% and 33.7%, 40% (p < 0.01) individually in osteoporotic post-menopausal ladies, contrasting with typical post-menopausal ladies. The mean estimations of range and the volume of the proximal neck were diminished −20% and −21% in the osteoporotic Indian ladies than in typical Indian ladies.

With the determining factor of actuation from data provided via wireless sensor and actuator networks has been subjected to missing data due to various reasons in wireless network trans mission. The terrain of co-localized sensors are utilized in conventionally predicting or estimating the values. This research work proposes a matrix completion missing values in wireless sensor and actuator networks (MCMV-WSAN) of appropriate correlation index for estimating the missing components. Updating the bias of sensors associated with actuator provides enormous information about data transfer. It also ensures that, the missing value has been predicted by involving the correlation of co-located sensors and its appropriate time. Assessment of the proposed work has been performed via network simulation for analyzing missing detection, root mean square error and energy efficiency.

In today’s digital era, developing digital circuits is bounded by the research towards investigating various nano devices. This paper provides the design of compact Baugh-Wooley multiplier using reversible logic. Even though various researches have been done for designing reversible multiplier, this work is the first in the literature to use Baugh-Wooley algorithm using reversible logic. In this work, a new 5 × 5 reversible multiplier cell is proposed which will be useful in designing Baugh-Wooley multiplier. The proposed single multiplier cell is able to perform addition of a 1 × 1 product with the sum and carry from the previous cell. This reversible multiplier cell is useful in building up regularity in the array multipliers. The Toffoli gate synthesis of the proposed reversible multiplier cell is also given. It is comprehended that the number of gates, the constant inputs and garbage outputs values are fewer in number in the proposed design compared to the existing approaches. The design can be enhanced to construct n × n reversible Baugh-Wooley multiplier circuit.

A novel approach has been presented to extend radix-feedforward architectures used for the Fast Fourier transform (FFT). The anticipated architectures take advantage of redundancy in the calculation of FFT samples to minimize the hardware complexity. Different algorithms have been urbanized to decrease computational intricacy. We present a novel method to design these architectures from the FFT flow graphs. This paper presents radix-feedforward architectures which requires fewer hardware resources than parallel feedback ones. To convert the DFG, we necessitate a folding set, which is a planned set of actions implemented by the similar functional part.

Background: In addition to the socioeconomic problems, COVID-19 related lockdown may have profound mental health consequences. Aims and Objectives: The objectives were to assess the influence of lockdown on lifestyle, psychosocial stresses and experienced quality of life (QOL). The study also assesses the association of the socio-demographic variables with lifestyle, psychosocial stress and QOL. Methodology: An online survey on the lifestyle changes, psychosocial stress and QOL were conducted using a validated questionnaire via the Google forms platform. The data collected were analysed using parametric and nonparametric tests. Results: The study included 263 respondents. The fear of developing COVID-19 was reported by 67.7%, 31.2% experienced weight gain, internet use was increased in 66.9%, and alcoholism and smoking decreased by 83.3% and 58.8% respectively. Lockdown upset 48.3% moderately, and 36.1% experienced anxiety, 23.4% feared job loss and 51.3% had financial worries. 91.1% of the study population reported fair to good QOL. Females showed significantly more religiosity, (?2= 7.81; p= 0.02) did lesser exercise, (?2= 10.9; p= 0.023) and had poor mood. (t=2.68; p=0.009) Older people were less afraid of COVID-19 infection and were less upset by the lockdown. The urban population were more fearful of COVID-19 and were more upset by the lockdown. Conclusion: Lockdown had a major effect on lifestyle and increased psychosocial stress, but people still experienced a fair QOL during this period.

Updates on clinical, investigatory, and therapeutic aspects of neuromyelitis optica (NMO) spectrum disorders are rapidly evolving. Recently published international consensus diagnostic criteria (ICDC) allowed clinicians to rapidly diagnose the expanding spectrum of NMO spectrum disorders more accurately.The aim of the study was to retrospectively analyze 36 consecutive cases of comprehensively evaluated NMO spectrum disorders using the ICDC.We retrospectively collected 36 cases of NMO spectrum disorders who attended our unit between August 2012 andOctober 2016 and fulfilled the ICDC. All patients underwent magnetic resonance imaging (MRI) of the brain and whole spine with contrast, anti-aquaporin 4 antibody, and detailed blood investigations to rule out systemic vasculitis and other alternate diagnoses.Female-to-male ratio was 6.2:1; 50% of the cases were in the 20-40-year age group. Six patients (16.67%) had combined optic neuritis and myelitis.Nine patients (25%) had pure longitudinally extending transverse myelitis LETM with positive anti aquaporin 4 antibody AQ4Ab. Fourteen patients (38.9%) had myelitis and optic neuritis separately. Nine patients (25%) had area postrema syndrome. Two patients (5.6%) had acute brainstem syndrome and one (2.8%) had hypothalamic syndrome. LETM was commonly found in the cervical level (69.4%).Four patients (11.1%) had no spinal cord involvement. Anti-aquaporin 4 antibody was positive only in 23 cases (63.9%).Initial presentation of NMO spectrum disorder is often due to brain lesions. The ICDC criteria have enhanced clinician's ability to diagnose NMO spectrum disorder in the early stages. In our study, ICDC criteria helped us to diagnose 33% additional cases that would have been missed if the old 2006 revised criteria was applied.

A novel approach has been presented to extend radix-feed forward architectures used for the FFT. The future architectures utilize idleness in computation of FFT observations to decrease the hardware intricacy. Different algorithms have been urbanized to decrease the computational intricacy. A novel method to design such architectures from underlying FFT flow graphs. This work presents radix-feed forward architectures which necessitate smaller number of hardware resources than parallel feedback ones. To convert the DFG, we necessitate a downfall set, which is being intended set of actions implemented by the similar functional part.

In today’s digital era, developing digital circuits is bounded by the research towards investigating various nano devices. This paper provides the design of compact Baugh-Wooley multiplier using reversible logic. Even though various researches have been done for designing reversible multiplier, this work is the first in the literature to use Baugh-Wooley algorithm using reversible logic. In this work, a new 5 × 5 reversible multiplier cell is proposed which will be useful in designing Baugh-Wooley multiplier. The proposed single multiplier cell is able to perform addition of a 1 × 1 product with the sum and carry from the previous cell. This reversible multiplier cell is useful in building up regularity in the array multipliers. The Toffoli gate synthesis of the proposed reversible multiplier cell is also given.

Trichotillomania is a chronic psychiatric disorder characterized by pulling out one's own hair, which results in an obvious loss of hair. Hair pulling was first described in Henri Allopeau in 1889. The term "trichotillomania" comes from the Greek words "thrix" - hair, "tillein" - to pull and "Mania" madness or frenzy. 30 year old man presented with complaints of hairpulling behavior and associated erectile dysfunction. His hairpulling behavior improved on treating his sexual dysfunction.

Objective: The safety and efficacy profile of risperidone and olanzapine were compared in a double-blind trial that used doses widely accepted in clinical practice. Methods: Subjects ( n = 71) who met Diagnostic and Statistical Manual of Mental Disorders-IV criteria for schizophrenia were randomly assigned to receive 2–8 mg/day of risperidone (mean modal dose = 5.5 mg/day) or 5–20 mg/day of olanzapine (mean modal dose = 14.4 mg/day) for 1 year. Results: The two study groups were similar at baseline in all aspects. Seventy-four percent of the participants completed the trial, with no between-differences in the proportion of dropouts. Olanzapine group showed significantly greater improvement in negative symptoms in assessments at 3 rd , 6 th , 9 th , and 12 th months ( P = 0.05, 0.00, 0.00, and 0.00, respectively). Clinical global impression of severity (CGI-S) scores were consistently lower in the olanzapine group at 3 rd , 6 th , and 9 th months ( P = 0.01, 0.03, and 0.05, respectively) as measured by positive and negative symptom scale (PANSS). Total scores on PANSS, positive symptoms, general psychopathology, and CGI improvement showed comparable improvement at 3 rd , 6 th , 9 th , and 12 th months of follow-up (all subjects, including dropouts). Severity of extrapyramidal symptoms was low in both groups, with no between-group differences. Mean change in body weight, fasting blood sugar, and fasting cholesterol was comparable in both groups. Risperidone group had significant hyperprolactinemia after one year ( P = 0.03). Conclusions: Both treatments were well-tolerated and efficacious. Greater reductions in severity of the illness and negative symptoms were seen with olanzapine consistently through 1 year. The frequency and severity of extrapyramidal symptoms were negligible and similar in the two treatment groups. Weight gain, hyperlipidemia, and hyperglycemia were comparable in both groups. Risperidone produced significant hyperprolactinemia.

Reversible quantum computer is the best choice for the future computer system. With the advent of quantum computer and reversible logic, design and implementation of all devices has received more attention. BCD digit adder is the basic unit of the more precise decimal computer arithmetic. Several proposals have been given for the BCD adders. This paper proposes a reversible implementation of 2:1 vector MUX and a combined BCD Adder / Subtractor. This paper can be extended to execute more complex operations using reversible logic.

Byline: E. Mohandas, V. Rajmohan Lithium, a monovalent cation, was first used for the treatment of mania in the 1940s. Half a century into its use, the drug continues to be the preeminent choice for bipolar disorder with antimanic, antidepressant (modest) and antisuicidal property. Lithium is the "gold standard" mood stabilizer against which potential mood stabilizer agents are judged. The therapeutic uses of lithium also include use as an augmenting agent in depression, schizoaffective disorder, aggression, impulse control disorder, eating disorders, attention deficit disorder and in certain subsets of alcoholism. Lithium has been used in many medical disorders, especially cluster headache and dermatological disorders (seborrheic dermatitis, eczematoid dermatitis, genital herpes).[sup] [1] The drug is however associated with neurologic, endocrine, cardiovascular, renal, dermatologic and gastrointestinal adverse effects and possible teratogenicity. History Lithium was first discovered and defined by Johan August Arfvedson in 1817 when he did an analysis of the mineral petalite [LiAl(Si2O5)2]. Petalite was first found by Brazilian scientist Jose Bonifacio Andrade e Silva in 1800. Lepidolite, spodumene, petalite and amblygonite are the more important minerals containing lithium. It was Arfwedson's laboratory chief John Jacob Berzelius who named this alkali metal "lithion." Arfvedson was never able to fully isolate lithium, and it wasn't until 1855 that it was isolated by William Thomas Brande. Brande and Sir Humphrey Davy earlier had done electrolysis on lithium oxide in 1818. Lithium was first produced commercially in 1923 by Metallgesellschaft AG.[sup] [2] The use of lithium for medicinal purposes can be traced back 1,800 years to the Greek physician Galen, who treated patients with mania by having them bathe in alkaline springs and drink the water, which probably contained lithium. In 1843 Alexander Ure introduced lithium into modern medicine, and he showed the in vitro reduction of weight of a uric acid bladder stone in a lithium carbonate solution. Sir Alfred Garrod later discovered that gouty uric acid deposits also were soluble in lithium solution. The view in that time was that uric acid imbalances caused a wide range of diseases, and Armand Trousseau and Alexander Haig proposed that mania and depression also may result from this imbalance and lithium may be effective in these conditions. In the 1840s, lithium was mixed with carbonate or citrate to form a salt and was used to treat gout, epilepsy, diabetes, cancer and insomnia. In the 1870s, the then American Surgeon General William Hammond had provided anecdotal evidence for the use of lithium bromide in the treatment of acute mania. In the 1880s and 1890s the Lange brothers Carl and Fritz used lithium in depression, and Carl Lange was the first to systematically use lithium in the acute and prophylactic treatment of depression.[sup] [2] The introduction of lithium preparations and tablets in the 1900s brought to the fore the toxic effects of the drug; and there were reports of weakness, tremor, diarrhea, vomiting and deaths. The drug disappeared from the British Pharmacopoeia by 1932, but later in the 1940s it was used as a sodium substitute in low sodium diets; but the reports of severe intoxication led to its removal from American markets in 1949. [sup] [1] The appearance in 1949 in the Medical Journal of Australia of a paper entitled "Lithium salts in the treatment of psychotic excitement" by John F. J. Cade was an unspectacular entry into a new era of psychiatry. Manic patients showed improvement, with the patient becoming calmer after four to five days. There was no improvement in the excited schizophrenic patients, though there was a calming effect. There was no improvement or deepening of depression. The paper also gave details of initial dosage, maintenance doses, appearance of toxic symptoms and warning about lithium over-dosage. …

Aim To compare the efficacy of lorazepam and chlordiazepoxide in alcohol withdrawal in a double blind design. Methods The study sample consisted of 108 consecutive admissions to the de addiction ward, which after informed consent and selection based on inclusion criteria, were randomised to two groups. A comparison of the efficacy of chlordiazepoxide and lorazepam was done post randomisation. The initial withdrawal assessment and subsequent progress of withdrawal were assessed using Clinical Institute Assessment for Alcohol-revised (CIWA-Ar). The rate of withdrawal and total duration of withdrawal were compared among the two groups. Results Lorazepam treated group showed a significant difference in the rate of improvement over 48 h compared to chlordiazepoxide group (70.4% vs. 54.8%; p = 0.000). The total duration of withdrawal was also significantly lesser with lorazepam (5.6 days vs. 6.7 days; p = 0.001). Conclusion Lorazepam is more effective than chlordiazepoxide in alcohol withdrawal in both a faster rate in the drop of withdrawal severity and lessening the total duration of withdrawal.

Background: Adenomyosis is characterised by the presence of ectopic endometrium, both glands and stroma deep in myometrium. Myometrial weakness caused by previous surgery or pregnancies, genetic factors, and tamoxifen use has been proposed as some aetiological factors.Methods: Present study aims to study the clinical profile of patients who have histological evidence of adenomyosis in hysterectomy specimens. The records of consecutive patients who had undergone hysterectomy were analysed.Results: The commonest age group affected is 41-50 years and menorrhagia is the predominant symptom. The preoperative diagnosis of adenomyosis remains poor at around 8%.Conclusions: The age of onset and clinical features of patients should serve as an index for suspecting adenomyosis.

Background: People who attempt suicide have certain individual predispositions, part of which is contributed by personality traits. Aims: The present study was conducted to identify the psycho-sociodemographic and personality related factors contributing to suicide attempts. Materials and Methods: 104 suicide attempters admitted in various departments and referred to the department of psychiatry of IQRAA Hospital formed the study sample. They were evaluated with a self designed socio-demographic proforma, Eysenck's Personality Questionnaire Revised, Albert Einstein College of Medicine-Impulsivity Coping Scale, and Past Feelings and Acts of Violence Scale. Statistics Analysis: The data was initially analyzed by percentage of frequencies. Association between socio-demographic and selected psychological factors was analyzed using t -test and Chi-square test. Intercorrelation among psychological factors was calculated by Pearson's correlation coefficient r. Results and Conclusion: Factors such as young age, being married, nuclear family, feeling lonely and burden to family, inability to solve the problems of day to day life, and presence of psychiatric diagnosis and personality traits such as neuroticism, impulsivity, and violence were contributed to suicide attempt. A significant positive relationship between these factors was also identified. Findings of the present study call the attention of mental health professionals to identify these high risk factors in susceptible individuals and to modify these factors to prevent them from attempting suicide.

Large space-occupying middle cerebral artery infarction accounts for 10-15% of all supratentorial infarctions and carries a mortality of 50% to 80%. Hemicraniectomy may be useful when optimal medical management has failed.Between June 1997 and June 2000, 19 patients who fulfilled the clinical and imaging criteria for large middle cerebral artery infarction underwent hemicraniectomy because of impending herniation despite best medical therapy. The National Institute of Health Stroke Scale (NIHSS) assessed neurological status on admission and at one week after surgery. At 3 month follow up, The Barthel Index (BI) and Rankin Scale (RS) were used to assess the functional outcome among survivors.There were 15 males and 4 females with a mean age of 46.5 years (range 27-76 years). Ten patients (53%) had dominant hemisphere stroke. The mean interval between stroke onset and surgery was 60.3 hours (range 20-103 hours). The mean NIHSS score before surgery was 20.5 (range 17-26) and 10.5 (range 6-22) after surgery. One patient (5.2%) died due to post-operative meningitis. At follow up, mean BI was 56.4 (range 25-90) and RS revealed severe handicap in 4 patients (21%). Patients under 50 years of age had a significantly better outcome with mean BI of 60.7 as compared to only 41.3 (p=0.048) in older patients. Speech function, especially comprehension improved in all patients with dominant hemisphere infarction.These findings add to previous studies suggesting hemicraniectomy may be a useful procedure in patients with large middle cerebral artery territory infarction. The functional outcome is good in younger patients. A randomised controlled trial is required to substantiate these findings.

Plica neuropathica (Polonica) is a common but rarely reported scalp hair condition. In this condition the hairs of scalp in a localized area is compacted into irregularly twisted, irreversibly entangled plaits. Psychological disturbance is a risk factor for plica formation. We report a case of plica neuropathica in an adult female with schizophrenia.

Now a days, reversible logic is seeking lot of attraction due to its low power consumption. Though lot of research has been done in reversible combinational circuit design, the less work has been done in sequential logic, especially shift registers. In this work we proposed a new D-flip-flop whose efficiency is shown in terms of garbage output, constant input and number of gates. Using this proposed D flip-flop we also proposed efficient shift registers.

Now-a-days, the reversible logic design attracts more interest due to its low power consumption. A lot of research has been done in combinational as well as sequential design of reversible circuits. In this paper we have proposed a reversible T-Flip-flop which is better than the existing designs in the literature. A novel design of reversible asynchronous and synchronous counters is also proposed in this paper. As far as it is known, this is the first attempt to apply reversible logic to the counter design. In this paper we have also proposed a new reversible gate which can be used as copying gate. We hope this paper will initiate a new area of research in the field of reversible sequential circuit.

Fetishism is a paraphilic sexual disorder characterized by recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving the use of nonliving objects. We describe a case of fetishism with comorbid alcohol and cannabis dependence. A 40-year-old man was presented with sexual fantasies and urges toward women's undergarments since the age of 25 years. He had fetish behavior even during prolonged period of abstinence from substance use. Our case remitted from fetishism and cannabis and alcohol use on treatment with naltrexone and maintains remission for the last 11 months. Experience with our patient suggests that naltrexone may be effective to treat fetishism with comorbid substance use. Our case is reported as it is the first reported case of successful use of naltrexone in fetishism comorbid with cannabis and alcohol dependence.

Byline: V. Rajmohan, E. Mohandas Mirror neuron system is a group of specialized neurons that "mirrors" the actions and behaviour of others. The involvement of mirror neuron system (MNS) is implicated in neurocognitive functions (social cognition, language, empathy, theory of mind) and neuropsychiatric disorders. MNS discovery is considered to be the most important landmark in neuroscience research during the last decade. Mirror neuron system - discovery The mirror neurons were discovered serendipitously by Giacomo Rizzolatti and colleagues while working on the grasp response of macaques. They observed that a group of neurons in the area F5 of the premotor cortex that fires when a macaque performs an action; also discharges when it observes the same action being performed by another animal.[sup] [1] Subsequent research has elucidated the diverse regions involved in the MNS of monkeys. Recently different cortical structures have been described as part of the MNS in humans. MNS in monkeys The area F5 of the premotor cortex (premotor area located.in the posterior bank of the inferior arcuate sulcus and the cortical convexity immediately caudal to it) in monkeys has two sets of visuomotor neurons namely the 'canonical' and the 'mirror neurons'. The 'canonical neurons' (in F5 bank region) respond to presentation of an object while mirror neurons (in F5 convexity) respond to performance of an action and observation of an object directed action.[sup] [2] The mirror neurons are triggered by any action that involves the interaction between a biological effector (mouth, hand etc.) and an object. They are stimulated by the observation of the exact same action involving the effector and object ('strictly congruent' neurons) and also by actions that are similar but not having exact effector-object interaction ('broadly congruent' neurons).[sup] [3] Other areas that form part of the MNS are the superior temporal sulcus (STS) and the area 7b (PF of Von Economo) in the inferior parietal lobule (IPL). The STS codes for a larger number of movements than the F5 neurons but lacks motor properties (i.e., does not discharge while performing the movement). The area 7b neurons in IPL are heterogeneous and have a role in coding sensory stimuli and respond to somatosensory, visual or bimodal stimuli. I in addition to this, they also have motor properties and discharge on action observation and performance. The IPL receives inputs from the STS and sends an important output to the ventral premotor cortex including area F5 [Figure 1].[sup] [3],[4] MNS in humans Brain imaging studies reveal that action observation in humans activates the inferior frontal gyrus (IFG), lower part of the precentral gyrus, the rostral part of the IPL and also the temporal, occipital and parietal visual areas.[sup] [3] The frontal and the parietal mirror neuron regions are somatotopically organized. The activation of pars opercularis of the IFG reflects the observation of distal hand and mouth actions, whereas the activation of the premotor cortex reflects proximal arm and neck movements [Figure 2]. The mirror neurons in humans, unlike those in monkeys fire even while observing meaningless (intransitive) movements. The observation of transitive actions causes the firing of the frontal and the temporal nodes of the MNS while that of intransitive actions result in the firing of the frontal node only.[sup] [5],[6] FUNCTIONS OF MNS Action understanding Action understanding is the fundamental function of the MNS. Each time the animal observes a certain action being performed by another animal, the mirror neurons representing the performance of that action are activated. The mirror neurons transform visual observation into knowledge.[sup] [3] Studies on humans during action observation have shown activation of the IFG, the IPL and a region within the STS. The precentral motor cortex though not activated by action observation is involved indirectly in action understanding as they have a role in motor imagery. …

Castleman’s disease is a type of non-neoplastic lymphoproliferative disease having lymph nodal hyperplasia. It has two distinct microscopic types: hyaline-vascular type and plasma cell type. Clinically, it may present either as a solitary mass, most commonly in the mediastinum, or as a multicentric form whose features are generalized lymph-adenopathy, splenomegaly and involvement of other organs like the lungs and kidneys. Here we report a case of isolated retroperitoneal Castleman’s disease, which presented as a lump in the iliac fossa in a young female. A clinico-radio-logical diagnosis of retroperitoneal soft tissue tumour was made and the patient underwent complete surgical excision. The exact diagnosis was only obtained at histopathology and there is no evidence of recurrence at six months follow-up.

Camptocormia is a condition characterized by severe frontal flexion of the spinal cord and knees, with passive drooping of both arms. It occurs as a form of conversion disorder. Some cases are associated with behavioral problems. A case of camptocormia of 2-year duration in a south Indian adolescent girl with oppositional defiant disorder and moderate mental retardation is reported.

Context: Psychological factors, such as that exist when we experience pain, can profoundly alter the strength of pain perception. Aim: The study aims to estimate the prevalence of psychiatric disorders, and its association with perception of pain and functional status in chronic patients in palliative care. Materials and Methods: The sample was selected via simple randomisation and post consent were assessed using (1) a semi- structured questionnaire to elicit socio-demographic information and medical data (2) Brief Pain Inventory (3) ICD-10 Symptom Checklist (4) ICD-10-Diagnostic Criteria for Research (DCR) (5) Montgomery Asberg Depression Rating Scale (MADRS) (6) Covi Anxiety Rating Scale (7) Karnofsky Performance Status Scale. Data was analysed using independent sample t test and chi square test. Results: The psychiatric morbidity was 67% with depression and adjustment disorders being the major diagnosis. There was a significant association between psychiatric morbidity pain variables (P = 0.000). Psychiatric morbidity significantly impaired activity, mood, working, walk, sleep, relationship, and enjoyment. There was no association between aetiology of pain, type of cancer, treatment for primary condition and treatment for pain and psychiatric morbidity. The functional status of cancer patients was also poorer in patients with psychiatric morbidity (P = 0.008). Conclusion: There is a high prevalence of psychiatric illness in chronic pain patients of any aetiology. Psychiatric morbidity is associated with increased pain perception, impairment in activity and poor functional status.

Trichotillomania is a disorder characterized by chronic hair pulling that often results in alopecia. Eating the part of hair pulled out is a common practice and trichorhizophagia is a new term to denote the habit of eating the root of hairs pulled out, associated with trichotillomania. Many psychiatric disorders are prevalent among patients with trichotillomania. Here we report a case of trichotillomania with trichorhizophagia in a 58-year-old man with schizophrenia. The various treatment options are also discussed.

Alzheimer's disease (AD) is a devastating neurodegenerative disease, the most common among the dementing illnesses. The neuropathological hallmarks of AD include extracellular beta-amyloid (amyloid precursor protein (APP) deposits, intracellular neurofibrillary tangles (NFT)), dystrophic neuritis and amyloid angiopathy. The mismetabolism of APP and the defective clearance of beta amyloid generate a cascade of events including hyperphosphorylated tau (tau) mediated breakdown of microtubular assembly and resultant synaptic failure which results in AD. The exact aetiopathogenesis of AD is still obscure. The preeminent hypotheses of AD include amyloid cascade hypothesis and tau hyperphosphorylation. The amyloid hypothesis states that extracellular amyloid plaques formed by aggregates of Abeta peptide generated by the proteolytic cleavages of APP are central to AD pathology. Intracellular assembly states of the oligomeric and protofibrillar species may facilitate tau hyperphosphorylation, disruption of proteasome and mitochondria function, dysregulation of calcium homeostasis, synaptic failure, and cognitive dysfunction. The tau hypothesis states that excessive or abnormal phosphorylation of tau results in the transformation of normal adult tau into PHF-tau (paired helical filament) and NFTs. Vascular hypothesis is also proposed for AD and it concludes that advancing age and the presence of vascular risk factors create a Critically Attained Threshold of Cerebral Hypoperfusion (CATCH) which leads to cellular and subcellular pathology involving protein synthesis, development of plaques, inflammatory response, and synaptic damage leading to the manifestations of AD. Multiple other aetiological and pathogenetic hypotheses have been put forward including genetics, oxidative stress, dysfunctional calcium homeostasis, hormonal, inflammatory-immunologic, and cell cycle dysregulation with the resultant neurotransmitter dysfunctions and cognitive decline. The available therapeutic agents target only the neurotransmitter dysfunction in AD and agents specifically targeting the pathogenetic mechanisms like amyloid deposition and tau hyperphosphorylation might provide a definite therapeutic edge.