Understanding Misunderstandings About the Relative Risk and Odds Ratio.

Categorical outcome analyses in randomized controlled trials (RCTs) and observational studies are commonly presented as relative risks (RRs) and odds ratios (ORs). In some situations, these RRs and ORs may be misunderstood, resulting in wrong conclusions. How this may happen is explained in the context of a hypothetical RCT that compares potentially lifesaving drugs A and B with placebo.

Physical and chemical characterization of smokeless tobacco products in India.

The rapid proliferation of smokeless tobacco (SLT) in India has occurred without adequate information on the possible dangers and toxicity of these products. Tobacco flavors as well as nicotine (both protonated and un-protonated) are responsible for health dangers and addiction. The study aimed to offer information on the physical characteristics of commonly used smokeless tobacco products (including microscopic analysis), along with nicotine content (both total and un-protonated), pH, moisture, and flavors.

How to Understand the 95% Confidence Interval Around the Relative Risk, Odds Ratio, and Hazard Ratio: As Simple as It Gets.

Statistics such as the mean difference (MD), standardized mean difference (SMD), relative risk (RR), odds ratio (OR), hazard ratio (HR), and others are meant to be examined along with their 95% confidence intervals (CIs), and their significance can be understood by viewing these CIs as compatibility intervals. The 95% CIs around the MD and SMD are easily understood because they are expressed along a linear scale. The 95% CIs around the RR, OR, and HR are harder to understand because they are expressed along an exponential scale; however, when the numbers are log-transformed, they are linearized, and understanding becomes easy.

Apoptotic Factors and Mitochondrial Complexes Assist Determination of Strain-Specific Susceptibility of Mice to Parkinsonian Neurotoxin MPTP.

Identification of genetic mutations in Parkinson's disease (PD) promulgates the genetic nature of disease susceptibility. Resilience-associated genes being unknown till date, the normal genetic makeup of an individual may be determinative too. Our earlier studies comparing the substantia nigra (SN) and striatum of C57BL/6J, CD-1 mice, and their F1-crossbreds demonstrated the neuroprotective role of admixing against the neurotoxin MPTP.

Ketamine vs Electroconvulsive Therapy for Major Depressive Episode: A Systematic Review and Meta-analysis.

Importance: The relative efficacy of ketamine and electroconvulsive therapy (ECT) in adults with major depressive episode (MDE) needs clarification.

Objective: To compare depression rating outcomes with ketamine vs ECT in adults with MDE and to compare response and remission rates, number of sessions to response and remission, and adverse effects.

Data Sources: Two investigators independently systematically searched MEDLINE, ScienceDirect, and Google Scholar databases using a combination of relevant Medical Subject Headings terms and free-text keywords from database inception through May 15, 2022, to identify relevant English-language trials.

Gestational Exposure to Benzodiazepines and Z-Hypnotics and the Risk of Major Congenital Malformations, Ectopic Pregnancy, and Other Adverse Pregnancy Outcomes.

A small proportion of women with anxiety, insomnia, and other conditions may require benzodiazepines or z-hypnotics intermittently or daily sometime during pregnancy. This article provides an update on pregnancy outcomes associated with pre-gestational or gestational exposure to benzodiazepines and z-hypnotics based on results from 2 meta-analyses, 2 registry-based studies, and 2 large retrospective cohort studies. In summary, the meta-analyses found that exposure was associated with an increased risk of spontaneous abortion, induced abortion, preterm birth, low birth weight, small for gestational age, low Apgar scores at 5 min, and neonatal intensive care unit admission.

Gestational Exposure to Benzodiazepines and Z-Hypnotics and the Risk of Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder in Offspring.

Two recent cohort studies, one from Norway and the other from Taiwan, examined for perhaps the first time whether gestational exposure to benzodiazepines and to z-hypnotics was associated with a clinical diagnosis of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in offspring. The studies had important methodological strengths that are not often seen; these included actual assessment during pregnancy of whether drugs prescribed were used, and, if so, when; adjustment of analyses for postbaseline time-varying covariates; inclusion of discordant sibling pair and paternal exposure analyses; inclusion of pre-pregnancy vs intrapregnancy analyses; and others. The studies also had important limitations; these included inadequate statistical power resulting in a failure to identify potential associations in even unadjusted analyses; lack of information on intermittent use vs daily dosing; and others.

Mitochondrial Complex I Inhibition in Dopaminergic Neurons Causes Altered Protein Profile and Protein Oxidation: Implications for Parkinson's disease.

Mitochondrial dysfunction and oxidative stress are critical to neurodegeneration in Parkinson's disease (PD). Mitochondrial dysfunction in PD entails inhibition of the mitochondrial complex I (CI) in the dopaminergic neurons of substantia nigra. The events contributing to CI inhibition and downstream pathways are not completely elucidated.

Prevalence of Bedtime Procrastination in University Students and Reexamination of the Bedtime Procrastination Scale.

To determine the prevalence of bedtime procrastination (BtP) among Indian university students and to evaluate the performance of the Bedtime Procrastination Scale (BPS). The BPS (scoring range, 9-45), with separate, additional questions related to sleep and influences thereon, was administered to all on-campus graduate and postgraduate students attending Navrachana University, Gujarat, India. The variable of regular sleep habits was defined as a BPS total score of 9-18 and BtP as a BPS total of 36-45.

Publication of studies registered in Clinical Trials Registry of India: An audit of mood disorder research protocols from 2009-2019.

Background: Selective publication of studies has important scientific, ethical, and public health implications.

Aim: We studied selective publication among mood disorder research protocols registered in the Clinical Trials Registry of India (CTRI) database. We also examined the frequency and nature of protocol deviations among the published articles.

Skeletal and Dental Fractures Associated With Electroconvulsive Therapy.

During the motor seizure associated with electroconvulsive therapy (ECT), the muscles of the trunk and limbs contract forcefully and repetitively, predisposing to injuries to muscles, joints, teeth, and bones. This motor seizure is irrelevant to the therapeutic action of the treatment. It is therefore modified by the administration of an intravenous muscle relaxant, such as succinylcholine, after the administration of the anesthesia in the ECT premedication.

Prolactin-Raising and Prolactin-Sparing Antipsychotic Drugs and the Risk of Fracture and Fragility Fracture in Patients With Schizophrenia, Dementia, and Other Disorders.

Patients who require antipsychotic drug treatment are at increased risk of fractures, including osteoporosis-related fragility fractures, for reasons related to demographics, illness-related factors, and treatment-related factors. As examples, patients with dementia may be vulnerable to falls due to cognitive and psychomotor impairment, patients with schizophrenia may be vulnerable to injury related to physical restlessness or physical aggression, and patients receiving antipsychotics may suffer falls related to sedation, psychomotor impairment, bradykinesia, or postural hypotension. Antipsychotics may also increase the risk of fracture through long-term hyperprolactinemia and resultant osteoporosis.

Efficacy of repetitive transcranial magnetic stimulation and transcranial direct current stimulation in focal hand dystonia: Systematic review of intervention trials.

We reviewed trials examining the efficacy of repetitive transcranial magnetic stimulation (rTMS) (seven trials) and transcranial direct current stimulation (tDCS) (seven trials) in focal and dystonia (FHD). Among tDCS trials, one randomized controlled trial and three quasi-experimental studies showed evidence of efficacy; these trials combined different types of stimulations or used tDCS along with neurorehabilitation. Four rTMS trials showed evidence of efficacy but differed in stimulation parameters.

A Primer on How to Critically Read an Observational Study on Adverse Medical Outcomes Associated With Long-Term Antidepressant Drug Use.

Whether long-term antidepressant use predisposes to or protects against adverse medical outcomes is unclear. In this context, a recent retrospective cohort study found that, for example, at a 10-year follow-up, selective serotonin reuptake inhibitors lowered the risk of diabetes mellitus and hypertension but raised the risk of cerebrovascular disease, cardiovascular mortality, and all-cause mortality. The findings of this study were widely and uncritically covered in the lay and medical media with potential to adversely impact opinions about antidepressant treatment among patients, caregivers, and health care professionals.

Practical Psychopharmacology: Using a Knowledge of Pharmacokinetics to More Rapidly Stabilize Patients at Lower Drug Doses.

Three drug dosing strategies can be employed to address dose-dependent drug adverse effects. The usual strategy is to continue the drug but at a lower dose; it would then take 5 half-lives of the drug for the new steady state to be attained and for a dose-dependent adverse effect to correspondingly attenuate. Such slow offset of the adverse effect could be disadvantageous for drugs such as fluoxetine, penfluridol, and cariprazine that have long half-lives.

Reconsideration of the Benefits of Pharmacological Interventions for the Attenuation of the Cognitive Adverse Effects of Electroconvulsive Therapy.

The cognitive adverse effects (AEs) of electroconvulsive therapy (ECT) limit the wider use of the treatment. These AEs can be attenuated by changing the way ECT is administered; however, such changes may reduce the response rate, the speed of response, or both. A recent systematic review and meta-analysis identified more than a dozen pharmacologic interventions in 26 randomized controlled trials (RCTs) that sought to reduce ECT-induced cognitive AEs.

Regional heterogeneity in mitochondrial function underlies region specific vulnerability in human brain ageing: Implications for neurodegeneration.

Selective neuronal vulnerability (SNV) of specific neuroanatomical regions such as frontal cortex (FC) and hippocampus (HC) is characteristic of age-associated neurodegenerative diseases (NDDs), although its pathogenetic basis remains unresolved. We hypothesized that physiological differences in mitochondrial function in neuroanatomical regions could contribute to SNV. To investigate this, we evaluated mitochondrial function in human brains (age range:1-90 y) in FC, striatum (ST), HC, cerebellum (CB) and medulla oblongata (MD), using enzyme assays and quantitative proteomics.

Antipsychotic Augmentation With N-Acetylcysteine for Patients With Schizophrenia.

-acetylcysteine (NAC) augmentation of antipsychotic medication is one of very many antipsychotic augmentation strategies that have been studied in schizophrenia. A recent systematic review and meta-analysis of 6 randomized controlled trials (RCTs) found that NAC (median dose, 2,000 mg/d) improved several clinical outcomes at different time points with medium to large effect sizes; however, many of the significant findings in this meta-analysis are suspect because they appeared to be influenced by 2 short-term (8-week) RCTs with outlying characteristics. Important findings not influenced by the 2 outlying RCTs were significant attenuation by NAC of negative symptom (3 RCTs) and total psychopathology (2 RCTs) ratings at ≥ 24 weeks and improvement in working memory but not processing speed (3 RCTs).

Potential clinical applications of Ashwagandha () in medicine and neuropsychiatry.

Introduction: Ashwagandha (ASW) is the extract of the plant . It is widely used in complementary, alternative, and integrative medicine (CAIM) but is little discussed in mainstream modern medical literature.

Areas Covered: We performed a review of potential pharmacotherapeutic properties of ASW.

Psychotropic Drugs With Long Half-Lives: Implications for Drug Discontinuation, Occasional Missed Doses, Dosing Interval, and Pregnancy Planning.

The half-life of a drug is the time taken for the blood level of the drug to fall by half, provided that no more doses of the drug are administered in the intervening period. Many psychotropic drugs and their active metabolites, if any, have very long half-lives that extend for 2 days or longer. Examples are chlordiazepoxide, diazepam, fluoxetine, vortioxetine, aripiprazole, brexpiprazole, cariprazine, penfluridol, donepezil, and memantine.