Prodromal Research Articles

20-year depressive symptoms, dementia, and structural neuropathology in older women.

Thecourse of depressive symptoms and dementia risk is unclear, as are potential structural neuropathological common causes. Utilizing joint latent class mixture models, we identified longitudinal trajectories of annually assessed depressive symptoms and dementia risk over 21 years in 957 older women (baseline age 72.7 years old) from the Women's Health Initiative Memory Study. In a subsample of 569 women who underwent structural magnetic resonance imaging, we examined whether estimates of cerebrovascular disease and Alzheimer's disease (AD)-related neurodegeneration were associated with identified trajectories. Five trajectories of depressive symptoms and dementia risk were identified. Compared to women with minimal symptoms, women who reported mild and stable and emerging depressive symptoms were at the highest risk of developing dementia and had more cerebrovascular disease and AD-related neurodegeneration. There are heterogeneous profiles of depressive symptoms and dementia risk. Common neuropathological factors may contribute to both depression and dementia. Highlights The progression of depressive symptoms and concurrent dementia risk is heterogeneous. Emerging depressive symptoms may be a prodromal symptom of dementia. Cerebrovascular disease and AD are potentially shared neuropathological factors.

Changes in responses of the amygdala and hippocampus during fear conditioning are associated with persecutory beliefs

The persecutory delusion is the most common symptom of psychosis, yet its underlying neurobiological mechanisms are poorly understood. Prior studies have suggested that abnormalities in medial temporal lobe-dependent associative learning may contribute to this symptom. In the current study, this hypothesis was tested in a non-clinical sample of young adults without histories of psychiatric treatment (n = 64), who underwent classical Pavlovian fear conditioning while fMRI data were collected. During the fear conditioning procedure, participants viewed images of faces which were paired (the CS+) or not paired (the CS−) with an aversive stimulus (a mild electrical shock). Fear conditioning-related neural responses were measured in two medial temporal lobe regions, the amygdala and hippocampus, and in other closely connected brain regions of the salience and default networks. The participants without persecutory beliefs (n = 43) showed greater responses to the CS− compared to the CS+ in the right amygdala and hippocampus, while the participants with persecutory beliefs (n = 21) failed to exhibit this response. These between-group differences were not accounted for by symptoms of depression, anxiety or a psychosis risk syndrome. However, the severity of subclinical psychotic symptoms overall was correlated with the level of this aberrant response in the amygdala (p = .013) and hippocampus (p = .033). Thus, these findings provide evidence for a disruption of medial temporal lobe-dependent associative learning in young people with subclinical psychotic symptoms, specifically persecutory thinking.

Alpha-synuclein pathology in isolated rapid eye movement sleep behaviour disorder: a meta-analysis.

Accumulating evidence indicates that patients with isolated rapid eye movement sleep behaviour disorder (iRBD), a prodromal stage of synucleinopathies, show abnormal deposition of misfolded alpha-synuclein (a-Syn) in peripheral tissues. The clinical utility of testing for a-Syn in iRBD is unclear. This meta-analysis focused on the utility of testing for the abnormal a-Syn phosphorylated at Ser129 (p-syn) and a-Syn seeding activity (a-Syn seed amplification assays [aSyn-SAA]). Following an electronic database search, 15 studies were included that provided at a minimum data on test positivity in participants with iRBD. Test positivity from cerebrospinal fluid (CSF) was 80% (95% confidence interval [CI] 68-88%, I2 = 71%) and for skin was 74.8% (95% CI 53.2-88.5%, I2 = 64%) for aSyn-SAA and 78.5% (95% CI 70.4-84.9%, I2 = 14%) for p-syn. The phenoconversion rate ratio of biopsy-positive versus biopsy-negative iRBD was 1.28 (95% CI 0.68-2.41, I2 = 0%). Skin as a source had a specificity of 99% (95% CI 95-100%, I2 = 0%; p = 0.01 compared to CSF). As a test, p-syn, had a specificity of 100% (95% CI 93-100%, I2 = 0%; p < 0.001) compared to aSyn-SAA. The odds ratio of a-Syn test positivity in iRBD versus other RBDs was 112 (95% CI 20-629, I2 = 0%). These results demonstrate clinically significant test positivity in iRBD and favour skin over CSF as the source of a-Syn pathological analysis, and p-syn over aSyn-SAA as the testing method. Overall, these findings indicate that testing for a-Syn could help in differentiating iRBD from RBD secondary to other conditions.

Distinct eye movement patterns to complex scenes in Alzheimer's disease and Lewy body disease.

Alzheimer's disease (AD) and Lewy body disease (LBD), the two most common causes of neurodegenerative dementia with similar clinical manifestations, both show impaired visual attention and altered eye movements. However, prior studies have used structured tasks or restricted stimuli, limiting the insights into how eye movements alter and differ between AD and LBD in daily life. We aimed to comprehensively characterize eye movements of AD and LBD patients on naturalistic complex scenes with broad categories of objects, which would provide a context closer to real-world free viewing, and to identify disease-specific patterns of altered eye movements. We collected spontaneous viewing behaviors to 200 naturalistic complex scenes from patients with AD or LBD at the prodromal or dementia stage, as well as matched control participants. We then investigated eye movement patterns using a computational visual attention model with high-level image features of object properties and semantic information. Compared with matched controls, we identified two disease-specific altered patterns of eye movements: diminished visual exploration, which differentially correlates with cognitive impairment in AD and with motor impairment in LBD; and reduced gaze allocation to objects, attributed to a weaker attention bias toward high-level image features in AD and attributed to a greater image-center bias in LBD. Our findings may help differentiate AD and LBD patients and comprehend their real-world visual behaviors to mitigate the widespread impact of impaired visual attention on daily activities.

Malignant Diseases in Ayurveda – A Review

Introduction: Malignant diseases or cancer are rapidly spreading among the masses all over the world making it a cause of concern and creating the need of exploring it from varied perspectives aiming at discovering newer dimensions of its treatment. It is not a novel entity, the history being prevalent since vedic period. Methods: It is not mentioned as such in ancient Ayurveda texts, instead the matter is scattered here and there due to vastness of the disease and its ability to affect any part of the body. Hence, all the texts including brihattrayee and laghytrayi were critically reviewed to find each and every minute detail and elaborate the disease in view of types, etiology, pathogenesis, prodromal symptoms, symptoms, complications, and treatment. Results: It was observed that the disease was discussed under different headings in different chapters, the details reported in the article. Analysis: Ayurveda principles focus on specific pathogenesis of disease rather than mere nomenclature and has much to offer in cancer management. Discussion and Conclusion: The data will be beneficial to provide conceptual base of the disease, further enlightening the way to devise newer techniques and newer dravya to deal with the dreadly entity.

Alzheimer Disease Using Machine Learning

The successful development of amyloid-based biomarkers and tests for Alzheimer’s disease (AD) represents an important milestone in AD diagnosis. However, two major limitations remain. Amyloid-based diagnostic biomarkers and tests provide limited information about the disease process and they are unable to identify individuals with the disease before significant amyloid-beta accumulation in the brain develops. The objective in this study is to develop a method to identify potential blood-based non-amyloid biomarkers for early AD detection. The use of blood is attractive because it is accessible and relatively inexpensive. Our method is mainly based on machine learning (ML) techniques (support vector machines in particular) because of their ability to create multivariable models by learning patterns from complex data. Using novel feature selection and evaluation modalities we identified 5 novel panels of non-amyloid proteins with the potential to serve as biomarkers of early AD. In particular, we found that the combination of A2M, ApoE, BNP, Eot3, RAGE and SGOT may be a key biomarker profile of early disease. Disease detection models based on the identified panels achieved sensitivity (SN) &gt; 80%, specificity (SP) &gt; 70%, and area under receiver operating curve (AUC) of at least 0.80 at prodromal stage (with higher performance at later stages) of the disease. Existing ML models performed poorly in comparison at this stage of the disease suggesting that the underlying protein panels may not be suitable for early disease detection. Our results demonstrate the feasibility of early detection of AD using non-amyloid based biomarkers.

Alterations in Blood Methylome as Potential Epigenetic Biomarker in Sporadic Parkinson's Disease.

To characterize DNA methylation (DNAm) differences between sporadic Parkinson's disease (PD) and healthy control (HC) individuals enrolled in the Parkinson's Progression Markers Initiative (PPMI). Using whole blood, we characterized longitudinal differences in DNAm between sporadic PD patients (n = 196) and HCs (n = 86) enrolled in PPMI. RNA sequencing (RNAseq) was used to conduct gene expression analyses for genes mapped to differentially methylated cytosine-guanine sites (CpGs). At the time of patient enrollment, 5,178 CpGs were differentially methylated (2,683 hypermethylated and 2,495 hypomethylated) in PD compared to HC. Of these, 579 CpGs underwent significant methylation changes over 3 years. Several differentially methylated CpGs were found near the cytochrome P450 family 2 subfamily E member 1 (CYP2E1) gene. Additionally, multiple hypermethylated CpGs were associated with the N-myc downregulated gene family member 4 (NDRG4) gene. RNA-Seq analyses showed 75 differentially expressed genes in PD patients compared to controls. An integrative analysis of both differentially methylated sites and differentially expressed genes revealed 20 genes that exhibited hypomethylation concomitant with overexpression. Additionally, 1 gene, cathepsin H (CTSH), displayed hypermethylation that was associated with its decreased expression. We provide initial evidence of alterations in DNAm in blood of PD patients that may serve as potential epigenetic biomarker of disease. To evaluate the significance of these changes throughout the progression of PD, additional profiling at longer intervals and during the prodromal stages of disease will be necessary. ANN NEUROL 2024;95:1162-1172.

Association Between Long-Term Exposure to Ambient Air Pollution and the Risk of Mild Cognitive Impairment in a Chinese Urban Area: A Case-Control Study.

As a prodromal stage of dementia, significant emphasis has been placed on the identification of modifiable risks of mild cognitive impairment (MCI). Research has indicated a correlation between exposure to air pollution and cognitive function in older adults. However, few studies have examined such an association among the MCI population inChina. We aimed to explore the association between air pollution exposure and MCI risk from the Hubei Memory and Aging Cohort Study. We measured four pollutants from 2015 to 2018, 3 years before the cognitive assessment of the participants. Logistic regression models were employed to calculate odds ratios (ORs) to assess the relationship between air pollutants and MCI risk. Among 4,205 older participants, the adjusted ORs of MCI risk for the highest quartile of PM2.5, PM10, O3, and SO2 were 1.90 (1.39, 2.62), 1.77 (1.28, 2.47), 0.56 (0.42, 0.75), and 1.18 (0.87, 1.61) respectively, compared with the lowest quartile. Stratified analyses indicated that such associations were found in both males and females, but were more significant in older participants. Our findings are consistent with the growing evidence suggesting that air pollution increases the risk of mild cognitive decline, which has considerable guiding significance for early intervention of dementia in the older population. Further studies in other populations and broader geographical areas are warranted to validate these findings.

Cardioneuroablation for Cardioinhibitory Vasovagal Syncope: Rationale, Approaches, and Its Role in Long-Term Management.

Cardioneuroablation (CNA) has emerged as a potential alternative to pacemaker therapy in well-selected cases with vasovagal syncope (VVS). In recent years, the number of CNA procedures performed by electrophysiologists has considerably risen. However, some important questions, including proper patient selection and long-term results, remain unanswered. The present article aims to critically review and interpret latest scientific evidence for clinical indications and how to approach long-term management. CNA is a new approach that has been supported mainly by retrospective or observational data for its use in syncope. Overall, in mixed population studies treated with CNA, 83.3 to 100% have been reported to be free of syncope over follow-up periods of 6 to 52.1 months. For studies including patients who underwent CNA with pure VVS, 73.2 to 100% have been reported to be syncope-free over follow-up periods of 4 to 45.1 months. One large meta-analysis showed 91.9% freedom from syncope after CAN. To date, only one randomized controlled trial with small case number has been performed of CNA compared to non-pharmacological treatment in VVS. In this study of 48 patients with an average of 10 ± 9 spontaneous syncopal episodes prior to study enrollment and 3 ± 2 episodes in the year prior to CNA. After CNA, 92% were free of syncope compared with 46% treated with optimal non-pharmacological treatment to prevent new syncope episodes (P = 0.0004). To date, most studies have included younger patients (< 60 years of age). There are only limited data in patients older than 60, and some studies suggest less of an effect in relatively older patients. Cardioneuroablation can be performed to decrease syncope recurrence in adult patients aged < 60 years, with severe or recurrent cardioinhibitory syncope without prodromal symptoms, after proven failure of conventional therapies. Due to a paucity of data supporting efficacy in older individuals or for vasodepressor components, CNA in adult patients aged > 60 years or in the presence of a dominant vasodepressor should be considered investigational in severely symptomatic patients after proven failure of pharmacological and non-pharmacological therapies.

Exploration of dreams in Charaka Samhita – an Ayurveda text and their content analysis of prodromal dreams in various conditions

IntroductionResearch into dreams, have shown the association between increased frequency of distressing dreams, specific content themes (analysed using the Hall Van de Castle system) and greater incidence of progression of neurological conditions and dementia. The history of predicting illnesses by the content of dreams, in the western world is popularly traced backed to the ancient Greek medicine. This stimulates the curiosity if any such practices existed in the ancient medical practises of the eastern world. Ayurveda is one such traditional system of medicine, that is native to the Indian subcontinent. Charaka Samhita is one of the oldest texts on Ayurveda consisting of 8 sections and 120 chapters totally. This text was selected for the purpose of this review, with the line of enquiry such as what does Ayurveda say about dreams associated with illnesses? What are the contents of such dreams? Furthermore, the dream content analysis was done using the Hall Van de Castle system, which is probably the first time being done on an Ayurveda text content.Objectives1) To explore if, Charaka Samhita mentions, describes dreams in relation to illnesses, stages of illnesses and their prognosis. 2) To analyse content of the dreams seen in prodromal stage of illnesses.Methods1-The Charaka Samhita text was scanned chapter by chapter, to answer the questions- a) What are the types of dreams? b) Are any associated with illnesses? c)Are any dreams mentioned in the prodromal stage of illnesses? d)What do they imply? e)What are their contents? 2- The contents of prodromal dreams were analysed against the categories of Hall Van de Castle system.ResultsAs per Charaka Samhita, the types of dreams are, i) those based on what was seen ii) heard iii) reflected upon iv) desired v) imagined vi) those of prophetic type and vii) those caused by illnesses. Specific dreams in the prodromal stage, predict manifestation of specific illnesses (mild or fatal). In the diverse dream contents (18 themes mentioned) ranging from things animals to gods and demons, except the elements of the past, rest of the general categories occur, at least once. The categories characters, objects, activities and social interactions were more common than the rest.ConclusionsThus akin to the ancient Greek medicine, Ayurveda too had the practice of predicting illnesses based on the dream contents.Disclosure of InterestNone Declared

Psychotic Depression, Mannerisms and Alzheimer’s Disease: a case report

IntroductionWe present the case of a 56-year-old patient with two depressive episodes with psychotic symptomatology in a period of three years, who began with mania and developed Alzheimer’s disease.ObjectivesThe case is presented with the aim of providing a brief review of psychiatric symptomatology as a prodrome of Alzheimer’s disease.MethodsA 56-year-old patient, with no psychiatric antecedents of interest, who presented a depressive episode with psychotic symptoms, requiring admission to a short hospitalisation unit, as well as antidepressant treatment with sertraline at 200mg daily and olanzapine 20mg. He remained stable for two years and was able to withdraw treatment progressively. However, after remaining euthymic without pharmacological treatment for six months, he had another episode with psychotic symptoms. In this last episode, he did not require hospital admission, but he did require a change in antidepressant treatment, given that he did not tolerate treatment with sertraline. Treatment was therefore started with duloxetine 120mg, aripiprazole 20mg and as no clear improvement was observed, months later it was decided to use lamotrigine 100mg as a stabiliser.ResultsIn this last episode, despite the significant affective improvement and maintaining psychopathological stability, without presenting psychotic symptoms, the patient presented marked dysfunction in day-to-day life due to a striking attention deficit, lack of concentration and reduced short-term memory. At the same time, he also exhibits mannerisms which are observed in the consultation room, in the form of repetitive hand movements.For these reasons, it was decided to request MRI and SPECT, obtaining results compatible with possible incipient cognitive deterioration.ConclusionsIt seems that up to 40% of patients with dementia have depressive symptoms. It seems that depression at an advanced age may in fact be a prodromal symptom of dementia.Disclosure of InterestNone Declared

Effect of Shunthi dhanyaka sadhita jala and lifestyle modifications in the management of Prameha purvarupa (prediabetes): An observation

In prediabetes, the blood glucose levels are higher than normal but not enough to qualify as diabetes. The prevalence of prediabetes in India is 14%. Prevention of prediabetes would prevent life-threatening consequences. Prameha purvarupa (~prodromal symptoms of diabetes mellitus) in Ayurveda correlates clinically to the features of prediabetes. Prameha purvarupa is a Santarpanottha (~sedentary lifestyle related) and Meda pradoshaja vikara (~disorder of adipose tissue) that typically manifests in individuals who are Chankramana dveshi (~aversion to walking) and is brought on by vitiated Doshas (~regulatory functional factors of the body) and Dushyas (~which gets vitiated by aggravated Doshas). Elevation of blood glucose level in prediabetes may be considered retention of Ama (~metabolic toxins) in the body. A 38-year-old prediabetic female, unable to lose weight after several attempts, was managed for three months with Shunthi dhanyaka sadhita jala (~water processed with dry ginger, and coriander). In addition, she was also suggested Chankramana (~brisk walking) during the early hours of the day and Swabhavika nidra (~regular and natural sleep). Improvement in glycosylated hemoglobin, and disappearance of Prameha purvarupa such as Karapada tala daha (~burning sensation of palms and soles), Madhura asyata (~sweet taste in mouth), and weight loss after three months of management. The case report depicts the effectiveness of a simple, practical, and affordable Ayurvedic treatment approach in the management of prediabetic conditions.

Assessment of the relationship between psychotic-like experiences and traumatic life events: a cross-sectional study

IntroductionTraumatic life events (TLEs) have been associated with the entire spectrum of psychosis outcomes, including risk and severity of psychotic disorders and psychotic-like experiences (PLEs). In a non-clinical setting, understanding the relationship could help improve prevention services.ObjectivesThe aim of this study is to establish the relationship between TLEs and PLEs.Methods A cross-sectional study was conducted in a Tunisan business and engineering school from March 2022 to June 2022. Participants completed the Tunisian dialect version of the Prodromal Questionnaire-Brief (PQ-B), a validated self-report instrument designed to evaluate prodromal symptoms. TLEs such as physical, sexual, and emotional abuse, as well as neglect experiences, lived or witnessed have been assessed along with bullying experiences.Results The final sample size consisted of 358 participants, with a median age of 22 ± 2.22 years, with a sex ratio (M/F) of 1.41. More than half of the participants (58.6%) reported having experienced TLEs (49% in the preceding 6 months) while 31% had experienced bullying or abuse in school (27.9% in the preceding 6 months). The mean total score of the PQ-B for the study population was 7.27 ± 4.387, 36.3% reached the threshold and were defined as PQ-B-positive subjects. Those with a lifetime history of major life events were more likely to screen positive on the total score PQ-B (p = 0.000), as were those with a lifetime history of bullying or abuse (p = 0.000).Conclusions Understanding the factors that interact in the significant association between PLEs and TLEs may provide useful information for prevention programs and the improvement of mental health.Disclosure of InterestNone Declared

Risk of depression in persons with Alzheimer's disease: A national cohort study.

Depression is a risk factor and possible prodromal symptom of Alzheimer's disease (AD), but little is known about subsequent risk of developing depression in persons with AD. National matched cohort study was conducted of all 129,410 persons diagnosed with AD and 390,088 with all-cause dementia during 1998-2017 in Sweden, and 3,900,880 age- and sex-matched controls without dementia, who had no prior depression. Cox regression was used to compute hazard ratios (HRs) for major depression through 2018. Cumulative incidence of major depression was 13% in persons with AD and 3% in controls. Adjusting for sociodemographic factors and comorbidities, risk of major depression wasgreater than two-fold higher in women with AD (HR, 2.21; 95% confidence interval [CI], 2.11-2.32) or men with AD (2.68; 2.52-2.85), compared with controls. Similar results were found for all-cause dementia. Persons diagnosed with AD or related dementias need close follow-up for timely detection and treatment of depression. In a large cohort, women and men with AD had >2-fold subsequent risk of depression.Risks were highest in the first year (>3-fold) but remained elevated ≥3 years later.Risk of depression was highest in persons aged ≥85 years at AD diagnosis.Persons with AD need close follow-up for detection and treatment of depression.

Does recency of prodromal symptom onset or worsening matter for psychosis prediction?

Does recency of prodromal symptom onset or worsening matter for psychosis prediction?

Childhood and adolescent schizophrenia and networking

IntroductionReviewing the histories of patients with childhood and adolescent schizophrenia, on numerous occasions, traumatic factors with great emotional and social impact are observed, such as situations of mistreatment, abuse and emotional deprivation, where help is requested but resources are scarce and the approach is limited without work in network.Objectives1. Analysis of the consultation pathways in adolescents with severe psychiatric and socio-familial symptoms and the time delay in optimal guidance. 2. Evaluate the services involved. 3. Evaluate the clinical control of treatment with aripiprazole.MethodsRetrospective observational analysis, 5 months, of prodromal symptoms of childhood psychosis and help-seeking pathways in a 13-year-old adolescent, as well as a description of the pharmacological approach and professional teams involved.ResultsA 13-year-old adolescent who went to the emergency room with her mother for ingesting anti-cockroaches with self-inflicted intent. Reviewing his medical history, 4 serious autolytic gestures were detected in the last 2 months. Referred to Mental Health who did not attend.On clinical examination, florid psychotic, with perplexity, self-reference, ideation of harm, language and behavioral disorganization. Auditory and kinesthetic hallucinations. A situation of neglect of the minor and abuse by the parents is detected; the risk had not been previously reported. Oral aripiprazole (up to 15 mg/day) was prescribed with good tolerance and progressive improvement in symptoms.We worked jointly with Social Services, the Juvenile Prosecutor’s Office, Education and the hospital Psychiatry unit. In some of the resources the situation was already evident, the scope of their action was limited and delaying attention for months.ConclusionsBased on cases like this, we ask ourselves if psychiatrists are sensitized to the comorbidity of serious mental pathology and the existence of risk situations in minors and if they are oriented toward multiprofessional management. Networking provides us with an early diagnosis, improving the therapeutic approach.Disclosure of InterestNone Declared

Idiopathic Rapid Eye Movement Sleep Behavior Disorder (iRBD) Shares Similar Fecal Short-Chain Fatty Acid Alterations with Multiple System Atrophy (MSA) and Parkinson's Disease (PD).

Idiopathic rapid eye movement sleep behavior disorder (iRBD) is considered as a prodromal stage of synucleinopathies. Fecal short-chain fatty acid (SCFA) changes in iRBD and the relationships with synucleinopathies have never been investigated. To investigate fecal SCFA changes among iRBD, multiple system atrophy (MSA), and Parkinson's disease (PD), and evaluate their relationships. Fecal SCFAs and gut microbiota were measured in 29 iRBD, 42 MSA, 40 PD, and 35 normal controls (NC) using gas chromatography-mass spectrometry and 16S rRNA gene sequencing. Compared with NC, fecal SCFA levels (propionic, acetic, and butyric acid) were lower in iRBD, MSA, and PD. Combinations of these SCFAs could differentiate NC from iRBD (AUC 0.809), MSA (AUC 0.794), and PD (AUC 0.701). Decreased fecal SCFAs were associated with the common reducing SCFA-producing gut microbiota in iRBD, MSA, and PD. iRBD shares similar fecal SCFA alterations with MSA and PD, and the combination of these SCFAs might be a potential synucleinopathies-related biomarker. © 2024 International Parkinson and Movement Disorder Society.

Insights into reproductive dynamics and feeding biology of Sphyraena putnamae Jordan and Seale, 1905 exploited in the Indian EEZ

The sawtooth barracuda Sphyraena putnamae, widely distributed in the Indo-Pacific region, isone of the commercially important barracuda species exploited by trawls in the Indian EEZ.The present study examined 2,135 S. putnamae collected during 2014-2020 from differentfish landing centres along the Indian coast, to elucidate their reproductive and feedingbehaviour. The fork length of sampled females and males varied from 12.5 to 130.9 cm and16.5 to 90.0 cm respectively. Negative allometric growth was observed with a significantdifference (p&lt;0.05) between the sexes. The observed sex ratio (Female:Male) was 1.23:1,indicating the dominance of females. Size at sexual maturity for females and males wereestimated at 55.3 and 45.4 cm fork length respectively. The higher proportion of spawningcapable individuals and higher gonadosomatic index (GSI) values in females observedduring March to May and November-December revealed the bimodal and protractedspawning nature of this species. Absolute fecundity increased with fork length and weightand varied from 70,080 to 10,18,068 oocytes with an average of 3,16,568 oocytes. Thestomach vacuity index of females and males was 49.09 and 47.92% respectively. Fifty-nineprey items were identified in the diet, with a predominance of fishes confirming S. putnamaehas a piscivorous feeding behaviour. Keywords:Management, Protracted spawners, Piscivore,Sawtooth barracuda, Sex ratio

Comparative Study between Operative and Non-Operative Management of Complete Achilles Tendon Rupture

ntroduction Achilles tendon rupture is the most common tendon rupture in the lower extremity. The injury most commonly occurs in adults in their third to fifth decade of life.[1] Acute ruptures often present with sudden onset of pain associated with a "snapping" or audible "pop" heard at the site of injury. Patients can describe the sensation of being kicked in the lower leg. The injury is causes significant pain and disability in patient populations. Achilles tendon injuries typically occur in individuals who are only active intermittently (i.e., the "weekend warrior" athletes). The injury is reportedly misdiagnosed as an ankle sprain in 20% to 25% of patients. Most commonly affected as 10% report a history of prodromal symptoms, and known risk factors include prior intratendinous degeneration, fluoroquinolone use, steroid injections, and inflammatory arthritides.[2,3]

Shifting our attention earlier in the multiple sclerosis disease course.

Revisions of multiple sclerosis (MS) diagnostic criteria enable clinicians to diagnose patients earlier in the biologic disease course. Prompt initiation of therapy correlates with improved clinical outcomes. This has led to increased attention on the earliest stages of MS, including the MS prodrome and radiologically isolated syndrome (RIS). Here, we review current understanding and approach to patients with preclinical MS. MS disease biology often begins well before the onset of typical MS symptoms, and we are increasingly able to recognize preclinical and prodromal stages of MS. RIS represents the best characterized aspect of preclinical MS, and its diagnostic criteria were recently revised to better capture patients at highest risk of conversion to clinical MS. The first two randomized control trials evaluating disease modifying therapy use in RIS also found that treatment could delay or prevent onset of clinical disease. Despite progress in our understanding of the earliest stages of the MS disease course, additional research is needed to systematically identify patients with preclinical MS as well as capture those at risk for developing clinical disease. Recent data suggests that preventive immunomodulatory therapies may be beneficial for high-risk patients with RIS; though management remains controversial.