Objective:Conventional antidepressants take two weeks before their therapeutic action begins. Recent studies have reported on the rapid antidepressant effect of ketamine when given as an intravenous (I.V.) infusion. Little is known about its intramuscular (I.M.) use in depression. Hence this study was conducted to compare the safety, tolerability and efficacy of I.M. versus. I.V. ketamine in Major Depression (ICD-10).Materials and Methods:It was a randomized open label parallel group study in a tertiary care teaching hospital. Study sample consisted of 27 subjects having major depression divided randomly into three groups of nine subjects each. Ketamine administered to each group in the dose of 0.5 mg/kg as an I.V. infusion, as 0.5 mg/kg I.M. or 0.25 mg/kg I.M. respectively. Depression rated on the Hamilton Depression Rating Scale (HAM-D) before the injection, two hours later, the next day, and after three days. Data analyzed using the Statistical Package for Social Sciences (SPSS).Results:Mean age of the sample was 36.81 years (SD 11.815). Two hours after the injection, HAM-D fell by 58.86%, 60.29% & 57.36% in each group respectively. The improvement was sustained for next three days. Adverse effects noticed were rare, of mild nature and transient, lasting less than an hour.Conclusions:Intramuscular ketamine in the dose of 0.25 mg/kg is as effective and safe as 0.5 mg/kg given either I.M. or I.V., substantially alleviating depressive symptoms within a few hours and sustained for 3 days.
It takes about 2 weeks for the onset of antidepressant action of drugs while electroconvulsive therapy though faster, is a cumbersome procedure requiring an anaesthetist and at least a minor operation theatre. Recent studies have shown that Ketamine, when given to severely depressed patients in the dose of 0.5 mg/kg as a slow intravenous infusion over 40 minutes, brought about acute relief from depression and amelioration of suicidal risk within a few hours. The improvement, however, was transient and lasted for up to a week but could be sustained by further weekly or biweekly injections. As the dose of ketamine administered was found to be safe, it was now tried in the intramuscular route in two severely depressed patients with similar rapid improvement. The cases are reported here which pave way for an easier mode of treating acute depression.
Purpose: To describe the causes and trends of corneal donor mortality from eye bank data in India during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This retrospective eye bank-based study included 13,529 donors who donated their cornea between January 2018 and December 2021. Donors in whom the cause of mortality was documented were included as cases. The data were collected from the eye bank records. Results: Overall, 13,529 corneal donors were included in the study. Most of the donors were males (69.71%). The mean age of the donors was 51.55 ± 20.54 years, whereas the median age was 51 (inter-quartile range: 35–68) years. The mean age of males (49.3 ± 19.47 years) was lesser than the mean age of females (56.72 ± 21.94 years) at the time of donation. The most common age group at the time of donation was during the sixth decade of life with 2,139 (15.81%) donors. The mean age of the donors decreased by a decade from 54.95 ± 20.51 years in 2018 to 44.35 ± 18.88 years in 2021. The most common cause of donor mortality was cardio-respiratory arrest in 5,190 (38.36%) donors and trauma in 3,469 (25.64%) donors, followed by suicide in 2,790 (20.62%) donors. The trend of cardio-respiratory arrest decreased from 53.01% to 9.5% ( p = <0.00001 ), whereas the trends of trauma increased from 21.93% to 36% ( p = <0.00001 ) and suicide increased from 12.71% to 36.41% ( p = <0.00001 ) between 2018 and 2021. Conclusion: Corneal donors are more commonly males in their sixth decade of life. The most common cause of donor mortality was related to cardio-respiratory arrest with a concerning rising trend in suicide cases over the years seen significantly during the pandemic.
Glial tumors account for about 60% of all primary brain tumors. About one-third of patients suffer deficits in one or more cognitive domains, of which language difficulties may be mistaken for confusion. A 60-year-old male who was brought to the medical outpatient department (OPD) on November 14, 2022, with complaints of mental confusion, talking irrelevantly, and increased sleep for 20 days. As the patient had irrelevant talk, he was referred to psychiatry OPD. The psychiatric evaluation revealed word-finding difficulty, memory impairment, and confabulation. His physical examination was normal, but the Montreal Cognitive Assessment Scale score was 8. A provisional diagnosis of organic amnesic syndrome, not induced by alcohol and other psychoactive substances (F04), was made. Plain computed tomography scan brain revealed a large cystic and solid lesion in the left capsuloganglionic region extending to left thalamic and temporal regions with severe perilesional vasogenic edema suggestive of glioblastoma multiforme with midline shift of 5.6 mm. The case was immediately referred to the neurosurgery department for further management. He was treated there with dexamethasone to reduce edema and was referred to a cancer center for chemotherapy and radiotherapy. The patient was put on chemotherapy and passed away on January 21, 2023, before that could happen. Any case with recent onset of neuropsychiatric symptoms needs thorough cognitive assessment and a high index of suspicion to rule out organic causes. Informed consent to submit the case report for publication was obtained from the son of the patient.
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