Abstract Background: Delirium is a fluctuating abnormality in attention and awareness. One of the most important causes is alcohol withdrawal. Delirium carries high mortality, so prompt diagnosis is essential. Neutrophil-to-lymphocyte ratio (NLR) is a promising biomarker for predicting delirium due to alcohol withdrawal. Aim: To investigate the role of the NLR as a predictor of delirium in patients with Alcohol Dependence Syndrome (ADS) undergoing alcohol withdrawal: A prospective observational study. Settings and Design: The study was done in Government Medical College in Calicut, Kerala, India. Materials and Methods: Eighty male patients admitted for detoxification were assessed, with delirium diagnosed using the confusion assessment method. NLR was calculated from blood samples collected within 24 h of admission. Statistical Analysis: Descriptive statistics, group comparisons, and receiver operating characteristic (ROC) curve analysis were performed, with P < 0.05 considered statistically significant. Results: Delirium developed in 42.5% of patients, with a significantly higher mean NLR compared to those without delirium (3.67 vs. 2.06; P < 0.001). Older age, higher alcohol consumption, and a previous history of delirium were also associated with increased delirium risk. ROC curve analysis demonstrated that an NLR cutoff of 2.56 had good predictive value, with an area under the curve of 0.816, sensitivity of 79.4%, and specificity of 82.6%. Conclusion: The findings suggest that NLR is a valuable, cost-effective biomarker for early identification of delirium in ADS patients.
Abstract Background: Nurse-delivered brief interventions (BIs) may offer a feasible strategy for reducing co-occurring substance use in resource-constrained addiction treatment settings. Materials and Methods: A quasi-experimental study was conducted among treatment-seeking opioid-dependent patients. Participants were assessed using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The intervention group received nurse-conducted ASSIST-linked BI, while the control group received routine care. Follow-up assessment was conducted after 15 days. Results: Among 100 opioid-dependent patients, tobacco was the most common co-occurring substance use (91%), followed by cannabis (31%) and alcohol (5%). The intervention resulted in a significant reduction in tobacco-related ASSIST scores compared with the control group ( F = 68.59, P = 0.001), whereas no significant differences were observed for alcohol or cannabis use ( P > 0.05). Conclusions: Nurse-conducted BI has the potential to reduce tobacco-related risk among opioid-dependent patients in this setting.
Abstract Background: Postburn contractures are a common complication of burn injuries and result in significant functional disability and psychological distress. Surgical release is a routine procedure used to restore mobility; however, its effect on psychological outcomes has been less studied. Aim: The aim of this study was to evaluate psychological and functional outcomes following surgical release of postburn contractures. Materials and Methods: This hospital-based prospective longitudinal cohort study with a pre–post design was conducted in 180 patients with postburn contractures undergoing surgical release. Functional disability was assessed using the World health organization disability assessment schedule 2.0 (WHODAS 2.0) and depressive symptoms using the Hamilton Depression Rating Scale (HAM-D). The evaluation was performed preoperatively and 12 weeks after surgery. Paired t -tests, Pearson correlation, and linear regression analysis were used. Results: The participants’ mean age was 37.74 ± 10.53 years. WHODAS scores decreased from 3.42 ± 0.66-2.04 ± 0.63 ( P < 0.001), indicating a significant improvement in functional disability after surgery. The HAM-D scores decreased from 21.63 ± 4.52 to 10.80 ± 3.20 ( P < 0.001), indicating a significant decrease in depressive symptoms. Disability and depressive symptoms were found to be significantly correlated ( R 2 = 0.55, P < 0.001). Both depression symptoms (Cohen’s d = 3.60) and disability (Cohen’s d = 3.83) had large effect sizes. Conclusion: Surgically releasing postburn contractures leads to both functional and psychological improvements. The results emphasize how crucial it is to combine surgical care with psychological evaluation and rehabilitation to maximize burn survivors’ recovery.
Abstract Background: Clozapine is the evidence-based treatment of choice for treatment-resistant schizophrenia, yet premature discontinuation and loss to follow-up remain major barriers to sustained benefit, particularly in low- and middle-income country settings. We examined real-world rates, timing, reasons, and predictors of clozapine discontinuation and care disengagement in a government-run tertiary psychiatric facility in India. Aim: To examine the rates, timing, reasons, and predictors of clozapine discontinuation and care disengagement among patients initiated on clozapine in a tertiary psychiatric center in India. Materials and Methods: We conducted a single-center retrospective cohort study where adult patients (≥18 years) with schizophrenia or schizoaffective disorder initiated on clozapine between January 2017 and December 2023 were followed for up to 12 months from initiation. Clozapine discontinuation was defined as permanent cessation or a dispensing gap >60 days; care disengagement was defined as no documented clinical contact for ≥90 days beyond the expected follow-up date. Multivariable Cox proportional hazards regression models were used to identify independent predictors of discontinuation and care disengagement. Results: Among 544 patients initiated on clozapine, 148 (27.2%) discontinued treatment and 77 (14.2%) disengaged from care within 12 months. Discontinuation clustered early: 12.3% occurred by month 3 and 19.7% by month 6; disengagement similarly concentrated early (5.1% by month 3; 9.0% by month 6). The most commonly documented reason for discontinuation was adverse effects (32.4%), followed by monitoring/follow-up difficulties (19.6%) and nonadherence (12.8%). In adjusted analyses, discontinuation was independently associated with comorbid substance use (hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.18–2.22), greater distance from the facility (HR per 10 km 1.08, 95% CI: 1.03–1.13), and adverse effects requiring dose modification (HR: 1.89, 95% CI: 1.34–2.66), while inpatient initiation was protective (HR: 0.74, 95% CI: 0.56–0.99). Care disengagement was also associated with substance use (HR: 1.54, 95% CI: 1.01–2.35) and distance (HR per 10 km: 1.12, 95% CI: 1.05–1.20), with inpatient initiation protective (HR: 0.68, 95% CI: 0.47–0.98). Conclusion: In this Indian tertiary care cohort, approximately one in four patients discontinued clozapine and one in seven disengaged from care within a year, predominantly in the first 6 months. Early-phase tolerability management, integrated substance-use care, and service delivery models that reduce travel and monitoring burden may improve retention and outcomes.
