Intestinal Parasitic Infestation in School Going Children of Rishikesh, Uttarakhand, India

Background: Intestinal parasitism(IP) remains a common problem in school going children. Aims & Objectives: To study the prevalence IP infestation in school going children and to study the relation with type of water supply and sanitation. Material and Methods: A cross sectional study was carried out and a total of 461 stool samples were collected from children under ten years of age from various schools of Rishikesh. The normal saline and iodine mounts of fresh and saturated salt solution concentrated samples were examined. Modified Ziehl Neelsen staining was done for detection of coccidian parasites. The statistical significance within gender, age, drinking water supply, sanitation and other socio-demographic parameters was assessed by Chi-square test. Results: 112 (24.3%) out of 461 were positive for intestinal parasites. Giardia lamblia was the commonest parasite (15.2%) followed by Hymenolepis nana (2.38%), Hookworm (2.17%), Enterobius vermicularis (2.17%), Entamoeba histolytica (2.17%), Ascaris lumbricoides (0.86%), and Cryptosporidium parvum (0.86%). Conclusions: Due to lack of proper sanitation & education along with low socioeconomic background, IP infections are still prevalent among school children. Regular awareness program on promoting good health, maintenance of proper personal hygiene and carrying out regular deworming in schools should be instituted for control.

Reduced susceptibility of carbapenem‑resistant Klebsiella pneumoniae to biocides: An emerging threat.

Dealing with carbapenem‑resistant Klebsiella pneumoniae (CR‑Kp) strains, which are generally pan‑drug resistant, is an uphill task for health care professionals. Owing to limited therapeutic options and the possibility of development of resistance to commonly used biocides in hospital settings, CR‑Kp infections pose a serious threat of emergence of a dreaded pandemic. The aim of the study was to highlight the possibility of emergence of biocide resistance among CR‑Kp strains. A case study was conducted in a Super‑specialty Hospital in September 2015. A 65‑year‑old female patient post‑laparotomy was admitted to the General Intensive Care Unit of a Super‑specialty Hospital. CR‑Kp was isolated from the blood and mucus trap samples of this patient. Susceptibility testing of three commonly used biocides in our hospital, namely sodium hypochlorite (4% available chlorine), 5% w/v povidone iodine (0.5% w/v of available iodine) and absolute ethanol (99.9%), respectively, was carried out using K. pneumoniae ATCC 700603 as control. The test isolate showed reduced susceptibility to sodium hypochlorite in comparison to K. pneumoniae ATCC 700603. The possibility of emergence of biocide resistance among CR‑Kp strains poses a threat of disrupting our ongoing efforts for implementation of effective infection control measures.

Cystathionine- -γ-lyase gene silencing with siRNA in monocytes/ macrophages attenuates inflammation in cecal ligation and puncture-induced sepsis in the mouse.

Hydrogen sulphide is an endogenous inflammatory mediator produced by cystathionine-γ-lyase (CSE) in macrophages. To determine the role of H2S and macrophages in sepsis, we used small interference RNA (siRNA) to target the CSE gene and investigated its effect in a mouse model of sepsis. Cecal ligation puncture (CLP)-induced sepsis is characterized by increased levels of myeloperoxidase (MPO) activity, morphological changes in liver and pro-inflammatory cytokines and chemokines in the liver and lung. SiRNA treatment attenuated inflammation in the liver and lungs of mice following CLP-induced sepsis. Liver MPO activity increased in CLP-induced sepsis and treatment with siRNA significantly reduced this. Similarly, lung MPO activity increased following induction of sepsis with CLP while siRNA treatment significantly reduced MPO activity. Liver and lung cytokine and chemokine levels in CLP-induced sepsis reduced following treatment with siRNA. These findings show a crucial pro-inflammatory role for H2S synthesized by CSE in macrophages in sepsis and suggest CSE gene silencing with siRNA as a potential therapeutic approach for this condition.

Gender dysphoria with homosexuality and comorbid depressive disorder: complexities in concept and management.

Gender identity disorder (GID) and homosexuality are complex entities debated over decades, whether should be categorized as a disorder or not. There are a number of problems specifically related to the criteria of the GID diagnosis like differences in the terms trans-sexualism and GID, failure of the proposed criteria in conceptualizing the whole spectrum of gender variance phenomena, the potential risk of physically invasive examinations to rule out intersex conditions and the application of diagnosis even after hormonal and surgical treatment. We hereby report complexities faced in the case of a male to female transsexual with homosexuality and depressive disorder and its management.

An evaluation of dark field microscopy, culture and commercial serological kits in the diagnosis of leptospirosis.

Context: This study was conducted to analyze the clinical utility of various leptospira diagnostic modalities. Aims: To evaluate the role of dark field microscopy (DFM), culture, immunochromatography (IgM Leptocheck), IgM enzymelinked immunosorbent assay (IgM ELISA), macroscopic slide agglutination test (MSAT) and microscopic agglutination test (MAT) in diagnosing leptospirosis in febrile patients. Settings and Design: Descriptive study conducted in a tertiary care hospital from January 2011 to April 2012. Subjects and Methods: Blood, urine and paired sera from 100 patients with clinical suspicion of leptospirosis (study group) were collected and subjected to DFM, culture, IgM Leptocheck, IgM ELISA and MSAT. Fifty randomly selected sera from febrile patients tested positive for infections other than leptospirosis (control sera) were also subjected to the aforementioned serological assays. All the leptospira seropositive samples were subjected to MAT. Statistical Analysis Used: Positive predictive values (PPV) and coefficient of agreement (kappa). Results: None of the clinical samples showed positivity by DFM. Leptospira inadai was isolated from a urine sample. The seropositivity of IgM Leptocheck, IgM ELISA and MSAT was 16%, 46% and 47%, respectively. The PPV of these assays was 14.3%, 8.7% and 6.5%, respectively. Poor agreement was obtained among these assays. Only four study group leptospira seropositive samples were confirmed by MAT with Australis being the predominant serovar. None of the leptospira-positive control sera were confirmed by MAT. Conclusions: DFM and culture have limited utility in diagnosing leptospirosis with serology being the mainstay. The present study shows discordant results with the commercially available serological kits. Further studies should be done to evaluate the various diagnostic modalities.

Family caregivers’ burden: A hospital based study in 2010 among cancer patients from Delhi.

BACKGROUND: A large number of patients with chronic diseases like, cancer are cared for in homes by the family members in India. The vital role that these family members play as “caregivers” is well recognized, however, the burden on them is poorly understood. AIMS: To assess burden and to determine the predictors of burden on family caregivers of cancer patients. SETTING AND DESIGN: A cross‑sectional, hospital based study conducted in National Capital Territory of Delhi. MATERIALS AND METHODS: 200 family caregivers of cancer patients were selected by systematic random sampling and interviewed using standard, validated Hindi version of Zarit Burden Interview. STATISTICAL ANALYSIS: Univariate analysis and multivariable logistic regression were carried out using Statistical Package for the Social Sciences software (version 17.0). RESULTS: The study population consisted of 90 (45%) males and 110 (55%) female caregivers aged 18‑65 years. 113 (56.5%) caregivers reported no or minimal burden while 75 (37.5%) caregivers reported mild to moderate burden. Using logistic regression marital status, education and type of family of caregivers, occupation of cancer patients and type of treatment facility were found to be the predictors of burden on caregivers. CONCLUSION: In view of the substantial burden on family caregivers coupled with lack of adequate number of cancer hospitals, there is a public‑health imperative to recognize this important group. All levels of health‑staff in cancer hospitals in developing countries should be sensitized to the various burdens faced by family caregivers.

Parenting in Children and Adolescents with Psychosis.

Need and Purpose of review: Psychotic symptoms appear in children and adolescents in the most crucial years, during the individual’s career development. The challenges faced by parents of psychotic children are in dealing with their disruptive behaviours, negative symptoms, cognitive deficits, delusions and hallucinations. This paper presents an overview of the childhood psychosis and how parenting can be done effectively for this population. Methods: Articles were retrieved from the Medline, Cochrane database, Google Scholar, Medscape; using the search terms ‘parenting and childhood psychosis’, and ‘childhood psychoses; and standard textbooks were consulted. Main conclusions: Educating parents how to recognize early symptoms, explaining treatment adherence, side effects of medications along with non-pharmacological measures like dealing with expressed emotions, lowering expectations, enhancing social supports, healthy lifestyle, and making patients independent. Awareness, early identification and effective parenting for psychosis may help bridge the wide gap between scarce skilled mental health professionals, inefficient resources and large paediatric population.

Assessment of Quality of Life during Treatment of Pediatric Oncology Patients.

Background: The objective of this study was to assess health-related quality of life (HRQOL) of pediatric cancer patients and their parents in North India. Materials and Methods: Seventy-fi ve cancer children were assessed for HRQOL, using Lansky play performance scale and health utility index-2 (HUI-2). Fifty-seven patients were followedup after 4 months after therapy and reassessed. Their parents were also assessed using World Health Organisation (WHO) QOL BREF. Seventy fi ve controls were also assessed and compared. Results: Lansky and HUI-2 scores of patients, as well as WHO QOL BREF of parents were signifi cantly poor in cancer patients when compared to controls. There was signifi cant improvement after therapy in patients with lymphomas and miscellaneous tumors. Pain and self-care were found to be maximally affected domains on HUI-2. Conclusions: Large prospective multicenter studies may be undertaken and hence that need based interventions can be planned.

Iloperidone – A Newer Antipsychotic.

The optimal treatment of schizophrenia poses a challenge to develop more effective treatments and safer drugs, to overcome poor compliance, discontinuation and frequent switching with available antipsychotics. Iloperidone is a new antipsychotic developed to overcome some of the limitations in the drug treatment of schizophrenia. It has been approved by regulating agencies for use in treatment of adult schizophrenia.

Comparison of effectiveness of acupuncture therapy and conventional drug therapy on psychological profile of migraine patien.

Migraine is a painful condition in which patients suffer from recurrent episodes of disabling pain, which could be very severe and can lead to grave psychological disturbances. There is no curative treatment for migraine, but there are various treatment modalities, though, with conflicting reports on their efficacy. This study was conducted to compare the effectiveness of electro acupuncture therapy and the conventional drug therapy on the psychological profile of migraneurs based on the assessment of quality of life and disability parameters. Migraneurs (n=60) were recruited from the Psychiatry and Neurology OPD, Guru Tegh Bahadur Hospital, Delhi. Following a written consent, migraneurs were randomly allocated into 2 study groups – Group A received 10 sittings of electro acupuncture on selected acupuncture points over a period of 30 days, while for the same duration the Group D received a conventional drug therapy in the form of oral flunarizine 20 mg OD along with paracetamol 500 mg SOS. The patients were assessed twice, before and after completion of the treatment programme (30 days). The quality of life was assessed with WHOQOL BREF (WHO Quality of Life Biomedical Research and Education Foundation) questionnaire and the disability was assessed with MIDAS (Migraine Disability Assessment) questionnaire. Statistical analysis was performed using repeated measure’s ANOVA with Tukey’s test. Migraneurs were found to have lower quality of life and higher disability scores but following the treatment regimes, the 2 study groups showed a significant improvement in both the parameters studied. It was however observed, that the acupuncture group showed a better response and was thus found to be more effective as compared to the drug group (P=0.005 to 0.000). We thus conclude that acupuncture is a better treatment option than the conventional drug therapy in not only relieving the pain of migraine but in also improving the psychological profile in migraneurs. Hence its use should be encouraged as an alternative/adjunct treatment for migraine.

Synthesis and microbial screening of 6-pyridin-4-yl-2, 3-dihydro-1Hpyridazin-pyridazin-4-one derivatves.

6-pyridin-4-yl-2, 3-dihydro-1H-pyridazin-4-one derivatives were synthesized by a simple method. The isonicotinic acid hydrazide was made to react with acetaldehyde and acetone. This results into the formation of the respective hydrazones. These hydrazones formed were cyclized to the pyridazine derivatives. All synthesized compounds were subjected to antimicrobial activity.

Burden and Quality of Life in Spouses of Patients with Schizophrenia and Bipolar Disorder.

Background: Several studies have explored the existence of burden primary caregivers and family members of schizophrenic patients. There were little convincing evidence to support the relationship between socio-demographic characteristics of the patients and family burden. Aim & Objective: The cross-sectional study was designed to investigate the effect of socio-demographic variables on spousal burden and quality of life of schizophrenic and dipolar patients. Methodolgy: 9 spouses of chronic schizophrenci patients were drawn from psychiatry OPD OF G.T.B Hospital, Delhi. Burden Assessment Schedule and WHOQOL-BREF was individually administered on each spouse. Results & Conclusions: The results indicated significant effects of gender and family type on spousal burden.

A Study of Psychiatric Symptomatalogy in Dengue Patients.

Introducation : Dengue Fever is an acute febrile infectious caused by dengue virus which is transmitted through mosquito. A fraction of Dengue patients exhibit idengifiable psychiatric symptoms. Aims; The present studywas undertaken with an aim to identify the psychiatric symtoms associated with dengue fever. Material & Methods: The study was carried out in the department of psychiarty, University Collange of medical science (U.C.M.S ) And guru Tegh Bahadur Hospital, a designated tertiary care center for Dengue cases in Delhi. The study period ranged from May 2012 to October 2012. The Study assessed the psychiatric symptomatology in dengue fever and its progression overt the course of dengue. Results During the acute phase, nearly all (90.3%) the patients exhibited thanatophobia. Over 80% of the subjects (most females ) had panic attacks and only less than 15% of these subject needed shor course of anxiolytics. During the recovery phase ( at the end of 1st week ), all the observed psychiatric symptoms decreased both in terms of frequency as well as severity.

A Study of the Prevalence, Socio-Demographic and Clinical Correlates of Metabolic Syndrome (M S) in Drug-naive Patients of Anxiety and Depressive Disorders.

Backgroud: The prevalence of Metabolic Syndrome (MS) and its components is reported to be higher in population with mental illness as compared to general population across al diagnostic categories. There is a paucity of studies on the baseline prevalence of MS and its these studes have produced mixed results. The present study was therefore carried out in patients attending the out-patient (OPD) psychiatry department. Aims and Objective:To find out and compare the prevalence and socio-demographic and clinical correlates of MS in drug native patients of anxiety and depressive disorders. Materials and Methods: Socio-demographic details, were collected and analyzed using appropriate statistical tools. Results and Conclusions: The overall prevalence of metabolic syndrome was 23.5% while it was 46.2% in the depressive group and 9.5% in the anxiety group. 50% of the sample fulfilled at least one criterion for MS. While age, all MS components predicted MS overall; HDL, waist circumference and BMI predicted MS in depressive patient and HDL and triglyceride abnormalities predicted MS in the anxiety group.