Prevalence of psychological morbidity and its correlates among school-going adolescents of urban Puducherry, India

BACKGROUND Experiencing poor mental health during adolescence predisposes an individual to psychiatric morbid conditions in adulthood. We estimated the prevalence of psychological morbidity and its associated factors, among school-going adolescents in higher secondary schools of urban Puducherry. METHODS We did this cross-sectional study among adolescents studying in classes 11 and 12 from selected schools of urban Puducherry, including one government and three private schools. Study tools used were the General Health Questionnaire-12 and Perceived Stress Scale-10 to assess psychological morbidity and perceived psychological stress in adolescents, respectively. Risk factors in academic, environmental, personal and health-related domains were captured using a structured questionnaire. Study questionnaires were self-administered by the participants in classrooms. Bivariate and multivariate analyses were done to identify risk factors for psychological morbidity. RESULTS Of the 820 adolescents surveyed, the prevalence of psychological morbidity was 25.4% (95% CI 22.4– 28.5). Academic factors such as reporting peer pressure for academic performance and lack of extracurricular activities at school were associated with psychological morbidity. Among health-related factors, adolescents who reported having difficulty in coping with pubertal changes, being worried about their physical appearance, reporting substance abuse and experiencing sleep disturbances had greater chances of having screened with psychological morbidity. Of note, adolescents with psychological stress had 2.5 times higher chances of having psychological morbidity. CONCLUSIONS We estimated that 1 in 4 school-going adolescents in urban Puducherry suffered psychological morbidity. Reducing the academic burden and advocating health promotion through a life skills approach may improve mental wellness in Indian adolescents.

Evaluation for airway obstruction in adult patients with stable ischemic heart disease

Background Ischemic heart disease (IHD) and chronic airway disease (COPD and Asthma) are major epidemics accounting for significant mortality and morbidity. The combination presents many diagnostic challenges. Clinical symptoms and signs frequently overlap. There is a need for airway evaluation in these patients to plan appropriate management. Methods Consecutive stable IHD patients attending the cardiology OPD in a tertiary care centre were interviewed for collecting basic demographic information, brief medical, occupational, personal history and risk factors for coronary artery disease and airway disease, modified medical research centre (MMRC) grade for dyspnea, quality of life-St. George respiratory questionnaire (SGRQ), spirometry and six-min walk tests. Patients with chronic airway obstruction were treated as per guidelines and were followed up at 3rd month with spirometry, six-minute walk test and SGRQ. Results One hundred fourteen consecutive patients with stable cardiac disease were included (Males-88, Females-26). Mean age was 58.89 ± 12.24 years, 53.50% were smokers, 31.56% were alcoholics, 40.35% diabetics, 47.36% hypertensive. Twenty five patients had airway obstruction on spirometry (COPD-13 and Asthma-12) and none were on treatment. Thirty-one patients had cough and 48 patients had dyspnea. Patients with abnormal spirometry had higher symptoms, lower exercise tolerance and quality of life. Treatment with appropriate respiratory medications resulted in increase in lung function, quality of life and exercise tolerance at 3rd month. Conclusion Chronic respiratory disease in patients with stable IHD is frequent but often missed due to overlap of symptoms. Spirometry is a simple tool to recognize the underlying pulmonary condition and patients respond favorably with appropriate treatment

Functional Outcome of Isolated Hoffa Fractures Treated with Cannulated Cancellous Screw

Introduction: Isolated Hoffa fracture is an infrequent injury and little research has been done on this subject. The purpose of this study was to evaluate the functional outcome and complications of surgically managed Hoffa fractures with cannulated cancellous screw. Materials and Methods: Between 2011 and 2014, eight isolated Hoffa fractures in seven adult patients with mean age 39.8±11.9 years (range 25-60 years) were managed with cannulated cancellous screw of 6.5mm diameter applied in anterior to posterior direction using swashbuckler and medial parapatellar approach for lateral and medial Hoffa fractures respectively. All patients were evaluated using knee evaluation score after two years or longer. Mean follow up was 28±3.8 months (range 24-36 months). Results: All fractures in the eight patients healed clinicoradiologically by the 16th week with excellent result in 87.5% cases and good in 12.5% cases. By the end of union, the range of motion (ROM) of the knee was 0° to 110° except in two patients. One patient had ROM 10°-100° and other had 15°-90°. Mean knee evaluation score was 87.5±10.4. There was no incidence of non-union, infection or avascular changes in the patients or loss of reduction till final follow up. Conclusion: Open reduction and fixation with two 6.5 mm cannulated cancellous screws with early mobilization yielded good functional outcome in isolated Hoffa fractures.

A Study Of Bacteriological Profile And Their Antibiotic Susceptibility Patterns Of Isolated Organisms From ICU's With Special Reference To Multi-Drug Resistant Organisms.

Background and Aim: Microbes are notorious for rapidly develop drugs resistant due to gene transfer and spontaneous mutation. So their continues surveillance of antibiogram pattern is necessary to detect muti-drugs resistant organisms to improve patients outcome admitted in ICUs. Objective is to detect bacterial organisms causing infection in different ICUs and to know their antibiotic resistance pattern. Methodology: Total 602 different samples were collected from different ICUs and processed for culture, bacterial identification and antibiotic susceptibility testing done according to CLSI recommendation. Results: Out of total 602 samples, 248 (41.02%) were culture positive. The number of isolated Gram negative and Gram positive organisms were 196 (79.03%) and 52 (20.97%) respectively. Most common isolated of Gram negative organism was Pseudomonas spp. 58(23.38%), followed by Acinetobacter spp. 46 (18.55%). While, most common isolated gram positive cocci was coagulase negative staphylococcus spp. 32 (12.95%), followed by Enterococcus spp 8 (3.24%). From total 196 isolates of gram negative, 71.43% were MDROs, 7.14% were XDROs. Out of total 52 gram positive isolates, 40.38% were MDRO, 3.85% were XDRO. Conclusion: Routine Microbiological surveillance helps to guide in implementing better antibiotic policies to improve patient’s morbidity and mortality suffering from multi-drug resistant infections in ICUs.

Attack rate and household secondary attack rate of acute conjunctivitis during an outbreak in South India: A community‑based survey.

Introduction: Knowledge on epidemiology of the disease in the contemporary world will help to develop appropriate strategies to curtail the transmission during an outbreak. This study was carried out during an outbreak of conjunctivitis in selected areas of Puducherry, South India, to assess the attack rate of conjunctivitis, identify factors associated with developing conjunctivitis and calculate household secondary attack rate (HSAR) of conjunctivitis and its correlates. Methodology: During December 2014, a community‑based survey was conducted in a selected urban and rural area in Puducherry, South India. Simple random sampling was used to select primary sampling units and systematic sampling to select households. All individuals in the selected households were studied. A questionnaire was used to obtain data on sociodemographic characteristics, conjunctivitis during September–November, 2014, and number of household contacts who developed conjunctivitis within 7 days of index case. The attack rate and HSAR of conjunctivitis was expressed as percentage. Multivariate logistic regression was used to find factors independently associated with developing conjunctivitis and also 100% HSAR. Results: Of 3193 study participants from 772 households, 509 (15.9%, 95% confidence interval 14.7–17.2%) had an attack of conjunctivitis during the reference period. Of the 772 households, 218 (28.2%) had at least one case of conjunctivitis. Of 218 households, 33 (15.1%) households had 100% HSAR. Lower age, not being unemployed, low socioeconomic status, and residing in rural area were independently associated with developing conjunctivitis. Index case being male and living in a household with ≥5 members were independently associated with 100% HSAR. Conclusion: In the outbreak under study, more than one‑fourth of households had at least one case of conjunctivitis and about one in every six individuals had an attack of conjunctivitis.

Prevalence of metallo-β-lactamase producing pseudomonas spp.(in Tertiary Care Hospital).

Background: Metallo-β-lactamase (MBL) mediated resistance to carbapenem is an emerging threat in Pseudomonas isolates. The aim of this study is to detect metallo-β-lactamase producing isolates of Pseudomonas spp. from various clinical samples from indoor patients in a teaching hospital. Materials and Methods: Total 900 bacterial strains were isolated from different clinical samples from indoor patients. The bacterial strains were isolated and identified as per the standard guidelines. Amongst them 100 isolates of Pseudomonas were taken for the present study. All pseudomonas isolates were subjected to antimicrobial susceptibility testing by Kirby-Bauer disc diffusion method (CLSIs). In all imipenem resistant isolates of Pseudomonas spp., MBL detection was carried out by Imipenem-EDTA combined-disc synergy test (CDST). Results: Out of 100 isolates of Pseudomonas, 44 (44%) were imipenem resistant. Of these 44 isolates, 30 were producing MBL enzyme. 30 MBL positive isolate included 12 (40%) from surgical wards, 10 (33.33%) from tuberculosis ward, 4 (13%) from medicine ward, 2 (7%) from paediatric ward, 1 (3%) from urology ward and 1 (3%) from neonatal ICU. All MBL positive strains were resistant to β-lactams, aminoglycosides and fluoroquinolones. Conclusion: Prevalence of MBL producing Pseudomonas spp. is 30%. The MBL producing Pseudomonas spp. isolates were multidrug resistant. It is important to identify MBL producing pseudomonas isolates in laboratory as may cause serious infections and may cause a nosocomial outbreak.

Candida prevalence and its antifungal susceptibility in various clinical specimens in tertiary care center.

Background: The purpose of this study was to isolate the Candida spp. & examine their susceptibility to antifungal drugs from various clinical specimens. One hundred fifty isolates of Candida spp. were included in this study. Clinical history revealed that all patients were on systemic broad spectrum antibacterial drugs. Materials and Methods: Candida spp. was differentiated by germ tube test, culture characteristics on special media for fungus, sugar fermentation, sugar assimilation and growth on corn meal agar. Antifungal drug susceptibility testing against Fluconazole, Ketoconazole, Itraconazole, Voriconazole, Nystatin and Amphotericin B were done on basis of CLSI guidelines on Methylene blue containing Mueller Hinton Agar by disk diffusion method. Result: We found 52% and 48%, C.albicans & Non albicans candida spp., respectively. There were no resistance to Nystatin and Amphotericin B. C.albicans was more susceptible than Non albicans candida. Nystatin & Amphotericin B were susceptible to all isolated Candida spp. In present scenario, Fluconazole is most commonly used empirical antifungal drug, which is more effective to C.albicans than Non albicans Candida. Conclusion: Due to emergence of resistance in Azole group of antifungal among Non albicans candida, it should be mandatory to use antifungal drugs as per the susceptibility testing.

Epidemiological and microbiological profile of infective keratitis in Ahmedabad.

Context: Study of patients attending tertiary care ophthalmology institute at Ahmedabad. Aims: To study the microbiological etiology and epidemiological factors associated with suppurative keratitis. Settings and Design: A total of 150 corneal scrapings were evaluated from patients presenting with corneal ulcers at a tertiary ophthalmology center, Ahmedabad from July 2007 to June 2008. Materials and Methods: Scrapings were subjected to Gram stain, potassium hydroxide preparation and culture for bacterial and fungal pathogens. Socio-demographic data and risk factors were recorded. Results: Ninety percent (135/150) people with corneal ulcers had trauma as predisposing factor for keratitis. Trauma due to wooden objects was the leading cause (46/135) followed by vegetable matter and stone injury (23/135). Microbial etiology was established in 59.3% (89/150) of scrapings. Out of 89 positive isolates, 65.1% (58/89) were bacterial while 34.9% (31/89) were fungal. Among the bacterial isolates, 60.3% (35/58) were Gram-positive cocci while 39.7% (23/58) were Gram-negative bacilli. The most common bacterial isolate was Staphylococus aureus (32.7%, 19/58) followed by coagulase-negative Staphylococci (25.8%, 15/58) and Pseudomonas (18.9%, 11/58). Among the 31 fungal pathogens, Aspergillus species was the most common (35.4%11/31), followed by Fusarium species (22.5%, 7/31). Conclusion: Trauma with wooden material is the most common predisposing factor for suppurative keratitis. Males were more affected than females. Bacterial ulcers were more common than fungal in areas in and around Ahmedabad. Staphylococcus aureus and Aspergillus were the commonest bacterial and fungal isolates respectively. Geographical variation persists in microbial etiology of suppurative keratitis.

Seroprevalence of sporadic acute viral hepatitis with their co-infection at tertiary care hospital.

Background: Viral hepatitis is one of the major causes of mortality & morbidity in developing countries. Present study was aimed to know the seroprevalence and co infection of the acute viral hepatitis caused by hepatitis A, hepatitis B, hepatitis C and hepatitis E virus from patient attending one of the largest tertiary care hospitals. Material and Methods: Study was carried out from May 2009 to June 2010 at our hospital. A total of 556 serum samples were tested for HBsAg, antibody for HCV, IgM antibody of HAV and HEV by ELISA method from the patients having clinical signs & symptoms of acute viral hepatitis. Statistical analysis: Chi square test was done and the association was considered to be statistically significant if p < 0.05. Results: Out of 556 suspected cases of acute hepatitis 281 were positive. Among the total positive cases, IgM anti HAV antibodies was 70 (24.91%), IgM anti HEV antibodies was 141 (50.18 %), HBsAg was 65 (23.13%) and HCV was 5 (1.78 %). Dual infection was seen in 14 (4.98 %) cases with 6 children cases. Among the HAV positive patients, 80% were children, In contrast to that HEV infection (63.1%) and HBsAg infection (61.5%) was common in young adult. HCV infection was found common in adults more than 20 years of age. Overall male was affected more than female. Conclusion: Sporadic HEV infection constitutes significant cause of the acute viral hepatitis. In the light of this result a nationwide survey is recommended to confirm this pattern in the other areas. As vaccine for HEV is not available, prevention in form of improvement of socio - economic and hygienic standards of the population is the better option.

Ovarian hydatid cyst in pediatric patient commencing as ovarian tumor: a rare site of echinococcosis

Echinococcosis or Hydatid disease is one of the important zoonotic, as well as occupational disease with worldwide distribution. In India, hydatid disease is endemic. However, hydatid disease of ovary is uncommon condition. We report such a case of ovarian hydatid disease in an 11-year-old girl, from rural Gujarat, Western India, presenting with symptoms of urinary obstruction. This case report highlights the rarest location of the Echinococcosis

“Seroprevalence of transfusion associated hepatitis c virus (Hcv) in multi-transfused thalassemic children of the tertiary care hospital.”

Aim: To know the seroprevalence of Hepatitis C Virus (HCV) in Multi-transfused Thalassemic Children attending a tertiary care hospital, Ahmedabad, Gujarat. Material and Methods: Serum sample were tested by Enzyme Linked Immuno Sorbent Assay (ELISA) test for Anti HCV antibody from the thalassemic children over a period of 4 years from January 2006 to December 2009. Result: A total of 163 thalassemic children were tested for antibody of HCV. Out of these HCV antibodies were positive in 38 (23.31 %) patients. Conclusion: Prevalence of HCV infection among the thalassemic cases is much higher than the routine blood donors. in the light of this result a nationwide survey is recommended to confirm this pattern in the other areas and more sophisticated diagnostic tool should be employed to rule out window period of these Transfusion Associated infections.

Salmonella paratyphi-B meningitis, isolated from CSF.

We report a case of meningitis due to Salmonella paratyphi-B, in an 11 month old male infant. The child was admitted in Emergency department with the complains of generalized convulsion and vomiting. On examination patient appearance of child was lethargic and irritable, had marked neck stiffness, with bulging fontanelle, lumbar puncture was done and sent for routine investigation, microscopy, culture and sensitivity. Later on Salmonella paratyphi-B was isolated from CSF.

Antibiotic susceptibility pattern in urinary isolates of gram negative bacilli with special reference to AMPC beta-lactamase in a tertiary care hospital

Resistance to higher antimicrobial agent is commonly seen in gram negative bacilli. This issue is a challenging problem to the medical practitioners in addition to it is financial impact on the health care system. To document the prevalence of multi drug resistant gram negative bacilli isolated from urine of patients attending the Urology Department of Tertiary care Hospital of western India in year 2008. Out of total 328 isolates, 118 [35.98%] E.coli, 72 [21.95%] Klebsiella, 64 [19.51%] Pseudomonas aeruginosa, 30 [9.15%] Acinetobacter, 18 [5.49%] Proteus vulgaris, 18 [5.49%] Proteus mirabilis, 6 [1.83%] Providencia rettgerii, 2 [0.61%] Citrobacter freundii. Out of these isolates, 228 [69.51%] were b-lactamase positive, while 100 [30.51%] were beta-lactamase negative. Out of 228 beta-lactamase positive, 104 [45.61%] were AmpC beta-lactamase positive. Stringent protocol such as Antibiotic policy and Hospital infection control program are mandatory to curb these microbes in a tertiary care hospital